Pain Flashcards
Pain is a…
universal, but individual subjective experience that is often misunderstood and inadequately treated
Pain definition
unpleasant subjective sensory and emotional experience often associated with actual or potential tissue damage
Nurse’s job in pain
assess; improve systems; provide patient-centered care
nociception
observable activity in NS in response to adequate stimuli
4 steps of NS pain activity
transduction, transmission, perception, modulation
acute pain
protective; short duration and limited tissue damage; can threaten recovery if untreated and can progress to chronic
Chronic pain
no outward sx; over 3-6 months; cause psych and phys disability (anorexia, depression, suicide, hopelessness); goal is it improve functional status
cancer pain
damage from tumors, chemo, infection, all cancer related
how does pain change wth time
observable signs decrease; acute pain is more observable (inc BP, pulse, RR, dilated pupils, sweat)
acute pain response
tachy, HTN, anxiety, muscle tension, diaphoresis
behavioral response
grimace, guarding
chronic pain response
physiologic response is uncommon; more fatigue, depression, decreased functioning
subjective opinions of pain
believe the patient, acknowledge own prejudice, think safety when deciding what meds to give–eval patient first
factors influencing pain
age, fatigue, genes, cog/neuro (problems communicating), previous pain experience, support system/coping, spirituality, anxiety/fear
cultural aspects of pain
may not acknowledge pain if threatens lifestyle; some cultures more demonstrative, some more stoic, assess pain in native language bc may translate differently
what does pain impact
QoL, self-care, work, social support
who is the authority on pain?
the patient
Measures of pain
visual analog scale, simple descriptive, visual pain assessment or word bank, subjective and objective, PQRSTU, Baker face scale
who establishes acceptable level of pain goal
patient and care team; 0 pain might not be a reasonable goal
NC for pain treatment
multidimensional, inc functional status, use multiple methods, include cultural beliefs, be open-minded, pain may not be eliminated; include all patient concerns
relaxation and guided imagery
alters cognitive and affective perception; dec physiological response to pain
distraction
reticular system inhibits pain stimuli if person gets sufficient sensory input; best for SHORT, INTENSE pain
music
ACUTE/CHRONIC pain—Dec SNS response, distract, positive mood and emo
cutaneous stim
stim skin with massage, temp, TENS (acute); unknown MOA but may be gate control, watch out for hot temperatures
What temperature to use for acute and chronic pain?
heat for chronic, cold for acute
adjuvants
enhance or have analgesic properties (ex: sleep meds)
pharmacological tx of pain; nurse responsibility
assess, give med, reasses
NSAID SE
Gi bleed especially in old
non-opioids what they are and function
Acetaminophen and NSAIDs; mild-moderate pain; can have ceiling effect, give up to 800 mg
Tylenol limit
4g/24h
opioids function and SE
moderate to severe pain; GI SE, memory, thought change, respiratory depression
opioids NC
don’t do edu immediately after getting; know pt baseline neuro status; start low and try to keep use temporary
Respiratory depression/overdose NC; when do you see it
have oxygen and open airway; assess breathing and give Narcan (check after 15 minutes and reassess); common with opioid naive and around the clock dosing; often seen with BDZs
around the clock dosing
max pain relief and potentially dec opioids use; give meds at a regular interval to prevent pain from coming back; might end up giving unneeded meds
range-order meds
med orders where the dose is flexible (ex: 2-6mg morphine q2h); know your patient and count TYLENOL if given like this
Patient controlled analgesia (PCA)
nurses program IV machine and pt pushes button to get bolus when needed; start with a higher loading dose to get pain under control then decrease; programmed frequency and lockout (limit)
epidural anesthetic
regional anesthesia; must be preservative free; PCA or continuous
SE of epidural
hypotension, N/V, urinary retention, constipation, respiratory depression, pruritis–itchy
nursing care for epidural
monitor site placement, monitor infection/bleed, urinary retention/cath need, fall risk depending on location, monitor coagulation
tolerance
Caused by repeated drug exposure long-term; associated with chronic opioid use but not a sign of addiction
dependence
withdrawal symptoms occur after long-term opioid use; need to withdraw drug gradually; not a sign of addiction
addiction
psychological dependence; use of drugs FOR mind-altering effects; “drug-seeking” behaviors
Nociceptive pain and what helps it
Arises from pain receptors and usually response to opioids/analgesia; ache/pound/gnaw
Neuropathic pain and tx
Injury to nerves or abnormal processes of sensory input; tx with adjuvant analgesics; burning, shooting, electrical, abnormal sensation; phantom limb, neuropathy, spinal cord
Somatic pain
Type of nociceptive pain In bones, joints, muscles, skin or connective tissue; well-localized
Visceral pain
Type of nociceptive pain in internal organs, often associated with referred pain (non-specific); often poorly localized
Cutaneous pain
A type of nociceptive pain in skin or SQ tissue; well localized
Idiopathic pain
Chronic pain w/o known cause
When to give IV acetaminophen
Post-surgery
Big complication of acetaminophen use
Liver failure esp with over 4g/24 hours
Goal of non-pharm/alt/complementary
Inc QoL, inc functioning
How does a support system/coping affect pain
Presence of these decrease pain sensitivity
How does anxiety and fear impact pain?
May increase pain perception which causes more anxiety and fear
How do genes impact pain?
May increase or decrease pain sensitivity
Should you use non-pharm interventions if your patient is having moderate to severe pain?
You can, but use pharmacological interventions first
What drug can cross the blood-brain barrier?
IV tylenol
