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Nursing 134 fundamentals > Pain > Flashcards

Pain Flashcards

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1
Q

Gate control theory

A
  • why each person interprets painful stimuli differently.
  • Explains why hot/cold and electrical stimulation can provide pain relief.
    1. Small Nerve Fibers conduct pain stimuli toward the brain.
    2. Large Nerve Fibers inhibit transmission of pain impulses from the spine to the brain by sending nonpain impulses.
    3. A “gate” in the spinal cord with these nerves determines which impulses reach the brain.
    4. The “gate” limits the amount of sensory info that can be processed at one time, therefore cells in the spine “close the gate” when excess info is sent through
    .5. The brain contributes by interpreting past experiences to influence how the “gate” works and regulating behavioral
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2
Q

Acute pain

A
  • Rapid onset
  • warning
  • Must resolve the underlying disease process / cause must heal first
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3
Q

Chronic pain

A
  • last beyond the normal healing period
  • persistent or intermittent
  • periods of remission and exacerbation
  • usually difficult for patient to describe
  • associated conditions
  • can be difficult to treat (have to change methods of treatment when one on longer works)
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4
Q

Cancer related pain

A

Acute or chronic

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5
Q

Breakthrough pain

A

Set an increase in pain even after pain medication has been given

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6
Q

Origin of pain

A

Cutaneous
Somatic
Visceral
Referred

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7
Q

Causes of pain

A
  • neuropathic injury = malfunction of nervous system (burning, stabbing)
  • intractable= Resistant to therapy in interventions (chronic)
  • phantom =Receptors in nerves absent but patient still experiences pain
  • psychogenic = no identifiable physical cause for the pain
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8
Q

Factors affecting elderly pain response

A
  • Multiple chronic illnesses -increased over the counter medication usage
  • increased risk for toxicity
  • decreased renal, liver and G.I. function
  • changes in body weight and proteins stores -decrease metabolism risk for depression
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9
Q

Pain assessment subjective data

A
  • location (does it radiate)
  • intensity (scale should be used)
  • quality( burning, stabbing, sharp, dull)
  • timing (onset, duration, most intense)
  • aggravating factors ( what makes it worse)
  • alleviating factors ( what helps)
  • impact on ADLS and lifestyle
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10
Q

Pain assessment objective data

A
  • nonverbal cues
    (restlessness, crying, guarding the affected area, clenching fist)
  • physiological changes
    (increased BP, HR, pallor, diaphoresis, pupil dilation, increase muscle tone, LOC, rapid irregular RR)
  • patient behaviors
    (anxiety, aggressiveness, confusion in elderly, moaning, sighing, social withdrawal, fatigue)
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11
Q

Pain management intervention

A
  • assess for pain using appropriate scale even if patient does not appear to be in pain
  • avoid judgment
  • create environment for therapeutic communication
  • involve the patient in plan of care
  • alleviate any fears or concerns
  • beware of common misconceptions about pain and pain relief methods
  • identify patient goals for pain relief
  • Explain process of pain management
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12
Q

Pain management interventions continued

A
  • perform detailed pain assessment
  • establish pain relief goal with patient
  • attempt to treat the cause of the pain first
  • alter the pain experience for the patient
  • implement non-pharmacological interventions
  • administer pharmacological pain measures as ordered as a final measure
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13
Q

Non pharmacological pain interventions

A
  • Distraction: focus on something else (effective with children)
    Ex: counting objects, reading watching tv, music, toy, game
  • humor: for patient with mild pain
  • imagery: concentrate senses on a imagery
    (more effective with chronic pain)
  • relaxation: reduces muscle tension and anxiety (effective with other measures)
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14
Q

Nonpharmacological pain interventions continued

A
  • Cutaneous stimulation: based of gate control (heat/ice, TENS, acupressure)
  • Acupuncture
  • Hypnosis
  • Biofeedback: Machine monitors physiologic responses and patients are taught to practice pain relieving techniques
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15
Q

TENS- Transcutaneous electrical nerve stimulation

A

Can be used throughout the day or worn for extended periods of time depending on doctors orders
Has been known to improve mobility after surgery and reduce postop pain

