Pain management Flashcards
Nociceptive pain
- Damage to bones, soft tissue, internal organs
- Throbbing, aching
- Localized
- Response opioid and non-opioid medications
Neuropathic pain
- Damaged pain nervous
- Pain is intense
- Burning, shooting, pains a needles
- Response to adjuvant medications
Somatic pain?
aching, throbbing(arthritis)
bone fractures.
strained muscles
connective tissue diseases, such as osteoporosis
cancer that affects the skin or bones
Visceral pain?
Squeezing, cramping
pain related to the internal organs in the midline of the bod= abdominal pain
Cutaneous pain
Sharp(surgical wounds)
pain perceived from the skin
Subcutaneous/below the skin=skin pain
Acetaminophen
Analogist and antipyretic
Consider maximum daily doses 4g(2-3g if liver disease)
Can cause liver dysfunction
NSAIDS
Aspirin, ibuprofen, naproxen
Mild pain alone or adjuvant
Inhibits inflammation
GI toxicity, bleeding
Renal dysfunction
What mean by pain is multidimensional?
pain is a bio-psycho-social-spiritual experience
Pain
Biological
Fifth vital sign
Cause of pain
Impact on functional status and sleep
a) Acute pain?
b) Chronic pain?
a) lasts less than 1-3 month
Protective
Fight and flight
Self-limiting
Direct cause
b) longer than 3 months
Not protective
Not impacted Vital sings
Wong-Baker FACES pain rating scale
- PQRST
- Age 3 and above
- Very important to qualify how the scale number means
best question
What pain level could you live with so you can be a function?
Pain assessment in advances
PAINAD
DEMENTIA
Pain assessment tool for patients with advanced dementia
1-3=mild pain; 4-6=moderate pain; 7-10=severe pain
FLACC pain score
For infant and toddler
1-3 = Mild discomfort. 4-6 = Moderate pain. 7-10 =pain
Pain
Psychological
Pain influences mood
Past experiences with pain
Depression or anxiety?
Stress and fear make pain stronger
Pain
Social
- *Impact on quality of life**
- If the pt immobility, isolate from the society
- *Cost and access**
- insurance?
Pain
Spiritual
- *Cultural considerations**
- pain is punishment
- *Chaplain support**
Opioid
- To use moderate to severe(first line therary)
- Block neurotransmitters=reduce pain
- No ceiling effect
- Contraindication is the history of reaction(cause opioid?)
- Nausea and vomiting is not a contraindication
Opioids options
- Fentanyl
- Hydrocodone
- Hydromorphone
- Methadone
- Morphine
- Oxycodone
What mean by no ceiling effect
Opioid
Keep working and working till respiratory depression and die
What is the most concerning side effect?
Opioid
- *Respiratory depression**
- *Opioid naïve patient with the first dose**
Reserve with naloxone(reverses an opioid overdose)
Ongoing assessment
EOL is the different
Another side effect of Opioid
Sedation
Urinary retention
Nausea and vomiting
Pruritis
Myoclonus
Orthostatic hypotension
Tolerance
medication
Starts not working as desire
It is not a significant problem with clinical setting
Physiological dependence
medication
Most happen with opioid medication
A person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses.
Substance-use disorder
medication
- A mental disorder
- Affects a person’s brain and behavior
- Inability to control their use of medications
- Starting fail
- Starting to see a problem but still functioning
Substances such as alcohol, marijuana and nicotine also are considered drugs.
Addiction
medication
- Primary, chronic, neurobiological disease
- Genetic, psychosocial factors
- Impaired control over drug use, cannot live without it
Chronic pain management
Things to keep in mind
-Body learns to adapt to deal with the pain
Vital signs may not be impacted….
But if pt says that pain is 5/10, means pain is 5/10!!!!
Ethnology and location
Where does it start from?
Where does it begin from?
