Pain Flashcards
1
Q
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Drugs that block the effects of the inflammatory response
A
anti-inflammatory agents
2
Q
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Compound with pain-blocking properties; capable of producing analgesia
A
analgesic
3
Q
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Treatment with gold salts; gold is taken up by macrophages, which then inhibit phagocytosis; it is reserved for use in patients who are unresponsive to conventional therapy, and can be very toxic
A
chrysotherapy
4
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Blocking fever, often by direct effects on the thermoregulatory center in the hypothalamus or by blockade of prostaglandin mediators
A
antipyretic
5
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Drugs that block prostaglandin synthesis and act as anti-inflammatory, antipyretic, and analgesic agents
A
nonsteroidal anti-inflammatory drugs (NSAIDs)
6
Q
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The body’s nonspecific response to cell injury, resulting in pain, swelling, heat, and redness in the affected area
A
Inflammatory response
7
Q
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Syndrome associated with high levels of salicylates – dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude (state of physical or mental weariness; lack of energy)
A
Salicylism
8
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Salicylic acid compounds, used as anti-inflammatory, antipyretic, and analgesic agents; they block the prostaglandin system
A
Salicylates
9
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Drug that causes a vascular constriction in the brain and the periphery; relieves or prevents migraine headaches but is associated with many adverse effects
A
ergot derivative
10
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Unmyelinated, slow-conducting fibers that carry peripheral impulses associated with pain to the spinal cord
A
C fibers
11
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Headache characterized by severe, unilateral, pulsating head pain associated with systemic effects, including GI upset and sensitization to light and sound; related to a hyper-perfusion of the brain from arterial dilation
A
migraine headache
12
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Small-diameter nerve fibers that carry peripheral impulses associated with pain to the spinal cord
A
A-delta fibers
13
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Large-diameter nerve fibers that carry peripheral impulses associated with touch and temperature to the spinal cord
A
A fibers
14
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Drugs that react at opioid receptor sites to stimulate the effects of the receptors
A
narcotic agonists
15
Q
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Theory that states that the transmission of a nerve impulse can be modulated at various points along its path by descending fibers from the brain that close the “___” and block transmission of pain information and by A fibers are able to block transmission in the dorsal horn by closing the ___ for transmission for the A-delta and C fibers
A
gate control theory
16
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Drugs originally derived from opium that react with specific opioid receptors throughout the body
A
narcotics
17
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Drugs that block the opioid receptor sites; used to counteract the effects of narcotics or to treat an overdose of narcotics
A
narcotic antagonists
18
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Drugs that react at some opioid receptor sites to stimulate their activity and at other opioid receptor sites to block acitvity
A
narcotic agonists-antagonists
19
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A sensory and emotional experience associated with actual or potential tissue damage
A
Pain
20
Q
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Receptor sites on nerves that react with endorphins and enkephalins, which are receptive to narcotic drugs
A
opioid receptors
21
Q
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Selective serotonin receptor blocker that causes a vascular constriction of cranial vessels; used to treat acute migraine attacks
A
triptan
22
Q
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Nerve pathway from the spine to the thalamus along which pain impulses are carried to the brain
A
spinothalamic tract
23
Q
What is Pain?
“Whatever the person says it is, and existing whenever the person says it does”
A
Unpleasant sensory and emotional experience; physical; psychological
Can have destructive events
Can warn of potential injury
A multidimensional experience
24
Q
Classification of Pain: Origin
A
Cutaneous/superficial
Deep somatic
Visceral
Radiating/referred
Phantom
Psychogenic
25
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Occurs at the level of skin; subq tissues; i.e. cuts/burns
Cutaneous/superficial
26
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Is hard to pinpoint
In abdomen, cranium, thorax; feel it generally throughout that area
Tight; pressure
i.e. headaches, menstrual cramps
Visceral
27
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Occurs at ligaments, tendons, bone
i.e. fractures, an ankle sprain
Deep somatic
28
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Occurs where surgical amputation has occurred; associated with nerves
Phantom
29
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Arises from the mind
Psychogenic
30
?
