Pain Flashcards
“An unpleasant sensory or emotional experience associated with actual or potential tissue damage” is
pain
Is pain a vital sign?
Should be checked as often as vital signs
Is pain subjective?
Yes, determined by pt not nurse
How long can acute pain last?
up to 6 months
Components of acute pain
- Inflammatory (redness, swelling, tenderness)
Not always present but…..
Sympathetic nervous system rxn (tachycardia/pnea, HTN)
Acute pain is considered a _____ mechanism
protective
How long does chronic pain last?
> 6 months
Chronic pain is no longer considered protective and is considered_______
a disease or condition
How do you treat chronic pain?
-complex, no set way or method
What is Nociceptive Pain?
acute pain from surgery, injury, or active disease process
What does somatic pain feel like?
aching, throbbing pain in bones, joints or skin
What is visceral pain? what does it feel like?
organ related, poorly localized, cramping, squeezing, heavy
What are the 4 phases that nociceptive pain transmits through?
- Transduction (prostaglandins released to potentiate action potential)
- Transmission (substance P is released: significant pain messenger)
- Perception
- Modulation
(tiny tiger paw massage)
Which phase of nociceptive pain releases prostaglandins? why?
Transduction , potentiate action potential
Which phase of nociceptive pain releases Substance P? why?
Transmission, significant pain messenger
Which 2 phases offer treatment?
transduction and transmission
What kind of pain medication is used in transduction phase of nociceptive pain?
NSAIDs or Steroids
What kind of pain medication is used in transmission phase of nociceptive pain?
Opioids
What causes neuropathic pain?
-damage to somatosensory nervous systems from nerve damage, chemotherapy, radiation
What are the symptoms/pain descriptions of neuropathic pain?
-tingling, electric like, pins, and needles, number characteristic
What is Allodynia?
things that cause pain that normally do not cause pain
What is Hyperalgesia?
a heightened feeling of pain
How do we treat neuropathic pain?
antidepressants
SNRI’s(selective NORepinephrine reuptake inhibitors)
Antiseizure (gabapentin, pregabalin)
2 issues with neuropathic pain
allodynia
hyperalgesia
What is Nociplastic or central pain?
-similar to nociceptive pain that does NOT HAVE DISCERNIBLE SOURCE
How is nociplastic or central pain described?
like nociceptive or neuropathic - electric, sharp
Example of nociplastic or central pain?
fibromyalgia
Treatment goals for Nociplastic or central pain?
- complex
- focus on RESTORING sleep/activity tolderance
- NOT OPIOIDS
Newborn and infant pain scales?
Neonatal Pain, Agitation and sedation Scale (N-PASS)
FLACC behavioral pain assessment
*newborn/infant pain is underrated
Toddler and preschoolers pain assessment scale?
Wong-baker FACES Scale
Toddler preschool pain manifests as
distrust
School aged and adolescent pain scale?
0-10
Persistent pain in school aged/adolescent can cause what?
developmental regression
How do school aged/adolescents manifest pain?
-may hide pain
Older Adult pain tools?
Checklist for Nonverbal Pain Indicators (CNPI)
Critical Care Pain Observation Tool (CPOT)
Physiological effects of pain- what increases?
BP HR RR+ shallow CBG O2 needs Lactate Ketones
Physiological effects of pain, what decreases?
Immune response
Ability to think/learn/decisions
When asking about location of pain try to distinguish between somatic and visceral.
What do those feel like?
somatic = localized
visceral =vague or radiating
When assessing quality of pain distinguish between…
nociceptive: aching, sharp, deep, gnawing
neuropathic: shocklike, burning, tingling, numb
Physical non-pharmacological pain management
- heat
- cold
- Transcutaneous Electrical Nerve Stimulation
- Massage
When is heat contradindicated?
-areas of bleeding, topical ointments, burned/irradiated skin
When is cold contraindicated?
- poor circulation
- raynaud syndrome
- radiated skin
Cognitive and Behavioral Pain Management options
- distraction
- relaxation
- imagery
- mindfulness
When would you want to use distraction for pain mgmt and how would you do it?
- short duration of pain
- match type of distraction to something patient enjoys
When to use relaxation for pain management?
-useful for all types of pain
4 categories for pharmacological pain mgmt?
- nonopioid
- opioid
- adjuvant analgesic (gabapentin, pregabalin)
- adjuvant (anxiolytics or sleep meds)
What does a patient need to be in order to usa PCA Pump?
cognitively alert
What safety parameters installed for PCA Pump?
- minimum time interval b/w doses
- maximum dose allowed over time period
- specific dosing mg or mcg
Who can push the PCA button?
ONLY patient
what 2 things must be added to monitor patient on PCA pump?
O2 sat, end tidal CO2
When is PRN dosing more appropriate?
-someone is a few days post op and working towards discharge
Benefits of around the clock dosing?
therapeutic drug levels and reduced harmful side effects
Can RNs do spinal analgesia?
NO
What size dose needed with spinal analgesia?
smaller dose
Common side effect of spinal analgesia?
hypotension
what are opioid side effects?
sedation
respiratory depression
constipation
vasodilation and hypotension
which 4 populations are at risk of opioid side effects?
-opioid naive
-elders
-use of other sedative meds
obstructive sleep apnea
what is POSS?
Pasero Opioid Induced Sedation Scale
How do you score POSS?
s= sleep, easy to around
1=awake/alert
2=slightly drowsy easily arousable
3=frequent drowsy, arousable, drifts to sleep during conversations
4=somnolent, minimal or no response to physical stimulation
