NUR 362 - PAIN Flashcards
Definition of Pain
pain is whatever the experiencing person says it is, existing whenever the person says it does
Acute pain
meaningful, linear, reversible, well defined
recent onset identified cause
observable signs (tachycardia, hypertension, pallor)
time limited: subsides when pain is treated and goes away
Chronic pain
meaningless, cyclical, irreversible > 6 mo. duration won't see observable signs (patient adjusted to chronic cycle of pain) increased appetite difficulty sleeping
Somatic pain symptoms
well localized aching stabbing throbbing can pinpoint where is
Visceral pain symptoms
poorly localized
deep aching
pressure referred
cannot pinpoint where pain is
Neuropathic pain symptoms
burning
shooting
tingling
Causes of somatic pain
cutaneous nociceptors
musculoskeletal
Causes of visceral pain
stretching
distension in internal organs
Causes of neuropathic pain
primary dysfunction in nervous system
Examples of somatic pain
bone
joint
skin
connective tissue injuries
Examples of visceral pain
bowel obstruction
MI
pancreatic tumor
Examples of neuropathic pain
TMJ
diabetic neuropathy
post stroke pain
Pain processes
transduction
transmission
pain perception
modulation
Gate control theory
pain impulses controlled by gating mechanism in substantial gelatinous of the dorsal horn of spinal cord to permit or inhibit transmission
A-alpha fibers
muscle sensory
A-beta fibers
skin sensory
A-delta fibers
prickling, sharp, localized
C-fibers
dull, aching, diffuse
Pain threshold
how much pain a person can experience when they start to feel pain
Pain tolerance
how much pain a person can experience without distress
Pain assessment is NOT
relying primarily on changes in vital signs
deciding whether person looks in pain
knowing how much a procedure should “hurt”
assuming a sleeping patient does not pain
assuming patients will tell you when they are in pain
Pain assessment IS
asking and believing the patient
Subjective assessment of pain
eight dimensions
documentation
document pain before giving medication
reassessment of pain within 30-60 minutes after pain med is given, if patient is still in pain then document and notify provider
Pain assessment tools
0-10 scale (adults)
wong-baker faces scale (pediatrics)
verbal scale (mild, moderate, severe)
Correlation between 0-10 scale and verbal scale
1-4 = mild 5-6 = moderate 7-10 = severe
Objective data for pain
vital signs
observation (facial expression, movement, ability to do ADLs)
physical exam
Assessment of cognitively impaired
agitation is often sign of pain
observe: facial movement, body movement, behavioral changes, daily activity changes
5 steps in ensuring effective pain management
1 = history (prior and current pain) 2 = assessment 3 = pharmacologic interventions 4 = non-pharmacologic interventions 5 = reassessment
WHO Analgesic Ladder
step 1 - patients with mild pain intensity (1-4) receive NSAIDs
step 2 - patients with unrelieved progression (5-6) receive oral opioid analgesics or low-dose opioid meds
step 3 - patients with severe pain (7-10) receive higher-dose IV opioids and more frequent dosing
Non-opioid analgesic
mild to moderate pain
ex: NSAID
opioid analgesic
moderate to severe pain
ex: morphine prototype
adjuvant analgesics
drugs with primary indication other than pain
ex: antidepressants, steroids
adjuvants
drugs without analgesic properties that can be critical in pain management in certain populations
ex: muscle relaxants, sleep medications
short acting drugs
morphine hydromorphine (dilaudid) codeine hydrocodone (Vicodin, portable) oxycodone (Percocet) demerol fentayl
long acting drugs
MS contin
oxycontin
transdermal fentanyl
drug routes
oral transmucosal nasal rectal transdermal parental (SQ, IM, IV, epidural, intrathecal)
loading dose
given at beginning of infusion for immediate relief
continuous dose
dose continually infused
bolus dose
single doses at prescribed times
lockout
time between boluses when no drug is delivered
demands
times bolus button pushed
side effects of medication
constipation sedation N/V respiratory depression itching/hives reversal agent - narcan (Naloxone)
tolerance
patient receives drug continuously over a long period of time, then develops a neuroadaptive response to require a larger dose to produce the same effect
dependence
physiologic adaptation that is characterized by the development of withdrawal symptoms such as diaphoresis, anxiety, tachycardia, or nausea when the drug is stopped abruptly
addiction
chronic neurobiology disease that has genetic, psychosocial, and environmental influences in which the patient has impaired control over drug use and craving despite harm
psuedoaddiction
drug-seeking, produced not by true drug addiction, but by the under-treatment of pain
non-pharmacological methods of basic comfort
positioning for body alignment
regular turning
appropriate lighting, low noise
cutaneous stimulation - heat, cold, massage
non-pharmacological methods of cognitive/behavioral comfort
relaxation meditation distraction biofeedback guided imagery
