Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health Assessment - Autumn > Pain Assessment & Management > Flashcards

Pain Assessment & Management Flashcards

1
Q

Chronic pain affects more Americans than _________________.

A

DM, Cancer, Heart Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who is pain unaddressed and inappropriately addressed in?

A

Females & minorities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Multi-modal approach for pain

A

Ketamine therapy, holistic options (PT, acupuncture), anti-depressants, CBD, mushrooms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can we make a difference in pre-op w/ pain management?

A
  1. Pre-op Meds
  2. Pain management plan
    *they need to understand our goal is to make their pain manageable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What pain medication can we give patients who are physiologically unstable?

A

Ketamine
-give a sub-dissociative dose
-0.2-0.3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Psychosocial contributor to pain

A

Financial stress, impaired sleep, anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where did opioid safety concerns arise from?

A

Overuse, overprescribing, driven by money
-street drugs: fentanyl & synthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Balance w/ Pain Management

A
  1. Balance safe opioid/analgesia prescribing
  2. High-risk pt. Recognition
  3. Be mindful of different types of pain, individual pain factors, and comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pts responses to pain may be related to _______________.

A
  1. Genetics
  2. Age, gender, ethnicity
  3. Socioeconomic and psychiatric factors
  4. Catastrophizing
  5. Culture, religion
  6. Previous experiences
  7. Pt perceptions & expectations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patient perceptions

A
  1. Perceived effective communication w/ physicians and nurses
  2. Perceived responsiveness by the treating team
  3. Perceived empathy by the treating team
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ultra-rapid metabolizers

A
  1. Convert codeine more rapidly to morphine
    *potential for Supra-therapeutic dosing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Slow metabolizers

A
  1. Don’t metabolize codeine - never reach therapeutic levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Concern drugs w/ genetic polymorphisms

A
  1. Muscle relaxants & analgesics
    -worry about pts who metabolize muscle relaxants quickly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Genetic metabolism in African Americans & Caucasians

A

Equal populations of fast and slow metabolizers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Asian/Native American Genetic metabolism

A
  1. 90% fast metabolizers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gender & Pain

A
  1. Females display more sensitivity & express their pain more frequently and effective
  2. Males: more exaggerative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ethnicity & pain

A
  1. Can be r/t disease process
    -sickle cell patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of whole body pain

A
  1. Fibromyalgia
  2. Depression
  3. Vascular issues
  4. DM
  5. Spinal injuries

*pain in one leg: DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Socioeconomic and psychiatric factors r/t pain

A
  1. Rural areas & lower socioeconomic status - report higher levels of pain
  2. Previous pain experiences: alters activity in certain brain regions responsible for pain processing
  3. Mood disorders/psych disorders: development of chronic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is pain catastrophizing?

A

Exaggerative cognitive response to an anticipated or actual painful stimulus
-affects how individuals experience & express pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ex of catastrophizing: magnification

A
  1. Response that symptoms can be or are greater than expected
    “I’m afraid something serious might happen”
  2. What we can do:
    -pre-op versed
    -precedex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Rumination

A
  1. Individual focuses repeatedly on attributes of an event that evoke a negative emotional response
    -fixated on 1 thing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Helplessness

A

Belief that there is nothing anyone can do to improve a bad situation
“There is nothing I can do to reduce the intensity of my pain”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Culture/religion r/t pain

A
  1. How pts cope can be influenced by their support system
    -cultural/religious ties: better support
    -variations in cultural norms: influence how people express pain/expect it to be managed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nociceptive Pain Definition

A

Direct tissue injury from noxious stimuli
-somatic/visceral
-1st trigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Clinical Examples of Nociceptive Pain

A

bone fractures, fresh surgical incision, fresh burn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment options for nociceptive pain

A

may include both opiate & non-opiate medications depending on injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Inflammatory Pain

A

Result of increased inflammatory mediators that control nociceptive input & released @ sites of tissue inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Clinical Examples of inflammatory pain

A

late stages of burn healing, neuritis, arthritis, appendicitis, inflammatory bowel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Treatment options for inflammatory pain

A

anti-inflammatory agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Neuropathic pain

A
  1. Result of injury to nerves leading to an alteration in sensory transmission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Clinical Examples of Neuropathic pain

A

Diabetic neuropathy, peripheral neuropathic pain, post-herpetic neuralgia, chemo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Treatment options for neuropathic pain

A

tricyclic, SNRIs, gabapentinoids, antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Idiopathic pain

A

cause unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Clinical Examples of idiopathic pain

A

chronic back pain w/o preceding trauma or obvious inciting event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Treatment options for idiopathic pain

A

Difficult to adequately address pain, underlying etiology unknown, especially in emergencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Somatic Pain

A

A-delta fiber activity in peripheral tissues

-Injury to skin, muscle, bone, joint, connective tissue, deep tissue pain
-musculoskeletal pain
-pain well localized, sharp, worse w/ movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Clinical Examples of Somatic pain

A

superficial lacerations, superficial burns, superficial abscesses, fractures, pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Treatment options for somatic pain

A

topical/LA, opiates, non-opiates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Visceral Pain