Starts in 1 spot and moves elsewhere
i.e. sore throat
?
Is distant from the original site; triggered by a different location
i.e. myocardial infarction (MI)
Radiating
Referred
31
Classification of Pain: Cause
Nociceptive
Neuropathic
32
?
Is injury to 1 or more nerves; results in a repeated transmission of the pain signals even in the absence of painful stimuli
i.e. burning, numbness
Can be very painful for clients
Neuropathic
33
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Is related to an injury to body tissue
i.e. by trauma, surgery, inflammation
Pain can be visceral (internal organs) or somatic (related to the skin, muscle, bone, tissues)
Nociceptive
34
Classification of Pain: Duration
Acute
Chronic
Intractable
35
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Pain that is long-term
3-6 months or longer
Chronic
36
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Pain that is short-acting
Less than 6 months
Acute
37
?
Is a form of chronic pain but is highly resistant to relief; difficult to manage
Intractable
38
Classification of Pain: Description
Pain Quality
Pain Periodicity
Pain Intensity
Pain Quality - sharp, dull, aching, throbbing, tingling, stabbing, burning, ripping, searing
Pain Periodicity - timings of the pain; episodic, intermittent, constant
Pain Intensity - mild, distracting, moderate-to-severe, intolerable
39
Physiology of Pain
Transduction
Transmission
Pain perception
Pain modulation
40
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Is the activation of nociceptors (sensory nerve cells) by stimuli
Mechanical, thermal (i.e. extreme heat), chemical
Transduction
41
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Is the conduction of pain message to spinal cord
Transmission
42
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Is recognizing and defining pain in the frontal cortex
Pain perception
43
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Is changing pain perception
Pain modulation
44
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Is how long, how intense can we handle that pain level before it's too much for us
Pain tolerance
45
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This tells us how much pain it takes; how much stimuli for us to feel and acknowledge pain
Pain threshold
46
What are the 3 regions of the brain involved in the physiology of pain?
Somatosensory cortex
Limbic system
Frontal cortex
47
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Region of the brain where pain is perceived
Frontal cortex
48
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Region of the brain that interprets physical sensations
Somatosensory cortex
49
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Region of the brain responsible for emotional reactions
Limbic system
50
?
This occurs when there is a greater than expected response to either the pain threshold or the pain tolerance
Hyperalgesia
51
Pain Modulation
Endogenous Analgesia System
The Gate-Control Theory
52
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Slower fibers involved in pain production
C fibers
53
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Faster fibers that inhibit pain
A-delta fibers
54
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Process thought to occur in the spinal cord
gate-control theory
55
?
Is naturally occurring; within us; pain relief
Involves endogenous opioids
Body tries to naturally react to pain
Naturally occurring neurotransmitters
Endogenous analgesia system
56
Factors That Influence Pain
Emotions
Past experience with pain
Developmental stage (children versus adults)
Sociocultural factors (i.e. stoicism within Asian culture)
Communication skills
Cognitive impairments
57
How Does the Body React to Pain?
- Acute pain stimulates the SNS (fight-or-flight response)
- Ongoing pain will cause the PNS (tries to slow down SNS) to take over
How Does the Body React to Pain? cont'd
- Impact of unrelieved pain on body systems
\* Endocrine (excessive hormone release; hypercoagulation)
\* Cardiovascular (↑ HR, BP & cardiac workload)
\* Musculoskeletal (impaired muscle function & fatigue)
\* Respiratory (shallowed breathing; leads to pneumonia, atelectasis)
\* Genitourinary (↓ urinary output; urinary retention)
\* Gastrointestinal (↓ gastric motility & gastric emptying)
58
Assessing Pain
- Take a complete pain history (PQRSTU)
- Observe for nonverbal signs of pain
- Utilize appropriate pain scales
Assessing Pain cont'd
59
Assessing Pain cont'd
P - ?
Q - ?
R - ?
S - ?
T - ?
U - ?
Assessing Pain cont'd
P - provocative and palliative factors; what makes it better? worse?
