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pain management Flashcards

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1
Q

what is pain

A

-body’s defense mechanisms to indicate a problem
-sensory and emotional, associated with actual or potential tissue damage
-universal and mysterious
-subjective assessment
-“pain is whatever the experiencing person says it is, existing whenever they say it does”

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2
Q

what are the physiological effects of pain

A

-hyperglycemia
-increased cardiac workload
-immune dysfunction
-altered coagulation
-ileus
-urinary retention
-decreased lung volume
-fatigue
-debility

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3
Q

what are some psychological effects of pain

A

-social isolation
-disability/lost work
-poor quality of life
-anxiety
-depression
-demoralization
-suicide

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4
Q

what are the four processes of pain

A

-transduction
-transmission
-perception
-modulation

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5
Q

describe transduction

A

-converts noxious stimuli to electrical impulses (noxious stimuli may be mechanical, thermal, or chemical and move from periphery (nociceptors) to doral horn of spinal cord)
-nociceptors are stimulated

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6
Q

nociceptors are stimulated by the release of…

A

-histamine (excites nerve endings)
-lactic acid (builds up in tissue)
-bradykinin (vasodilator)
-prostaglandins (sends stimuli to CNS)
-substance P (sensitive recpetors on nerves for pain)
-serotinin (stimulates vasoconstriction)

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7
Q

describe transmission

A

-A-delta fibers and C fibers move pain impulse
-reflex arc

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8
Q

describe A-delta fibers

A

larger, transport more localized pain

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9
Q

describe C fibers

A

transport aching pain

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10
Q

describe perception of pain

A

-individual interpretation of stimuli
-threshold (lowest intensity of stimulus that causes recognition of pain)
-adaptation (pain become tolerable over time)

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11
Q

describe modulation of pain

A

-regulation or inhibition of pain sensation
-neuromodulators are involved

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12
Q

what are neuromodulators

A

-endogenous opiod compounds
-released by both pain and stress
-found in spinal cord and brain
-bind to specific opioid receptor sites and reduce perception of pain

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13
Q

name two neuromodulators

A

-endorphins (released when pain relieving drugs are used
-enkephalins (widespread in CNS, less potent, inhibit substance P)

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14
Q

what is gate control theory

A

-provides ideas for pain relief emphasizing multiple dimensions of pain; relationship between pain and emotions (sensory, emotional, behavioral, cognitive)
-different pain interventions may be used to address various dimensions of pain for more holistic approach to therapy

basically says only certain signals can get through, motor is let through before sensory

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15
Q

types of pain

describe duration

A

can be
-acute
-chronic/prolonged/persistent (which can be malignant or nonmalignant)

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16
Q

types of pain

describe source

A

-cutaneous
-somatic
-visceral

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17
Q

types of pain

describe mode of transmission

A

referred

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18
Q

types of pain

describe etiology

A

-nociceptive
-neuropathic
-psychogenic

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19
Q

describe acute pain

A

-rapid onset
-varies in intesity
-protective in nature
-after underlying cause is gone the pain goes away

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20
Q

describe chronic/persistent/prolonged pain

A

-intermittent or persistent
-lasts beyond normal healing period
-periods of remission and exacerbation
-difficulty describing pain -> often perceived as meaningless

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21
Q

describe cutaneous pain

A

-superficial
-ex. paper cut

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22
Q

describe somatic pain

A

-diffused/scattered
-ex. sprained ankle

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23
Q

describe visceral pain

A

-body organs due to stretch/spasm
-most difficult to describe
-ex. cholangitis

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24
Q

describe neuropathic pain

A

-usually chronic
-abnormal function of peripheral nervous system or central nervous system
-burning, electric, tingling, stabbing
-allodynia (pain after non painful stimuli)
-pain syndromes (phatom pain, diabeteic neuropathy)

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25
Q

describe psychogenic pain

A

-no physical cause, cant be identified
-results from a mental event

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26
Q

describe intractable pain

A

-resistent to treatment
-persists despite interventions

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27
Q

pain experience is affected by…

A

-culture/ethnicity
-family/gender/age
-religious beliefs
-environment
-anxiety
-past pain experience

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28
Q

lifespan considerations r/t pain

newborn/infant

A

-can’t communicate
-under treatment of pain

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29
Q

lifespan considerations r/t pain

toddler/preschooler

A

cannot ID pain

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30
Q

lifespan considerations r/t pain

school age/adolescent

A

cant rationalize pain

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31
Q

lifespan considerations r/t pain

culture

A

communication/devalued

32
Q

describe assessment of pain

A

-5th vital sign
-patient’s verbalization and description of the pain
-nonverbal behaviors
-include a goal

33
Q

whats the PQRST pain assessment

A

-Provokes
-Quality
-Radiates
-Severity
-Time

34
Q

describe assessment frequency

A

-initial assessment
-new onset pain
-prior to pain relieving intervention
-(evaluation) after pain relieving intervention
-routine intervals

35
Q

what are some tools for quantifying pain

A

-verbal rating scale (1-10)
-wong baker FACES
-NVPS (adult nonverbal pain scale)
-CRIES observer pain scale
-FLACC

CRIES and FLACC are for children

36
Q

name some shit involved in the assessment of pain

A

-duration
-location
-quantity/intensity
-quality
-aggravating/alleviating factors
-physiologic indications of pain
-behavioral responses
-effect of pain

