pain management Flashcards
physiologic effects of pain
hyperglycemia, increased cardiac workload, immune system dysfunction, altered coagulation, GI ileus, urinary retention, decreased lung volume and fatigue
psychological effects of pain
social isolation, disability and lost work productivity, decrease in quality of life, depression, and demoralization
pain is
“whatever the experiencing person says it is, exciting whenever he (or she) says to does
physiology of pain: four processes
transduction, transmission, perception, modulation
transduction
converts noxious stimuli to electrical impulses (move from periphery nociceptors to dorsal horn of the spinal cord), nociceptors are stimulated by release of histamine, lactic acid, bradykinin, prostaglandins, substance P, serotonin
nociceptors are stimulated by release of
histamine, lactic acid, bradykinin, prostaglandins, substance P, serotonin
transmission
A delta fibers, C fibers, reflex arc
perception
individual interpretation of stimuli, increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads, adaptation
modulation
regulation or inhibitor of pain sensation, neuromodulators (endogenous opioid compounds) endorphins/ enkephalins
gate control theory
provides ideas for pain relief emphasizing multiple dimensions of pain; relationship between pain and emotions; sensory, emotional, behavioral, cognitive
types of pain: duration
acute, chronic/ malignant- nonmalignant
types of pain: source
cutaneous, somatic, visceral
types of pain: mode of transmission
referred
types of pain: etiology
nociceptive, neuropathic, psychogenic
a patient who has bone cancer is most likely experiencing which of the following types of pain?
somatic, pain is scattered throughout the bones, tendons and ligaments
cutaneous pain is
superficial. ex. paper cut
somatic pain is
diffuse/ scattered. ex. sprained ankle
visceral pain is
body organs due to stretch/ spasm. ex. cholangitis
neuropathic pain is
abnormal function of peripheral nervous system or central nervous system/ burning, electric/ tingling/ stabbing
allodynia is
pain after non-painful stimuli
Nociceptive pain is
caused by damage to body tissue/ caused by an external injury
psychogenic pain
cause of pain can not be identified
intractable pain
pain whose cause cannot be removed/ difficult to treat or manage/ constant pain/ so severe effects eating and sleeping. ex. migraine, headaches, tension headaches
5th vital sign
patients verbalization and description of the pain: duration, location, quantity, intensity, quality, aggravating factors, alleviating factors, behavioral responses, effect of pain
examples of nursing diagnosis for pain
acute pain r/t midsternal surgical incision/ anxiety r/t pain anticipation and inadequate pain management in the past
non pharmacological interventions for pain
music, cold, heat, acupressure, positioning, hypnosis, therapeutic touch, humor, massage, distraction
non-opioids
aspirin, NSAIDs, acetaminophen, corticosteroids
adjuvant analgesics
tricyclic antidepressants, antihistamines, caffeine, muscle relaxants, anticonvulsants, antiemetic
opioid analgeics
morphine, codeine, hydromorphone, oxycodone, meperidine, fentanyl, methadone
opioid antagonist
naloxone
invasive pain management: PCA
patient controlled analgesia: intravenous, nerve block, epidural, intrathecal
invasive pain management, PCA, used to control
postop pain, chronic non malignant pain, severe cancer pain
to be able to use PCA, patient must
be cognitively able to manage pushing the clicker for analgesia administration
RNs do what with PCA
set up, educate, monitor, advocate
opioid side effects, most serious
respiratory depression, apnea, respiratory arrest, circulatory depression, hypotension, shock
opioid side effects, common
constipation, N/V, sedation, dizziness, pruritus, headache, dry mouth
opioid physical dependence
withdrawal syndrome arises if drug discontinued, dose substantially reduced, or antagonist administered
opioid tolerance
greater amount of drug needed to maintain therapeutic effect, or loss of effect over time
opioid pseudoaddiction
behavior suggestive of addiction; caused by undertreatment of pain
opioid addiction (psychological dependence)
psychiatric disorder characterized by continued compulsive use of substance despite harm
numeric sedation scale (POSS)
pasero opioid induced sedation scale: S, 1., 2., 3., 4.
numeric sedation scale (POSS) S.
sleep, easy to arouse: no action necessary
numeric sedation scale (POSS) 1.
awake and alert; no action necessary
numeric sedation scale (POSS) 2.
occasionally drowsy, but easy to arouse; no action necessary
numeric sedation scale (POSS) 3.
frequently drowsy, drifts off to sleep during conversation; reduce dosage
numeric sedation scale (POSS) 4.
somnolent with minimal or no response to stimuli; discontinue opioid, consider use of naloxone
an hour after a patient received 2 mg of IV morphine, the nurse assesses that the patient is frequently drowsy and drifts off during his conversation with he nurse. What number on the sedation scale best describes this patient?
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