Pain management Flashcards
pain def
unpleasant sensory, emotional experience w/ pot. tissue damage
pain factors
age, sex, race, gender, socioecon class,
genetics, past trauma, undrlying mental health, co-morb.
emotional response pain
fear and depression
vital sign response pain
inc heart rate, bp and respir rate
acute pain
localized, < 3-6 mon, follows injury, HAS biological purpose
result tissue damage
chronic pain
time-limited or lifetime
inc resistance versus diff pain modalities
no bio purpose
cancer, osteoarth, peripheral neuropathy
breakthrough pain
chronic pain w/ acute exacerbations
nociceptive pain
physiologic- tissue injury
nocioreceptors in skin, bone, musc signal to spinal cord
neuropathic pain
pathophysiologic- damage to PNS or CNS
chronic
ex. diabetic neuropathy
numbness and tingling
somatic v visceral pain
somatic- skin, bones, muscles
visceral- organs
nociception processes- transduction
stimuli activate nociceptors
act neurons, sent sc, brain and received by sensory cortex
prostaglandins
responsible for pain and swelling
produced when COX inhib act on arachdonic acid
nociception processes- transmission
couples w/ transduction to get signals to brain
nociception processes- perception
altering factors for pain- imagery, distraction
nociception processes- modulation
process that changes/inhib signals in spinal tract via neurochem
ex. anti-depres.
neuropathic pain factors
does not have to occur w/ inflamm
abnormal processing of stimuli
neuropathic pain peripheral mech
neuroplasticity
damage nerve endings= abnorm firing
neuropathic pain central mech
neur become hyperactive
inc response to stimuli
pain assessment components
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
pain management techniques
multimodal pharmacologic
multip. diff meds or nsaids w/ opioid or w/ distraction and imagery
PCA
continuous dose w/ option for bolus
entirely patient controlled
pain medication routes
oral pref- need to be able to swallow and intact GI tract
transfer off IV ASAP- dec risk infection, reach discharge goals faster
NSAID patho
dec pain by inhib COX enzymes
Opioid patho
act on CNS inhibit act. ascending nociceptive pathways
local anesth. patho
nerve block
analgesic agents- nonopiod
mild to moderate pain
acetaminophen
nsaids-
side effects- GI bleeding, peptic ulcer
analgesic agents- opioid
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
Monitoring for OIRD 1st step
id pt at risk obstructed sleep apnea obesity hypoventilation syndrome prior experience w/ acute opioid trtment pre-existing chronic pain
monitoring for OIRD
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
excessive sedation ORID response
hold opioids, notify provider stimulate pt monitor trends rapid response team naloxone- goal pt alert , rr >10
physical dependence
dev w/ in 3-5 days
normal response w/ use opioids 2+ wks
manifested by withdrawl symptoms
addiction 4C’s
compulsive use
cravings
loss of control
conseq. after use
chronic, relapsing, treatable
influenced by genetics, psychosocial and environment
nerve blocks
multimodal
help manage pain post
12-18 hr duration
blocks motor/ sensory function
assess for circulation, sensation, motor function and skin breakdown
adjunctive analgesics
local anesth- lidocaine patch
anticonvulsants- gabapentin
antidep- TCAs and SNRIs
gerontologic considerations
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
nonpharmacologic methods
natural products- herbs, vitamins mind/body- yoga, massage therapy positioning heat/cold- about 20 min range of motion
nursing process for pain
id goals (educated realistic options) est. nurse-pt relationship provide physical care manage anxiety r/t pain evaluate pain management strategies continually
