Pain, Comfort, and Sleep Flashcards
Standards relative to direct pt care state the following. 4 things
1) pts have the right to appropriate assessment and management of pain.
2) pain is assessed in all patients
3) Patients are educated about pain and managing pain as part of treatment, as appropriate
4) the discharge process provides for continuing pain care based on the pts assessed needs at the time of discharge
These machines allow pts to self administer medications within safe boundaries based on their perception of pain.
PCA (patient controlled analgesia) machines
what are some nonpharmacologic methods of pain relief
biofeedback, distraction, guided imagery, massage, and relaxation techniques.
often a warning of potential or actual tissue damage and allows the sufferer to withdraw from the source or to seek help in relieving symptoms
acute pain
pain is transmitted to the brain through the ?
nervous system. This is done through afferent (sensory) neurons leading to the spinal nerves and then to the brain.
endogenous naturally occurring opiatelike peptides that reduce or block the perception of pain.
Endorphins
attach to nerve endings in opioid receptors and block pain t
Endorphins
treatment for pain should be bases on assessment that considers what factors? 3
1) pts verbal description of pain
2) nonverbal signs of pain
3) physiologic indicators of pain
this pain involves injury to tissue in which receptors called nociceptors are located
Nociceptive pain
this phase of nociceptive pain begins when tissue damage causes the release of substances that stimulate the nociceptors and start the sensation of pain
Transduction
this phase of nociceptive pain involves movement of the pain sensation to the spinal cord
transmission
this phase of nociceptive pain occurs when pain impulses reach the brain and the pain is recognized
perception
this phase of nociceptive pain occurs when neurons in the brain send signals back down the spinal cord by release of neurotransmitters
modulation
assists the patient in focusing on something other than the pain
Distraction technique
places a fine catheter in the epidural space near the base of the spine and then connects the catheter to a small battery operated programmable pump to relieve pain
epidural analgesia
verbally guiding the patient to imagine something as it is used for pain control, patients are assisted in forming mental images of a plesant envioronment where they are comfortable and happy. (vacation place)
guided imagery
also called therapeutic suggestion. Involves inducing a trance like state using focusing and relaxation techniques and giving the pt suggestions that may be helpful after the return to an alert state of consciousness.
hypnosis
(focusing on an image, thought, the breath, or awareness) can provide the same relief from a painful situation, but it relies on the use of a focus point rather than the mental creation of an alternate environment.
Meditation technique
(analgesia doses controlled by the patient) this method uses one of a variety of programmable pumps
Patient controlled analgesia (PCA)
is helpful in reducing pain and allows the pts to obtain greater relief from pain medications.
relaxation technique
uses a small electrical stimulator attached to electrodes to block pain. available in high frequency and low frequency stimulation.
Transcutaneous electrical nerve stimulation (TENS)
use of fine needles along meridians of the body to relieve pain or other symptoms and restore balance
acupuncture
feeling of distress or suffering
pain
naturally occurring opiate like peptides
endorphins
manipulation of the joints and adjacent tissues of the body
chiropractic
method of learning muscle relaxation using a machine that measures muscle tension
biofeedback
line or passageway of energy that passes through the body
meridian
Nonopioid pain medications that have no steroidal effect
nonsteroidal anti inflammatory
drug that relieves pain
analgesic
difficulty in getting to sleep or staying asleep
insomnia
condition where breathing stops for a brief period during sleep
sleep apnea
focusing on an image or thought for relaxation
meditation
concentrated dose given in a short period
bolus
specialized relaxation technique using a machine that measures the degree of muscle tension with skin electrodes
biofeedback technique
engaging in interesting activity reduces pain perception by…
diverting the attention elsewhere for a time
anxiety increases pain perception causing?
acute pain
what are the three basic categories of medications for pain relief?
NSAIDS- nonopioid analgesics
COX-2 inhibitors
Narcotics or opioids
injectable pain medication is used for severe pain. when administering such an injection IM, it is very important to be careful not to?
damage the nerves
the infant sleeps about ? hours per day in divided segments.
?
