Pain Flashcards
1
Q
Cellular damage by thermal, mechanical, or chemical stimuli causes pain, and results in the release of what neurotransmitters?
A
- Excitatory NT, that increase inflammatory response and increase sensitivity to pain such as:
- Prostaglandins
- Bradykinin
- Substance P
- Histamine
2
Q
What is transduction
A
- transduction converts energy produced by painful stimuli into electrical energy. Begins in periphery when the pain impulse meets a nociceptor (peripheral pain nerve fiber). This initiates an action potential
3
Q
What is transmission
A
- occurs after transduction. Sending of he nerve impulse. It travels along sensory afferent nerve fibers to the spinal cord. The pain stim enters spinal cord at dorsal horn, then up to the the thalamus. The thalamus transmits the pain stim to higher functioning parts of the brain
4
Q
What do myelinated A-delta fibers do?
A
- Peripheral nerve fibers that send sharp, localized pain and distinct sensations. They specify the source of the pain and detect its intensity
5
Q
What do C fibers do?
A
- Slow, small, unmyelinated. Relay impulses that are poorly localized such as burning or persistent pain. diffuse and widespread pain
6
Q
What is pain perception
A
- the patients experience of pain
7
Q
What is modulation
A
inhibitiion of pain or release of inhibitory NT (opioids, serotonin, GABA). Release after the brain perceives pain
8
Q
Describe the gate control theory
A
- pain has emotional and cognitive components as well as physical sensation
- gating mechanisms along peripheral nervous system regulate or block pain impulses
- pain passes through when gate is open, and is blocked when gates are closed. Closing gate is basis for non-pharmacological pain relief interventions.
- EX= stress and exercise release endorphins and raise pain threshold
9
Q
describe acute pain
A
- protective
- serves purpose and has identifiable cause
- short duration
- limited tissue damage and emotional response
- primary nursing goal is pain relief that allows patient to participate in their recovery
10
Q
describe chronic pain
A
- non protective, no purpose
- lasts longer than 6 months
- constant, reoccuring
- does not always have identifiable cause
- arthritis, low back pain, myofascial pain, headache, peripheral neuropathy
- usually non-life threatening
- can lead to depression
- doesnt usually show obvious symptoms
11
Q
What is chronic episodic pain
A
- occurs sporadically over an extended period of time. Lasts for hours, days, weeks. Example=migraine, pain related to sickle cell
12
Q
What is cancer pain
A
- can be acute or chronic
- nociceptive and/or neuropathic pain
- usually caused by tumor progression
- referred pain is common
13
Q
what is inferred pathological pain
A
- nociceptive pain (somatic/musculoskeletal)
- visceral (internal organ pain)
- neuropathic (abnormal or damaged pain nerves
14
Q
what is idiopathic pain
A
- chronic pain in the absence of an identifiable physical or psychological cause, or pain received in excess for the extent of an organic pathological condition. Example= complex regional pain syndrome
15
Q
Things to remember to avoid misconceptions of pain in older adults
A
- Pain is NOT a natural outcome of growing old (older adults are just at greater risk for many painful conditions)
- Pain perception or pain sensitivity does NOT increase with age. There is no evidence that they have dulled sense of pain
- Older patients commonly under-report pain but this does not mean they arent experiencing pain
- If they are sleeping, it does not mean they are not in pain. May be coping mechanism
- Opioids are safe for them
16
Q
What is the main nursing goal of managing pain?
A
- Promote the patients optimal function
- need to determine what the pain has prevented the patient from doing, then decide mutually what an acceptable level of pain would be for the patient to return to functioning.
17
Q
What are some non pharmacological pain relief interventions
A
- guided imagery
- bio feedback ( chiropractor, acupuncture)
- prayer
- music
- distraction
- cutaneous stimulation (heat/cold, massage, transcutaneous electrical nerve stimulation) Effective for postsurgical and procedural pain control.