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16
Q

Stimulation for pain management

A
  • Electrical Stimulation: Low voltage electrical impulses apply to certain parts of the nervous system (TENS)
  • Spinal cord stimulation: surgically implanted device that allows patient to provide the electrical stimulation
  • Deep brain stimulation: Electrodes placed on selected sides in the brain

Works best for intractable pain (pain where nothing else seems to help)

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17
Q

Analgesic

A
  • medication used to relieve pain
    Ex: opioids, non opioids, adjuvants
  • should be used in combination with other nonpharmacological pain relief measures
  • use the simplest and least invasive methods/medication’s first!
  • should be mindful of under medicating pain
  • Access past medical history to determine previous responses to certain treatments
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18
Q

non opioid analgesics

A
  • mild to moderate pain
  • affective with arthritis, cancer related bone pain, postop pain
  • affective in combination with opioids
  • usually OTC !
    Acetaminophen (Tylenol)
  • NSAIDS (nonsteroidal anti inflammatory drugs)
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19
Q

NSAIDS (nonsteroidal anti inflammatory drugs)

A

COX 1: mediates prostaglandin formation involved in inflammation and protection of the lining of the stomach
COX 2: mediates prostaglandin formation involved in pain, inflammation, and fever

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20
Q

Opioid analgesic

A

“Narcotic” moderate to severe pain

  • bind opioid receptors in the brain, alter pain perception
  • Morphine, meperidine (Demerol) codeine, hydrocodone, oxycodone, tramadol, hydromorphone (dilaudid) fentanyl

Routes: oral, IM, Iv etc

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21
Q

Opioid analgesic side effects

A
  • sedation: more likely with increased doses
  • risk for respiratory depression
  • nausea and vomiting
  • constipation
  • pruritus
  • urinary retention
  • decreased HR and BP, confusion in elderly!, cough suppression
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22
Q

Adjuvant drugs

A

Not used for pain, but enhance side effects of analgesic
- May reduce side effects from analgesic meds
- may reduce anxiety related pain
- effective with metro path of pain
Example:
- tricyclic antidepressant: amitriotyline (Elavil)
- anti seizure medication: phenytoin (Dilantin)

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23
Q

Local anesthetic

A

Applied directly on the nerve fibers to block conduction at the site of injury
- injection or topical

24
Q

Intraspinal/epidural

A

Medication inserted into the spine
- rapid onset with short duration
- morphine and fentanyl drug of choice
Side effects includes spinal headache in addition to opioid side effects (lay patient flat and give fluids notify MD)

25
Q

Intrathecal

A

Given directly into the subarachnoid space and CSF

26
Q

Epidural

A

Given in the Dura of the spinal canal

27
Q

patient controlled analgesia (PCA)

A

Patient controls the message ministration of pain medicine by pressing the button
Used for post op, trauma and cancer pain
Acute and chronic pain
Persistent pain at home or in healthcare setting
More consistent pain relief
Allows medication to be given before pain becomes severe
Patient must be alert and able to use and understand
IV or epidural
Morphine, dilidid fentanyl

28
Q

Cutaneous origin

A

skin or subcutaneous tissue

29
Q

Somatic origin

A

diffuse/ scattered

30
Q

Visceral origin

A

body organs

31
Q

Referred origin

A

Originates in one part of the body but perceived in another location

32
Q

Patient controlled analgesia continued

A
  • PCA orders specific to each patient
  • patient can be ordered to revive PCA dose only (this should be the only drug they are getting) basal rate only (very rare) or a combination of both
33
Q

Types of PCA

A
  • Loading dose = administered to rise drug levels in blood to a therapeutic level (when first hooked up)
  • PCA dose / bolus = patient self administers at times of pain (every time patient presses button)
  • Basal / continuous = constant infusion of medication administered by the PCA pump
34
Q

PCA safeguards

A
  • Decrease risk of over medication
  • lock out interval prevents re-administering during a certain time period
  • dose limit allows only a certain amount of medication to be administered within a certain time frame
  • hourly rate = if continuous/basal dose is ordered
  • lock system

Two nurses must check after programming !

