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N201 > Pain II > Flashcards

Pain II Flashcards

1
Q

What is the triple whammy effect of ineffective pain management?

A

1) physicians under prescribe
2) nurses under administer
3) patients may under report

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2
Q

What are the 4 general methods of treatment for pain relief?

A

1) modifying the disease process
2) interrupting pain transmission (nerve blocks, rhizotomy)
3) pharmacological management
4) non-pharmacological management

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3
Q

What are the drugs listed under non-opioid analgesics?

A

Acetaminophen

NSAIDs

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4
Q

What are the adverse effects for acetaminophen?

A

Hepatic failure

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5
Q

What are the adverse effects for NSAIDs?

A

Ulcers/GI bleeds, inc bleeding, renal failure

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6
Q

How do non-opioid analgesics act (acetaminophen and NSAIDs)?

A

peripherally by blocking prostaglandins

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7
Q

What is one of the disadvantages of non-opioid analgesics?

A

they have a ceiling effect (that is, there is a point where increasing the dose no longer increases the relief)

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8
Q

What is often given alongside of NSAIDs to help reduce the adverse effects?

A

a PPI for ulcer reduction

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9
Q

List an advantage and disadvantage of using an opioid analgesic.

A

advantage: no ceiling effect
disadvantage: become tolerant and require higher doses

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10
Q

What are the AE that are associated with opioid analgesics?

A 
Constipation
Resp depression
Pruritis
Nausea
Hallucinations
HTN
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11
Q

How do opioid analgesics act?

A

on CNS receptor sites binding to opioid receptors

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12
Q

what is used to treat the nausea associated with opioids?

A

gravol

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13
Q

When someone takes too much opioids and goes into resp depression, what is the drug given to reduce this?

A

Narcan

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14
Q

What is the purpose of an adjuvant pain medication?

A

to manage specific types of pain and enhance the effectiveness of other analgesic meds and may decrease dose required of opioid

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15
Q

What are the 4 main classes of adjuvant pain medication?

A

1) Antidepressants
2) Anti-anxiety
3) Anti-convulsants
4) Corticosteroids

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16
Q

What type of pain are anticonvulsants used as an adjunctive for?

A

Neuropathic pain

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17
Q

What are the benefits of corticosteroids related to pain management?

A

suppresses inflammation and does also have a direct analgesic effect

used for Ca, bone pain

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18
Q

What type of pain are antidepressants often used as an adjunctive medication for?

A

chronic pain

19
Q

What type of pain symptoms are anti-anxiety meds used as an adjunctive medication for?

A

Anxiety and muscle spasms

ex ativan

20
Q

What types of analgesics are good for musculoskeletal pain?

A

Acetaminophen, NSAIDs, COX-2 inhibitor

21
Q

What types of medication are used for bone pain?

A

Corticosteroids if Ca

Calcitonin, vit D and calcium for osteoporosis

22
Q

What types of medications are used for neuropathic pain?

A

Anticonvulsants, antidepressants, capsaicin cr, combined with other classes

baclofen for muscle spasms

23
Q

Describe the WHO three step pain ladder.

A

1) mild pain: non opioid + adjuvant
2) mild to mod pain: add opioid
3) mod to severe pain: inc dose of opioid and consider choice and route of opioid

24
Q

What does ATC dosing mean? what does it help prevent?

A

it is around the clock dosing and helps prevent the recurrence of intolerable levels of pain

25
Q

What are the 4 principles of pharmacological management?

A

1) 3 step pain ladder
2) combined analgesia (treat acute and chronic)
3) preemptive analgesia (treat perioperative pain or prior to mobilizing)
4) titrating dose upwards or downwards to individualize management

26
Q

If you are using non-pharmacological approaches, are they a substitute for medications?

A

no they are not, they are to be used in addition.

27
Q

What can be said about the outcomes of non pharmacological approaches?

A

they are highly unpredictable. Plans need to be individualized as different interventions will be effective for different individuals.

28
Q

What are the guidelines for non-pharmacological treatment of pain?

A

1) clarify that it is not a replacement
2) assess attitude and experience
3) ask what helps besides medication for their pain
4) assess lvl of fatigue, cognitive status, and ability to concentrate and follow instructions
5) ask family and friends if they wish to be involved
6) provide adequate support

29
Q

List some common non drug treatments.

A

Cutaneous stimulation: hot and cold, vibration, massage

Distraction

Relaxation

30
Q

What must be done when assessing pain in the elderly.

A

1) ask about pain regularly
2) remember the misconceptions about pain in the elderly
3) expect pain whenever there is any possibility of it
4) use appropriate pain rating scales
5) believe the family and the pt
6) use the word pain medicine over drugs/narcotics
7) use the words discomfort or aching

31
Q

What are some common misconceptions about pain in the elderly?

A

belief that pain is part of the aging process

belief that they have dec ability to detect pain

32
Q

List some barriers to assessment of pain

A

Cognition
Hearing
Family members and individuals not wanting meds

33
Q

What should you do when assessing elderly individuals with cognitive and communication impairment?

A

1) start with pt’s self report of pain
2) consider pathologic conditions and procedures that might cause pain
3) look for behaviours that indicate pain
4) use a proxy pain rating
5) know the pt and family
6) when in doubt, administer meds and evaluate response

34
Q

What are the guidelines for pain management in the elderly?

A

1) use WHO ladder
2) combined analgesia
3) titrate slowly
4) preemptive analgesia
5) oral preferred
6) ATC dosing
7) use caution with certain drugs

35
Q

What are some myths/misconceptions regarding pain in children?

A

Children do not feel pain

Children do not remember pain

Children may develop complications from opioid use

Fear of addiction

36
Q

List some factors that influence pain in children.

A

Cognitive level
Temperament
Previous pain experience
Culture/family

37
Q

What needs to be considered regarding pain in children?

A

conceptualization of pain r/t to age/stage

responses to pain r/t age/stage

cognitive knowledge

control issues

38
Q

What is the acronym for child pain assessment and what does it mean?

A

QUEST

Question the child
Use rating tools
Evaluate behavior
Sensitize parents and staff
Take action
39
Q

What age group is the faces assessment tool appropriate for?

A

3 and up

40
Q

What age group is the poker chip assessment tool appropriate for?

A

4 and up

41
Q

What age group is the visual analog scale good for?

A

age 7 and up

42
Q

What are the two types of behavioural scales to assess pain?

A

Riley infant

FLACC

43
Q

What is one thing you could do if you suspect a child is experiencing pain, but is not expressing it?

A

Use a teddy bear and ask if teddy is hurting today.

they often project

N201 (5 decks)

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