Pain Flashcards

1
Q

Pain; definition

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

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2
Q

Different definitions of pain

A

-Whatever and wherever the person experiencing pain says it is.
-Unpleasant sensory and emotional experience associated with actual or potential tissue damage.
-Multidimensional and entirely subjective.
-Pain can be experienced in the absence of identifiable tissue damage.
-Pain is not synonymous with suffering.
-Pain is subjective - it is entirely the clients experience and self report is essential.

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3
Q

Pain

A

-A major problem that causes suffering and reduces quality of life.
-One major reason why people seek health care.
-Nurses have a central role in assessment and management of pain.
-Effective pain relief is a basic human right.

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4
Q

Pain Management; an individuals rights

A

-Their pain to be acknowledged and expected.
-The best possible personalized evidence-based pain assessment and management including relevant bio-psychosocial components.
-Ongoing information and education about the assessment and management of pain.
-Involvement as an active participant in their own care in collaboration with the inter professional team.
-Communication and documentation among interprofessional team members involved in their care to monitor and manage their pain.

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5
Q

Nursing intervention; pain

A

-Assess pain, document it, and communicate with other health care providers.
-Ensure delivery of adequate pain relief measures.
-Evaluate effectiveness of interventions.
-Monitor ongoing effectiveness of pain management strategies.
-Provide education to clients and their families.

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6
Q

Consequences of untreated pain…

A

-Unnecessary suffering.
-Physical and psychosocial dysfunction.
-Impaired recovery from acute illness and surgery.
-Immuno-Suppression
-Sleep disturbances

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7
Q

Dimensions of pain

A

-Physiological
-Sensory-Discriminative
-Motivational-affective
-Cognitive-evaluative
-Sociocultural

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8
Q

Causes and types of pain; by underlying pathology

A

Nociceptive
-Somatic
-Visceral

Neuropathic

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9
Q

Causes and types of pain; by duration

A

-Acute
-Persistent

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10
Q

Acute pain

A

-Sudden onset
-Usually within the normal time for healing
-Mild to severe
-In general, a precipitating illness or event can be identified
-Lowers over time and goes away as recovery occurs
-Manifestations reflect sympathetic nervous system activation:
•Increased HR
•Increased RR
•Increased BP
•Diaphoresis, Pallor
•Anxiety, agitation, confusion
NOTE: responses normalize quickly owing to adaptation
-Goal is pain control with eventual elimination.

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11
Q

Persistent Pain

A

-Gradual or sudden
-May start as acute injury but continues past the normal time for healing to occur
-Mild to severe
-cause may not be known; original cause of pain may differ from mechanisms that maintain the pain
-Typically, pain persists and may be ongoing, episodic, or both -predominantly behavioural manifestations:
•Changes in affect
•Decrease in physical movement and activity
•Fatigue
•Withdraw from other people and social interaction
-Goal is minimizing pain to the extent possible; focusing on enhancing function and quality of life

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12
Q

Nursing assessment of pain

A

Assess for the presence or risk of pain
•on initial assessment and all subsequent assessments
• Each time vital signs are completed
•Prior to, during and after a procedure
•Prior to and following using pharmacological and non-pharmacological treatment for pain

Assessment: the patients pain goal or expectations of comfort and pain relief
Characteristics: intensity, timing, location, quality
Aggravating or reliving factors
Behaviours associated with the pain

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13
Q

Assesment

A

-PQRST
-Wong-baker FACES pain rating scale

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14
Q

Pain assessment; components

A

-Effects of pain on clients sleep and daily activities, relationships, physical activity, and emotional well-being should be assessed.
-Past pain experiences, meaning of pain for the client, ways client expresses the pain, and clients pain-Control strategies should all be included.

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15
Q

Pain Treatment: basic principles

A

-Routine assessment is essential for effective management
-Unrelieved acute pain complicates recovery
-Clients self-report of pain should be used whenever possible
-Health providers have a responsibility to assess pain routinely, to accept clients pain reports, to document them, and to intervene in order to manage pain.
-The best approach to pain management involves clients, families, and health providers.

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16
Q

Pain treatment: basic principles continued

A

-Many clients at high risk for suboptimal pain management - all clients should have assailants pain relief
-Treatment based on clients and family’s goals for pain treatment
-Combination of drug and non drug therapies
-Multidimensional and interdisciplinary approach
-Evaluation of therapies
-Prevent or manage adverse effects
-Client and caregiver teaching is the cornerstone of the treatment plan.

17
Q

Drug therapy for pain

A

-Equianalgesic dose
-Scheduling analgesics
-Titration

18
Q

Drug therapy for pain: analgesic ladder 1-3

A

Mild pain
-1-3 on a scale of 1-10
“Step 1” drugs
•nonopioid analgesics (aspirin and other salicylates, other NSAIDs, and acetaminophen (Tylenol))
-ceiling effect: increasing the dose beyond and upper limit provides no greater analgesia, no tolerance or physical dependence, many available without a prescription.

19
Q

Drug therapy for pain: analgesic ladder 4-6

A

Mild to moderate pain
-4-6 on a scale of 1-10, or mild but Presistent despite nonopoid therapy
-“step 2” drugs
•Mu: morphine, oxycodone, hydromorohone, methadone
•opioid agonists (morphine)
•antagonists (naloxone)
•mixed (pentazocine, butorphanol)

20
Q

Drug therapy for pain: analgesic ladder (severe pain)

A

Opioid analgesics commonly used for severe pain
-Morphine
-Morphine-like agonists (hydromorohone (dilaudid), methadone (metadol), fentanyl (duragesic), meperidine (Demerol) (not recommended))
-Mixed agonists - antagonists (butorphanol (stadol))

21
Q

Adjuvant analgesic therapy

A

-used in conjunction with opioids and nonopioids
-Sometimes called coanalgesics
-Enhance pain therapy through one of three mechanisms:
1.enhancing the effects of opioids and non opioids
2.possessing analgesic properties of their own
3. Counteracting adverse effects of other analgesics

22
Q

Non-pharmacological therapy

A

-Massage
-Therapeutic exercise
-TENS
-Application of heat
-Application of cold
-Cognitive techniques
•Distraction
•Relaxation strategies
•Self-management

23
Q

Tolerance

A

A persons diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to the continued presence of the drug

24
Q

Addicition

A

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and sue despite adverse reactions

25
Q

Dependence

A

Use of drugs of alcohol that continues even when significant problems related tot here use have developed

26
Q

Trends and changes in the treatment of pain

A

-Clinicians confuse physical dependence, tolerance, and addiction and are more likely to assess pain by observing behaviours rather than believing or eliciting a clients report.
-Growing interest in inter professional educational intervention trials for practicing health care providers that target common pain-related misconceptions.

27
Q

Trends and changes in the treatment of pain continued

A

-International association of the study of pain has published a core curriculum plan
-Provincial organizations such as the RNAO have also developed evidence informed practice guidelines on pain
-Opioid crisis and recent legal outcomes for pharmaceutical companies.