Pain And Nutrition Flashcards
Referred pain
Appears in a different area of the body
Visceral pain
Pain arising from organs or hollow viscera
Duration
Acute and chronic
Acute pain
Pain lasts only through the expected recovery period
Chronic pain
Persistent or prolonged
Usually reoccurring and lasting longer than 3 months
Nociceptive pain
When intact properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care
Transient or persistent
Nociceptive
Somatic pain
Originates in the skin, muscles, bone, or connective tissue.
Paper cut or sprained ankle
Nociceptive
Visceral pain
Activation of pain receptors in the organs and/or hollow viscera.
Cramping, throbbing, pressing, or aching
Neuropathic pain
Associated with damage or malfunctioning nerves due to illness, injury, or undetermined reasons.
Burning, electric shock, tingling
Tends to be chronic and difficult to treat
Peripheral neuropathic pain
Eg- phantom limb pain
Carpel tunnel
Follows damage or sensitization of peripheral nerves
Central neuropathic pain
Spinal chord injury, post stroke, ms
Resulting from malfunctioning nerves in the central nervous system
Sympathetically maintained pain
Temp regulation, blood flow regulation, edema
Occurs occasionally when abnormal connections between pain fibers and the sympathetic nervous system perpetuate problems with both the pain and sympathetically controlled functions
Hyperalgesia and hyperpathia
Heightened response to a painful stimuli
Allodynia
Non painful stimuli that produces pain. Light touch, contact with wind, linen
Dysesthesia
An unpleasant abnormal sensation
Nociception
The physiological process related to pain perception
Four physiological process in nociception
Transduction
Transmission
Perception
Modulation
Transduction
Nociceptors can be excited by mechanical, chemical, or thermal stimuli
Harmful stimuli trigger the release of biochemical mediators such as prostaglandins
Pain meds can work during this phase by blocking the production of prostaglandins
Transmission
First segment the pain impulses travel from the peripheral nerve fibers to the spinal chord.
Second segment is transmission of the pain signal through an ascending pathway in the spinal chord to the brain
Third segment transmission of info to the brain where pain perception occurs. Sensory Cortex
Pain control can take place in the second process with opioids that block the release of substance p and stops the pain at the spinal level
Perception
When the client becomes conscious of the pain
Modulation
Neurons in the brain send signals back down to the dorsal horn of the spinal chord. These descending fibers release substances such as endogenous opioids, serotonin, and norepinephrine. Which can inhibit or reduce the ascending painful impulses in the dorsal horn
Factors that affect the pain experience
Cultural Developmental stage Support people Previous pain experience Meaning of pain
Assessment interview
Location Quality Intensity Pattern Precipitating factors Alleviating factors Associated symptoms Effects on adl's Past pain experience Meaning of pain Coping resources Affective response
Pain history
Subjective and objective data
Pain scales
11 point scale
Flacc scale
Painad for dementia- breathing, vovalization, facial expression, body language, and consolability
The faces scale
Signs of pain
Increase in Blood pressure, pulse rate, respiratory rate, pallor, diaphoresis, and pupil dilation.