Q - quality of pain; dull/sharp/burning?
R - region in body or radiation
S - severity
T - timing
U - understanding that pain is unique to the client
60
Nonverbal Signs of Pain
The ___ data we collect in addition to ___ data
- Facial expression, posture, body position
- Vital sign changes (temporary)
- Behavioral manifestations
- Pain as an expression of weakness
- Assess for depression
obective; subjective
61
Pain Management: Nonpharmacological Measures
- Cutaneous stimulation
\* Transcutaneous electrical nerve stimulation (TENS) [stimulates A delta sensory nerve fibers; move quicker than C fibers]
\* Percutaneous electrical nerve stimulation (PENS) [placed through the skin]
\* Spinal cord stimulator (SCS)
\* Acupuncture [small needles along energy meridians]
\* Acupressure [no needles; "acupoints" along the 12 meridians; based on Chinese medicine]
\* Massage [effleurage]
\* Use of heat and cold [heat - promotes circulation; cold - prevents swelling/bleeding]
\* Contralateral stimulation [stimulation of skin opposite to site; important for those who experience phantom pain]
Pain Management: Nonpharmacological Measures cont'd
- Immobilization
- Cognitive-behavioral interventions
\* Distraction (i.e. visual, tactile, intellectual, auditory)
\* Relaxation (sequential muscle relaxation; cephalocaudal)
\* Guided imagery
\* Diaphragmatic breathing
\* Hypnosis
\* Therapeutic touch
\* Humor (produces endorphins)
\* Expressive writing (journaling)
\* Animal-assisted therapy
62
Pain Management: Pharmacologic Measures
Nonopioid analgesics
- NSAIDs, acetaminophen, aspirin
Adjuvant analgesics
Opioid analgesics
- Includes IV, transdermal, & epidural forms
- Client-controlled analgesia pumps (PCA pump)
63
Nonopioid Analgesics
NSAIDs
Aspirin (ASA)
Acetaminophen (brand, Tylenol)
64
Nonopioid Analgesics: Pharmacodynamics
Most nonopioid analgesics work by inhibiting \_\_\_, peripherally for analgesic effect and centrally for \_\_\_
prostaglandin synthesis
antipyretic effect
65
Ibuprofen (an NSAID) is metabolized in the ?
Acetaminophen is metabolized in the ?
kidneys
liver
66
Nonopioid Analgesics: Interactions
Use carefully in patients with hepatic or renal dysfunction, chronic alcohol use/abuse, and/or malnutrition
Long term use of NSAIDs with ___ may increase the risk of adverse renal effects
May increase the risk of bleeding with Warfarin (Coumadin)
Acetaminophen
67
Nonopioid Analgesics: Nursing Assessment
Assess pain prior to administering, and at the peak following administration (complete PQRSTU)
Hematologic, hepatic, and renal function should be monitored periodically throughout prolonged therapy
NSAIDs, Tylenol - potential for renal damage
Tylenol - potential for liver damage
Aspirin - interferes with platelet aggregation
68
Nonopioid Analgesics: Nursing Implementation
Administer NSAIDs and salicylates (ASA) with or immediately following meals or with food to prevent or minimize GI irritation
69
What is the maximum dosage per day for Tylenol?
