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3105 > pain management > Flashcards

pain management Flashcards

1
Q

pain often goes _____ because it is subjective.

A

unrecognized

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2
Q

overview of pain

A

-most common reason that people seek healthcare.
-under recognized
-misunderstood
-inadequately treated
-purely subjective
-misreported or under reported

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3
Q

effects of pain

A

-decreased energy
-emotional and cognitive components
-effects interpersonal relationships
-decreased QOL
-may lead to serious physical, psychosocial, social, and financial burdens.

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4
Q

steps of nocicpetion

A
  1. transduction
  2. transmission
  3. perception
  4. modulation
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5
Q

transduction

A

activation of pain receptors.

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6
Q

transmission

A

conduction of pain sensations from injury or inflammation site along nerve pathways to the spinal cord.

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7
Q

perception

A

involves sensory process that occurs when a stimulus for pain is present. influenced by past experiences of pain. culture can also influence this.

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8
Q

modulation

A

process by which the sensation of pain is inhibited or modified. exaggerated response to combat the pain. body tries to adapt and compensate

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9
Q

tissue injury triggers _____________ to be released.

A

neurotransmitters

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10
Q

histamine and substance P

A

released to produce vasodilation and edema

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11
Q

bradykinin and prostaglandins

A

released to increase pain stimuli or sensitivity.

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12
Q

prostaglandins are inhibited by _____.

A

NSAIDs (non steroidal anti-inflammatory drugs)

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13
Q

Gate Control Theory of Pain

A

pain has emotional, cognitive, and physical components.
-non-oxious stimuli have the ability to distract the perception of noxious stimuli.

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14
Q

sympathetic responses to pain

A

-increased heart rate
-increased blood pressure
-increased blood sugar
-diaphoresis
-increased muscle tension
-dilated pupils
-decreased gastric motility

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15
Q

parasympathetic responses to pain

A

-decreased heart rate
-decreased blood pressure
-vomiting
-pallor
-nausea

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16
Q

sympathetic responds to _______ pain.

A

low or moderate

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17
Q

parasympathetic responds to ______ pain.

A

severe or deep

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18
Q

behavioral responses to pain

A

-grimacing, clenching teeth, or guarding
-decrease in activity, withdrawal
-agitation or restlessness

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19
Q

classifications of pain by duration

A

acute, chronic, and chronic episodic

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20
Q

acute pain

A

-short duration, transient, temporary
-usually identifiable cause (surgery, trauma, MI)
-predictable ending
-can inhibit recovery, so it needs to be treated

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21
Q

chronic pain

A

-prolonged, usually beyond 3-6 months
-not always from an identifiable cause. (idiopathic)
-often associated with significant psychological and cognitive effects.

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22
Q

chronic, episodic pain

A

-occurs sporadically over an extended period of time.
-migraines (frequent, same type of pain)
-sickle cell anemia

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23
Q

classifications of pain by pathology

A

nociceptive, neuropathic, and cancer pain

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24
Q

nociceptive pain

A

“aching, throbbing”
-somatic
-visceral

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25
Q

somatic pain

A

type of nociceptive pain
-bone, joint, muscle, skin

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26
Q

visceral pain

A

type of nocicpetive pain
-organs (stimulating the PNS)
-referred pain

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27
Q

referred pain

A

pain in a separate part of the body from source.
-kidney stones: may present with back or groin pain.
-MI: may present with jaw pain or left arm pain

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28
Q

neuropathic pain

A

“shooting, burning, pins, and needles”
-diabetic neuropathy
-phantom pain
-spinal cord injury

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29
Q

phantom pain

A

patients with paralysis feeling pain in a part of their body that is no longer there

30
Q

cancer pain

A

often caused by tumor progression or as a result of treatment
-more often nociceptive but can be either.

31
Q

factors influencing pain

A

-physiological
-social
-psychosocial
-cultural

32
Q

physiological influence on pain

A

-age
-developmental changes
-nuerological
-threshold tolerance
-genes

33
Q

social influence on pain

A

previous experience, labor (expected pain)

34
Q

psychosocial factors influence on pain

A

attention or distraction from the pain

35
Q

cultural factors influencing pain

A

verbalizing pain, stoic, what is within the patients ____.

36
Q

impacts of pain

A

quality of life (QOL), self care, work and school, social support

37
Q

assessing pain

A

-Provocative / palliative
-Quality
-Region / radiation
-Severity
-Timing
-Understanding effect

38
Q

provocative/palliative assessment of pain

A

what makes it better or what makes it worse?

