Pain management

Question 1

pain def

Answer 1

unpleasant sensory, emotional experience w/ pot. tissue damage

Question 2

pain factors

Answer 2

age, sex, race, gender, socioecon class,

genetics, past trauma, undrlying mental health, co-morb.

Question 3

emotional response pain

Answer 3

fear and depression

Question 4

vital sign response pain

Answer 4

inc heart rate, bp and respir rate

Question 5

acute pain

Answer 5

localized, < 3-6 mon, follows injury, HAS biological purpose

result tissue damage

Question 6

chronic pain

Answer 6

time-limited or lifetime
inc resistance versus diff pain modalities
no bio purpose
cancer, osteoarth, peripheral neuropathy

Question 7

breakthrough pain

Answer 7

chronic pain w/ acute exacerbations

Question 8

nociceptive pain

Answer 8

physiologic- tissue injury

nocioreceptors in skin, bone, musc signal to spinal cord

Question 9

neuropathic pain

Answer 9

pathophysiologic- damage to PNS or CNS
chronic
ex. diabetic neuropathy
numbness and tingling

Question 10

somatic v visceral pain

Answer 10

somatic- skin, bones, muscles

visceral- organs

Question 11

nociception processes- transduction

Answer 11

stimuli activate nociceptors

act neurons, sent sc, brain and received by sensory cortex

Question 12

prostaglandins

Answer 12

responsible for pain and swelling

produced when COX inhib act on arachdonic acid

Question 13

nociception processes- transmission

Answer 13

couples w/ transduction to get signals to brain

Question 14

nociception processes- perception

Answer 14

altering factors for pain- imagery, distraction

Question 15

nociception processes- modulation

Answer 15

process that changes/inhib signals in spinal tract via neurochem
ex. anti-depres.

Question 16

neuropathic pain factors

Answer 16

does not have to occur w/ inflamm

abnormal processing of stimuli

Question 17

neuropathic pain peripheral mech

Answer 17

neuroplasticity

damage nerve endings= abnorm firing

Question 18

neuropathic pain central mech

Answer 18

neur become hyperactive

inc response to stimuli

Question 19

pain assessment components

Answer 19

self- report- pt most important source
location
intensity
quality
onset-duration
aggravating and relieving factors
effects on quality of life
comfort-function goal for pain

Question 20

pain management techniques

Answer 20

multimodal pharmacologic
multip. diff meds or nsaids w/ opioid or w/ distraction and imagery

PCA
continuous dose w/ option for bolus
entirely patient controlled

Question 21

pain medication routes

Answer 21

oral pref- need to be able to swallow and intact GI tract

transfer off IV ASAP- dec risk infection, reach discharge goals faster

Question 22

NSAID patho

Answer 22

dec pain by inhib COX enzymes

Question 23

Opioid patho

Answer 23

act on CNS inhibit act. ascending nociceptive pathways

Question 24

local anesth. patho

Answer 24

nerve block

Question 25

analgesic agents- nonopiod

Answer 25

mild to moderate pain
acetaminophen
nsaids-
side effects- GI bleeding, peptic ulcer

Question 26

analgesic agents- opioid

Answer 26

Mu agonist- morphine, fentanyl, oxycodone
act dopamine release
agonist-antagonist- buprenorphine, nalbuphine
side effects- confusion, LOC changes, inc falls, respir depression
3-5 day trtmnt recommended

Question 27

Monitoring for OIRD 1st step

Answer 27

id pt at risk
obstructed sleep apnea
obesity hypoventilation syndrome
prior experience w/ acute opioid trtment
pre-existing chronic pain

Question 28

monitoring for OIRD

Answer 28

cont. ox
capno for those on o2
(ETCO2 lvl change before O2 changes)
20-30 min monitoring after parenteral, 1-2 hrs after oral
sedation scales

Question 29

excessive sedation ORID response

Answer 29

hold opioids, notify provider
stimulate pt
monitor trends
rapid response team
naloxone- goal pt alert , rr >10

Question 30

physical dependence

Answer 30

dev w/ in 3-5 days
normal response w/ use opioids 2+ wks
manifested by withdrawl symptoms

Question 31

addiction 4C’s

Answer 31

compulsive use
cravings
loss of control
conseq. after use

chronic, relapsing, treatable
influenced by genetics, psychosocial and environment

Question 32

nerve blocks

Answer 32

multimodal
help manage pain post
12-18 hr duration
blocks motor/ sensory function

assess for circulation, sensation, motor function and skin breakdown

Question 33

adjunctive analgesics

Answer 33

local anesth- lidocaine patch
anticonvulsants- gabapentin
antidep- TCAs and SNRIs

Question 34

gerontologic considerations

Answer 34

sensitive to sedation and CNS effects
start w/ lose dose
inc risk NSAID- induced GI toxicity
opioid dose dec 25-50% due dec renal func

Question 35

nonpharmacologic methods

Answer 35

natural products- herbs, vitamins
mind/body- yoga, massage therapy
positioning
heat/cold- about 20 min
range of motion

Question 36

nursing process for pain

Answer 36

id goals (educated realistic options)
est. nurse-pt relationship
provide physical care
manage anxiety r/t pain
evaluate pain management strategies continually