4 grams/day
70
Nonopioid Analgesics: Patient Teaching
Recommend - Educate patient on recommended daily dose and maximum daily dosages
Avoid - Avoid concurrent use of alcohol to minimize gastric irritation, hepatic impairment, and risk of bleeding
Nonopioid Analgesics: Patient Teaching cont'd
Notify - Have patients notify providers of these medications prior to surgical procedures (may need to be withheld)
71
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Used to control mild to moderate pain and inflammatory conditions
- Prolong bleeding time due to suppressed platelet aggregation
- Use with opioid analgesics may have additional analgesic effects and warrant lower opioid dosing
72
NSAIDs: Common Side Effects
Increased bleeding
Constipation
Dizziness
Drowsiness
Dyspepsia (indigestion)
Headache
Nausea/vomiting
\* May cause Stevens-Johnson Syndrome (rare, serious disorder; causes flu-like symptoms; a blistering rash leading to sloughing of the skin; is a medical emergency)
73
Ibuprofen (\_\_\_, \_\_\_)
Normal Dose: ___ to ___ mg every 4-6 hours not to exceed ___ mg per day
Increased dosages do not increase effect, but may increase side effects
Do not give to patients with active GI bleeding or ulcer disease
Use cautiously in elderly and patients with cardiovascular disease
Motrin, Advil
200-400
1200
74
Naproxen (\_\_\_)
Normal dose: ___ to ___ mg twice daily up to ___ per day
Do not give to patients with active GI bleeding or ulcer disease
Encourage patients to wear sunscreen and/or protective clothing to avoid photosensitivity reactions
Available over the counter (OTC) as \_\_\_
- Dosing changes to \_\_\_mg every 8-12 hours with a maximum of ___ mg per day
Aleve
250-500
1.5g
Naproxen Sodium
200
600
75
Ketorolac (\_\_\_)
Normal dose: ___ - ___ mg IVP every 6 hours not to exceed \_\_\_mg per day
Short-term therapy; not to exceed five days of use
Typically administered intravenously
Contraindicated with Probenecid and Pentoxifylline
May cause fluid retention and edema - monitor BP (fluid goes into extracellular space)
Toradol
15-30
120
76
Aspirin
Normal dose: ___ to ___ mg every 4-6 hours not to exceed ___ per day
Prolongs bleeding time for 4-7 days and may prolong prothrombin time (PTT)
Food slows but does not alter amount absorbed
Signs of toxicity and overdose
\* tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, diaphoresis
325-1000
4g
77
Acetaminophen (\_\_\_)
Normal dose: ___ to ___ mg every six hours OR ___ 3-4 times daily with a maximum daily dose of \_\_\_
Can give IV or oral
Adults should not take acetaminophen more than 10 days unless prescribed by a physician
Risk of hepatotoxicity, especially with concurrent alcohol use
May take on an empty stomach
Antidote: Acetylcysteine (Acetadote)
Tylenol
325-650
1g
4g
78
Opioid Analgesics
Opioids: Pharmacodynamics
Bind to opiate receptors in the ___ resulting in an alteration in perception and response to painful stimuli
central nervous system (CNS)
79
Opioids: Side Effects
**RESPIRATORY DEPRESSION**
Anorexia (more loss of appetite than mental aspect)
Confusion
Constipation
Hypotension
Nausea/vomiting
Sedation
Weakness
80
Opioids: Interactions
Increased CNS depression when used concurrently with alcohol, antihistamines, antidepressants, sedatives/hypnotics, and MAO inhibitors
81
Opioids: Nursing Assessment
- Assess pain prior to and at peak following administration
- Not recommended for prolonged use or as a first-line therapy
\* Prolonged use may lead to physical and psychological dependance and tolerance
Opioids: Nursing Assessment cont'd
- Assess BP, pulse, and respirations before and periodically following administration
- Assess bowel function routinely and work to prevent constipation
Antidote: Naloxone (Narcan)
82
Opioids: Nursing Implementation
Do not confuse MORPHINE with HYDROMORPHONE or MEPERIDINE - has resulted in fatal medical errors
Regularly administered doses are often more effective than PRN dosing - more effective when given before pain becomes severe
Discontinue gradually to prevent withdrawal symptoms
Opioids: Patient Teaching
- Educate about the known abuse potential of opioids
- Avoid driving or operating machinery until the effects of the medication are known
- Change position slowly to minimize orthostatic hypotension
- Encourage patient to turn, cough, and deep breathe every two hours to prevent atelectasis
- Concurrent use of kava-kava, valerian, skullcap, hops, or chamomile can increase CNS depression
83
Codeine
Normal dose: ___ to ___ mg every 4-6 hours not to exceed ___ mg per day
Contraindicated if MAOIs used within past 14 days
Oral route is common
Administer with food or milk to minimize GI irritation
15-60
360
84
Hydromorphone (\_\_\_)
Normal dose: PO ___ to ___ mg every 4-6 hours
May convert PO to extended release once 24-hour dosing is determined
Seen in PCA pumps
Decrease doses in patients with moderate hepatic or renal impairment
Patients on continuous infusion should have bolus dosing available every 15-30 minutes for breakthrough pain
Dilaudid
2-4
85
Morphine Sulfate
Normal dose: PO ___ to ___ mg every 4 hours; IV ___ to ___ mg every 3-4 hours
Effective for pain r/t myocardial infarction (MI)
Patients on continuous therapy (PO or IV) may need additional doses for breakthrough pain
Use extreme caution in patients who have taken MAOIs within past 14 days
10-30
2-10
86
Fentanyl
Normal dose: IV ___ to ___ mcg every 1-2 hours; transdermal ___ mcg/hr
Use supplemental short-acting opioids for pain management until relief achieved with transdermal system
Seen in PCA pumps
May cause \_\_\_
50-100
25
LARYNGOSPASM
87
?