A

C-fiber activity - Internal pain, occurs from internal organs or tissues that support them
-poorly localized, vague deep aches, colicky, cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Clinical Examples of visceral pain

A

Appendicitis, peptic ulcer disease, diverticulitis, endometriosis, ureteral stones, uterine fibroid pain, pyelonephritis, biliary colic

42
Q

Treatment options for visceral pain

A

opiates, systemic pain control, nerve blocks, mobilizing

43
Q

things we do that cause visceral pain

A
  1. Opioids
  2. Constipation
44
Q

Acute Pain

A

<3mos.
Should resolve w/ normal healing
-EX: post-op pain, fracture bones, appendicitis, crush injuries, L&D pain

45
Q

Treatment options for acute pain

A

opiates, non-opiates

46
Q

Chronic pain

A

> 3 months
-extends beyond time of normal wound healing
-development of neurophysiological changes int he CNS
-EX: low back pain, neck pain, chronic pancreatitis, fibromyalgia

47
Q

Treatment options for chronic pain

A

depends on the nature of the pain

48
Q

Acute on chronic:

A

Time of acute exacerbations of a chronic painful syndrome or new acute pain in a person suffering from a chronic conditions
-EX: sickle cell exacerbation, cancer, RA, abscess in sickle cell pt.

49
Q

Causes of flare-ups w/ sickle cell:

A

Dehydration, increased metabolic demands (exercise), stress

50
Q

Pain Intensity

A

Subjective data, based on pain score and history/physical

51
Q

Essential elements to pain assessment

A
  1. detailed history of current pain
  2. previous pain history
52
Q

Basics of Pain Assessment

A
  1. Onset: sudden/gradual
  2. aggravating & alleviating factors: what makes it better/worse?
  3. Quality: ask if the pt. can describe it
  4. location: does it radiate?
  5. Severity: pain scale
  6. Circumstances: when did the pain start?
53
Q

Assessing functionality & Pain

A

can they work? are they on light duty?

Are they coping w/ the pain?

54
Q

Why are tumors problematic for pain?

A
  1. cause neuropathic pain
  2. cause inflammatory pain
  3. involve bone, vessels, nerves, and organs
  4. cause HA, seizures, constipation, abdominal pain 4. cause
55
Q

Procedures r/t cancer that are painful

A
  1. biopsies (skin, bone marrow) - somatic/visceral
  2. radiation, surgery, chemo
56
Q

What shows up on a UDS?

A
  1. cocaine
  2. opioids/BZDs
  3. amphetamines
  4. marijuana
  5. codeine

*fent patches do not (synthetic), street fentanyl does not

57
Q

Pain control for port access

A

LA, EMLA cream, lidocaine cream

58
Q

Pain assessment in intubated ICU patients

A
  1. assess v/s - HTN, tachycardia
  2. visual distress
  3. consider nerve blocks
59
Q

Pain management for Herpes Zoster (shingles)

A
  1. lidocaine patches
  2. gabapentin
  3. tx underlying condition - antiviral
60
Q

Migraine pain management

A
  1. R/O stroke, bleed, and red-flag signs
  2. tx migraine
61
Q

OPQRST

A

O: onset - what were they doing? sudden/gradual

P: provocation & palliation - better or worse w/ activity/positioning/adjuvant (what meds? heat? ice?)

Q: Quality - ask pt. to describe it

R: region/radiation - referred/localized

S: severity - pain scale

T: timing - when did it start? how long has it been going on? has it happened before?

62
Q

SOCRATES

A

Site
Onset
Character
Radiation
Associations
Time course
Exacerbating/relieving factors
Severity

63
Q

What populations is assessing pain challenging in?

A
  1. age
  2. level of development
  3. communication skills/language
  4. cognitive skills
  5. prior pain experience 6. associated beliefs
64
Q

physical exam: appearance

A
  1. obese/emaciated
  2. histrionic: exaggerated, dramatic
  3. flat affect
65
Q

physical exam: posture

A
  1. splinting
  2. scoliosis/kyphosis
66
Q

Pain physical exam: gait

A
  1. antalgic: limp
  2. hemiparetic
  3. assistive devices
67
Q

Pain physical exam: facial expression

A
  1. grimacing
  2. tense
  3. diaphoretic
  4. anxious
68
Q

pain physical exam: v/s

A
  1. SNS overactivity
  2. temp asymmetry
69
Q

Pain: inspection

A
  1. skin: color changes, hair loss, flushing, goose bumps, sweating
  2. muscle: atrophy/spasm
  3. edema
70
Q

Pain: palpation

A
  1. demarcation of painful area
  2. detection of changes in pain intensity in the area
  3. trigger points
  4. changes in sensory/pain processing
71
Q

Pain: MS systems

A
  1. flaccidity: paralysis
  2. abnormal movements: neuro damage, impaired proprioception
  3. limited ROM: disc disease, arthritis, pain
72
Q

Pain: neuro exam

A
  1. cranial nerve exam
  2. motor strength
  3. spinal nerve function: DTRs, pinprick, proprioception
  4. Coordination: Romberg’s test, toe-heel, finger to nose
73
Q

Pt. cues: position of comfort

A
  1. give meds before you move them
  2. ketamine - pain relief & cooperative
  3. induce on the stretcher/bed
74
Q

Pt. cues: psychological

A
  1. skin flushing, diaphoresis
  2. vocalizations
  3. facial expressions
  4. body posture/movement
  5. motor response

*baseline mental status: can they communicate w/ you?

