pain management Flashcards
what is pain
-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”
what are the physiological effects of pain
-hyperglycemia
-increased cardiac workload
-immune dysfunction
-altered coagulation
-ileus
-urinary retention
-decreased lung volume
-fatigue
-debility
what are some psychological effects of pain
-social isolation
-disability/lost work
-poor quality of life
-anxiety
-depression
-demoralization
-suicide
what are the four processes of pain
-transduction
-transmission
-perception
-modulation
describe transduction
-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
nociceptors are stimulated by the release of…
-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)
describe transmission
-A-delta fibers and C fibers move pain impulse
-reflex arc
describe A-delta fibers
larger, transport more localized pain
describe C fibers
transport aching pain
describe perception of pain
-individual interpretation of stimuli
-threshold (lowest intensity of stimulus that causes recognition of pain)
-adaptation (pain become tolerable over time)
describe modulation of pain
-regulation or inhibition of pain sensation
-neuromodulators are involved
what are neuromodulators
-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
name two neuromodulators
-endorphins (released when pain relieving drugs are used
-enkephalins (widespread in CNS, less potent, inhibit substance P)
what is gate control theory
-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
types of pain
describe duration
can be
-acute
-chronic/prolonged/persistent (which can be malignant or nonmalignant)
types of pain
describe source
-cutaneous
-somatic
-visceral
types of pain
describe mode of transmission
referred
types of pain
describe etiology
-nociceptive
-neuropathic
-psychogenic
describe acute pain
-rapid onset
-varies in intesity
-protective in nature
-after underlying cause is gone the pain goes away
describe chronic/persistent/prolonged pain
-intermittent or persistent
-lasts beyond normal healing period
-periods of remission and exacerbation
-difficulty describing pain -> often perceived as meaningless
describe cutaneous pain
-superficial
-ex. paper cut
describe somatic pain
-diffused/scattered
-ex. sprained ankle
describe visceral pain
-body organs due to stretch/spasm
-most difficult to describe
-ex. cholangitis
describe neuropathic pain
-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)
describe psychogenic pain
-no physical cause, cant be identified
-results from a mental event
describe intractable pain
-resistent to treatment
-persists despite interventions
pain experience is affected by…
-culture/ethnicity
-family/gender/age
-religious beliefs
-environment
-anxiety
-past pain experience
lifespan considerations r/t pain
newborn/infant
-can’t communicate
-under treatment of pain
lifespan considerations r/t pain
toddler/preschooler
cannot ID pain
lifespan considerations r/t pain
school age/adolescent
cant rationalize pain
lifespan considerations r/t pain
culture
communication/devalued
describe assessment of pain
-5th vital sign
-patient’s verbalization and description of the pain
-nonverbal behaviors
-include a goal
whats the PQRST pain assessment
-Provokes
-Quality
-Radiates
-Severity
-Time
describe assessment frequency
-initial assessment
-new onset pain
-prior to pain relieving intervention
-(evaluation) after pain relieving intervention
-routine intervals
what are some tools for quantifying pain
-verbal rating scale (1-10)
-wong baker FACES
-NVPS (adult nonverbal pain scale)
-CRIES observer pain scale
-FLACC
CRIES and FLACC are for children
name some shit involved in the assessment of pain
-duration
-location
-quantity/intensity
-quality
-aggravating/alleviating factors
-physiologic indications of pain
-behavioral responses
-effect of pain
describe the assessment of the quality/intensity of pain
-making the subjective objective
-use appropriate and consistent pain scale
-what is an acceptable level of pain? (pain tolerance)
describe the physiologic responses to pain
-sympathetic (moderate pain)
-parasympathetic (severe pain)
describe sympathetic responses to pain
moderate pain
-HTN