- herbals (be sure there is no drug interactions)
18
Q
What are the 3 types of analgesics
A
opioids
non-opioids (acetaminophen, NSAIDS- anti-inflammatory_
adjuvants/co-analgesics (analgesic enhancers)
19
Q
Acetaminophen
A
- most tolerated and safest analgesic
- no anti-inflammatory effects
- major adverse effect is hepatotoxicity
- max 24 hour does is 4 grams
- often combo with opioids because it reduces the dose of opioid needed.
- used in older adults for mild-mod. musculoskeletal pain
20
Q
NSAIDS
A
- aspirin, ibuprofen
- headaches and muscle strain
- most likely inhibit prostaglandins to inhibit inflammation
- do not depress CNS like opioids
- dont interfere with bowel and bladder fx
- frequent use is assoc with GI bleeds, renal insufficiency
21
Q
Opioids
A
- mod-severe pain
- adverse effect is respiratory depression but is only clinically significant if rate AND depth of respirations are depressed
- sedation always occurs before respiratory depression
- is respiratory depression occurs- administer naloxone in IVpush
- additional adverse effects are nausea, vomiting, itching, constipation, urinary retention, altered mental processes.
22
Q
Patient controlled analgesia (PCA)
A
- patient self-administers opioids (morphine, hydromorphone, and fentanyl)
- minimum risk of overdose
- goal is to maintain constant plasma level of analgesic to avoid the problems of PRN drug admin.
- locked systems that prevent tampering by family, etc.
23
Q
Local anesthetic infusion
A
- perineural infusion pumps (Breg, On-Q)
- un sutured catheter from a surgical wound is placed near a nerve or groups of nerves connects to a pump containing local anesthetic.
- set pump on demand or continuous mode
24
Q
Topical analgesics
A
- Disks or thick creams applied30-60 min before minor procedures. Can be used on kids
- never use around eyes, tympanic membrane, or over large skin surfaces
- Lidoderm patch= for neuropathic pain in adults. 12 hrs on, 12 hrs off.
25
Local anesthesia
local infiltration of anesthetic med. to induce loss of sensation to a body part.
- used during brief surgical procedures
- can be applied topically on skin, mucous membranes, or injected
26
Regional anesthesia
- injection of local anesthesia to block a group of sensory nerve fibers.
- tissues are anethesized layer by layer as administrator introduces agent into deep structures of the body.
- motor and autonomic fx are lost quickly.
ex= epidural, pudendal blocks, spinal anesthesia
27
Epidural analgesia
- acute post-op pain, labor, chronic cancer pain
- permits control or reduction of severe pain and reduced opioid requirement
- admin into epidural space by blunt tip needle into the level of the vertebral interpsace.
- nurse should never administer supplemental doses of opioids to epidural patient.
- monitor patient every 15 min. Assess vital signs, respiratory effort, skin color. Once stable, monitor every hour
28
nursing care for epidurals
- secure catheter carefully
- check dressing for discharge
- use a transparent dressing
- inspect cath for breaks
- monitor vital signs, respirations
- assess for pruritus, nausea, vomiting
- monitor I&O, assess bladder and bowel distention
29
Things to consider when admin opioids
- liver and kidney function
- breast feeding
- patients on dialysis
- neurological or respiratory conditions
- recent abdominal surgery
- never use in patients with sleep apnea
30
Principles for administering analgesics
- ID previous doses and routes of analgesic admin. to avoid undertx. Determine if pain relief was acheived
- Use nonopiod or opioid combos for mild-moderate pain
- avoid combining opioids for older adults
- fentanyl patches, morphine, hydromorphone are opioids of choice for long-term severe pain mgmt.
- avoid IM analgesics, especially in older adults
- for severe pain use combo of nonopioid and opioid because it acts on both peripheral and central pain.
31
Managing chronic pain
- long acting and CR meds
- fentanyl patch (continuous opioid admin.)
- never use IM route because of inconsistent absorption and pain
- give on regular basis, not PRN, to maintain therapeutic drug levels.
32
What is the 3-step approach to managing cancer pain
begin is NSAIDS and/or adjuvants and progress to strong opioids is pain persists.
