pain management Flashcards
effects of pain
poor wound healing, weakness, muscle breakdown
decreased limb movement, increased risk DVT/PE
resp effect - shallow breathing, tachypnea, cough suppression increase risk pneumonia and atelectasis
increased sodium and water retention
decreased GI mobility
tachycardia, elevated BP
acute pain
short in duration well-defined cause decreases w/ healing reversible mild to severe in intensity accompanied by anxiety and restlessness meaningful biologic purpose triggers sympathetic nervous system stimulation - tachy cardia/pnea, hypertension, diaphoresis, mydriasis
chronic pain
lasts longer than 3 mos ill-defined cause begins gradually then persist exhausting mild-severe in intensity associated with fatigue, depression, functional impairment no meaningful purpose body adapts over time vital signs don't fluctuate 2 subcategories - cancer/non-cancer pain
gate control theory
nociceptive fibers carry pain impulses to dorsal horn or spinal cord
closed gate control theory
impulses do not ascent to brain
no pain perceived
open gate control theory
impulses ascend to brain
pain perceived
somatic pain
readily localized
sharp, burning, aching
ie incisional pain, would complication, arthritis
visceral pain
poorly localized
diffuse
dull, aching
ie pancreatitis, appendicitis, colitis
neuropathic pain
poorly localized
pins-and-needles
ie diabetic neuropathy, phantom limb pain
assessment of pain - PQRST
Precipitating factors Quality Region/location, Radiate Severity Timing - onset, duration, frequency
localized pain
confined to site of origin
projected pain
not well localized
diffuse
radiating
sign nerve/nerve root along spinal column under pressure from some sort injury or inflammation
referred
pain felt in part body other than actual source
NEVER WITHHOLD PAIN MED
hold only if having resp depression
hold if not time give yet
if pt is still having pain after giving med, contact physician to increase dose
non-verbal pain indicator
facial expression vocalization body movement change in activity patterns mental status change increased heart rate
pharmacologic pain management - non-opioid
ASA NSAID Tylenol first line for mild-mod pain ceiling effect - if give more, not going to make pain better GI upset, decreased platelet adhesion
pharmacologic pain management - opioid
no ceiling effect
more side effects but will help
co analgesics
enhance analgesic efficacy
independent anagesic activity for specific types pain
relieve concurrent symptoms which exacerbate pain
able use lower doses of drugs
combo of meds helps w/ other symptoms
acetaminophen (Tylenol)
antipyretic and analgesic effects no anti-inflammatory effects no adverse GI effects no effect on platelet aggregation do no exceed over 4000mg/day
opioids
manage mod-severe pain
centrally acting - block release neurotransmitters in spinal cord
diminish perception of pain
no ceiling effect but can develop tolerance
adverse effects can prevent titration
range from weak to potent
start low and slow for elderly
opioid meds
morphine, fentanyl (sublimaze), methadone, tramadol (Ultram), meperidine (Demerol)
opioid side effects
n/v constipation pruritus (itchy skin) mental confusion sedation respiratory depression hyper sensitivity reaction
manage side effects of drugs instead of discontinuing opioid
physical dependence
body needs it
if stop, will go into withdrawal stage