Allows the ability to transition route of administration or opioid while maintaining comparable analgesia
e.g. Hydromorphone (Dilaudid) is 7x more potent than morphine
Equianalgesia
88
Naloxone (\_\_\_)
Normal dose: IV ___ mg every 2-3 minutes up to ___ mg; intranasal 1 spray (2-4mg) in one nostril every 2-3 minutes (alternating nostril used)
Reverses CNS depression and respiratory depression caused by suspected opioid overdose
Can cause \_\_\_, hypertension, hypotension, nausea vomiting
Narcan
0.4
2
VENTRICULAR ARRYTHMIAS
89
Knowledge Check
The nurse is administering 2mg Hydromorphone PO to a client. What should the nurse assess prior to administration? Select all that apply.
a. Respiratory rate
b. Bowel function
c. Pain level
d. Pulse and blood pressure
Answer: all of the above
90
Pain Management: Chemical Measures
Nerve blocks
Epidural injections
Local anesthesia
Topical anesthesia
Pain Management: Invasive Measures
Radiofrequency ablation (reduces pain by creating an electrical current that delivers heat to specific nerve tissues)
Surgery
\* Cordotomy
\* Rhizotomy
\* Neurectomy
\* Sympathectomy
91
Special Nursing Considerations
Managing pain in the elderly
Managing pain in clients with addictions
Use of placebos
92
Managing Pain in the Elderly
"Undertreated pain and inadequate pain management can result in falls, poor sleep, delayed healing, reduced activity, and prolonged hospitalization"
Be aware of adding analgesics to already complex medication regimens, as this increases the potential for drug interactions
Change of drug distribution as a physical change of aging
Managing Pain in the Elderly cont'd
Providers are reluctant to prescribe analgesics
Ineffective pain management may not be recognized due to dementia, sensory impairment, and/or inability to communicate verbally
Increased risk of overdose - START LOW and GO SLOW
93
Managing Pain in Clients with Addiction
Proper, short-term use of opioid analgesics is safe and rarely will lead to addiction
Addiction is physiological or psychological dependence often associated with self-destructive behaviors
Screen for abuse risk using validated risk assessment tools
\* Opioid Risk Tool (ORT)
\* Screener and Opioid Assessment for Patients with Pain (SOAPP)
\* Current Opioid Misuse Measure (COMM)
Managing Pain in Clients with Addiction cont'd
Monitor for substance abuse behaviors
Monitor for and minimize suicide risk
For those at risk, maximize nonopioid medication and nonpharmacological therapies
94
Pain Relief from Placebos
A placebo is a medication or procedure that leads to a desired outcome (e.g. analgesia) even if it does not consist of substance or action that contribute to outcome
**They are NOT suitable for pain management**
95
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Is a pre-programmed pump that patients can use to self-administer medication
Has a lock-out mechanism on it
Patient-controlled analgesica (PCA) pump
96
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Utilizing non-opioid analgesics as much as possible, bringing in a little of an opioid
e.g. Percocet (using acetaminophen with a little codeine)
Adjuvant therapy
