Pain Flashcards
What is pain?
Warning of potential tissue damage
How should a nurse consider a patient’s stated pain scale?
The patient’s pain is always accurate
What timeframe defines acute pain?
duration less than 1 month
What timeframe defines chronic pain?
duration grate than 3 months
What timeframe defines subcute pain?
duration 1-3 months
Define visceral pain
internal organ pain. Often called referred pain when originating in the abdomen. Ex: Pain in the ovary or testis felt in the umbilicus or abdomen
Pain in the gallbladder or liver felt in the epigastric region or right shoulder
Define acute pain
Sudden onset and relatively short duration. Has anticipated/predictable end.
Recurrent acute pain means acute pain episodes come back through an extended period of time.
Can be an indicator that the body is in danger. usually doesn’t last more than 6 months. Greater than 6 months it turns into chronic pain
Difference between chronic malignant and chronic nonmalignant pain?
Malignant: occurs as a result of progressive tissue injury
Nonmalignant: occurs in people who do not have progressive tissue injury.
Define nociceptive pain
Nociceptive pain is a type of pain caused by damage to body tissue.
It feels sharp, aching, or throbbing, and is often caused by an external injury, like stubbing your toe, having a sports injury, or a dental procedure2.
Nociceptive pain involves the activation of pain receptors by a stimulus that normally causes pain3.
Most pain you experience is nociceptive pain, and it commonly affects your muscles, joints, and bones
Describe somatic pain
Somatic is a type of nociceptive pain. You will experience somatic pain if you cut your skin, stretch a muscle too far, exercise for a long period of time, or fall down onto the ground and hurt yourself1.
What are the four phases of nociceptive pain?
Transduction (involves the changing of noxious stimuli in sensory nerve endings to energy impulses), Transmission (involves the movement of impulses from site of origin to the brain/reflex arc), Perception (when the pain impulse has been transmitted to the cortex and the person develops conscious awareness of the intensity, location, and quality of pain), Modulation (refers to the activation of descending neural pathways that inhibit the transmission of pain).
Describe Pain Transduction
1Transduction (involves the changing of noxious stimuli in sensory nerve endings to energy impulses)
Define Pain Transmission
2Transmission (involves the movement of impulses from site of origin to the brain/reflex arc)
Define Pain Perception
3Perception (when the pain impulse has been transmitted to the cortex and the person develops conscious awareness of the intensity, location, and quality of pain)
Define Pain Modulation
4Modulation (refers to the activation of descending neural pathways that inhibit the transmission of pain).
What kind of patient tends to have neuropathic pain?
Nerve pain: Described as intense burning or itching/needles and pins
Diabetic neuropathy
Phantom limb pain
Spinal cord injury pain
Describe cancer pain
Includes tumor, bone, chemotherapy, radiation, and post surgical pain.
What factors influence the pain experience
Age/gender, stress, anxiety, previous experience with pain, cultural norms/attitudes.
Describe the PQRSTU acronym
provocative/palliative, quality/quantity, region/radiation, severity, timing/treatment, understanding
How does this class what you to remember PQRST
precipitating factors, quality, region, severity, timing
What pain assessments should you document in their chart?
location, intensity (0-10), quality (nature/characteristics of pain), associated symptoms (anxiety, fatigue, and depression)
What’s the FLACC pain scale?
Face, Legs, Cry, Consolability used for children and disabled people
Whats the CRIES scale
FOR INFANTS crying, requires O2, increased vital signs, expressions, sleepiness
Describe the NVPS
Non-verbal pain scale. You score face, activity, guarding, physiologic 1, physiologic 2 on scale 0-2.
numeric pain scale
1-10
wong baker FACES pain scale
has a bunch of cute faces you pick
Define breakthrough pain
transient, moderate to severe pain that occurs in patients with baseline chronic pain
How do you pharmalogically manage moderate to severe pain?
Opioids (usually immediate release oral, IV, or PCA)
Combine analgesics to maintain therapeutic serum levels
How do you treat mod-severe chronic pain?
Opioids, usually extended release or long acting. Immediate release/IV for breakthrough pain
Define multimodal analgesics
the use of 2 or more classes of analgesic agents to take advantage of the various mechanisms of action. Goal is minimizing adverse effects and can be used for both chronic/acute pain
Ex: Rx morphine, NSAID, gabapentin
Name five classes of pain meds
nonopioids, opioids, adjuvant, analgesic, therapy.
Examples of nonopiods
acetametaphen, aspirin/other salicytes
Define the analgesic ceiling
The drug ceiling effect refers to a particular phenomenon in pharmacology where a drug’s impact on the body plateaus. At this point, taking higher doses does not increase its effect.
List some adverse effects of NSAIDS
higher risk of cardiovascular events 9MI, stroke, HF,) risk of hypersensitivity (allergic reaction) to NSAID
What are some examples of adverse reactions to Nonselective (inhibit COX-1 and COX-2 Enzymes)
Ibuprophen, naproxen, others can cause renal impairment, bleeding tendencies, GI irritation/bleeding. To avoid give with food or milk
What is a common example of a selective (inhibits COX-2 enzymes) drug
Celecoxib used for pain and stiffness with arthritis
How do opioids work in the body?
