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NSG 470 > Nursing Mgmt of chronic pain > Flashcards

Nursing Mgmt of chronic pain Flashcards

1
Q

Primary reason why people seek medical care

A

Pain

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2
Q

Pain is what the patient says

A

Always true unless they are incapable of saying they are in pain, in which we use another scale

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3
Q

Afferent Fibers

A

To the brain

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4
Q

Efferent Fibers

A

To the body, away from brain

(Efferent=Effect)

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5
Q

Transduction

A

-Conversion of pain to an electrical impulse through the nociceptors

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6
Q

Which drugs facilitate, descending pain modulation

A

These are going to be the adjuvant medications that their primary action is not pain relief, but their secondary action affects pain
-These act on serotonin or Na+ channels to decrease pain

-Anti-epileptics (Gabapentinoids, Na channel agents)
-Anti Depressants (TCAs and SNRI)
-Cannabinoids
-Ketamine

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7
Q

What type of pain to adjuvant medications work on

A

Neuropathic pain, but also nociceptive pain

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8
Q

OLD CART

A

Onset
Location
Duration

Characteristics
Assosiated symptoms (N+V, headache)
Relieving factors (rest)
Treatment (Drugs)

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9
Q

Non-verbal signs of pain

A

-Moaning, Crying, irritability, grimacing, Insomnia, Rigid posture, pacing, Elevated BP HR RR, Nausea, Diaphoresis, Teeth grinding

-Use the FLACC scale for this

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10
Q

When questioning someone with chronic pain what should you do

A

Ask them indirect questions, because what their normal is may be someone else’s unbearable

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11
Q

Acute pain

A

Pain that exist in a short period of time

-Caused by injury, surgery,… Usually some identifiable cause and resolves once its reated

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12
Q

Chronic Pain

A

Pain that has been occurring for over 6 mo, and continues after the injury is healed, does not have to have a definite injury that is linked to it

-There is aggressing factors and reliving factors for each person
-Can have other symptoms such as tense muscles, lack of energy, change in appetite, depression, anxiety, fear of re-injury, anger

-Chronic pain affects a persons ability to work, enjoy life or care for themselves

-Polypharm, street pharm

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13
Q

Breakthrough Pain

A

Sudden increase in pain, those that already have chronic conditions

-During this period they may need more or alternative medications to manage pain

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14
Q

T/F there is a discrimination based on race and the treatment of pain

A

True AA, Hispanic and AM are less likely to receive adequate pain treatment than those who are white

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15
Q

Chronic: Episodic pain

A

Pain that occurs sporadically, lasting hours to weeks

-Arthritis, migraines, Sickle cell

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16
Q

Cancer pain

A

Caused by tumor progression, related pathological process, invasive procedures, treatment toxicity, infection, physical imitations

-Chemo can cause neuropathic
-Pain is progressive

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17
Q

Idiopathic pain

A

No known cause

18
Q

Sickle cell anemia and pain

A

Cells become sickled which clump together and block blood flow causing swelling and pain

-This usually causes hospitalization

19
Q

Sickle cell anemia pain interventions

A

-Elevation of the extremity
-Relaxation techniques
-Yoga
-Whir-pool bath
-PT
-Maintain hydration, makes the vessels bigger
-Heat packs, Heat makes vessels bigger
-Analgesics
-Encourage rest points
-Look for infection
-Priapism

20
Q

Priapism

A

Erection lasting for hours and hours which is extremely painful, usually can be addressed by a warm compress but if not you have to extract the blood flow with a needle

21
Q

Cancer pain mgmt

A

Develop pain mgmt plan with other team members

-Oral if you can, then transdermal or trans mucosal
-Asa. Acetaminophen pr NSAIDS for mild to moderate pain
-Severe pain is opiates
Neuropathic pain with anticonvulsanrs and anti depressants and opiods
-Sub Q and IV opiates for rapid relief
-Monitor vitals for se meds
-Provide non pharm methods too

22
Q

Non-pharm methods for pain relief

A

-Cognitive
-Relaxation techniques
-Distraction
-Guided imagery
-Education
-Stress mgmt
-Physical agents
-Exercise
-Deep breathing

-Herbal therapy, but beware interactions with other drugs

23
Q

Amitriptyline (Elavil)

A

Tri-cyclic antidepressant

-Side effects include
-Blurred vision, Dry mouth, dizziness, weight gain
-Cardiotoxicity risk

-Very possible to overdose which is deadly
-Start slow with dosage

24
Q

Nortriptyline (Pamelor)

A

Tri-cyclic antidepressant

-Side effects include
-Blurred vision, Dry mouth, dizziness, weight gain
-Cardiotoxicity risk

-Very possible to overdose which is deadly
-Start slow with dosage

25
Q

Duloxetine (Cymbalta)

A

-SNRI
-S/E include: Nausea, headache,, elevated BP, Weight gain, tremors

-Fibromyalgia, diabetic neuropath, FDA approved for chronic MS including OA and lower back pain
-May increase bleeding, urinary retention, and increased BP (potential for seizures)
-Need to weigh themselves for concern of weight gain

26
Q

Venlafaxine (Effexor)

A

-SNRI
-S/E include: Nausea, headache,, elevated BP, Weight gain, tremors
-May increase bleeding, urinary retention, and increased BP (potential for seizures)
-Need to weigh themselves for concern of weight gain

27
Q

Gabapentin (Neurontin)

A

anti-convulsants

-Used first for neuropathic pain
-Improves analgesia
-Allows for lower doses of narcotics
-Start low and titrate

28
Q

Pregabalin (Lyrica)

A

anti-convulsants

-Used first for neuropathic pain
-Improves analgesia
-Allows for lower doses of narcotics
-Start low and titrate

29
Q

Asprin

A

-Abreiviated ASA
-Avoid in children with flu, or viral sx
-May cause bleeding, monitor kidney function, avoid alc
-Sit up 30 min after taking dose
-Dont crush an enteric tab ya dummy

-Max dose is 4000mg per day

30
Q

Acetaminophen (Tylenol)

A

-Affects liver and kidney so its contraindicated for those with impaired function, alcoholism and use of anticoagulants

-S/E is Anorexia, N+V rash and hepatotoxicity
-Need to access for liver dmg ,monitor LFT (Liver enzymes) and look out for jaundice

-MDD= 4000mg per day

31
Q

Ibuprofen

A

-NSAID ,relieves inflammation and pain
-Contraindicated in those with hypersensitivity, Liver/ renal disease, use of anticoagulants
-Hypoglycemia with insulin or other drugs like insulin
-Assess for GI upset, bleeding, liver issues, edema
-Need to take with food or milk to avoid those GI issues

32
Q

Opioids

A

-Decreases pain sensation, suppresses resp and coughing as well
-May cause dependence, from euphoria and sedation
-Used for mild, moderate, severe pain

-Tolerance-decreased effectiveness of dose from its previous dose, requiring higher dose for same effect
-Also pseudo addiction where they need a higher and high dose but thats due to increasing pain

33
Q

Morphine

A

Used often for cancer and other pains

-S/E: resp depression, orthostatic hypotension, constipation, urinary retention, sedation, hallucinations, miosis
-Naloxone for OD
-Monitor vitals and LOC

Instruct pt to avoid benzo and and alc, and notify provider if dizziness or SOB develops

-May need short and long acting morphine for standard and breakthrough pain.

34
Q

Miosis

A

Pin point pupils

35
Q

When to hold dose of morphine

A

RR= 12
Urine output is 30 ml/hr

36
Q

Other opiates

A

Hydrocodone/ acetaminophen
-Buprenorphine
-Fentanyl
-Hydromorphone
-Oxycodone/acetaminophen
-Tramadol

37
Q

Stress and pain

A

-May not be able to eliminate pain, stressful
-Focus on improving functioning
-Understand interactions between stress and pain
-More stress=more pain

38
Q

When should you reaccess pain after giving medication

A

30-60 min after giving med , depending on drug and route

39
Q

Patient goals for Pain

A

The patient will assist in the mgmt of chronic pain
-Pt identify factors that aggravate, cause or relieve pain
-Each pt has an individual goal with their own values
-Return to work
-Increasing exercise
-Increasing social activity

-Quality of life is always number one

40
Q

PCA pump

A

Patient controls their pain med admin through a IV pump
-Mgmt of all types of pain
-Programed with safe dose in mind, still have to monitor though as most the time it uses opioids
-Lowers chance of drug overdose

-Monitor for: Allergic reaction, IV infection,
-Sedation, Resp suppression, constipation, uncontrolled pain

NSG 470 (26 decks)

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