Pain Management Flashcards
describe PAIN
- is completely SUBJECTIVE
- no two people experience it the same way
- the most common reason why people seek healthcare
describe PAIN MANAGEMENT
- practicing PATIENT ADVOCACY
- must be PATIENT-CENTERED
- nurses are legally responsible for ASSESSING & MANAGING PAIN
describe the NATURE OF PAIN
- can be PHYSICAL, EMOTIONAL, & COGNITIVE
- type of PHYSIOLOGICAL MECHANISM that protects an individual from a harmful stimulus
describe the PHYSIOLOGY OF PAIN
has the processes of;
TRANSDUCTION
TRANSMISSION
PERCEPTION
MODULATION
these are all aspects of NOCICEPTION
nociception
- an observable activity in the nervous system that allows people to detect pain
- the PROTECTIVE PHYSIOLOGICAL SERIES OF EVENTS that brings awareness of actual or potential tissue damage
transduction
conversion of specific THERMAL, MECHANICAL, or CHEMICAL STIMULI (energy) into ELECTRICAL IMPULSES
transmission
- sending and transmission of the NOCICEPTIVE IMPULSE
- usage of MYELINATED (A-DELTA FIBERS) + UNMYELINATED FIBERS (C-FIBERS)
- transmission into MULTIPLE AREAS OF THE BRAIN
perception
- interpretation of the QUALITY OF PAIN & processing of information from other experiences, knowledge etc…
- point of AWARENESS of NOCICEPTIVE IMPULSES
modulation
activation of ENDOGENOUS DESCENDING INHIBITORY MEDIATORS
endorphins, GABA, norepinephrine, serotonin
production of an ANALGESIC EFFECT
helps to HINDER TRANSMISSION OF NOCICEPTIVE IMPULSES
gate-control theory of pain
- consists of PHYSIOLOGICAL or BEHAVIORAL RESPONSES
physiological response
- AUTONOMIC NERVOUS SYSTEM:
- stimulated in the SYMPATHETIC BRANCH
- results in PHYSIOLOGICAL RESPONSES;
- increased heart rate, dilation of bronchial tubes, peripheral vasoconstriction, increased blood glucose, increased cortisol levels, diaphoresis
behavioral responses
- affected by CULTURE, PAIN PERCEPTION, STRESS MANAGEMENT, & EXP. WITH PAIN
acute pain
- protective and typically of SHORT DURATION
- common from ACUTE INJURY, DISEASE, or SURGERY
- often have FRIGHTENED, ANXIOUS PATIENTS
CHRONIC/PERSISTENT NONCANCER PAIN
- is NOT protective
- prolonged + varies in intensity; usually lasts longer than 3 - 6 months
- does NOT ALWAYS have an IDENTIFIABLE CAUSE
- low back pain, arthritis, fibromyalgia etc…
- can sometimes FRUSTRATE a PATIENT
CHRONIC EPISODIC PAIN
- pain that happens SPORADICALLY & over extended period of time
- ex. sickle cell crisis or migraines
CANCER PAIN
- often caused of TUMOR PROGRESSION - related to PATHOLOGICAL PROCESSES + INVASIVE PROCEDURES + TOXICITIES of CHEMOTHERAPY, INFECTION, or PHYSICAL LIMITATIONS
IDIOPATHIC PAIN
- type of CHRONIC PAIN that either does NOT HAVE an IDENTIFIABLE PHYSICAL or PSYCHOLOGICAL CAUSE
- ex. COMPLEX REGIONAL PAIN SYNDROME
what are some preconceptions nurses have about pain?
- don’t believe the patient is in pain
- thinks patient is just difficult, complaining
- only reporting and observing through objective data
- fear of medication addiction
what are the factors that influence PAIN?
- PHYSIOLOGICAL
- SOCIAL
- PSYCHOLGICAL
- CULTURAL
what are the PHYSIOLOGICAL FACTORS that influence pain?
- AGE
infants - they DO FEEL PAIN; cannot express or understand
adolescents - development changes
elders - pain is NOT a normal thing as we age/polypharmacy/decreased app. - FATIGUE
more tired = more pain - GENES
- NEUROLOGICAL FXN.
neuropathy - diabetic patients/SCI
what are the SOCIAL FACTORS that influence pain?
- PREVIOUS EXPERIENCE
- FAMILY & SOCIAL NETWORK
- SPIRITUAL FACTORS
what are the PSYCHOLOGICAL FACTORS that influence pain?
- ATTENTION
- ANXIETY & FEAR
- COPING STYLE
what are the CULTURAL FACTORS that influence pain?
- MEANING OF PAIN
- ETHICITY
what are the FACTORS THAT ARE IMPACTED BY PAIN ITSELF?
- person’s quality of life
- way of self-care
- how one works
- proper social support
what factors to consider during PAIN ASSESSMENT?
- pain level scale; the SUBJECTIVITY OF PAIN
- pain expression
- physical exam
- pain characteristics;
timing (onset, duration & pattern)
what are our types of PAIN SCALES?
- NUMERICAL RATING SCALE (older adults - cog. active)
- VERBAL DESCRIPTIVE SCALE (use of descriptors or words)
- VISUAL ANALOG SCALE
- WONG-BAKER FACES PAIN RATING SCALE (often used in pediatric settings)
what are the PAIN CHARACTERISTICS?
- the quality
- aggravating/precipitating factors (what makes it better or worse)
- relief measures
what are the PAIN EFFECTS?
- effects on behavior
- effects on ADLs
concomitant symptoms
symptoms that come with pain; increases severity
ex. headaches, or nausea
how to promote health - pain
be OPEN MINDED
use measures that the patient believes
- IMPROVEMENT IS THE GOAL; being completely free of pain is not always realistic
what are our NONPHARMACOLOGICAL PAIN-RELIEF INTERVENTIONS?
- relaxation/guided imagery
- distractions
- music
- cutaneous stimuli; massages/hot/cold
- herbals
- reducing pain perception
what are our PHARMACOLOGICAL PAIN THERAPIES?
- PCA; PATIENT-CONTROLLED ANALGESIA
- topical/transdermal
- local anesthesia / injection
- epidural
- perineural local anesthetic infusions
what type of ANALGESICS CAN WE TAKE FOR PAIN?
- NONOPIOIDS; tylenol
- OPIOIDS; narcotics/oxycodone (mod-severe)
- ADJUVANTS/CO-ANALGESICS; not directly meant for pain; but helps
how are PCAs controlled?
- the PATIENT IS THE ONLY PERSON who should press button
- look for signs of oversedation/resp. depression
- only certain amts are administered
