Pain Management : Chapter 46 Flashcards
Pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage
How is Pain Described
Location
- Referred - arises in different areas ex…cardiac pain may be felt in shoulder or left arm
- Visceral - arising form organs or hollow viscera
Duration
- Acute - lasts only through expected recovery period
- Chronic - prolonged, lasts 3 months
- Cancer - results from the the effects of the disease
Intensity
* Mild 1-3, *Moderate 4-6, *Severe 7-10
Etiology
- Nociceptive - Nervous system sends signals that tissues are damage and require care
1) Somatic Pain - skin, muscles, bone, or connective tissue ex…paper cut
2) Visceral Pain - pain from the organs: heart attack, labor pain, angina, irritable bowel - Neuropathic - damage to nerve due to illness such as
1) Peripheral - phantom limb pain
2) Central - spinal cord injury
Sympathetically Maintained Pain - abnormal connections between pain fibers and the sympathetic nervous system perpetuate problems with both the pain and sympathetically controlled functions
Common Chronic Pain Syndromes
Post Herpetic Neuralgia - Shingles
Phantom Limb Pain - amputation
Trigeminal Pain - intense stablike pain, 5th cranial nerve, face muscle spasms
headache or migraine
Low Back and Neck Pain
Fibromyalgia - widespread musculoskeletal pain, fatigue, and multiple tender spots
Concepts Associated With Pain
Pain threshold - least amount of stimuli that is needed for person to have pain
Pain tolerance - max amount of painful stimuli that a person is willing to withstand w/o seeking avoidance of the pain or relief
Hyperalgesia /Hyperpathia - heightened response to a painful stimuli (sever pain reponse to a paper cut)
Allydonia - nonpainful stimuli (light,touch, water, wind)
Dysesthesia - unpleasant abnormal sensation that can be spontaneous or evoked
Sensitization - increases sensitivity of a receptor after repeated activation by noxious stimuli
Gate Control Theory
Pain Stimulates the nerve fibers ABeta and C, they’re responsible for taking the nerve pain stimulation to the brain.
ABeta fibers are responsible for pain that is acute and immediate
C fibers are responsible for pain that is chronic
Factors That Affect Pain
refer to book
page 1211, green box at the bottom and page 1212, 1213,1214
Observation
Noverbal Responses to Pain
- facial expressions; facial grimaces
Vocalizations - moaning, groaning, crying, screaming
Immobilization - person with chest pain may hold their chest (Splinting)
Purposeless body movements - tossing and turning in the bed, flinging the arms, involuntary movements such as reflexive jerking away from a needle.
Behavioral Change - confusion, restlessness
rhythmic body movements such as rubbing, rocking back and forth
Physiological Response to Pain
SNS is stimulated which mimics the “fight or flight” mechanisms of the ANS
Signs Are : increased BP, P, RR, pallor, diaphoresis, and pupil dilation. May be absent in people w/ chronic pain because of ANS adaptation
Barriers to Effective Pain Management
- lack knowledge of adverse effects of pain
- provided wrong info about use of analgesics
- not reporting pain due to fear of nothing being done for it pain is not severe enough
- fear of addiction to pain meds
Pharmacologic Interventions
- Nonopiod analgesics/NSAIDS for mild pain
- Acetaminophen (Tylenol), Acetylsalicylic (asprin), Ibuprofen (Mortin, Advil), Ketrolac (toradol),
- Opiod Analgesics for Moderate Pain
- Hydrocodone (Lortab, Vicodin), Codeine (Tylenol No.3), Tramadol (Ultram, Ultracet)
- Opiod Analgesics for Severe Pain
- Fentanyl citrate (Sublimaze, transdermal patches, Actiq)
Hydromorhone (Dialudid), Oxycodone (OxyContin), - Coanalgesics
- Tricyclic antidepressants (nortriptyline, amitriphyline)
Anticonvulsants (gabapentin, pregabalin)
Topical local anesthetic (lidoderm)
Opiod Side Effects
- Constipation - all clients should receive prophylactic stimulant laxative therapy( senokot). If that doesn’t work then cathargic laxatives (bisacodyl) follwed by an enema or impaction
- nausea and vomitting
- sedation
- respiratory depression
- pruritus
- urinary retention
