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
psychological dependence
dopamine in brain gives euphoric feeling
abstinence syndrome
occurs when opioid therapy abruptly discontinued
symptoms - autonomic nervous system stimulation
tachycardia, hypertension, tremors, delirium
seizure activity, abd pain, vomiting
administration
oral - most preferred
IV - most efficient
IM - least preferred d/t tissue damage, ineffective, inconsistent results
PCA
better control of pain less med used basal rate - continuous infusion demand dose - preprogrammed amt bolus dose for breakthrough pain lockout interval - typically 5-15 mins patient controls admin of med more consistent pain relief
PCA pump requirement
requires 2 nurses to - confirm setting, confirm and doc waste, clear settings, initiate new syringe
epidural analgesia
local anesthetic, narcotic or both into epidural space
for management of acute, post-op pain
usually for pts w/ significant risk of resp complication w/ general anesthesia
nurses role during epidural
hold pt in tucked, sitting position
intrathecal analgesia
med directly into subarachnoid space where CSF housed
for chronic, intractable pain
more risk of CNS side effects ie sensory/motor effects
complications of epidural/intrathecal analgesia
inf side effects ie n/v, itching respiratory depression hypotension urinary retention lower extremity weakness
elderly and obese pts at highest risk of resp depression
implantable device
catheter portion of device inserted into epidural space
med intermittently injected/connected to infusion device for steady delivery of analgesia
reduce chance catheter dislodgement and inf
adjuvant analgesics
non-analgesic + analgesic = greater analgesic effect
anti-epileptic useful in treating neuropathic pain ie neurontin or lyrica
tricyclic antidepressant useful in treating neuropathic pain ie elavil or cymbalta
antianxiety agents
cannabinoids
non-pharmacologic intervention
cutaneous stimulation, physical therapy
cutaneous stimulation - heat/ice, pressure, vibration, massage
physical therapy - increase ROM, help restore fx and improve quality life
application of ice vs heat
ice when have inflammation
heat when need muscle relax and increase blood flow
non-pharmacologic intervention
TENS unit, CAM therapy
TENS unit - electrodes placed over painful area, generate impulse yielding pins-needle sensation
CAM - acupuncture, magnets, herbal supplements, imagery, distraction, relaxation, hypnosis
types of invasive pain management
nerve block, spinal cord stimulation, rhizotomy, cordotomy
nerve block
nerve root injected w/ local anesthetic to achieve neurolysis
high failure rate
spinal cord stimulation
electrodes implanted in area of pain
electrical stimulation replaces pain impulse w/ more pleasant ones
rhizotomy
destruction sensory nerve roots where enter spinal cord
cordotomy
pain pathways cut
impulses cannot ascend to brain
discharge plan for pain control
see specialist for pain management rx to cover pt at home HH for PT/OT and pain management pain clinic referral TENS unit support for pt and family TEACHING