A large portion of infant sleep is spent in the REM stage and it is thought that this is necessary for what
brain maturation
sleep and rest affect pain. a person who is rested shows both increased ? and a greater response to ?
pain tolerance; analgesia
school age children should get ? hours of sleep each night
10-11
in which stage does the body receive the most rest?
NREM.
Transition stage, person falls into a light sleep, muscles relax, lasts a few minutes
stage 1
person falls into a deeper sleep, brain wave activity become larger with bursts of electrical activity, last about 10-20 minutes
stage 2
person enters delta sleep, slow wave sleep, respirations and heart rate slow, body becomes immobile, lasts 20-40 minutes, dreaming is common, deepest stage of sleep, difficult to arouse the sleeping person
stage 3
obstructive sleep apnea can be successfully treated by
continuous positive airway pressure (CPAP)
what are two things that snoring is caused by
vibration and or obstruction of the air passage at the back of mouth and nose
and obstructed airways related to colds or allergies
narcolepsy is characterized by
..
a diagnosis of narcolepsy is achieved by
clinical evaluation, sleep logs or diaries, and results of sleep laboratory tests
three uses of cold for pain or discomfort are?
reducing swelling, calming muscle spasms, reducing the pain in joints
two precautions when using ice packs are?
should only be in contact with the skin for a few mins, and applied with a towel or other barrier between pack and skin not left in place for more than 15-20 mins.
in instructing a pt how to apply heat safely, the nurse would caution a pt not to…
go to sleep lying on a heating pad
there are many types of pain scales. for a preverbal or non-communicative child, the ? scale would be a good choice
FLACC
signs of fentanyl patch overdose are?
confusion and inability to walk normally
a pt comes to the clinic complaining of insomnia. she has had difficulty sleeping for past 2 months is tired all the time, and her work is suffering in assessing the problem the nurse would ask her about
pattern of caffeine intake, stresses and problems in her life, (what medications she takes and when??)
one thing the nurse would ask the pt to do to try to locate the reason for her insomnia is to
keep a diary related to sleep and problems encountered.
The nurse would advise the pt with insomnia to
get up at the same time each day and avoid naps, eliminate alcohol and nicotine for are least 2 hours before bedtime
whatever the experiencing person says it is
pain
endogenous chemicals that act like opioids
endorphins
larger dose of analgesic required to relieve same pain
Tolerance
psychological dependence
addiction
self administered analgesics
patient controlled anesthesia PCA
dose of analgesic limited by side effects
ceiling effect
medications that relieve pain
analgesics
drugs that are used to potentiate analgesics
adjuvants
neurotransmitter released during pain
prostaglandin
a morphine like drug
opioid
which of the following definitions of pain is most appropriate to use when planning nursing care?
whatever the experiencing person says it is, occurring whenever the experiencing person says it does
which of the following terms describes a feeling of threat to ones self image or life that may accompany pain?
suffering
which of the following is a common side effect of opioid administration?
constipation
which is the most accurate way to assess the severity of a pts pain?
have the pt rate pain on a standard pain scale
which of the following statements best explains why a pt can be laughing and talking and yet still be in pain?
distraction can help relieve pain when used in combination with analgesics
which type of pain may be accompanied by changes in vital signs?
acute pain
an 82 yr old male pt has been receiving meperidine (demerol) IM for chronic back pain. after several weeks he becomes very irritable which is unlike him. which response by the nurse is best
consult with the registered nurse or physician about changing to a different analgesic
A nurse is caring for a pt who reports being in severe pain. the pt has an order for percocet 2 tabs every 6 hours for pain. prior to providing the medication which of the following actions should the nurse take?
assess the pts pain level and respiratory rate
a pt with severe pain is receiving narcotic pain medication through the use of a pt controlled analgesia intravenous pump. the LPN notes that the pt is lethargic and difficult to arous with a respiratory rate of 7 breaths per minute. after informing the RN which of the following drugs does the nurse anticipate will be ordered?
naloxone (narcan)
a pt with a known history of cocaine abuse is admitted following a motorcycle accident he calls you into his room and says I need something for this pain now. which assumption by the nurse is the best?
