Pain Exam 1 Flashcards
What type of patient is least likely to receive standardized pain assessment and to receive pain meds
Physiologically unstable patients
Pain can present with non pain diagnoses such as
LE pain- can be vascular, spinal cord, or if bilateral most likely DM.
Depression can also present as pain.
For unstable pt what is one barrier for pain administration
Hypotension
What pain med can be given for unstable pt and at what dose
Ketamine 0.2-0.3 mg/kg
This is below the dissociative dose. Induction dose of ketamine 0.5-2mg/kg
How do studies skew pain reported in African Americans
The studies may not take into account sickle cell anemia which can be extremely painful. This may be why the pain reported in this population is higher.
How does culture play a part in pain management
Patient may need to go thru there ministry to get approval for certain treatment options.
Strong cultural ties may lead to stronger support system.
How does living in rural areas and having lower socioeconomic status affect reported pain
Lower socioeconomic status and living in rural areas has seen an increased reporting of chronic pain, pain related disability, and depression.
How can previous pain experiences lead to persistent pain
Previous pain can alter activity within certain brain regions resposible for pain processing resulting in persistent pain .
What disorders have been linked to chronic pain
mood disorders and other psychiatric disorders.
An exaggerated cognitive response to an anticipated or actual painful stimulus
pain catastrophizing
What is magnification component of catastrophizing
Magnification response that symptoms can or are greater than expected
What is Rumination component of catastrophizing
Individual focuses repeatedly on attributes of an event that evokes negative response
Ex. “I can’t stop thinking about how much it hurts”
Describe the helplessness component of catastrophizing
The belief that there is nothing that anyone can do to improve a bad situation.
What medicines can be given to help with pain catastrophizing
Versed, possibly more than the 1-2 mg dose.
Precedex may be a good option.
What non medicine it perfections help with catastrophizing
Talk to patient/have family/chaplain talk to them
What are two things that were worry about in regards to pain and genetics
Worry about ultra rapid metabolizers. E.g. codeine metabolized rapidly and converted to morphine more quickly. Supra-therapeutic doses.
Slow metabolizers.
E.g. codeine not efficiently metabolized and never reach therapeutic doses.
What patient info can help determine their drug metabolism
Medication list, family history, talk about previous anesthetic.
Did they wake up with pain? Were they easy to wake up after surgery?
What are the different factors used to classify pain
Underlying etiology (source of pain), anatomical location (site of pain), temporal nature (duration),
intensity (degree or level of pain)
Basics of pain assessment
Functionality assessment of pain
Describe OPQRST
Onset of pain, Provocation and palliation of symptoms, Quality, Region and radiation, Severity, Timing
Why may PO opioids be beneficial to IV
The PO may take longer to take effect but the effects last longer. The PO opioids help achieve a steady state of the drug.
IV is fast on but fast off.
Pediatric Tylenol dosages
15 mg/kg PO q 4-6 hours
MAX: 90 mg/kg/day
Pediatric IV Tylenol dose
15mg/kg IV q6h or
12.5 mg/kg q4h
Max 75 mg/kg/day
What side effects can be seen with Toradol
Increased risk for bleeding d/t alteration in platelet function.
Renal impairment.
What is Toradol dose and duration
Toradol adult dose is 15-30mg IV/IM q6h
Max: 120 mg/day x5 days
What is the benefit of nebulized ketamine
Ketamine has topical effects in addition to its systemic effects. This may help localize the airway in addition to getting sedation.
What are the effects of ketamine
Disassociate, analgesia, bronchodilation, hallucinate later, increased salivation
What is one of the most common mistakes made in pain management
Failure to reassess pain
What percent of decrease in pain is clinically meaningful from a patients perspective
A decrease in 33-50% decrease in pain intensity. This represents a reasonable standard of intervention for acute and chronic pain.
