Pain Flashcards
pain is
unpleasant sensory/emotional experience w actual/potential tissue damage
many patients are reluctant to report pain due to
wanting to be a “good” patient and fear of addiction
acute pain
activation of SNS that is temporary with a sudden onset
signs of acute pain
localized redness, bruising, bleeding, warmth, inflammation, swelling
chronic pain
lasting at least 3 mon with gradual onset that changes over time
acute pain responses
high HR/BP/RR, dilated pupils, sweating
cancer pain
pain in more than one area where chemo/radiation cause more pain
chronic noncancer pain
common in neck, shoulder, low back in over 65 yrs old
chronic pain can result in
emotional/financial/relationship burdens, depression/hopelessness
procedural pain
acute pain from procedures or surgery
nociceptive pain is the
normal pain transmission
transduction (nocicpetive)
push pain signal forward
modulation (nocicpetive)
serotonin, NE, other processes to reduce activity
transmission (nocicpetive)
message relayed from injury site to brain
somatic pain
bones, skin, muscles
perception (nocicpetive)
conscious awareness of pain
visceral pain
organs
neuropathic pain
peripheral NS or CNS sense and transmit impulses to tell the body you have pain
pain transmission
nerve fibers that transmit pain
A delta fibers
fast/myelinated that detect sharp and localized thermal/mechanical injury
C fibers
slow/unmyelinated that respond to widely distributed mechanical/chem/thermal injury
low drug dosing for older adults
increase dosing based on response to previous dose due to slower metabolism/excretion
multimodal analgesia
combination of opioids and nonopioids
nonopioids
effective as opioids for mild/mod pain
NSAIDS
cause GI issues and increased bleeding risk, must monitor heart and renal
NSAIDS+aspirin
rarely used due to poor side effects
acetaminophen
for pt who have increase GI bleeding risk but can cause liver toxicity
opioid analgesics
interact with opioid receptor sites to block release of neurotransmitters in spinal cord
monitor opioid analgesics for
sedation and resp despression
types of opioid analgesics
codeine, oxycodone, morphine, hydromorphone, fentanyl, methadone, tramadol, meperidine, oxymorphone
opioid epidemic
misuse of prescription opioids and illicit drugs
physical dependence and tolerance when taking opioids
normal response
pseudoaddiction
mistaken diagnosis of addiction due to underprescription of drugs when pain still present
opioid addiction
uncontrollable cravings, inability to control use, compulsive use, use despite harm
dependence
predictable and manage with meds and a slow taper off
opioid naive
person who has not taken enough opioid to become tolerant
opioid tolerant
person who has taken opioids at high doses to develop tolerance
patient ed for opioids
time frame of usage, disposal, alternatives to reduce risk of misuse
Short acting, fast acting, immediate release (IR), normal release opioids
Onset 30 minutes; duration 3-4 hrs
Modified-release, extended release (ER), sustained release (SR), controlled release (CR) opioids
over prolonged time, NEVER crush/chew/break
why to avoid meperidine
cause resp/circulatory depression, hallucinations, seizures
level 1 pain (1-3 rate)
use non-opioids
level 2 pain (4-6 rate)
use weak opioids alone or w adjuvant drug
level 3 pain (7-10 rate)
use opioids
adverse effects of opioid analgesics
resp depression, constipation, N/V, pruritis, sedation
pain management in end of life
opioid regimen should be consistent as pain is still felt while unconscious (no concern for addiction)
medical marijuana
not regulated by FDA but is good for cancer pain
medical marijuana adminstration
doctors cannot prescribe, nurses cannot administer, ONLY caregiver or pt
selected opioid analgesics
Codeine, fentanyl, hydromorphone, oxycodone, hydrocodone, methadone
nonpharmacologic interventions
heat/cold, massage, PT/OT, imagery, relaxation
