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NURSING 3 > Pain > Flashcards

Pain Flashcards

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1
Q

Reasons for acute pain

A

Trauma
surgery
burns

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2
Q

Reasons for chronic pain

A

Cancer

Peripheral

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3
Q

Breakthrough pain

A

Someone who has chronic pain, but they have an exacerbation of their pain

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4
Q

Cancer related pain

A

Acute or chronic
Direct or indirect
Increase pain can indicate progression of their disease

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5
Q

Physiological response to acute pain: endocrine and metabolic response

A

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.

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6
Q

Physiological response to acute pain: pulmonary function

A

Decreased phrenic nerve activity and diaphragmatic dysfunction manifested as…

  1. decrease in functional residual capacity
    - – the volume remaining in the lungs after a normal, passive exhalation
  2. decrease in tidal volume
    - – amount of air that moves in or out of the lungs with each respiratory cycle
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7
Q

Physiological response to acute pain: cardiovascular

A

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.

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8
Q

Physiological response to acute pain: GI motility

A

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.

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9
Q

Physiological response to acute pain: immune system

A

Decreased responsiveness to antigens, delayed hypersensitivity, natural killer cell activity, and antibody response.

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10
Q

Nociceptive pain

A

Normal functioning of physiologic system that leads to the perception of noxious stimuli as being painful

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11
Q

Nociceptive pain: transduction

A

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

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12
Q

Nociceptive pain: transmission

A

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

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13
Q

Nociceptive pain: perception

A

Requires activation of higher brain structures for the occurrence of awareness, emotions and drives associated with pain

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14
Q

Nociceptive pain: modulation

A

Information generated in response to noxious stimuli

Different neurochemicals

Body alters a pain signal

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15
Q

Nociceptive pain: somatic

A

Bone, joint, muscles, skin, or CT

– achy, throbbing

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16
Q

Nociceptive pain: visceral pain

A

arises from visceral organs

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17
Q

Nociceptive pain: treatment

A

Nonopioids, opioids, and local anesthetics

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18
Q

Neuropathic pain

A

Pathologic and results from abnormal processing of sensory input by the nervous system as a results of damage to the peripheral or CNS

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19
Q

Neuroplasticity

A

hyperexcitable nerve endings that are damaged and reorganize

– type of neuropathic pain

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20
Q

Allodynia

A

pain from a normally nonnoxious stimulus

– type of neuropathic pain

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21
Q

neuropathic pain – examples

A

phantom paon
post stroke pain
spinal cord injury

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22
Q

What are examples of polyneuropathies?

A

Diabetic neuropathy
Postherpetic neuralgia
Guillain-Barre pain

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23
Q

Neuropathic pain treatment

A

Adjuvant analgesic agents – antidepressants, anticonvulsants, local anesthetics

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24
Q

Factors that influence pain

A 
Past experience 
Anxiety and depression
Culture 
Age
Gender
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25
Q

Pain assessment

A

COLDSPA

Character, onset, location, duration, severity, pattern, associated factors

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26
Q

What are examples of different pain scales?

A 
Numeric rating 
Wong-Baker FACES 
Faces pain scale - revised 
Verbal discriptor scale 
Visual analog scale
27
Q

What are examples of pain scales

A

FLACC
PAINAD
CPOT

28
Q

Pain reassessment: what is pain reassessed in the PACU and when is pain reassessed if it is stable?

