Pain Flashcards by Macee Sugrue

Transduction

nerve receptor converts action potential by stimuli

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Transmission

Action potential travels to nerve fibers of spinal cord and brain

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Perception

Action potential reached brain and cerebral cortex area to interpret stimuli as pain

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Modulation

Neurons activate inhibitory mediators and causes pain relief

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Acute pain

warns people of harm of disease

protective mechanism

limited tissue damage

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What is the duration of acute pain?

Short duration

<3 months

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Chronic Pain

not protective

goal: improve functional status

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What is the duration of chronic pain?

Longer, >3-6 months

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What are signs of acute pain?

Increased BP, HR, RR, dilated pupils and sweating

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Cancer Pain

arises from abnormal or damaged nerves related to chemo, tumor, toxicities, etc.

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Descriptive words of nociceptive pain

aching, gnawing, pounding

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Descriptive words for Neuropathic Pain

burning, shooting, tingling, shocking

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Examples of neuropathic pain

phantom pain
diabetic neuropathy
spinal pain
amputated limbs
compression injuries

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Somatic Pain

bones, joints, muscles, skin or connective issues

well localized

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Cutaneous Pain

skin or SubQ tissue

well localized

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Visceral Pain

internal organs, referred pain

nonspecific

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Idiopathic Pain

form of chronic pain with no known cause

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Factors that influence pain

age
fatigue
genes
cognitive/neuro function
previous experiences
support system/coping
spirituality
anxiety/fear

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Impacts of pain

quality of life
self care-hygiene, nutrition
work-absenteeism
social support-isolation

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Wong Baker Pain Scale

used in ages 3+

based on facial expression of smiling to crying

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Pain Assessment

Provocative or palliative
Quality or quantity
Region or radiation
Severity
Timing
Understanding

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Nonpharmacologic Pain Interventions

Guided imagery
Relaxation
Distraction
music
cutaneous stimulation
herbal supplements

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What nonpharm method would be best for longer pain time?

relaxation and guided imagery

(labor pain)

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What nonpharm method would be best for short timing pain?

Distraction

(IV)

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What are examples of cutaneous stimulation?

massaging, temp (cold or hot) electrical nerve stimulation

Pharmacological Pain Treatments

analgesics opioids nonopioids adjuvants lidocaine

What is the most common method of pain relief?

analgesics

Does acetaminophen have anti inflammatory effects?

Do non opioids have a ceiling effect?

yes

Do opioids have a ceiling effect?

What is the max amount of Tylenol that can be taken?

4g/4000mg

What causes GI bleeding to be so common in NSAIDs?

loss of protective GI lining

What is the safest and most tolerated NSAID?

acetaminophen

What are common side effects of opioids?

constipation GI upset confusion drowsiness

Should you start at the highest or lowest dose when administering opioids?

lowest

What nursing intervention is often paired with administering opioids?

Stool softener or laxatives

What is the main concern when administering opioids?

Respiratory depression

What is the antidote for respiratory depression?

nalaxone

Around the clock dosing

maximizes pain relief and potentially decreases use of opioids Ex- percocet q4hrs

Range order meds

doses vary over a prescribed range to provide flexibility Ex- 2-6mg IV morphine

What has to be done with Tylenol if ordered?

it has to be counted

Patient controlled analgesia (PCA)

starts with a loading dose when programmed by nurse ONLY THE PATIENT uses a bolus dose when needed There is a lock out for frequency and limit Must educate patient how and why to use

Epidural Anesthesia

sterile procedure can be bolus or continuous

What are side effects of epidurals?

HYPOtension N/V urinary retention constipation respiratory depression

What nursing actions should be done with epidurals?

monitor site placement monitor for infection monitor coags monitor BP and HR fall risk may need catheter for urinary retention

Tolerance

occurs with repeated exposure to med associated with chronic opioid use

Is tolerance a sign of addiction?

Dependence

occurs with repeated exposure to meds patients can have withdrawal if stopped abruptly gradually decrease dosages

Addiction

psychological dependence overwhelming involvement with obtaining and using a drug for their mind altering effects

What are signs of respiratory depression?

There are no visible signs shallowed, low breathing

Normal neuro changes in OA

degeneration of nerve cells decreased: neurotransmitters reaction/impulse conduction voluntary reflexes

Normal skin changes in OA

pallor in absence of anemia loss of subQ fat decreased skin elasticity wrinkles age spots

Normal eye changes in OA

decrease visual acuity and accommodation yellowing lenses alternating color perception presbyopia increased sensitivity to glare

Normal hearing changes in OA

prebycusis

Normal taste changes in OA

taste buds lack of differentiation atrophy of mucosa

Normal cardiac changes in OA

decreased contractile strength of myocardium, cardiac output abnormally increased BP hypertrophy of heart lower peripheral pulses

Normal lung changes in OA

decreased lung expansion AP diameter increases

Normal thorax changes in OA

kyphosis calcification of costal cartilage less recoil of chest wall

Normal GI changes in OA

increased fatty tissue in trunk and abd decreased peristalsis, saliva production delayed gastric emptying

Normal GU changes in OA

hypertrophy in prostate for men incontinence, UTI weakened perineal and bladder muscles

Does the sexual drive go away with older aged adults?

Does memory or judgement become impaired with older adults?

No, they remain intact

Intrinsic risk factors of falls

History of previous falls fear of falling muscle weakness impaired vision probs with balance and gait chronic conditions

Extrinsic risk factors of falls

poor lighting lack of handrails in hallways or stairs hazards for tripping slippery and uneven surfaces improper use of assistive devices inappropriate footwear

polypharmacy

concurrent use of multiple meds by a patient

What are common signs of UTI and pneumonia?

confusion and incontinence

Elder mistreatment

intentional act or failure to act that causes or creates a risk for harm to an older adult

Psychosocial interventions

validation therapy reality orientation touch therapeutic communication reminiscence

What are risks of delirium?

dehydration malnutrition HAI urinary incontinence

What nursing care should be done for delirium patients?

encourage fam to visit provide memory cues compensate for sensory deficits use reality orientation