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pain management Flashcards

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1
Q

effects of pain

A

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

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2
Q

acute pain

A 
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
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3
Q

chronic pain

A 
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
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4
Q

gate control theory

A

nociceptive fibers carry pain impulses to dorsal horn or spinal cord

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5
Q

closed gate control theory

A

impulses do not ascent to brain

no pain perceived

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6
Q

open gate control theory

A

impulses ascend to brain

pain perceived

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7
Q

somatic pain

A

readily localized
sharp, burning, aching
ie incisional pain, would complication, arthritis

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8
Q

visceral pain

A

poorly localized
diffuse
dull, aching
ie pancreatitis, appendicitis, colitis

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9
Q

neuropathic pain

A

poorly localized
pins-and-needles
ie diabetic neuropathy, phantom limb pain

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10
Q

assessment of pain - PQRST

A 
Precipitating factors
Quality
Region/location, Radiate
Severity
Timing - onset, duration, frequency
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11
Q

localized pain

A

confined to site of origin

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12
Q

projected pain

A

not well localized

diffuse

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13
Q

radiating

A

sign nerve/nerve root along spinal column under pressure from some sort injury or inflammation

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14
Q

referred

A

pain felt in part body other than actual source

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15
Q

NEVER WITHHOLD PAIN MED

A

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

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16
Q

non-verbal pain indicator

A 
facial expression
vocalization
body movement
change in activity patterns
mental status change
increased heart rate
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17
Q

pharmacologic pain management - non-opioid

A 
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
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18
Q

pharmacologic pain management - opioid

A

no ceiling effect

more side effects but will help

19
Q

co analgesics

A

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

20
Q

acetaminophen (Tylenol)

A 
antipyretic and analgesic effects
no anti-inflammatory effects
no adverse GI effects
no effect on platelet aggregation
do no exceed over 4000mg/day
21
Q

opioids

A

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

22
Q

opioid meds

A

morphine, fentanyl (sublimaze), methadone, tramadol (Ultram), meperidine (Demerol)

23
Q

opioid side effects

A 
n/v
constipation
pruritus (itchy skin)
mental confusion
sedation
respiratory depression
hyper sensitivity reaction

manage side effects of drugs instead of discontinuing opioid

24
Q

physical dependence

A

body needs it

if stop, will go into withdrawal stage

25
Q

psychological dependence

A

dopamine in brain gives euphoric feeling

26
Q

abstinence syndrome

A

occurs when opioid therapy abruptly discontinued
symptoms - autonomic nervous system stimulation
tachycardia, hypertension, tremors, delirium
seizure activity, abd pain, vomiting

27
Q

administration

A

oral - most preferred
IV - most efficient
IM - least preferred d/t tissue damage, ineffective, inconsistent results

28
Q

PCA

A 
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
29
Q

PCA pump requirement

A

requires 2 nurses to - confirm setting, confirm and doc waste, clear settings, initiate new syringe

30
Q

epidural analgesia

A

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

31
Q

nurses role during epidural

A

hold pt in tucked, sitting position

32
Q

intrathecal analgesia

A

med directly into subarachnoid space where CSF housed
for chronic, intractable pain
more risk of CNS side effects ie sensory/motor effects

33
Q

complications of epidural/intrathecal analgesia

A 
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

34
Q

implantable device

A

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

35
Q

adjuvant analgesics

A

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

36
Q

non-pharmacologic intervention

cutaneous stimulation, physical therapy

A

cutaneous stimulation - heat/ice, pressure, vibration, massage
physical therapy - increase ROM, help restore fx and improve quality life

37
Q

application of ice vs heat

A

ice when have inflammation

heat when need muscle relax and increase blood flow

38
Q

non-pharmacologic intervention

TENS unit, CAM therapy

A

TENS unit - electrodes placed over painful area, generate impulse yielding pins-needle sensation
CAM - acupuncture, magnets, herbal supplements, imagery, distraction, relaxation, hypnosis

39
Q

types of invasive pain management

A

nerve block, spinal cord stimulation, rhizotomy, cordotomy

40
Q

nerve block

A

nerve root injected w/ local anesthetic to achieve neurolysis
high failure rate

41
Q

spinal cord stimulation

A

electrodes implanted in area of pain

electrical stimulation replaces pain impulse w/ more pleasant ones

42
Q

rhizotomy

A

destruction sensory nerve roots where enter spinal cord

43
Q

cordotomy

A

pain pathways cut

impulses cannot ascend to brain

44
Q

discharge plan for pain control

A 
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

nursing (9 decks)

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