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P&A final > Pain and Sleep > Flashcards

Pain and Sleep Flashcards

1
Q

What is nociception?

A

Physiologic process that communicates tissue damage to the CNS

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2
Q

What are the 4 processes of nociception?

A

Transduction
Transmission
Perception
Modulation

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3
Q

What factors affect the way pain is expressed?

A

Age
Culture
Ethnicity

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4
Q

What does SLIDTA stand for?

A 
Severity/intensity
Location
Influencing factors
Duration
Type
Associated factors
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5
Q

How do you assess pain in children under 7?

A

Use faces pain rating scale

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6
Q

What is considered objective data in assessing pain?

A 
Facial expressions
Moaning
Crying
BP
Pulse
RR
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7
Q

How does chronic pain affect physiological measures of pain?

A

Physiological measures eventually normalize

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8
Q

What is the FLACC scale?

A

Objective measurement of pain in patients who aren’t able to verbalize/self-report (infants and children under 3, nonverbal, intubated pt, cognitively impaired, dementia)

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9
Q

What does the FLACC score represent?

A

An indicator that pain may be present, not a level of pain

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10
Q

What are physiological responses to acute pain?

A 
Tachycardia
HTN
Anxiety
Diaphoresis
Muscle tension
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11
Q

What are physiological responses to chronic pain?

A

Body eventually adapts to the pain, resulting in no more acute activation of the SNS
Vital signs often normalize

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12
Q

What is nociceptive pain?

A

Normal processing of stimuli that has damaged normal tissue

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13
Q

What is somatic nociceptive pain?

A

Pain coming from bones, joints, muscles, skin, or connective tissues

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14
Q

What is visceral nociceptive pain?

A

Pain coming from internal organs

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15
Q

What is cutaneous nociceptive pain?

A

Pain coming from the skin or subcutaneous tissue

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16
Q

What is neuropathic pain?

A

Abnormal processing of sensory input by the peripheral or CNS

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17
Q

How is neuropathic pain usually described?

A

Pins and needles, shock-like, tingling, numbness, burning, cold, itching

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18
Q

What does neuropathic pain respond to?

A

Adjuvant meds
Antidepressants
Antispasmodics
Muscle relaxants

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19
Q

What are gerontological considerations when assessing pain?

A

The variety of terms that could be used
Their expectation to have pain
Their fear of addiction/stigma of narcotics
Drug therapy being affected

20
Q

In what ways is drug therapy affected in geriatric pts?

A

Absorption rates may be affected by thinner, less elastic skin
Distribution is affected from a lower serum albumin - more bioavailable drug
Metabolism is affected from age-related decreased liver and kidney function - higher drug levels
Pain is often undertreated

21
Q

What factors affect the perception of pain?

A

Fatigue, fear, anxiety, lack of knowledge, cognitive function, culture, values, beliefs, age, pain threshold, adaptation

22
Q

How is pain classified?

A

Acute vs. chronic
Nociceptive vs. neuropathic
Somatic vs. visceral
Persistent vs. episodic

23
Q

What are some nonpharmacologic relief measures of pain?

A 
Pt teaching
Distraction
Humor
Music
Imagery
Relaxation techniques
Cutaneous stimulation (massage, cold/hot application)
Acupressure
Acupuncture
24
Q

What are the three types of analgesics?

A 
Nonopioid analgesics (NSAIDs and Acetaminophen) - mild to moderate pain
Opioids - used for moderate to severe pain
Adjuvant analgesics (anticonvulsants/antidepressants) - enhance analgesics. Good for neuropathic pain
25
Q

What are side effects of opioids?

A 
Constipation
Drowsiness
Dizziness
Orthostatic hypotension
Nausea/vomiting
Sedation
Urinary retention
26
Q

What are side effects of nonopioids?

A

NSAIDs can increase CV risk, decrease clotting and cause GI bleeding or ulcers

27
Q

What is tolerance?

A

Diminished response to a drug as a result of repeated use

28
Q

What is dependence?

A

Physical condition in which the body adapts to the present of a drug as a result of constant exposure

29
Q

What is addiction?

A

Chronic, relapsing brain disease characterized by compulsive drug seeking and use

30
Q

What are some general principles of administering pain meds?

A

Around the clock administration is better for acute pain
Don’t wait until pain is severe
Ongoing assessment of pain/sedation
ID changes in pt’s condition
Maintain steady bloodstream levels of drug

31
Q

What are the Observer’s Assessment of Alertness and Sedation and the Pasero Scales?

A

Sedation scales

32
Q

What is PCA?

A

Pt controlled analgesia - self-administered via IV

33
Q

What is PCEA?

A

Pt controlled epidural analgesia - action of delivery close to the site, so smaller amounts can be used

34
Q

What are benefits of PCA?

A

Avoids delays in administration

Decreases the likelihood of oversedation

35
Q

What are some side effects of PCEA?

A 
Hypotension
Urinary retention
Nausea
Vomiting
Infection
Pruritus
36
Q

What are some functions of sleep?

A

Routine restoration of biological processes
Preservation of cardiac function
Conversation of body’s energy supply
Brain tissue restoration and cognitive restoration

37
Q

What is the BEARS approach to sleep assessment?

A 
Bedtime
Excessive daytime sleepiness
Awakenings
Regular schedule
Snoring
38
Q

What are interventions to improve rest and sleep?

A

Health promotion

  • Good sleep hygiene
  • Reduce stimulants before bed
  • Environmental controls
  • Bedtime routines
39
Q

What are pharmacological approaches to sleep?

A

Nonbenzodiazepines
Benzodiazepines
Melatonin

40
Q

What are examples of nonbenzodiazepines?

A

Ambien, Lunesta

41
Q

What are examples of benzodiazepines?

A

Ativan, Restoril

42
Q

What are some sleep disorders?

A

Insomnia
Obstructive sleep apnea
Sleep deprivation

43
Q

Why is chronic NSAID use not recommended for older adults?

A

It causes GI bleeding and renal insufficiency

44
Q

What is the scoring scale for OAAS?

A

0 - no response to deep stimulus

6 - agitated

45
Q

What is the scoring scale for the Pasero scale?

A

S - sleep, easy to arouse

4 - somnolent, minimal or no response to physical stimulation

P&A final (6 decks)

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