the pt is in pain and needs an analgesic (you can not assume that the pt isn’t in pain and only seeking drugs)
the nurse is providing care for a pt in the emergency department who is experiencing a migraine heardache the pt reports taking two extra strength acetaminophen every 6 hours for the fast few days the nurse would be most concerned by which of the following statements by the pt?
i usually drink three or four beers a day
how pain is transmitted and perceived is called
nociception
what is the gate control theory
describes the dorsal horn of the spinal cord as a gate, allowing impulses to go through when there is a pain stimulus and closing the gate when those impulses are inhibited.
represents the initiation of the stimulus and conversion of that stimulus into an electoral impulse at the time of the injury. chemical substances called neurotransmitters are released from damaged tissue. these substances include prostaglandins bradykinin serotonin and substance p
Transduction
the process of moving a painful message from the peripheral nerve endings though the dorsal root ganglion and the ascending tract of the spinal cord to the brain
transmission
actually feeling the pain. during this processes the hypothalamus activates and controls emotional input and also generates purposeful goal directed behavior while the cerebral cortex receives the pain message
perception
the body’s attempt to interrupt pain impulses by releasing endogenous (naturally occurring)opioids
modulation
endogenous chemicals that act like opioids inhibiting pain impulses in the spinal cord and brain
endorphins
one type of endorphin
enkephalin
refers to the bodes normal reaction to noxious stimuli such as tissue damage with the release of pain producing substances.
nociception
pain associated with injury to either the peripheral or central nervous system. not usually localized and it may spread to involve other areas along the nerve pathway
neuropathic pain
malingerer
pretending to be in pain
categories of drugs that were originally developed for a different purpose but have been found to have pain relieving properties in certain painful conditions
adjuvants
limited in their use because they have a ceiling effect to analgesia
nonopioid analgesic
level 1 on the WHO ladder
mild pain, pt can usually sleep perform activities of daily living and even work Non opioid pain persisting or increasing
level 2 on the WHO ladder
mild to moderate pain may not be able to sleep and may have trouble working and staying focused adds an opioid analgesic
level 3 on the WHO ladder
Opioid for moderate to severe pain affecting the quality of the pts life.
can help pts understand and cope with pain and take an active part in its assessment and control. include interventions such as educational information relaxation exercises guided imagery distraction and biofeedback
cognitive behavioral interventions
may include providing comfort correcting physical dysfunction altering physiological responses and reducing fear that might be associated with immobility . include application of heat or cold massage exercise immobilization, and transcutaneous electrical nerve stimulation
physical agents
Meperidine should be avoided in?
elderly patients
the pt will experience the best pain relief with the combination of?
an opioid and nonopiod
nociceptive pain occurs with
tissue injury
chronic sleep loss can increase the risk of? (7)
obesity, depression, hypertension, diabetes, heart attack, and stroke
very light sleep, only a few mins long, vital signs and metabolism beginning to diminish, can be awakened easily, feels relaxed and drowsy
Stage 1 NREM
deeper sleep, 10-20 min in length, vital signs and metabolism continuing to diminish, requires slightly more stimulation to be awakened, increased relaxation
Stage 2 NREM
deep sleep, 15-30 min in length, vital signs continuing to decrease, difficult to awaken, relaxation such that the person seldom moves
Stage 3 NREM
called delta sleep, deepest sleep, 15-30 min in length, vital signs very low as compared to when awake, very difficult to awaken, stage at which the body achieves physical rest and restoration, stage at which enuresis and talking and walking in ones sleep occurs, repair and renewal of tissue.
Stage 4 NREM
Occurrence of dreams, usually begins about 90 min after falling asleep, length increases with each sleep cycle, average length is 20 mins, varying vital signs, very difficult to awaken, stage at which mental rest and restoration occur.
