Pain Flashcards
What causes perception of pain
nociceptor stimulation
by cell wall destruction, inflammation, infection, nerve injury, extravasation of fluid, pressure, distention, occlusion, obstruction
what are conceptors mediated by
bradykins, prostaglanids, substance p, histamine, seratonin, leukotrienes, H, nerve growth factor
pain tolerance
the amount of pain you can endure
pain threshold
when pain is percieved as pain
based on past expirences
Nociceptive pain
caused by direct tissue damage
sharp, stabbing, is localized and acute
cutaneous pain
nociceptive pain of the skin, very localized, high amount og nocicpetive receptors
somatic pain
nociceptive- deeper, dull, muscle, bone ligament
visceral pain
organ pain, dull, diffuse, vague, may present as referred pain
neuropathic pain
of the nerves, more tingling/numb
like phantom limb pain or diabetic neuropathy
treatment of nociceptive pain
gabapentin, lyrica, anti-depressants
diabetic neuropathy
from damage to vascular system, pain/tingling/pins and needles
chronic pain
must separate acute and chronic pain
chronic pain may not present as normally because of adjustment to it. especially with vital signs
elderly pain
felt just as intensely, but may present more atypically
more concerns with drugs bc lower kidney and liver function
use appropriate tools when diagnosing pain- dementia pain scales based on behavior
goals of pain managment
able to participate in activities that will help in preventing complications
addiction
psychological, diagnosed by a specialist
placebo
saying something is a drug when it is not, can only be done consually in trials
steps in pain management
find cause, know how pt percieves it, identify charactersitcs, implement plan
when should pain meds be given
before pain in severe, start with minimal dosing and titrate up
pain assessment
location, intensity, character, onset/duration, constant/intermittent, aggravating/relieving factors, associated symptoms, vital signs
vital signs with pain
increased everything, although not always 100% reliable
common post op pain
from incision site, sore throat from intubation, musculoskeletal pain based on positioning
ceiling effect
increased dose will not give more pain relief
happens w/ non- narcotics, aspirin, tylenol, NSAIDs
opioids do not have a ceiling effect
rescue dose
for breakthrough pain
higher dose of IV push, morphine, dilaudid
analgesic ladder
way of thinking for treating pain, starting low and going higher
it tylenol, codeine, stronger IV med
tylenol dose lim per day
3-4 g
opioid crisis with med
has changed go to use of dilaudid and morphine into trying alternative methods like ice, lidocaine, nerve blocks
are IV meds stronger
no, but they are faster and may take less time, however therapeutic effects end faster as well
opioids in pain treatment
CNS depressant, no ceiling, yes dependance/ tolerance
keep naloxone/ narcan near by with resp depression, pt may be in pain/ agitated
causes urinary/GI retention- stool softners, ambulation
Itching- helped with benadryl
NSAIDS with pain
ibuprophen.
Cotorolac/ torodol in IV, especially good for inflammation
yes ceiling effect, no tolerance/dependance
take with food to reduce ulcer risk
need good renal system
sallicylates with pain
aspirin
avoid with other anticoagulents/ chances of bleeding
tylenol with pain
does not effect pain as much because no inflammation effect
best with fever
multimodal pain treatment
blockin paintransduction with hot/cold, that block perception with med or distraction
Baclofen
for muscle spasms
can be through a pump
Clonidine
for BP, but also used for migraines/ headaches
anxiolytics
muscle spasms, anxiety
coritcosteroids
decrease inflammation
anti-seizure durgs
neuropathic pain
Non-pharmacological therapies
music, relaxation, massage, TENS, exercise, cold/hot, acupuncture, distration
Fentanyl patches
good for 3 days, chronic pain
get lost easily
need to be flushed when disposed
injections with pain
quicker than PO, slower than IV
good for acute, not chronic
PCA pumps
patient controlled analgesia
typcially small dose every 10 min-1hr
can only be controlled by pt
explain and remind pt of pump
loading dose
high bolus of pain medictation to releive pain quickly
continuous basel pump
continuous small amount of pain med
Evaluation
pain level, vital signs, activity level
minimize adverse effects like consitpation, lethargy, urniary retention, hypoventilation, hypotension, itching, GI bleeding, renal damage, nausea, vomiting
Meds causing GI bleeding
NSAIDS, Aspirin
