pain management Flashcards
a subjective and individual phenomenon that warns us of potential injury and alerts us when tissue damage has occurred.
pain
involves the normal processing of painful stimuli and is described in terms of a 4 step process that occurs when pain becomes a conscience event.
nociception
extends from the periphery through the spinal cord, brain stem, and thalamus to the cerebral cortex, where the sensation is perceived.
the nociceptive system
Occurs when energy is converted from one form to another and injured cells release substances that activate nearby nociceptors. Substance P, bradykinins, prostaglandins are released.
transduction
a peripheral nervous system receptor that is sensitive to harmful stimuli
nociceptor
the bright, sharp, well localized pain that is immediately associated with the injury
A-delta fibers
cause second pain sensation that is dull, poorly localized and persistent after injury
C-fibers
where complex processing of messages occurs. It is one of the most important areas for pain transmission
the spinal dorsal horn
the result of potential or actual injury and includes activation of nociceptive fibers at the site of localized injury. It is time limited and occurs after trauma, surgery, or disease process. May have observable signs such as increased heart rate, respirations and elevated blood pressure.
acute pain
an abnormal pain signaling process with origins that can occur both peripherally and centrally. It is cyclical and irreversible and generally persists longer than 3-6 months. These patients may appear flat.
persistant (chronic) pain
A mechanism that can lead to chronic pain. It occurs when nociceptors bombard the CNS from the periphery, which leads to long term changes in the CNS.
central sensitization
an exaggerated réponse to normal painful stimuli. Results in a lower pain threshold. Common in patients with postherpetic neuralgia
hyperalgesia
occurs due to abnormal pain signaling that results in perceived pain with mild, non painful stimuli. Example- diabetic neuropathy
allodynia
originates in bone, skin, and soft tissue and is often well localized
somatic pain
originates internally as the result of stretching, distention and inflammation or damage to the hollow and solid organs. usually described as aching, throbbing, pressure, cramping, deep, or radiating.
visceral pain
arises from damage of the peripheral nerves or the CNS and unlike nociceptive pain is the result of abnormal sensory input
neuropathic pain
pain that can be observed by objective signs in the face, lower extremity positioning, activity level, crying and level of consolation
newborn and infant pain
they have the ability to describe but may also be associated with lethargy, fatigue, anorexia, and regression
toddler and preschooler pain
are able to describe, identify and rationalize pain. Regression is possible.
school aged children
pain puts them at greater risk for depression, social isolation, and cognitive dysfunction. They most likely have decreased opioid receptors and increased inflammatory activity and are at risk for poor pain management.
older adults
an emotional response associated with increased pain. It is associated with events that threatens a person’s intactness.
suffering
occurs when a patient receives a drug such as an opioid continuously over an extended period of time
tolerance
a physiologic adaptation that is characterized by the development of withdrawal symptoms such as diaphoresis, anxiety,tachycardia, or nausea when the drug is stopped abruptly
physical dependance
patients who take medication for euphoria rather than for it’s intended pain relieving properties
addiction
- must be controlled only by the PATIENT
- decreases the likeliness of over sedation events
- documentation is important to monitor for safeness and effectiveness.
PCA (patient controlled analgesia)
a catheter is placed in the epidural space to deliver analgesia
- hypotension is a common side effect
- patient should sit upright on bedside before getting up
- calf pump exercises can increase blood flow prior to ambulation
epidural infusion therapy
a band of skin innervated by the sensory root of a single spinal nerve
dermatome
maintaining body alignment, regular scheduled turning, and limb elevation to decrease edema, maintaining a therapeutic environment, good hygiene
basic comfort measures
decreases the sensitivity to pain and increases blood flow through vasodilatation of blood vessels. 40-45 degrees C and 5-30 minutes as tolerated.
heat application
decreases sensitivity to pain and is useful for muscle spasms, back pain, arthritis, headache trauma, and surgical incisional pain.
- acts faster than heat
- 15 degrees C
- no longer than 20 mins
cold application
used as an adjunct in the overall management of acute and chronic pain. It is a palm-sized light weight, simulator that generates a mild electrical impulse.
- contraindication for patient with pacemaker and implanted devices
TENS ( transcutaneous electrical nerve stimulation) unit
the patient learns voluntary control over autonomic functions such as heart rate, hand temperature and muscle tension
biofeedback
- Pain receptors
- pain impulse
- A delta fibers
- C fibers
transmission
Cortical structures of brain (emotions, physiological)
Therapies- relaxation, imagery
perception
Either pain signal transmission or pain receptor Occurs in “descending system Endorphins released Medications Heat,cold,pressure Gate Control Theory
modulation
hastens death potential decrease immune system decrease mobility risk for pneumonia/embolism increase work heart/lung impairs quality of life
inadequate pain relief