-tachycardia/tachypnea
-pallor
-increased blood sugar
-muscle tension
describe parasympathic repsonses to pain
severe pain
-N/V
-fainting
-hypotension
-bradycardia
-rapid/irregular breathing
name some bhavioral responses to pain
-grimacing
-moaning
-restlessness
-guarding
-moving away from painful stimuli
-crying
name some affective responses to pain
-withdrawal
-stoicism
-anxiety/depression
-fear/anger
-anorexia
-fatigue
-hopelessness/powerlessness
describe the diagnosis of pain
pain can be the primary problem
or
pain can be the etiology of another problem
describe planning with pain
-patient outcomes reflect the possible realiztic outcomes
-demonstrate nurses commitment to assist the patient in pain management
describe interventions with pain
-remove or alter the source of pain
-alter factors that contribute to pain tolerance (fatigue, misunderstanding of cause of pain, fear)
-establish trusting relationship
what are some nonpharmacologic interventions for pain
-establihs trusting relationship and acceptable pain level
-distraction
-humor
-music
-imagery/relaxation
-cutaneous stimulation
-acupuncture
-massage/therpeutic touch
-heat/cold
-elevation
-pet therapy
name 3 possible pharmacologic interventions for pain
-nonopioids
-adjunctive analgesics
-opioid analgesics
name some nonopioids for pain
-aspirin (ASA)
-NSAIDs
-acetaminophen
-corticosteroids
describe aspirin (ASA)
-analgesic
-anti inflammatory
describe NSAIDs
-analgesic
-anti inflammatory
describe acetaminophen
analgesic
describe corticosteroids
anti inflammatory
describe what nonopioids do for pain
-work on localized pain
-often given in scheduled manner
-not working on CNS
what do adjuvant analgesics do?
confuse the nervous system
name some adjuvant analgesics
-tricyclic antidepressants
-antihistamines
-caffeine
-muscle relaxants
-anticonvulsants
-antiemetic
what do opioid analgesics do
work on CNS to alter percepion of pain
name some opioid analgesics
-morphine
-codeine
-hydromorphone
-oxycodone
-meperidine
-fentanyl
-methadone
name an opioid antagonist
naloxone
which is more concentrated? morphine or hydromophone (dilaudid)
hydromorphone
1mg of hydromorphone = 7-10mg of morphine
what does PCA stand for
patient controlled analgesia
what are some different ways PCA is administered
-intravenous
-nerve block
-epidural
-intrathecal
what are PCAs used to control
-post op pain
-chronic non malignant pain
-severe cancer pain
who can push the clicker/button for PCA?
only the patient
the patient must be cognitively able to manage pushing the clicker for analgesia administration
describe programming of PCA
-pump is programmed at the prescribed concentration and dose
-may include a continuous infusion and or patient bolus doses
-RNs may administer clinician doses
what is the RNs role in using PCA
RNs set up, educate, monitor, and advocate
describe evaluation of pain management
-optimal pain management with minimal side effects or complications
-must re-asses/evaluate after pain relieving intervention
what are some serious opioid side effects
-respiratory depression
-apnea
-respiratory arrest
-circulatory depression
-hypotension
-shock
what are some common opioid side effects
-constipation (decreased peristalsis and decreased secretions)
-nausea and vomiting
-sedation
-dizziness
-pruritus
-headache
-dry mouth
name and describe the categories of the numeric sedation pain scale (POSS)
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
when does opioid dependence usually occur
after 10 days of use
what are some opioid concerns a patient may have
may be reluctant to take r/t fear of addiction
describe physical dependence
-withdrawal syndrome arises if drug is discontinued
-dose substantially reduced, or antagonist administered
describe tolerance
greater amount of drug is needed to maintain therapeutic effect (loss of effect over time)
describe pseudoaddiction
-behavior suggestive of addiction
-caused by undertreatment of pain
describe addiction (psychological dependence)
psychiatric disorder characterized by continued compulsive use of substance despite harm
lifespan considerations
adults/older adults
-MSK pain
-occupational pain
-repetitive injuries