35
Q

PCA nursing implications and safety

A
  • avoid use in elderly, very young, patients with cognitive impairments
  • avoid patients with severe asthma and sleep apnea
  • be cautious of nurse controlled/ caregiver controlled analgesia
  • monitor for side effects and effectiveness
  • monitor IV site
  • only RN can program
  • always keep PCA keys in safe location
  • verify PCA ordered and pump setting with another nurse before administering at least once a shift
  • monitor and document assessment of sedation and side effects every 4 hours
  • continuous pulse ox, cardiac and sedation monitoring may be ordered
36
Q

PCA patient teaching

A
  • explain how it works
  • alleviate fears about over medication
  • explain side effects
  • Encourage patient to monitor effectiveness and presence of side effects
  • explained that only patient should use button
  • button should always be within reach
  • explain to use before pain becomes severe and prior to painful procedures
37
Q

Nursing implications

A
  • be aware of other medication’s and use, OTC, history
  • Ask patient to write his/her pain before intervention
  • medication dosage and intervals should be individualized
  • use least invasive and lowest effective dose first unless otherwise ordered ( PO before IV)
  • combination therapies are most effective (opioids with NSAIDS)
  • patient intervals should be initiated before pain becomes severe or before activities
  • explain to patients they are responsibility in a ministration of PRN pain medication
38
Q

Meds for mild pain

A

Nonopioid medication

Example: NSAIDS

39
Q

Meds for moderate pain

A

Opioids with nonopioid

Example: oxycodone w/ acetaminophen

40
Q

Meds for severe acute pains

Example: post-op

A

Strong opioids- continuous IV infusion

Example: PCA hydromorphone or PCA morphine

41
Q

Meds for chronic pain

home or in health care

A
  • Strong opioids- PO
    Example: morphine, hydromorphone, meperidine
  • Moderate opioids PO
    Example: oxycodone
42
Q

Meds for breakthrough pain

A

PRN supplemental dose of short acting opioid

Example: IV morphine, hydromorphone

43
Q

Meds for neuropathic pain

A

Opioids and adjuvant

- opioids with antidepressants or anti seizure medication

44
Q

Pain management evaluation

A
  • should begin with implementation of any pain relief intervention
  • monitor for manifestation of allergic reaction and side effects
  • assess the effectiveness using the same pain intensity scale:
    (30-60 min with PO) (30 mins with IV)
  • explain multiple dose may be required to be effective
  • act if intervention is ineffective
  • document !
45
Q

Pain intensity scale

A

Should be consistent, type of scale should be document

46
Q

Numeric pain rating scale

A

Use for people > 9

Without cognitive, language or hearing impairments

47
Q

Simple descriptive pain scale

A

Elderly
Example: “my pain is moderate”
No pain, mild, moderate, severe, very severe, worst possible pain

48
Q

Visual analogue pain scale

A

They point to the area on the pain scale

49
Q

Face Pain scale

A

Appropriate for children, elderly and people limited English
They point to a face

50
Q

PAINAD

Pain assessment in advanced dementia

A

Rate non verbal ques to get a total number

51
Q

Acetaminophen (Tylenol) side effect

A

hepatotoxicity

52
Q

NSAIDS side effects

A

Ulcers and bleeding

- take with food or on full stomach to lessen side effects of meds tearing at the lining of the stomach

53
Q

Scale to stop opioids

A 
S= sleep, easy to arouse, no action necessary
1= awake and alert, no action necessary
2= occasionally drowsy but easy to arouse, requires no action
3= frequently drowsy and dress off to sleep during conversation, decrease the opioid dose
4= no response to stimuli, discontinue and consider use of naloxone
54
Q

naloxone (narcan)

A

Used to reverse sedation effect of opioids

55
Q

Special considerations for children

A
  • child is best source for assessment
  • use appropriate assessment tools
  • opioid medication should not be withheld due to fears
56
Q

Special consideration for elderly

A
  • persistent and chronic pain is common
  • pain is not normal part of aging
  • caution with NSAIDS due to risk of renal and GI effects
  • oral meds preferred
  • caution with injection - decreased circulation
  • observed or change in behavior or confusion
  • avoid meperidine (Demerol)
57
Q

SPICE TOOL

A 
Skin integrity 
Problems eating 
Inconvenience 
Confusion 
Evidence of falls 
Sleep disturbance

Nursing 134 fundamentals (31 decks)

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