37
Q

describe the assessment of the quality/intensity of pain

A

-making the subjective objective
-use appropriate and consistent pain scale
-what is an acceptable level of pain? (pain tolerance)

38
Q

describe the physiologic responses to pain

A

-sympathetic (moderate pain)
-parasympathetic (severe pain)

39
Q

describe sympathetic responses to pain

A

moderate pain
-HTN
-tachycardia/tachypnea
-pallor
-increased blood sugar
-muscle tension

40
Q

describe parasympathic repsonses to pain

A

severe pain
-N/V
-fainting
-hypotension
-bradycardia
-rapid/irregular breathing

41
Q

name some bhavioral responses to pain

A

-grimacing
-moaning
-restlessness
-guarding
-moving away from painful stimuli
-crying

42
Q

name some affective responses to pain

A

-withdrawal
-stoicism
-anxiety/depression
-fear/anger
-anorexia
-fatigue
-hopelessness/powerlessness

43
Q

describe the diagnosis of pain

A

pain can be the primary problem
or
pain can be the etiology of another problem

44
Q

describe planning with pain

A

-patient outcomes reflect the possible realiztic outcomes
-demonstrate nurses commitment to assist the patient in pain management

45
Q

describe interventions with pain

A

-remove or alter the source of pain
-alter factors that contribute to pain tolerance (fatigue, misunderstanding of cause of pain, fear)
-establish trusting relationship

46
Q

what are some nonpharmacologic interventions for pain

A

-establihs trusting relationship and acceptable pain level
-distraction
-humor
-music
-imagery/relaxation
-cutaneous stimulation
-acupuncture
-massage/therpeutic touch
-heat/cold
-elevation
-pet therapy

47
Q

name 3 possible pharmacologic interventions for pain

A

-nonopioids
-adjunctive analgesics
-opioid analgesics

48
Q

name some nonopioids for pain

A

-aspirin (ASA)
-NSAIDs
-acetaminophen
-corticosteroids

49
Q

describe aspirin (ASA)

A

-analgesic
-anti inflammatory

50
Q

describe NSAIDs

A

-analgesic
-anti inflammatory

51
Q

describe acetaminophen

A

analgesic

52
Q

describe corticosteroids

A

anti inflammatory

53
Q

describe what nonopioids do for pain

A

-work on localized pain
-often given in scheduled manner
-not working on CNS

54
Q

what do adjuvant analgesics do?

A

confuse the nervous system

55
Q

name some adjuvant analgesics

A

-tricyclic antidepressants
-antihistamines
-caffeine
-muscle relaxants
-anticonvulsants
-antiemetic

56
Q

what do opioid analgesics do

A

work on CNS to alter percepion of pain

57
Q

name some opioid analgesics

A

-morphine
-codeine
-hydromorphone
-oxycodone
-meperidine
-fentanyl
-methadone

58
Q

name an opioid antagonist

A

naloxone

59
Q

which is more concentrated? morphine or hydromophone (dilaudid)

A

hydromorphone

1mg of hydromorphone = 7-10mg of morphine

60
Q

what does PCA stand for

A

patient controlled analgesia

61
Q

what are some different ways PCA is administered

A

-intravenous
-nerve block
-epidural
-intrathecal

62
Q

what are PCAs used to control

A

-post op pain
-chronic non malignant pain
-severe cancer pain

63
Q

who can push the clicker/button for PCA?

A

only the patient

the patient must be cognitively able to manage pushing the clicker for analgesia administration

64
Q

describe programming of PCA

A

-pump is programmed at the prescribed concentration and dose
-may include a continuous infusion and or patient bolus doses
-RNs may administer clinician doses

65
Q

what is the RNs role in using PCA

A

RNs set up, educate, monitor, and advocate

66
Q

describe evaluation of pain management

A

-optimal pain management with minimal side effects or complications
-must re-asses/evaluate after pain relieving intervention

67
Q

what are some serious opioid side effects

A

-respiratory depression
-apnea
-respiratory arrest
-circulatory depression
-hypotension
-shock

68
Q

what are some common opioid side effects

A

-constipation (decreased peristalsis and decreased secretions)
-nausea and vomiting
-sedation
-dizziness
-pruritus
-headache
-dry mouth

69
Q

name and describe the categories of the numeric sedation pain scale (POSS)

A

S: sleep, easy to arouse, no action necessary
1: awake and alert, no action necessary
2: occasionally drowsy, but easy to arouse, no action necessary
3: frequently drowsy, drifts off to sleep during conversation, reduce dosage
4: somnolent with minimal or no response to stimuli, discontinue opioid, consider use of naloxone

70
Q

when does opioid dependence usually occur

A

after 10 days of use

71
Q

what are some opioid concerns a patient may have

A

may be reluctant to take r/t fear of addiction

72
Q

describe physical dependence

A

-withdrawal syndrome arises if drug is discontinued
-dose substantially reduced, or antagonist administered

73
Q

describe tolerance

A

greater amount of drug is needed to maintain therapeutic effect (loss of effect over time)

74
Q

describe pseudoaddiction

A

-behavior suggestive of addiction
-caused by undertreatment of pain

75
Q

describe addiction (psychological dependence)

A

psychiatric disorder characterized by continued compulsive use of substance despite harm

76
Q

lifespan considerations

adults/older adults

A

-MSK pain
-occupational pain
-repetitive injuries

nursing 20030 (31 decks)

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