Pain Flashcards
Pain: 3 important principles
Patient is always believed- pain is real even if the cause is unknown.
A nurse who Suspects pain when a patient denies it must explore the concern with the client.
Perception is reality
Chronic pain
Usually persists at least six months (not a hard and fast rule)
Constantly or intermittently over a period of time
Assessing for pain
Location intensity quality pattern precipitating factors alleviating factors associated symptoms
Nocicepters
Transmit pain
Bradykinin
One of a group of endogenous (produced by body)proteins that act on nociceptor nerve endings. directly activates the nociceptors and causes the release of inflammatory chemicals, such as histamine.
Causes vasodilation and increases capillary permeability resulting in redness and tender tissues
Substance P
Chemical that increases the inflammatory response and acts on blood vessels in the damaged area to release chemicals that contribute to the conduction of nociception.
Breakthrough pain
Pain that occurs beyond the chronic pain already being treated by appropriate analgesics
Difference between:
neuropathic pain and
somatic pain
neuropathic pain- caused by damage to peripheral nerves or to CNS
somatic pain- pain that is localized and arises from bone,joint, muscle or connective tissue
What could explain why people feel different amounts of pain for similar pain stimuli?
The presence of enkephalins and endorphins.
Anxiety can affect levels.
How is absorption and metabolism of medications altered in Elderly?
Decreased liver, kidney and GI function.
Watch for toxicity.
Metabolism is slowed and elderly may obtain more pain relief for a longer period of time.
Smaller doses are required.
What does a nurse do if pain scale number reported is not matching the external appearance of pain?
Example patient says pain is 10 but is smiling and moving easily. OR patient says 2 and is crying and guarding.
Educate patient on pain scale system.
What other problem should be assessed for in chronic pain patients?
Depression
What is the rationale for a TENS?
Block painful stimuli traveling over small nerve fibers.
How is pain determined in a Patient?
McCaffery’s definition
“Pain is whatever the person says it is.”
What is extended gate theory?
Theory proposes that Information is processed in neuromatrix from which a pattern emerges called a neurosignature. The pattern changes when a limb is removed and then is interpreted as a painful limb.
How do you morphine and morphine agonists alter the clients pain experience?
They bind to naturally occurring opioid receptor sites and alter the clients perception of the painful experience. They do not change the cause or transmission of pain.
What pre-operative factor is most likely to result in increased postoperative pain?
Anxiety
What is a good choice for a site of a continuous subcutaneous infusion of opioid analgesia?
Just below the clavicle. Extremities are avoided to prevent restricted movement. Also often times circulation is impaired or edema is present if the patient is terminally ill.
What is a nursing intervention for a client and pain that is based on the gate control theory?
Massage.
The gate control theory suggests that cutaneous stimulation activates larger faster transmitting a-beta sensory nerve fibers.
What are common complications of an epidural analgesia?
Vital signs must be monitored every 15 minutes. Some complications include nausea and vomiting, urinary retention, constipation, respiratory depression, and pruritus.
Hypotension is very common.
Strict surgical a sepsis is needed to prevent serious and potentially fatal infections.
Catheter should clearly label “epidural catheter”
Why would blood glucose levels be elevated with acute pain?
Parasympathetic stimulation from body’s normal response to pain
What is deafferentation pain?
Pain comes from injury to either the peripheral or central nervous system. Phantom pain reflects injury to the peripheral nervous system.
Types of pain
1-Nociceptive pain
a- somatic
b- visceral
2- neuropathic
How does ibuprofen relieve pain?
Decreases production of pain sensitizing chemicals. Decreases prostaglandins at the site of injury
