Pain Flashcards
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Drugs that block the effects of the inflammatory response
anti-inflammatory agents
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Compound with pain-blocking properties; capable of producing analgesia
analgesic
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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
chrysotherapy
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Blocking fever, often by direct effects on the thermoregulatory center in the hypothalamus or by blockade of prostaglandin mediators
antipyretic
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Drugs that block prostaglandin synthesis and act as anti-inflammatory, antipyretic, and analgesic agents
nonsteroidal anti-inflammatory drugs (NSAIDs)
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The body’s nonspecific response to cell injury, resulting in pain, swelling, heat, and redness in the affected area
Inflammatory response
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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)
Salicylism
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Salicylic acid compounds, used as anti-inflammatory, antipyretic, and analgesic agents; they block the prostaglandin system
Salicylates
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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
ergot derivative
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Unmyelinated, slow-conducting fibers that carry peripheral impulses associated with pain to the spinal cord
C fibers
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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
migraine headache
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Small-diameter nerve fibers that carry peripheral impulses associated with pain to the spinal cord
A-delta fibers
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Large-diameter nerve fibers that carry peripheral impulses associated with touch and temperature to the spinal cord
A fibers
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Drugs that react at opioid receptor sites to stimulate the effects of the receptors
narcotic agonists
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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
gate control theory
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Drugs originally derived from opium that react with specific opioid receptors throughout the body
narcotics
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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
narcotic antagonists
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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
narcotic agonists-antagonists
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A sensory and emotional experience associated with actual or potential tissue damage
Pain
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Receptor sites on nerves that react with endorphins and enkephalins, which are receptive to narcotic drugs
opioid receptors
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Selective serotonin receptor blocker that causes a vascular constriction of cranial vessels; used to treat acute migraine attacks
triptan
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Nerve pathway from the spine to the thalamus along which pain impulses are carried to the brain
spinothalamic tract
What is Pain?
“Whatever the person says it is, and existing whenever the person says it does”
Unpleasant sensory and emotional experience; physical; psychological
Can have destructive events
Can warn of potential injury
A multidimensional experience
Classification of Pain: Origin
Cutaneous/superficial
Deep somatic
Visceral
Radiating/referred
Phantom
Psychogenic
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Occurs at the level of skin; subq tissues; i.e. cuts/burns
Cutaneous/superficial
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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
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Occurs at ligaments, tendons, bone
i.e. fractures, an ankle sprain
Deep somatic
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Occurs where surgical amputation has occurred; associated with nerves
Phantom
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Arises from the mind
Psychogenic
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Starts in 1 spot and moves elsewhere
i.e. sore throat
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Is distant from the original site; triggered by a different location
i.e. myocardial infarction (MI)
Radiating
Referred
Classification of Pain: Cause
Nociceptive
Neuropathic
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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
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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
Classification of Pain: Duration
Acute
Chronic
Intractable
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Pain that is long-term
3-6 months or longer
Chronic
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Pain that is short-acting
Less than 6 months
Acute
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Is a form of chronic pain but is highly resistant to relief; difficult to manage
Intractable
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
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)
Assessing Pain
- Take a complete pain history (PQRSTU)
- Observe for nonverbal signs of pain
- Utilize appropriate pain scales
Assessing Pain cont’d
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
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
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
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
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
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)
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
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
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
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
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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
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
