Pain Flashcards
Reasons for acute pain
Trauma
surgery
burns
Reasons for chronic pain
Cancer
Peripheral
Breakthrough pain
Someone who has chronic pain, but they have an exacerbation of their pain
Cancer related pain
Acute or chronic
Direct or indirect
Increase pain can indicate progression of their disease
Physiological response to acute pain: endocrine and metabolic response
Activation of sympathetic nervous system and an increase in glucagon secretion, which causes hyperglycemia, increased lipolysis (fat breakdown), accelerated protein breakdown, and nitrogen loss.
The stress response presents as hypertension, tachycardia, arrhythmias, myocardial ischemia, protein catabolism, immune system suppression, and impaired renal excretory function.
Physiological response to acute pain: pulmonary function
Decreased phrenic nerve activity and diaphragmatic dysfunction manifested as…
- decrease in functional residual capacity
- – the volume remaining in the lungs after a normal, passive exhalation - decrease in tidal volume
- – amount of air that moves in or out of the lungs with each respiratory cycle
Physiological response to acute pain: cardiovascular
Increased sympathetic tone, which causes an increase in heart rate and blood pressure as well as redistribution of blood to and within various organs. The redistribution predisposes patients to myocardial ischemia in the presence of coronary artery disease and may induce arrhythmias.
Physiological response to acute pain: GI motility
Decreased gastric motility, especially in the colon. The stomach and small intestines recover within 12–24 hours after abdominal surgery; however, the colon is inhibited for at least 48–72 hours.
Physiological response to acute pain: immune system
Decreased responsiveness to antigens, delayed hypersensitivity, natural killer cell activity, and antibody response.
Nociceptive pain
Normal functioning of physiologic system that leads to the perception of noxious stimuli as being painful
Nociceptive pain: transduction
Noxious stimuli activate primary afferent neurons
Located throughout the body – skin, subcutaneous tissue, visceral organ, somatic
Prostaglandins initiate inflammatory response that increase tissue swelling and pain at the site of injury
NSAIDs – block the formation of prostaglandins in the periphery
Nociceptive pain: transmission
Transduction that is transmitted along the A-delta and C fibers
– A-delta – largest and respond to touch, movement, vibration – rapid withdrawal from pain
– C fibers – slow impulse and respond to mechanical, thermal and chemical stimuli
Nociceptive pain: perception
Requires activation of higher brain structures for the occurrence of awareness, emotions and drives associated with pain
Nociceptive pain: modulation
Information generated in response to noxious stimuli
Different neurochemicals
Body alters a pain signal
Nociceptive pain: somatic
Bone, joint, muscles, skin, or CT
– achy, throbbing
Nociceptive pain: visceral pain
arises from visceral organs
Nociceptive pain: treatment
Nonopioids, opioids, and local anesthetics
Neuropathic pain
Pathologic and results from abnormal processing of sensory input by the nervous system as a results of damage to the peripheral or CNS
Neuroplasticity
hyperexcitable nerve endings that are damaged and reorganize
– type of neuropathic pain
Allodynia
pain from a normally nonnoxious stimulus
– type of neuropathic pain
neuropathic pain – examples
phantom paon
post stroke pain
spinal cord injury
What are examples of polyneuropathies?
Diabetic neuropathy
Postherpetic neuralgia
Guillain-Barre pain
Neuropathic pain treatment
Adjuvant analgesic agents – antidepressants, anticonvulsants, local anesthetics
Factors that influence pain
Past experience Anxiety and depression Culture Age Gender
Pain assessment
COLDSPA
Character, onset, location, duration, severity, pattern, associated factors
What are examples of different pain scales?
Numeric rating Wong-Baker FACES Faces pain scale - revised Verbal discriptor scale Visual analog scale
What are examples of pain scales
FLACC
PAINAD
CPOT
Pain reassessment: what is pain reassessed in the PACU and when is pain reassessed if it is stable?
PACU - q 10 minutes
Stable pain - 4-8 hours
Pharmacologic management of pain: Multimodal Analgesia
Combine drugs with different mechanisms to lower each dose and reduce side effects and create greater pain relief
Multimodal pain: oral route
1st choice
Multimodal analgesia: IV route
post-operative
- PCA is an example
Multimodal analgesia: rectal route
palliative
Multimodal pain: transdermal route
long lasting
– requires absorption into the systemic circulation to achieve effects
Multimodal pain: topical route
effets in the tissues immidiately under the site of application
She is going to test on what pain scale we think is being used in questions
go look up
Intraspinal analgesia (neuraxial)
look up
Peripheral nerve block
go look
Go look up/ read about the Critical Care Pain Observation Tool
book and slides
What are dosing regimens nurses may follow when treating pain
Around the clock, PRN, or PCA
Nonopioid analgesic agents: Acetaminophen - route
Oral, rectal, IV
– there is a max dose per day
nonopioid analgesic agents: NSAIDS sfx
More side effects than acetaminophen
GI issues
An increase in bleeding
Opioid analgesics: what to consider?
Age, pain intensity, coexisting diseases, current drug regimen, prior treatment outcomes, patient preference.
Opioid analgesics: Mu agonist
Morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and methadone
Opioid analgesics: Mu agonist - monitor
CNS depression
Opioid analgesics: Mu agonist – antidote
Naloxone (narcan)
Complications with opioids: addiction
Chronic, relapsing, treatable neurological disease
Genetic, psychosocial and environmental factors
Complications of opioids: Physical dependence
Normal response if taking opioids for 2 or more weeks
Withdrawal symptoms may be suppressed by natural reduction of opioids - tapering
Complications with opioids: tolerance
Normal response that occurs with regular administration of opioid and decrease in effect
Complications with opioids: pseudoaddiction
When pain is not well controlled but symptoms suggest addiction
What are the several complications of opioids?
addiction physical dependence tolerance pseudoaddiction CNS depression n/v Puritus Urinary retention endocrine deficiencies
Lidocaine patch administration
on for 12 hours, off the 12 hours
Oxycodone, hydrocodone, oxymorphone administration considerations
must be taken on an empty stomach
Methadone - what is it
Long acting (over 20 hours) - used for those with addiction
PCA adminstration considerations
Need 2 nurses to sign of
– no LPN
Tramadol: dual mechanism
mu opioid and block reuptake neurotransmitters pathway – allows them more available to fight pain
Tramadol: complications
– lowers seizure threshold, SSRIs – risk for serotonin syndrome – agitation, diarrhea, heart and BP changes, loss of coordination
Facts about fentanyl
Given in mcg
Best for a hemodynamically unstable pt.
Does not have the same effect on BP
Local anesthetic: example and sfx
Lidocaine patch
circumoral tingling and numbness
bradycardia
Cardiac dysrhythmias
CV collapse
Adjuvant Analgesic agents: anticonvulsants – exampels and sfx
Gabapentin and Prebalin
sedation and dizziness
Adjuvant Analgesic agents: antidepressants examples and sfx
Nortriptyline & duloxetine, Venlafaxine
dry mouth, sedation, dizziness, weight gain, impaired memory, seating, tremors
Adjuvant Analgesic Agents: Ketamine
- what does it do and what are sfx
Prevents transmission of pain to the brain
Hallucinations, dreamlike feelings
Gerontological considerations for medications:
CNS effects
GI toxicity (NSAIDS)
Falls/injury
What are examples of nonpharmacological methods of pain managements?
Physical modalities
Cognitive and behavioral methods
Biologically based therapies (herbs, vitamins, proteins)
Energy therapies (yoga, tai chi, reiki)
