Pain Flashcards
What is pain
Physical or emotional, what the PT says it is, SUBJECTIVE
What are the two types of pains
Prevent injury )hot stove) or resulr from injury (fracture)
What does unrelieved pain result from
Failure to ASSESS, ACCEPT, or INITIATE
How does age affect pain
Infants can’t VERBALIZE, older people have lots of PROBLEMS
How does fatige affect pain
Increases sensitivity
How does genetic sensitivity affect pain
In/decrease tolerance
How does cognitive function effect pain
Reporting pain
How does prior experiences effect pain
in/decrease sensitivity, positive/negative experience
How does anxiety and fear affect pain
Increase sensitivity to pain
How does a support system affect pain
Can help cope
How does the culture affect pain
Can make people more/less likely to show pain
What must nurses be aware of regarding pain
Their own attitudes and expectations
What do all pts have the right to
Effective pain management
What must nurses do related to caring for pain
Assess, advocate, monitor, evaluate, educate, document
What does the ANA say about pain
We have the ethical RESPONSIBILITY, INDICIDUALIED, MULTIMODAL
What is nociception
The sensation of tissue injust is conducted from pain RECEPTORS to the brain
What are the 4 steps of nociception
Transduction, transmission, perception, modulation
What is transduction
At the TISSUE, they convert pain into ELCETRICAL impulse
What is transmission
The impulse TRAVELS, regulated by NEUROTRANSMITTERS
What can increase pain tranmission lead to
inflammatory response
What can decrease pain transmission
analgesias
What are the inflammatory neurotransmitters
Substace P, prostagladins, bradykinin, histamine
What are the analgesia neurotransmitters
Serotonin and endorphins
What is perception
Recognition of pain in the brain
What influences perception of pain
thoughts and emotions
What is the pain threshold
Point in which someone FEELS pain
What is pain tolerance
Amount of pain the pt will BEAR
What is modulation
The brain changes the perception by sending INHIBITORY input
What are inhibitory inputs
Endogenous endorphins
Why are there pain theories
Because it’s not completely understood
What is the specificity theory of pain
Understanded that pain receptors existed
What is the sensory interaction theory
large vs. small nerve fibers
What is the gate control theory
Thoughts and emotions influence pain, wheither the pain goes up to the brain or not
What substances close the gate
Opioids, massage, nonpainful stimuli, topical analgesics
What is the neuromatrix theory
Each person has a unique network of neurons and that’s why pain is different for each person
What type of pain is protective
Acute
How does acute pain resolve
With tissue healing, 3-6 months
What type of pain is associated with trauma, surgery, acute, disease, and labor
Acute
What is the physiological response of acute pain
Fight or flight response
What is the behavioral response of acute pain
Grimacing, moaning, guarding
What is the intervention of acute pain
Treat the underlying cause
What type of pain is not protective
chronic
What is chronic pain
ongoing or repeated pain, interfers with ADLs
What are the causes of chronic pain
May not have a know cause: arthritis, fibromyalgia, neuropathy
What is the physiological response with chronic pain
Does NOT alter vitals, depression, decreased level of functioning
What can chronic pain lead to
disability
What are the interventions of chronic pain
Symptomatic releif
What is nociceptive pain
most COMMON, physical pain that is caused by tissue DAMAGE
What is the type of physcial pain with nociceptive pain
Throbbing, aching, sharp, burning
What can cause nociceptive pain
Surgery, inflammation, injurt, trauma
What are the two types of nociceptive pain
Somativ, visceral
What is somatic pain
INjury to the skin, muscles, bones, and joints
What is visceral pain
From the internal organs
What type of pain is caused from sunburns, lacerations, fractures, sprains, arthritis, bone cancer
Somatic
What type of pain is caused from appendicitis, pancreatitis, IBS, bladder distention, cancer
Visceral
What type of pain can cause reffered pain in other body locations
visceral
What are the interventions for nociceptive pain
non/opioid meds
What are the two types of symtpoms to nociceptive pain
Reffered and radiating
What is referred pain
Originates in one area but hurts in another
What is radiating pain
Extends from source ot an adjacent area
What type of symptom is heart attack
Reffered
What type of symptom is sciatica
Radiating
What is neuropathic pain
Results from nerve injury but continue after stimuli are gone
What are the symptoms of neuropathic pain
Intense, shootin, burning, pins and needles
Is neuropathic chronic
Usally
What type of pain can neuropathies, tumors, infection, and chemotherapy cause
Neuropathic
What type of pain can CVA, viral infections, phantom limbs, DM lead to
Neuropathic
what are the interventions of neuropathic pain
Adjucant meds: antidepressants, antispasmodics, muscle relaxers
What is psychogenic pain
Perceived pain with no physical cuase
What can effect psychogenic pain
Mental, emotional, or behavioral factors
What typ eof pain are headaches, backache, stomachaches
Psychogenic
What can peripheral neuropathy from DM cause
alterations in pain pathways which can alter perception of apin
What are the physiologic alterations caused by pain
The body reacts and over time that can cause issues, Ex. increase RR can lead to pneumonia
What are some factors that influence pain
Age, gender, diasbilities, culture, wthnicity, religion
What is pain
SUBJECTIVE
How does the nurse assess pain
Asking quesiotions. SOCRATES, OLDCARTS, OPQRSTU
What does OPQRSTU stand for
Onset, precipitating/palliative, quality, region, severity, timing, understanding
What is the most reliable indicator of pain
Pts self report
What is the numeric scale