REM
birth to 3 months
16 hr a day
infants (3 months to 1 year)
8-10 hours plus with two to three naps
toddlers
12 hour with some sleep during a daytime nap
preschooolers
12 hour with less napping during the day
school age
11-12 hour for younger children with 9 to 10 hour for older ones
adolescents
7.5 hours
young adults
6-8.5 hours
middle adults
6-8.5 hours
older adults
6-8.5 with daytime naps possibly accounting for some of the hours
most common sleep disorder, is defined as the inability to get an adequate amount of sleep and to feel rested.
insomnia
a disorder of the sleep and wake mechanism. the person may lose the ability to stay awake. often happens at inappropriate times and can put the person at risk for injury
narcolepsy
medications of choice for insomnia are?
benzodiazepine like medications which include the sedative hypnotics zolpidem(ambient) eszopiclone(luniesta), and zaleplon (sonata)
Transduction
is the conversion of painful stimuli to an electrical impulse through peripheral nerve fibers (nocieptors)
Transmission
Occurs as the electrical impulse travels along the nerve fibers and is regulated by neurotransmitters
the pain threshold is?
the point at which a person feels pain
Substances that Increase pain transmission and cause an inflammatory response (4)
substance P, prostaglandins, bradykinin, histamine
substances that Decrease pain transmission and produce analgesia
serotonin, endorphins
occurs in various areas of the brain and is influenced by thought and emotional processes
perception or awareness of pain
occurs in the spinal cord, causing muscles to contract reflexively, moving the body away from painful stimuli
modulation
this pain arises from damage to or inflammation of tissue other than that of the peripheral and central nervous systems. usually throbbing aching and localized. this pain typically resounds to opioids and nonioioid meds.
Nociceptive pain
arises from abnormal or damaged pain nerves. includes phantom limb pain, diabetic neuropathy. This pain is usually intense, shooting burring or described as pins and needles. This pain typically responds to adjuvant meds, (antidepressants, antispasmodic agents, skeletal muscle relaxants)
Neuropathic Pain
risk factors for under treatment of pain include (4)
cultural and societal attitudes, lack of knowledge, fear of addiction, exaggerated fear of respiratory depression
causes of acute and chronic pain include (7)
trauma, surgery, cancer, arthritis, fibromyalgia, neuropathy, diagnostic or treatment procedures (injection, intubation, radiation)
(acetaminophen, nonsteroidal anti inflammatory drugs(NSAIDs) including salicylates) are appropriate for treating mild to moderate pain
nonopioid analgesics
morphine sulfate, fentanyl (sublimaze) and codeine are appropriate for treating moderate to severe pain (post operative pain myocardial infraction pain, cancer pain)
opioid analgesics
enhance the effects of nonopioids, help alleviate other symptoms that aggravate pain (depression, seizures, inflammation) and are useful for treating neuropathic pain
adjuvant analgesics
Adjuvant medications include? (6)
anticonvulsants; carbamazepine(tegretol)
antianxiety agents; diazepam (valium)
tricyclic antidepressants; amitriptyline (elavil)
antihistamine; hydroxyzine (visatril)
glucocorticoids; dexamethasone (decadron)
antiemetics; ondansetron hydrochloride (zofran)
4 types of Neuropathic pain
Diabetes, HIV/AIDS, Guillain-Barre syndrome, Caner
3 types of Nociceptive pain
Trauma, burns, surgery
6 types of acute pain
surgery, injury, cholecystitis, appendicitis, infection, renal colic
this type of pain is usually not relieved by analgesics and opioids alone. Is managed with common analgesics such as those in the NSAID family, but also increasingly with adjuvant medications such as tricyclic antidepressants, anticonvulsants, and corticosteroids.
Neuropathic pain
what does the mnemonic device for pain assessment stand for PQRST
precipitating events, quality of pain or discomfort radiation of pain severity of pain timing
FLACC
face, legs, activity, cry, and consolability scale is used for preverbal or non communicative children.
NIPS
Neonatal infant pain scale
CRIES
crying, requires oxygen to maintain saturations, increased vital signs, expression, and sleeplessness
PIPP
premature infant pain profile
acute pain may be treated with? whereas; chronic pain may be treated with?
conventional high frequency TENS therapy; low frequent TENS therapy
PENS
Percutaneous electrical nerve stimulation is used for relief of some severe headaches and lower back pain
