Pain

Question 1

what are the harmful effects of untreated pain?

Answer 1

Cardiovascular: tachycardia, hypertension, increased peripheral vascular resistance, increased myocardial oxygen consumption, myocardial ischaemia
Respiratory: decreased lung volumes, atelectasis, decreased cough, sputum retention, infection, hypoxaemia
Gastrointestinal: decreased gastric and bowel motility
Genitourinary: urinary retention
Endocrine: increased catabolic & decreased anabolic hormones, insulin resistance
Musculoskeletal: muscle spasm, immobility
Psychological: anxiety, fear, sleeplessness

Question 2

0 pain score

Answer 2

no pain at rest none on movement

Question 3

1 pain score

Answer 3

no pain at rest slight on movement

Question 4

2 pain score

Answer 4

intermittent at rest, moderate on movement

Question 5

3 pain score

Answer 5

continuous at rest severe on movement

Question 6

what type of analgesia is no good for the vomiting patient

Answer 6

oral analgesia

Question 7

what analgesia could you give to a vomiting patient

Answer 7

think of sublingual or rectal medicines before subcut or iv

Question 8

morphine orally needs ….. time the dose of im/iv morphine

Answer 8

2-3 times

Question 9

how does paracetamol work

Answer 9

inhibits prostaglandin synthesis

Question 10

reduce dose of paracetamol if weight

Answer 10

less than 50kg

Question 11

contraindications to nsaids

Answer 11

DU renal failure coagulopathy

Question 12

cautions to nsaids

Answer 12

Elderly, Dehydration, Asthma, Pregnancy, Cardiac failure, Concurrent medication, Certain types of surgery.

Question 13

name weak opioids

Answer 13

codeine tramadol

Question 14

name strong opioids

Answer 14

Morphine, Diamorphine, Oxycodone, Fentanyl, Methadone

Question 15

how do you manage resp depression?

Answer 15

o2
adjust or stop opioid
if necessary give naloxone and titrate to effect

Question 16

what may delay resp depression

Answer 16

intrathecal or epidural opioids

Question 17

what is pca and how does it work

Answer 17

patient controlled analgesia - - 1mg morphine bolus and 5 minute lockout (can receive up to 12mgs morphine per hour)

Question 18

advantages of pca

Answer 18

Enables individual titration of analgesia to keep plasma opioid levels within the analgesic corridor.
Patients feel in control of their analgesia.
No delay waiting for nurses to be available.

Question 19

contraindications to pca

Answer 19

Patient inability to comprehend the technique e.g. extremes of age.
Patients inability to press the button e.g. RA
Patient rejection.
Untrained staff.

Question 20

advantages to epidural

Answer 20

Excellent analgesia.
Less stress response.
Lower incidence of DVT and thus PE.
Earlier mobilisation.
Earlier recovery of GIT function.

Question 21

disadvantages of epidural

Answer 21

Special staff training required.
Blocks may not be perfect.
Hypotension may occur.
Anticoagulation.
Major complications are very rare - e.g. spinal haematoma or abscess.

Question 22

define acute pain

Answer 22

<3mths

Question 23

define chronic pain

Answer 23

> 3mths