Can be absent in people with chronic pain
Pain may be the etiology of other nursing diagnosis
Hopelessness. Ineffective airway clearing Anxiety Ineffective coping Impaired physical mobility
Management of pain
Consists of both independent and collaborative nursing actions
Misconceptions about pain management
Lack of knowledge
Client thinks nothing can be done
They think pain is not severe enough
They think they will become addicted
Tolerance
Using opioids over time an increases dose is needed to provide the same level of pain
Physical dependence
Expected physical response when a client who has used opioids long term reduces or stops meds
Nausea, vomiting, diarrhea, chills and change in vitals
Addiction
Chronic relapsing treatable disease influenced by psychosocial and environment factors
Craving for substance
Lack of control over the substance
Compulsive use
Continue despite harm
Pseudo addiction
Under treatment of pain that the patient watches clock for next dose and can seem drug seeking
Non opioids / NSAIDs
Management for acute and chronic pain
Moderate pain
24 hour max
Tylenol 3000mg affects liver
Ibuprofen 3200mg kidneys, thins
blood, stomach ulcer
Aspirin 4000mg thins blood irritates gastric lining
Ceiling effect
Once the maximum analgesic benefit is reached taking additional amounts will not produce more analgesics
Narrow therapeutic index
There is not much margin for safety between the dose that produces a desired effect and the dose that produces a toxic, even lethal effect
Opioids
Full antagonist
There is no ceiling Morphine the gold standard Oxycodone Fentanyl Hydromorphone
Severe pain
Mixed agonists antagonist
Can act like opioids to relieve pain
When given to a client whom hasn’t had opioids
Can block or inactivate other opioids
No ceiling
Partial agonists
Have a ceiling
Buprenorphine alternative to methadone
Coanelgesics
Not classified as a pin medication
Antidepressants
Anticonvulsants
Local anesthetic a
Sedatives
Have properties that may reduce pain alone or in combination with other analgesics
Non pharmacological pain management
Ice or heat Tens ( transcutaneous electrical nerve stimulation) Immobilization Therapeutic exercise Acupuncture Distracting activities Relaxation techniques Spiritually Acupressure
Nonpharmacologic invasive therapy
A nerve block is a chemical interruption of a nerve pathway caused by injecting a local anesthetic into the nerve
Used in dental work
Used to treat whiplash, lower back disorders,
Bursitis and cancer
Pain may be described in terms as
Location duration intensity and etiology
Macronutrients
We need these in large amounts
Carbohydrates, fats, proteins, minerals, vitamins, and water
Micronutrients
Are those vitamins and minerals We need in small amounts
Carbohydrates
Simple carbs high calories low nutrients
Complex carbs lower calories higher nutrients
Proteins are
Tissue building
Essential amino acids
They can not be manufactured in the body and must be supplied by being injested
Nonessential amino acids
Are those that the body can manufacture
Complete proteins
Contain all essential amino acids and many nonessential
Eg- poultry, fish, dairy, eggs
Incomplete proteins
Lack one or more essential amino acid and are usually derived from a vegetable
Vitamins
Are organic compounds that cannot be manufactured by the body and is needed in small quantities to catalyze metabolic processes
Minerals
Found in organic and compounds, inorganic compounds, and free ions
Most common deficiencies are iron and calcium
Basal metabolic rate
The rate at which the body metabolizes food to maintain the energy requirements of a person who is awake and at rest
Resting energy expenditure
The amount of energy required to maintain the basic body functions in other words the calories required to maintain life
Body mass index
Underweight
Factors that affect nutrition
Age Culture Belief Personal preference Religious practice Lifestyle Economics Medications and therapy Health Alcohol consumption Advertising Psychological factors
Assessing nutrition
NSI for older adults
PG-SGA
History: age, sex,activity level, difficulty eating, condition of the mouth and teeth, changes in appetite, changes in weight, physical disabilities that affect purchasing preparingand eating, cultural and religious believes that affect food choices, living arrangement such as living alone and economic status, general health status,medical condition, medication history
Serum albumin
A low level indicates prolonged protein depletion
Serum Transferrin
Binds and carries iron from the intestine through the serum. Shorter half life so it shows resent protein depletion
Total iron binding capacity TIBC
Indicates the amount of iron in the blood which the transferrin can bind
Pre albumin
Shortest half life
Most responsive serum protein to rapid changes in nutritional status
15-30mg/dl normal
Creatinine
Reflects A person’s total muscle mass
The chief and product of the creatinine produced when energy is released during skeletal muscle metabolism
As skeletal muscle atrophies the creatinine excretion goes down
Total parenteral nutrition (TPN)
Long term
Dextrose, water, fat, proteins, electrolytes, vitamins, and trace elements
To prevent malnutrition or severe malnutrition
10-50% dextrose
Precautions with TPN
Start slow to prevent hyperglycemia
Decrease slowly to prevent hypoglycemia
And hyperinsulinema
Peripheral parenteral nutrition (ppn)
Through peripheral veins
10-20% dextrose
Short time higher rate for phlebitis
