Pain and Sleep Flashcards
What is nociception?
Physiologic process that communicates tissue damage to the CNS
What are the 4 processes of nociception?
Transduction
Transmission
Perception
Modulation
What factors affect the way pain is expressed?
Age
Culture
Ethnicity
What does SLIDTA stand for?
Severity/intensity Location Influencing factors Duration Type Associated factors
How do you assess pain in children under 7?
Use faces pain rating scale
What is considered objective data in assessing pain?
Facial expressions Moaning Crying BP Pulse RR
How does chronic pain affect physiological measures of pain?
Physiological measures eventually normalize
What is the FLACC scale?
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)
What does the FLACC score represent?
An indicator that pain may be present, not a level of pain
What are physiological responses to acute pain?
Tachycardia HTN Anxiety Diaphoresis Muscle tension
What are physiological responses to chronic pain?
Body eventually adapts to the pain, resulting in no more acute activation of the SNS
Vital signs often normalize
What is nociceptive pain?
Normal processing of stimuli that has damaged normal tissue
What is somatic nociceptive pain?
Pain coming from bones, joints, muscles, skin, or connective tissues
What is visceral nociceptive pain?
Pain coming from internal organs
What is cutaneous nociceptive pain?
Pain coming from the skin or subcutaneous tissue
What is neuropathic pain?
Abnormal processing of sensory input by the peripheral or CNS
How is neuropathic pain usually described?
Pins and needles, shock-like, tingling, numbness, burning, cold, itching
What does neuropathic pain respond to?
Adjuvant meds
Antidepressants
Antispasmodics
Muscle relaxants
What are gerontological considerations when assessing pain?
The variety of terms that could be used
Their expectation to have pain
Their fear of addiction/stigma of narcotics
Drug therapy being affected
In what ways is drug therapy affected in geriatric pts?
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
What factors affect the perception of pain?
Fatigue, fear, anxiety, lack of knowledge, cognitive function, culture, values, beliefs, age, pain threshold, adaptation
How is pain classified?
Acute vs. chronic
Nociceptive vs. neuropathic
Somatic vs. visceral
Persistent vs. episodic
What are some nonpharmacologic relief measures of pain?
Pt teaching Distraction Humor Music Imagery Relaxation techniques Cutaneous stimulation (massage, cold/hot application) Acupressure Acupuncture
What are the three types of analgesics?
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
What are side effects of opioids?
Constipation Drowsiness Dizziness Orthostatic hypotension Nausea/vomiting Sedation Urinary retention
What are side effects of nonopioids?
NSAIDs can increase CV risk, decrease clotting and cause GI bleeding or ulcers
What is tolerance?
Diminished response to a drug as a result of repeated use
What is dependence?
Physical condition in which the body adapts to the present of a drug as a result of constant exposure
What is addiction?
Chronic, relapsing brain disease characterized by compulsive drug seeking and use
What are some general principles of administering pain meds?
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
What are the Observer’s Assessment of Alertness and Sedation and the Pasero Scales?
Sedation scales
What is PCA?
Pt controlled analgesia - self-administered via IV
What is PCEA?
Pt controlled epidural analgesia - action of delivery close to the site, so smaller amounts can be used
What are benefits of PCA?
Avoids delays in administration
Decreases the likelihood of oversedation
What are some side effects of PCEA?
Hypotension Urinary retention Nausea Vomiting Infection Pruritus
What are some functions of sleep?
Routine restoration of biological processes
Preservation of cardiac function
Conversation of body’s energy supply
Brain tissue restoration and cognitive restoration
What is the BEARS approach to sleep assessment?
Bedtime Excessive daytime sleepiness Awakenings Regular schedule Snoring
What are interventions to improve rest and sleep?
Health promotion
- Good sleep hygiene
- Reduce stimulants before bed
- Environmental controls
- Bedtime routines
What are pharmacological approaches to sleep?
Nonbenzodiazepines
Benzodiazepines
Melatonin
What are examples of nonbenzodiazepines?
Ambien, Lunesta
What are examples of benzodiazepines?
Ativan, Restoril
What are some sleep disorders?
Insomnia
Obstructive sleep apnea
Sleep deprivation
Why is chronic NSAID use not recommended for older adults?
It causes GI bleeding and renal insufficiency
What is the scoring scale for OAAS?
0 - no response to deep stimulus
6 - agitated
What is the scoring scale for the Pasero scale?
S - sleep, easy to arouse
4 - somnolent, minimal or no response to physical stimulation
