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NURS 212 > Pain > Flashcards

Pain Flashcards

1
Q

___ is the 5th vital sign

A

Pain

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2
Q

Pain is objective or subjective

A

subjective

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3
Q

4 steps of pain

A

Transduction
Transmission
Perception
Modulation

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4
Q

Two major types of pain

A

Nociceptive and neuropathic pain

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5
Q

Nociceptive pain

A

Caused by injury or inflammation

Generally reversible (responding to analgesics and opioids)

Usually localized, constant and often associated with ache/throb

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6
Q

Example of nociceptive pain

A

Burn fracture, tomor, obstuctions

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7
Q

Neuroptathic pain

A

Caused by injury or malfunction within the CNS or PNS

Can occur without immediate tissue damage or inflamattion

Associated with diapetic neuropathy, inflammation around nerves, viruses)

Does not respond well to analgesics or opiods

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8
Q

Acute pain

A

Sudden onset

Subsides once treated (usuallyP

Often affecting BP,HR, RR

Behaviour changes may be apparent with cultural influences

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9
Q

Chronic pain

A

Ongoing/recurring

More difficult to treat

Can be complex, not afecting BP, HR, RR

Acute behaviour change less apparent

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10
Q

Onset of chronic pain

A

Days to months

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11
Q

Description of chronic pain

A

Dull, aching, always there

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12
Q

Example of chronic pain

A

Arthritis, cancer, lower back pain, peripheral neuropathy

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13
Q

Why is cancer pain often complicated

A

can be caused by tumor
pressure and inflammation on a
nerve near or within an organ or
bone.

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14
Q

What are the contributers to complicated pain

A

Sorrow and suffering, anxiety and
depression, an unknown outcome,
family pressures, loneliness and
isolation, etc., can contribute to
complicated pain.

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15
Q

Classification of Pain by Manifestation

A

Somatic (generalized body aches)
* Visceral (organ pain)
* Superficial (surface, skin-deep)
* Vascular (pulsating, or vessel
related)
* Referred (pain that is felt away
from the source)
* Chest (angina or potential
myocardial infarction MI)
* Phantom (limb loss)
* Neuropathic (nerve related pain:
pins & needles, burning, numbing,
freezing sensations)
* Cancer (severe, complex)
* Psychogenic (suffering caused by,
or triggered by, non-physical
causes)
* Radiating (traveling, usually along a
nerve path)
* Cramping (Gastro-intestinal pain
that is triggered by peristaltic
waves)

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16
Q

Pain scales for rating pain systematically:

A
  • O-10 scale
  • Verbal Descriptor Pain scale
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17
Q

Comprehensive pain assessment tools:

A

Body mapping of pain
* Pain diary (patient keeps this and brings it to the
provider)
* Interview with patient and family

18
Q

LOTTAARRPP

A
  • Location
  • Onset
  • Type
  • Timing
  • Alleviating factors
  • Aggravating factors
  • Related symptoms
  • Radiating?
  • Personal Perception (0-10 scale)
  • Precipitating event
19
Q

Assessment for
Non-verbal or dementia patients

A

Basic Needs Assessment
* ADD protocol
* Universal Pain Assessment (‘Faces’ scale)
* PAINAD

20
Q

Basic Needs Assessment

A
  • Does the resident need his or her eyeglasses or hearing aid?
  • Is the hearing aid working?
  • Is the patient’s discomfort due to toileting or incontinence
    needs? Hunger? Thirst?
  • Is the resident too hot or too cold?
  • Does the patient need a position change to relieve pressure?
  • Does the resident need more light? Shadows can be
    disturbing. Lots of natural or indirect bright light may reduce
    anxiety.
  • Does the resident need more stimulation? Less stimulation? `
21
Q

Possible disturbing environmental stressors for elderly patients

A

Noise from a television
* Echoes in bathrooms or other heavily tiled areas
* Noise from background conversations
* Pounding from pill crushers
* Ringing telephones or pagers
* Public address systems
* Glare from lighting
* Hard, unpadded chairs or uncomfortable vinyl furniture
* Wrinkled bed sheets or clothing
* Garments made of rough or itchy materials
* Poorly fitting shoes or clothing

22
Q

Potential barreirs to the treatment of pain

A

Health care provider’s bias
* Patients’ misconception of what pain is
* Cultural beliefs
* Cost of medication
* Lack of knowledge