39
Q

quality assessment of pain

A

describe your pain. aching, shooting, burning

40
Q

region / radiation assessment of pain

A

where is your pain? does it spread or radiate?

41
Q

severity assessment of pain

A

how much pain do you have now? how bad has it been in the past 24 hours?

42
Q

timing assessment of pain

A

when did it start? how long has it lasted? how often do you experience the pain?

43
Q

understanding effect assessment of pain

A

describe what you cannot do as a result of the pain. how does it impact your life?

44
Q

tools for the assessment of pain

A

-numerical
-FACES
-unable to self report: FLACC, PAINAD, NVPS, CPOT

45
Q

FLACC tool pain assessment

A

pain tool for infants and children
(Face, Legs, Arms, Cry, Consolability)

46
Q

PAINAD tool pain assessment

A

pain tools for patients with dementia
(breathing, negative vocalization, facial expression, body language, consolability)

47
Q

NVPS pain assessment tool

A

pain tool for general nonverbal pain scale
(face, activity, guarding, vital signs)

48
Q

CPOT pain assessment tool

A

pain scale for critical care patients
(Face, muscle tension, body movements, compliance with ventilator)

49
Q

key concepts of implementation

A

-requires holistic approach
-multimodal therapy may be needed
-refer to practice guidelines and stay current with EVP

50
Q

pharmacological therapy implementation

A

-around the clock (ATC)
-PRN
-Breakthrough pain
multimodal analgesia

51
Q

analgesics implementation

A

-opiods
-non opiods
-adjuvant

52
Q

opiods

A

morphine, codeine, oxycodone, hydromorphone

53
Q

non opiods

A

acetaminophen, ibuprofen, lidocaine

54
Q

adjuvants

A

antidepressants, anticonvulsants, corticosteroids

55
Q

opiod analgesics

A

SE: nausea, constipation, confusion, somnolence, respiratory depression
-start low, go slow
-monitor for drug tolerance if taken long term
-assess current or past substance abuse / addiction
-reversal agent: naloxone (narcan)

56
Q

reversal agent for opiods

A

Naloxone (Narcan)

57
Q

acetaminophen

A

Tylenol. max dose is 4,000 mg in 24 hours. cautious use with liver disease

58
Q

ibuprofen

A

Advil. max dose is 3,200 mg in 24 hours. may cause gastric upset. increase risk for bleeding, kidney injury

59
Q

lidocaine

A

often used transdermal or via local anasthesia

60
Q

pharmacological therapy routes

A

PO, IM, IV, topical.
-local anesthesia: peri neural infusion
-regional anesthesia: epidural infusion
-patient controlled analgesia (PCA)

61
Q

PCA pharmacological therapy

A

-IV or subcutaneous infusion
-locked system
-allows patients to self administer opioids
-physically able to push button
-set dose with lockout for time / frequency
-patient and family education
-verification by two nurses

62
Q

non pharmacological therapies

A

-cognitive and behavioral approach
-cutaneous stimulation
-complementary and integrative modalities

63
Q

cognitive and behavioral approach

A

-relaxation
-guided imagery
-distraction
-music

64
Q

cutaneous stimulation

A

-cold and heat application
-TENS (transcutaneous electrical nerve stimulation)

65
Q

complementary and integrative modalities

A

-acupuncture
-acupressure
-chiropractic
-massage
-movement therapy (yoga)
-therapeutic touch
-aromatherapy
-herbals

66
Q

restorative and continuing care

A

-pain clinics
-palliative care
-hospice

67
Q

patient barriers

A

-fear of addiction
-dont want to be a bother
-lack of knowledge
-cultural beliefs
-language barrier

68
Q

provider barriers

A

-inadequate assessment
-concern for addiction
-fear of legal repercussions
-dont believe patient report of pain
-time constraint
-concern for side effects or overdose

69
Q

pediatric considerations

A

-infants DO have the ability to feel pain
-infants and young children express pain differently
-infants and young children may require different pain assessments
-infants and children process medications differently (pharmacokinetics), so need to monitor more frequently

70
Q

geriatric considerations

A

-pain is NOT a normal part of aging
-older adults may be less likely to report pain
-older adults are at increased risk of side effects from medications
-adults with cognitive decline may express pain differently

71
Q

evaluation of pain management

A

-nursing process is ongoing
-variations in expression of pain
-holistic evaluation

72
Q

holistic evaluation of pain management

A

what is the effect of pain on ADLs, sleep, appetite, work, etc.

3105 (4 decks)

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