Pain Flashcards
What is somatic pain ?
arises from bone, joint, muscle, skin or connective tissue
- usually aching or throbbing in quality
- well localized pain
What is visceral pain ?
arises from visceral organs, such as the GI tract and bladder
- vague, harder to pinpoint pain
What is neuropathic pain ?
abnormal processing of sensory input by the peripheral or central nervous system
How is neuropathic pain described as ?
numbing, hot, burning, shooting, stabbing, sharp or electric shock-like
What are the causes of neuropathic pain ?
trauma, inflammation, metabolic disease (DM), alcoholism, infections of the nervous system, tumors
What is acute pain ?
- <3 months duration
- increased HR, RR, BP
- diaphoresis/pallor
- anxiety, agitation, confusion
- urine retention
- Goal: pain control w/ eventual elimination
What is chronic pain ?
- > 3 months duration
- decreased physical movement/activity
- fatigue
- withdrawal from others and social interaction
- Goal: control pain to the extent possible focusing on quality of life & function
What is OLDCARTS ?
- Onset
- Location
- Characteristics
- Aggravating
- Relieving
- Treatment
- Severity
What is the pain scale for babies ?
FLACC
Who is the FACES pain scale used for ?
- self report
- 4+ year olds
- can be used as young as 3 yrs old
Who is the numeric pain scale used for ?
- 8 yrs or older
- developmentally able
- can be used as young as 5 yrs old if they can count
- if a pt can self-report, do not change to an observational scale while asleep
What are some physiological reactions to pain ?
- skin flushing/diaphoresis
- vital sign changes: BP, HR, RR
- O2 saturation, restlessness
- pupil changes
- chronic pain may result in physiological changes
What are some physical non-medicated pain relief strategies ?
- massage
- exercise
- transcutaneous electrical nerve stimulation (TENS)
- percutaneous electrical nerve stimulation (PENS)
- acupuncture
- heat/cold therapy
What are some non-pharmacological pain management for pediatrics ?
- distraction
- nonnutritive sucking (pacifer)
- kangaroo care
- containment and swaddling (sleep sacks)
- relaxation
- guided imagery
- cutaneous stimulation
What are some characteristics of Acetaminophen/Tylenol ?
can harm the liver in large doses
What is a characteristics of toradol/ketorolac ?
may cause bleeding & kidney damage
What are some common side effects of opioids ?
drowsiness, respiratory depression, constipation, nausea
What drug category is Nalbuphine (Nubain) & Butorphanol ?
mixed agonst-antagonist
- less respiratory depression
- may cause withdrawal to occur
What is Tramadol ?
weak mu agonist
- inhibits reuptake or norepinephrine and serotonin
- may cause seizures
What are some meds for opioid addiction ?
- Methadone: opioid agonist, more mild and long acting
- Suboxone: Buprenorphine + Naloxone
How may we manage pain in those with opioid addiction ?
- assess for substance abuse or possible diversion of opioids
- consider referral to pain clinic/specialist
- right to receive effective pain management
- consider complications of withdrawal
What type of pain med schedule is effective for those with chronic & predictable pain ?
around the clock (ATC)
What is the goal of med titration ?
use the smallest dose of analgesic that provides effective pain control with the fewest side effect
When is the oral route for medication good for ?
with pt’s that has functioning GI system
- immediate release q4 hrs
- sustained release q12-24 hrs (takes 2 hrs for onset)
When is the sublingual and buccal route for med good for ?
for pt’s who can’t swallow
- faster relief (5-7 mins) and lasts about 2-5 hrs
When is the rectal med route good for ?
for pt’s who can’t swallow
- absorption may vary
How long does it take for the transdermal med route to work ?
12-17 hrs for full effect
- report use of this med/assess for it
- remove previous patch before applying new
When is the parenteral med route good ?
- SQ: slow absorption, not used to acute pain
- IM: painful, unreliable absorption
- IV: best route for immediate analgesia
How does a patient controlled analgesia (PCA) pump work ?
programmed to give a dose of med every time the patient hits the button
- can only hit the button a certain amount of times
- only the patient should press the button
- occasionally a basal rate is added where a certain amount of med is being given constantly, no matter if the button is pressed
- high risk & end-tidal CO2 monitoring
What are some signs of opioid overdose ?
- slow or shallow respirations
- oversedation
- confusion
What is the treatment for opioid overdose ?
- if running a PCA, put it on hold and shut it off
- if receiving opioids, give Narcan (Nalaxone) is respirations < 8 (usually)
What are some special considerations about pain management with older adults ?
start low, and go slow
- they metabolize drugs more slowly
- NSAIDS cause GI bleeding
- drug interactions
- cognitive impairment
- incorporate exercise and other nonpharmacologic interventions
What are some consequences of untreated pain ?
- suffering
- immunosuppression
- sleep disturbances
- impaired recovery from acute illness and surgery
- physical and psychosocial dysfunction
What are some harmful effects of unrelieved pain ?
- tachycardia
- increased clotting
- shallow breathing/decreased tidal volume (can cause pneumonia)
- urinary and bowel retention
- anorexia
- weakness/fatigue
- impaired muscle coordination
- disorganized thought processes