23
Q

Pain Threshold

A

The point at which
pain begins to be felt

24
Q

Pain Tolerance

A

Maximum level of pain a patient can endute

25
Q

Medication tolerance

A

Body is accustomed to the medication and has a decreased responses to its therapeutic effect (a person requires more of the medication to achive the same effect)

26
Q

Dependence

A

Development of withrdrawl symptoms when an opiod is suddenly discontinued

27
Q

Addication

A

craving, compulsive use,
inability to control

28
Q

Non-Opiod Analgesics

A
  • Many are OTC (for mild to moderate pain):
  • Tylenol
  • Ibuprofen
  • Naproxen
  • Advil
  • Aspirin (contraindicated for chronic pain)
  • These medications are typically better than
    opioids for bone and inflammation-related
    pain.
29
Q

How to use non-opiod analgesics

A

Wigh reisk.versus benefits

Start with low dose to determine
resident’s/patient’s reaction.
* Increase gradually to dose that relieves
pain, not to exceed maximum daily dose

If maximum anti-inflammatory effect is desired
in addition to analgesia, allow adequate trial
before discontinuing or switching

30
Q

Some non-opiods take how long to work

A

Some non-opioids (especially those for
neuropathic pain) may take several weeks
to begin to work well (ex. Gabapentin).

31
Q

What are Adjuvant Analgesics

A
  • Medication that have a primary indication
    other than treatment of pain but relieve pain in
    some conditions.
32
Q

Ex of adjuvant analgesics

A

Antidepressants
* Tricyclic antidepressants (TCAs)
* Selective Serotonin Reuptake Inhibitors (SSRIs)
* Anticonvulsants (neuropathic pain)
* Carbamazepine, Clonazepam, Lyrica
* Corticosteroids (inflammatory pain)
* Prednisone, Dexamethasone
* Caffeine (acts as a synergist, or ‘booster’ to
other analgesics) and is a ‘true’ adjuvant
medication.
* Ex. Midol is very common example

33
Q

Opioid Analgesics

A

Pain relievers that contain opium, derived
from the opium poppy (morphine, a ‘true’
opiate) or are chemically related to opium but
synthetically manufactured (codeine sulfate):
* Methadone HCl
* Hydromorphone
* Morphine sulfate
* Oxycodone
* Fentanyl
* Tramadol/ Tramacet
* Meperidine HCl (Demerol) (not indicated
for older adults)

Start LOW and GO SLOW with the elderly

34
Q

Side effects of opiods

A

Constipation
* Nausea and Vomiting (N & V)
* Orthostatic hypotension
* Dizziness
* Potential CNS (respiratory) depression
* Confusion, drowsiness

35
Q

Opiote antagonists

A

Bind to opiate receptors and prevent a
response.
* Used to attempt complete or partial
reversal of opioid-induced respiratory
depression.
* Naloxone (Narcan)
* Naltrexone (Revia)

36
Q

Always evaluate what after opiod administration

A

Evaluate Sedation and Vital Signs

37
Q

POSS

A

Pasero Opioid-induced Sedation Scale

4 point scale assessing level of arousal

38
Q

Pain clinics

A
  • Provide specialized, comprehensive, and
    multidisciplinary approach to pain
    management.
  • Important advocacy for residents/patients
    with complex, unresponsive pain.
  • Religious leaders may become part of the
    team if complicated pain (suffering) is
    causing physiological treatments to be
    ineffective.
39
Q

Non pharm interventions for pain

A
  • Music therapy
  • Pet therapy
  • Biofeedback
  • TENS (transcutaneous nerve
    stimulation, usually by PT)
  • Body movement therapy
  • Reposition
  • Games and visits
  • Gardening
  • Favorite foods
  • Therapeutic touch
  • Counseling
  • Art therapy
  • Prayer and meditation
  • Swimming or hydrotherapy
  • Movement & stretches
  • Heat and/or icing
  • Herbal formulations
  • Acupuncture/acupressure
40
Q

Therapeutic outcomes of pain management

A

Decreased complaints of pain
* Decreased severity of pain
* Increased periods of comfort
* Improved activities of daily living, appetite,
and sense of well-being
* Improved ability to relate with family and
friends
* Improved QOL

41
Q
A

NURS 212 (21 decks)

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