Patient controlled analgesia
PCA
- Only controlled by the patient
- Small dose
- Another RN to verify the pump settings
Which of the following signs or symptoms in a patient who is opioid-naïve is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
- Oxygen saturation of 95%
- Difficulty arousing the patient
- Respiratory rate of 12 breaths/min
- Pain intensity rating of 5 on a scale of 0 to 10
２
arousing/awaken (someone) from sleep.
A patient is being discharged home on an around-the-clock (ATC) opioid for postoperative pain. Because of this order, the nurse anticipates an additional order for which class of medication?
- Opioid antagonists
- Antiemetics
- Stool softeners
- Muscle relaxants
3
A new medical resident writes an order for oxycodone CR 10 mg PO q2h prn. Which part of the order does the nurse question?
- The drug
- The time interval
- The dose
- The route
2
Adults—10 to 30 milligrams (mg) every 4 hours as needed
The nurse reviews a patient’s medical administration record (MAR) and finds that the patient has received oxycodone/acetaminophen (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?
- The patient’s level of pain
- The potential for addiction
- The amount of daily acetaminophen
- The risk for gastrointestinal bleeding
3
- An oriented patient has recently had surgery. Which action is best for the nurse to take to assess this patient’s pain?
a.
Assess the patient’s body language.
b.
Ask the patient to rate the level of pain.
c.
Observe the cardiac monitor for increased heart rate.
d.
Have the patient describe the effect of pain on the ability to cope.
B
One of the most subjective and therefore most useful characteristics for reporting pain is its severity.
When using ice massage for pain relief, which of the following is correct? SATA
1: Apply ice using firm pressure over the skin
2: Apply ice for 5 minutes or until numbness occurs.
3: Apply ice no more than 3 times a day
4: Limit application of ice to no longer than 10 minutes
5: Use slow, circular steady massage
1,2,5
Firm
Idiopathic pain
- Chronic pain
- Not know the reason
Adjuvant Medications
- To enhance the effects of pain medications,
- Treat concurrent symptoms, and provide analgesia for other types of pain
Pain pathway
Transduction
Noxious stimuli cause cell damage
Damaging to tissue and liable to cause pain(detected by sensory receptor)
Pain pathway
Transmission
Action potential continue to form
Site of injury to spinal cord
Pain pathway
Perception
Experience of pain
Pain pathway
Modulation
Where can pain be modulated in the body, and what causes its modulation?
Answer:
Pain is modulated at many places. It can be modulated at the level of pain receptors by simultaneous activity in low-threshold mechanoreceptors
The nurse understands that the shortest acting relief method is
1: Patient controlled analgesia
2: Intramuscular sedatives
3: Intravenous narcotics
3
Quick response, but duration is short
The nurse is caring for a pt who is experiencing pain. The nurse understands that a common psychological pt response to pain is
1: Experiencing fear related to loss of independence
2: Developing an increased tolerance to the drug
3: Asking for pain meds relieve pain
1
2-physiological response
3-Behavioral response
A pt complains of pain. When caring for this pt, the most important things that nurse must recall is that
1: The extent of pain is directly related to the amount of tissue damage
2: Administering opioids for pain will eventually lead to addiction
3: The person experiencing the pain is the authority about the pain
4: Behavioral adaptions are congruent with statements about pain
3
authority=right
A pt requests pain medication. What should the nurse do first when responding to this pt request for pain meds?
1: Use distraction to minimize the pt’s perception of pain.
2: Place the pt in the most comfortable position possible
3: Administer pain meds to the pa quickly
4: Asses the various aspects of the pt’s pain
4
ADPIE!!!!
Which statement by the pt to a nurse indicates a precipitating factor associated with pain?
1: “ I usually feel a little dizzy and think I ‘m going to vomit I have pain”
2: “I usually have pain after I get dressed in the morning”
3: “My pain usually comes and goes throughout the night”
4: “My pain feels like a knife cutting right through me”
2
precipitating=induce
A pt has a history of severe chronic pain. One of the most important guidelines associated with providing nursing care to this pt is
1: Determining the level of function that can be performed without pain
2: Focusing on pain management intervention before pain is excessive
3: Providing interventions that do not precipitate pain
4: Asking what is an acceptable level of pain
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