A

PACU - q 10 minutes

Stable pain - 4-8 hours

29
Q

Pharmacologic management of pain: Multimodal Analgesia

A

Combine drugs with different mechanisms to lower each dose and reduce side effects and create greater pain relief

30
Q

Multimodal pain: oral route

A

1st choice

31
Q

Multimodal analgesia: IV route

A

post-operative

- PCA is an example

32
Q

Multimodal analgesia: rectal route

A

palliative

33
Q

Multimodal pain: transdermal route

A

long lasting

– requires absorption into the systemic circulation to achieve effects

34
Q

Multimodal pain: topical route

A

effets in the tissues immidiately under the site of application

35
Q

She is going to test on what pain scale we think is being used in questions

A

go look up

36
Q

Intraspinal analgesia (neuraxial)

A

look up

37
Q

Peripheral nerve block

A

go look

38
Q

Go look up/ read about the Critical Care Pain Observation Tool

A

book and slides

39
Q

What are dosing regimens nurses may follow when treating pain

A

Around the clock, PRN, or PCA

40
Q

Nonopioid analgesic agents: Acetaminophen - route

A

Oral, rectal, IV

– there is a max dose per day

41
Q

nonopioid analgesic agents: NSAIDS sfx

A

More side effects than acetaminophen
GI issues
An increase in bleeding

42
Q

Opioid analgesics: what to consider?

A

Age, pain intensity, coexisting diseases, current drug regimen, prior treatment outcomes, patient preference.

43
Q

Opioid analgesics: Mu agonist

A

Morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and methadone

44
Q

Opioid analgesics: Mu agonist - monitor

A

CNS depression

45
Q

Opioid analgesics: Mu agonist – antidote

A

Naloxone (narcan)

46
Q

Complications with opioids: addiction

A

Chronic, relapsing, treatable neurological disease

Genetic, psychosocial and environmental factors

47
Q

Complications of opioids: Physical dependence

A

Normal response if taking opioids for 2 or more weeks

Withdrawal symptoms may be suppressed by natural reduction of opioids - tapering

48
Q

Complications with opioids: tolerance

A

Normal response that occurs with regular administration of opioid and decrease in effect

49
Q

Complications with opioids: pseudoaddiction

A

When pain is not well controlled but symptoms suggest addiction

50
Q

What are the several complications of opioids?

A 
addiction
physical dependence 
tolerance
pseudoaddiction 
CNS depression
n/v
Puritus 
Urinary retention
endocrine deficiencies
51
Q

Lidocaine patch administration

A

on for 12 hours, off the 12 hours

52
Q

Oxycodone, hydrocodone, oxymorphone administration considerations

A

must be taken on an empty stomach

53
Q

Methadone - what is it

A

Long acting (over 20 hours) - used for those with addiction

54
Q

PCA adminstration considerations

A

Need 2 nurses to sign of

– no LPN

55
Q

Tramadol: dual mechanism

A

mu opioid and block reuptake neurotransmitters pathway – allows them more available to fight pain

56
Q

Tramadol: complications

A

– lowers seizure threshold, SSRIs – risk for serotonin syndrome – agitation, diarrhea, heart and BP changes, loss of coordination

57
Q

Facts about fentanyl

A

Given in mcg
Best for a hemodynamically unstable pt.
Does not have the same effect on BP

58
Q

Local anesthetic: example and sfx

A

Lidocaine patch

circumoral tingling and numbness
bradycardia
Cardiac dysrhythmias
CV collapse

59
Q

Adjuvant Analgesic agents: anticonvulsants – exampels and sfx

A

Gabapentin and Prebalin

sedation and dizziness

60
Q

Adjuvant Analgesic agents: antidepressants examples and sfx

A

Nortriptyline & duloxetine, Venlafaxine

dry mouth, sedation, dizziness, weight gain, impaired memory, seating, tremors

61
Q

Adjuvant Analgesic Agents: Ketamine

- what does it do and what are sfx

A

Prevents transmission of pain to the brain

Hallucinations, dreamlike feelings

62
Q

Gerontological considerations for medications:

A

CNS effects
GI toxicity (NSAIDS)
Falls/injury

63
Q

What are examples of nonpharmacological methods of pain managements?

A

Physical modalities

Cognitive and behavioral methods

Biologically based therapies (herbs, vitamins, proteins)

Energy therapies (yoga, tai chi, reiki)

NURSING 3 (16 decks)

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