75
Q

Issues w/ pain scales

A
  1. they are subjective
  2. don’t take into account:
    -genetics, past experiences, comorbidities, other influences
76
Q

What can be the best pain intensity indicator besides a pain scale?

A

Patient functionality

77
Q

Diff. options for pain scales

A
  1. numeric rating scale
  2. FACES
  3. critical care observation tool
  4. neonatal infant pain scale
  5. FLACC
78
Q

What pain meds may work better in non-opioid naive patients?

A

PO XR opioids instead of IV
-they get to steady state

79
Q

Pediatric Tylenol dose

A

15mg/kg
-PO q4-6h
-max: 90mg/kg/d

80
Q

Pharmacologic Order of meds for non-opioid naive patients

A
  1. Tylenol
  2. celebrex
  3. gabapentin
  4. opioid
81
Q

What concerns do we have w/ Toradol?

A

Bleeding from altering platelet function

-less of a risk now b/c we use lower doses (15-30mg)

82
Q

Who are nebulized medications benefical in?

A
  1. asthmatic kids
  2. if they don’t have an IV

*can also give intranasal

83
Q

Nebulized Ketamine Benefits - adult

A
  1. bronchodilator
  2. works topically: sore throat, awake intubation
84
Q

Lidocaine Nebulized

A

Used for awake fiberoptic/glidoscope

85
Q

Ketamine effects:

A
  1. pt. dissociates
  2. analgesia
  3. bronchodilator
  4. drooling - give a drying agent (bendaryl, glycopyrrolate)
86
Q

What med do we not want to give w/ Ketamine?

A

Atropine - they both cause tachycardiaD

87
Q

Dose differences w/ Ketamine

A
  1. low dose: sub-dissociative
  2. high dose: calming people, emergence delirium
88
Q

Ketamine Pharmacology

A
  1. blockade NMDA, peripheral Na+ channels, and Mu opioid receptors
  2. provides sedation, amnesia, analgesia
  3. retrograde amnesia
  4. highly lipid soluble - crosses BBB fast - peak 1min.
89
Q

Intranasal medications

A

Ketamine, Fent, versed, lidocaine, precedex

90
Q

Intranasal administration

A
  1. use concentrated solution
    -Ketamine: 50mg/mL
    -fent: 50mcg/mL
    -Versed: 5mg/mL
    -Precedex: 200mcg/2mL
  2. use an atomizer
    -if >1mL divide b/w nares
    -spray toward turbinates/pinna
91
Q

Benefits of non-pharmacological pain interventions:

A
  1. improve assessment
  2. decrease/avoid opioids & anxiolytics
  3. decrease time/recovery for procedures
  4. decrease adverse events
92
Q

Painting analogy

A
  1. non-pharmacologic interventions as the primer/base coat
  2. analgesic tx as the paint
93
Q

Examples of non-pharmacological pain interventions

A
  1. preparation, education
  2. distraction: music/TV, toys
  3. Relaxation: breathing, meditation
  4. Training/Coaching
  5. positioning
  6. pressure/massage
  7. heat/ice/splinting
94
Q

What is one of the most common mistakes in pain management?

A

failure to reassess in timely manner
-30min after IV
-60min after PO

*also monitor for resp. depression

95
Q

consequences of unrelieved acute pain

A
  1. psychological
    -PTSD
    -anxiety
    -catastrophizing
    -depression
  2. chronic pain syndromes
  3. increased M&M
    -increased O2 demand
    -increased metabolic rate
    -CV/pulmonary complications
    -impaired immune function
96
Q

Chronic pain syndrome

A
  1. viscous cycle
  2. affects sleep, mood, activity, energy level
  3. physiological & psychological effects
97
Q

Why do we avoid opioids on pts?

A
  1. n/v, constipation, resp. depression
  2. make sure the receiving team knows why
  3. communicate w/ hospitalist & surgeon for d/c planning
98
Q

Things to consider when d/c patients w/ pain

A
  1. safety: can they get home? are they ambulatory? lethargy?
  2. will the pt be able to obtain their meds?
    -cost, supply
  3. clear & easy to understand instructions
99
Q

Why is pain management during transition important ?

A
  1. reduces return visits
  2. reduces progression to chronic pain
100
Q

How long does it take for acute pain to be reduced?

A

4-6wks

*most painful time for pt - 1st 12-48hrs

101
Q

Car w/ 4 flat tires analogy

A
  1. medications only pump 1 tire
  2. other options:
    -biofeedback
    -PT
    -counseling
    -pacing
    -nutritional guidance
    -support group

*patient actively participates in

102
Q

PDMP

A

prescription drug monitoring program

-drug monitoring log
-integrated system: pharmacies, providers

Health Assessment - Autumn (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions