Nursing Mgmt of chronic pain Flashcards
Primary reason why people seek medical care
Pain
Pain is what the patient says
Always true unless they are incapable of saying they are in pain, in which we use another scale
Afferent Fibers
To the brain
Efferent Fibers
To the body, away from brain
(Efferent=Effect)
Transduction
-Conversion of pain to an electrical impulse through the nociceptors
Which drugs facilitate, descending pain modulation
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
What type of pain to adjuvant medications work on
Neuropathic pain, but also nociceptive pain
OLD CART
Onset
Location
Duration
Characteristics
Assosiated symptoms (N+V, headache)
Relieving factors (rest)
Treatment (Drugs)
Non-verbal signs of pain
-Moaning, Crying, irritability, grimacing, Insomnia, Rigid posture, pacing, Elevated BP HR RR, Nausea, Diaphoresis, Teeth grinding
-Use the FLACC scale for this
When questioning someone with chronic pain what should you do
Ask them indirect questions, because what their normal is may be someone else’s unbearable
Acute pain
Pain that exist in a short period of time
-Caused by injury, surgery,… Usually some identifiable cause and resolves once its reated
Chronic Pain
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
Breakthrough Pain
Sudden increase in pain, those that already have chronic conditions
-During this period they may need more or alternative medications to manage pain
T/F there is a discrimination based on race and the treatment of pain
True AA, Hispanic and AM are less likely to receive adequate pain treatment than those who are white
Chronic: Episodic pain
Pain that occurs sporadically, lasting hours to weeks
-Arthritis, migraines, Sickle cell
Cancer pain
Caused by tumor progression, related pathological process, invasive procedures, treatment toxicity, infection, physical imitations
-Chemo can cause neuropathic
-Pain is progressive
Idiopathic pain
No known cause
Sickle cell anemia and pain
Cells become sickled which clump together and block blood flow causing swelling and pain
-This usually causes hospitalization
Sickle cell anemia pain interventions
-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
Priapism
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
Cancer pain mgmt
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
Non-pharm methods for pain relief
-Cognitive
-Relaxation techniques
-Distraction
-Guided imagery
-Education
-Stress mgmt
-Physical agents
-Exercise
-Deep breathing
-Herbal therapy, but beware interactions with other drugs
Amitriptyline (Elavil)
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
Nortriptyline (Pamelor)
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
Duloxetine (Cymbalta)
-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
Venlafaxine (Effexor)
-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
Gabapentin (Neurontin)
anti-convulsants
-Used first for neuropathic pain
-Improves analgesia
-Allows for lower doses of narcotics
-Start low and titrate
Pregabalin (Lyrica)
anti-convulsants
-Used first for neuropathic pain
-Improves analgesia
-Allows for lower doses of narcotics
-Start low and titrate
Asprin
-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
Acetaminophen (Tylenol)
-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
Ibuprofen
-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
Opioids
-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
Morphine
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.
Miosis
Pin point pupils
When to hold dose of morphine
RR= 12
Urine output is 30 ml/hr
Other opiates
Hydrocodone/ acetaminophen
-Buprenorphine
-Fentanyl
-Hydromorphone
-Oxycodone/acetaminophen
-Tramadol
Stress and pain
-May not be able to eliminate pain, stressful
-Focus on improving functioning
-Understand interactions between stress and pain
-More stress=more pain
When should you reaccess pain after giving medication
30-60 min after giving med , depending on drug and route
Patient goals for Pain
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
PCA pump
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