0-10, with a verbal and acitivty tolerance scale
What is the wong-baker faces sclae
Used for people who have a hard time communicating, use for kids <3
What is the FLACC scale
OBservational, kids 2 months- 7 years old, or pts with cognitive disabilities
What are the scores for the FLACC tool
0: relaxed
1-3: mild
4-6: moderate
7-10 Severe
What objective data can you collect to complement the pts self report
Vital signs, behaviors, psychological response
When should you assess pain
When getting vitals
What can an elevated HR and BP indicate
Acute pain, need for med
What can a decreased HR and CP indicate
chronic pain
Are vitals accurate over a long period of time
No
What type of pain is related to burns, MI, amputation as evidence by tissue damage, EKG changes, incision
Acute
What type of pain is related to cancer, arthritis, DM as evidence by burning feeling, malignacny
Chronic
What can indicate a difficulty of coping with pain
Prolonged pain, poor concentration, inability ot ask for help
How do you know if your goal statement works
If your goal was meat with a YES or NO
When can you use just nonpharmacologica pain management
Mild pain but use is concurrently with meds for severe or chronic pain
What are the nonpharmacologica pain management things you can do
Repositioning, skin stimulation, distraction, relaxation, imagery, acupuncture, reduction of painful stimuli, elevation of swollen limbs, naurolgic and neurosurgical pain therapies
What does skin stimualtion do
interrupt pain pathways, heat increases blood flow, cold helps inflammtion
Me are somethings you can do to distract your pt
ambulation, deep breahting, TV, vistors, conversation
What are some relaxation tecniques
meditation, yoga, prayer
What are the neurologic and neurosurgicla pain therapies
Spinal cord stim, TENS
What is the spinal cord stim
Device implanted to treat chronic neuroligc pain, tingling sensations alters pain perception
What are the three classes of pharmacologic pain management
Nonopioids, opioids, adjuvants
What are the mainstay for relieving pain
Analgesics
What class is appropriate for mild to moderate pain
Nonopioids
What class is appropriate for moderate to severe pain
Opioids
What class enhances the effects of nonopioids
Adjuvants
What are the two therapeutic stategies to manage pain
Mulitimodal analegesia and preemptive analgesia
What is mulimodal anagesia
Using more than one type of agent
What are the benefits of mulimodal analgesia
More effective, lower dosese, less side effecrts
What is preemptive analgesia
Giving meds before a painful event
What are some nonopioids drugs
Acetaminophen, NSAIDs, aspirin
What should you know about acetaminophen
Hepatotoxicity, max 4g/day
What should you know about NSAIDs
Renal function, bleeding, w/ food
What should you know about aspirin
Monitor for salicylism+ tinnits, vertigo
What drugss are used for pain post-op, MI, or cancer
Opioids
What drugs are opioids
Morphine, fentabyl, codeine
How should you manage giving opioids
Short-term sceduled meds rather than PRN
What are the adverse effects of opiods
Constipation, orthostatic hypoteneion, urinary retention, sedation, RESPIRATORY DEPRESSION
What must you check before giving opioids
Vitals
What are the risks of opioid use
Tolerance, dependence, addiction, accidental ingestion
What is drug tolerance and what should you do about it
Body gets use to meds and is less effective, use a difference drug
What is physicla dependence
Body can not function and will have withdrawal symptoms
What is addiction
Psycholoigcal or emotion dependence, compulsively takes the drug
What can substance use disorders lead to
Disability, health issues, interfers with life
What is the leading cause of accidental death in the US
drug overdose
How can you prevent accidental ingestion
Educate pts to keep opioids secure and out of reach of hcildren
What is patient-controlled analgesia (PCA)
pt controls small frequent dosing to improve pain control with less lag time
What is important with PCAs
2 RNs must set it up, monitor for respiratory depression, and only the PT can push the button
What do adjuvant drugs do
Enhavne the effects of nonopiods to alleviate other symptoms
What are adjuvants useful for
neuropathic pain
What are SNRIS
duloxetine+ cymbalta
What are the type of meds in adjuvant care
anticonvulsants, anxiety, depressatns, histamines, metics
What is medical marifuana used for
neuropathic pain, spams, cancer, HIV pain
What should the nurse try frist for mild pain
nonpharmacologic measures
What type of approach should a nurse have when giving pain meds
proactive, around the clock, follow up and reassess
When should you reassess after giving pain meds
30 mins- 1 hour
What are some pt barriers to good pain management
Fear, cost, no access
What are the health care provider barriers to good pain management
Bad assessment, beliefs, attitude, sterotyping, lack of education
What are the health care system barriers to good pain management
Not a high priority, not good resources, or reimbursement
What is undertreatment of pain
SERIOUS health care problem
What can acute and chronic pain lead to
Anxiety, fear, depression
What can poorly managed acute pain lead to
Chronic pain syndrome
What are the risk factors of undertreatment of pain
attitudes, lack of knowledge, fear od addiction, respiratory depression
In what case are we not as worried about respiratory depression
Chronic use
Who are the populations at risk for undertreatment of pain
yound, old, pain with substance use issues
What are some detrimental outsomes of inadequate pain management
Impaired revocery, chronic pain, ADLs, sleep, suffering, work loss, increased costs, relationships
What must you document
Time given, post assessment, duration, score, education at discharge
When do you need to assess the pain score
Every shift
What do you need to do if goals are unmet
Collaborate