Opioids bind to receptors in the central nervous system resulting in:
inhibition of the transmission of nociceptive input from the periphery to the spinal cord
altered limbic system activity
activation of descending inhibitory pathways that modulate transmission in the spinal cord
Name most common opioids
morphine, hydromorphone, methadone, fentanyl, oxycodone, hydrocodone, codeine
How do you give narcan to a patient?
0.4-2mg IV/SC, repeat every 2-3min PRN NO MORE THAN 10MG can also use with nasal infuser.
What is the basal rate of a PCA?
Basal rate is the amount of pain reliever that is infused independent of any demands made by the patient1. In patient-controlled analgesia (PCA), the basal rate of drug infusion is often set at zero to ensure that all doses of pain medication are dictated by the patient’s individual needs for pain control12. However, a basal/continuous infusion rate may be necessary for severe pain, opioid tolerant patients, or those patients who are unable to activate the PCA button
How does PCA dosing work?
There is a time delay in minutes before another dose is given.
How does the 1 hour limit of a PCA work?
One hour limit: To be manually calculated based on basal dose, PCA dose and lockout interval. The prescriber can choose a lower hourly limit if the clinical situation warrants.
How does the lockout interval of a PCA work?
This is the time the patient must wait after giving themselves a PCA dose before their click can deliver another PCA dose of medication. If the Lockout interval is 15 minutes, it means, the patient may click when it’s not 15 minutes from their last dose.
Difference between a PCA and nurse bolus
Blous: nurse controls prn dosing for severe breakthrough of pain to be administered through the pump.
PCA; nurses may not push the patient operated button
What is the 1 hour mas dose limit for a PCA
The 1-hour maximum dose limit for a Patient-Controlled Analgesia (PCA) is the pre-determined maximum drug amount that can be delivered during any one hour period1. It includes the demand dose, continuous dose, and breakthrough/incident pain bolus doses2. The specific limit may vary depending on the patient’s condition and the type of opioid used. For example, at one institution, the limit is set to zero3. Another source suggests that the one-hour limit is often set to deliver 3-5 times the estimated required hourly dose4. In general, it is important to consider factors such as patient tolerance, comorbidities, and the risk of over-sedation and respiratory depression when determining the appropriate PCA dosing2.
What should you teach your patient when the PCA is hooked up
Try to get ahead of pain and don’t let anyone but you push the button.
What is opioid stacking
When a patient’s liver/kidneys don’t work well so the opioid stays in the body longer.
T/F: Opioid side effect diminish with tolerance
T
What side effect might a opioid naive pt experience
sedation, decreased gut motility, respiratory depression, and pruritic
When is risk for opiod sedation highest
4 hours after leaving PACU
What opioid is associated with neurotoxicity (seizures)
Demerol
What medications do you use for adjunctive therapy
Corticosteroids to decrease inflammation.
Tricyclic antidepressants-Neuropathic pain
SNRI (serotonin norephedrine reuptake inhibitor) antidepressants for neuropathic pain, multimodule acute pain, and fibromyalgia
Antiseizure drugs: neuropathic pain, multimodal acute pain, fibromyalgia,
Local/oral/systemic anesthetics: neuropathic pain, arthritis, topical application prior to painful procedures
What are the three major principles of the CDC Guidelines for prescribing opioids
- Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, and end of life care.
- when opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose. start with immediate release formulations first.
- Clinicians should always exercise caution when prescribing opioids and monitor all patients closely.
Define tolerance in pain management
Occurs with chronic exposure, is expected need for an increased dose to maintain the same degree of analgesia
Define physical dependence in pain management
Occurs when the body adjusts it normal functioning around regular opioid use. Withdrawal or unpleasant physical symptoms occur when the opioid is stopped.
Define drug misuse in pain management
The use of illegal and/or the use of rx drugs in a manner other than directed by a physician such as using greater amounts, more often, or longer than told to take the drug. Misuse can also be taking someone else’s Rx.
Define drug addiction (opioid use disorder) in pain management
Occurs when attempts to cut down or control use are unsuccessful. Can create social problems and a failure to fulfill obligations at work, school, and home. Opioid addiction often comes and the individual has developed opioid tolerance and dependence, making it challenging to stop opioid use and increasing the risk of withdrawal.
List the cognitive behavioral interventions
distraction, reframing biofeedback, cutaneous stimulation, transcutaneous stimulation, exercise
What are pain management considerations for the older adult
metabolize drugs slower
higher risk of adverse effects
start low, go slow
increased risk of drug-drug interactions
analgesics can exacerbate cognitive impairment and ataxia
Use the least invasive route
Tailor nonpharmacologic needs to the indv
Describe the rule of double effect
The principle of double effect is used to justify the administration of medication to relieve pain even though it may lead to the unintended, although foreseen, consequence of hastening death by causing respiratory depression1. However, opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life1. Therefore, no secondary “double” effect is brought about
What receptors do opioids attach to
mu opiod receptors
Levels of prevention
primary: prevention of opioid addiction
secondary: early identification of opioid addiction
tertiary prevention: ensures access to treatment
