Pain Management Part 1 Flashcards
What are your 5 vital signs?
Heart Rate, Respiratory Rate, Blood Pressure, Temperature, & Pain
This is whatever the patient says it is =
Pain
What kind’s of pt’s will you need to monitor for pain by assessing for things like Facial Grimacing + Guarding and by monitoring their vitals?
People who are Dementia pt’s, Mentally Disabled, Children (With an undeveloped sense of talking), have Communication Challenges (Expressive Aphasia, Comatose, On Ventilators)
How do you know which pain scale to give a patient?
It depends on their age and their condition
What are things that you would document about pain?
You’d document their description of the pain, any objective assessments that you see (Hypertension, Diaphoresis, and any Behavioral Responses such as Guarding, Restlessness, Facial Grimacing)
What is the definition of Pain?
An unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage
Can pain be an emotional experience?
Yup
Is pain subjective, objective, or both?
Subjective
What are things that pain may affect?
Ability to perform ADL’s.
Participate in Activities.
Work.
Sleep.
Undertreatment of pain is a serious healthcare problem that cause what kinds of issues for pt’s?
Psychological and Physiological
The family encourages the client to “tough out the pain” rather than risk drug addiction. The client is stoic and does what the family says. The nurse recognizes that the cultural dimension of pain is a priority for this client.
Which question does the nurse ask?
A.) “Where is the pain located and does it radiate to other parts of your body?”
B.) “How would you describe the pain and how is it affecting you?”
C.) “What do you believe about the use of pain medication?”
D.) “What information do you need about pain, healing, and addiction?”
C
What separates the different categories of factors that cause pain?
The Biopsychosocial Model of Pain
What are the different factors that form pain?
Biological Factors, Social Factors, Psychological Factors
List some Psychological Factors that form pain:
Mood/Affect
Catastrophizing
Stress
Coping
List some Biological Factors that form pain:
Disease Severity
Nociception
Inflammation
Brain Function
List some Social Factors that cause pain:
Cultural Factors
Social Environment
Economic Factors
Social Support
What can cause an increased sensitivity to pain?
Fatigue
What can cause an increase OR decrease to pain tolerance?
Genetics
Impairment of cognitive functioning may leave the pt unable to-
Express pain or to express it clearly
What can increase or decrease a pt’s pain sensitivity?
Their past experiences (It all comes down to when or if their pain was relieved and what actions were took to decrease it)
Anxiety & Fear can-
Increase Pain Sensitivity
What non-drug things can decrease pain sensitivity?
Support Systems & Coping Styles
What influences how a pt expresses pain and how they define pain?
Their Cultural Factors
A post-op pt expresses concern about discharge and has nowhere to live. How does the Biopsychosocial Model of Pain (particularly the Social Factors) contribute to the pt’s pain?
This person doesn’t have a place to live, so they likely don’t have anyone to support for them or have a support system. This can increase the pt’s anxiety and their pain perception.
The pt may also not have a job, have poor or no insurance, have no ability to forward supplies, have no access to further therapies.
All of these concerns can increase the pt’s pain level + their response to stimuli.
How should a nurse prioritize their responsibilities for a pt in pain?
Measure their pain level continuously.
Provide individualized interventions.
Reassess the pain after giving pain meds.
Analgesics =
Pain Meds
How long after giving Analgesics should you reassess a pt’s pain level?
10 - 60 mins
What are the types of pain management?
Pharmacological
Nonpharmacological
Invasive Therapies
What are invasive therapies used for?
Intractable Pain
What can cause intractable pain?
Cancer
This is when a painful physical or chemical stimulus is transformed into a signal that can be carried (via transmission) to the CNS and be perceived as pain =
Transduction
The process of communication between neurons =
Transmission
The point at which a stimulus causes the client perceive pain =
Pain Threshold
How much of a stimulus the client is willing to accept =
Pain Tolerance
The Perception / Awareness of Pain can be called-
Nociception
Neurons originating in the brainstem descend to the spinal cord and release substances that inhibit nociceptive impulses =
Modulation
What are pain mechanisms called?
Nociceptive
The physiologic phases of how info about tissue damage is relayed to the CNS =
Nociception
When does Nociception occur?
From the point of first getting tissue damage to the point of feeling the pain from that damage
What chemicals activate Nociceptors, increase Transduction, and lead to a generation of action potential (Pain Signals)?
Prostaglandins
Bradykinin
Substance P
Histamine
What chemicals decrease pain transmission and produce analgesia?
Serotonin
Endorphins
What’s one substance released during Modulation that can inhibit nociceptive impulses =
Endogenous Opioids
What does the process of Modulation do to pain?
Lowers it a little
How many phases of Nociception are there?
4
What activates pain receptors?
Noxious Stimuli
What types of Noxious Stimuli are there?
Chemical, Thermal, and Mechanical
What occurs during the first phase of Nociception?
Substances are released (Prostaglandins, Histamine, and Serotonin).
Nociceptors are activated.
What is the first phase of Nociception called?
Transduction
What is a Noxious Stimuli?
A stimulus that is actually, or potentially, damaging to tissue and liable to cause pain, but does not invariably do so
Specialized nerve endings that detect painful stimuli =
Nociceptors
What does Phase 1 Pain Control do?
Block Transduction
What meds can block transduction?
NSAIDS (like Ibuprofen) and Local Anesthetics
How do NSAIDS block transduction?
They decrease inflammation and block prostaglandins (preventing Nociceptors from activating)
How do Local Anesthetics block transduction?
They desensitize the Nociceptors which decreases the effects of chemicals released at the injury site
Rejection of any stimulation (Irritation, Scratching, Pressure) will -
Block Transduction
What causes mechanical stimuli?
Trauma to body tissues (Like Surgery)
Alterations in body tissues (Like Edema)
Blockage of a body duct
Tumors
Muscle Spasm
How does trauma to body tissues (Like Surgery) cause mechanical stimuli?
Tissue damage.
Direct irritation of the pain receptors.
Inflammation.
How does an alteration in body tissues (Like Edema) cause mechanical stimuli?
Pressure on pain receptors
How does the blockage of a body duct cause mechanical stimuli?
Distinction of the lumen of the duct
How do Tumors cause mechanical stimuli?
Pressure on pain receptors.
Irritation of nerve endings.
How do Muscle Spasms cause mechanical stimuli?
Stimulation of pain receptors
What causes a Thermal Stimulus?
Extreme heat or cold (burns)
How does extreme heat or cold cause thermal stimuli?
Tissue Distruction.
Stimulation of thermosensitive pain receptors.
What can cause a Chemical Stimulus?
Tissue Ischemia (Like a Coronary Blocked Artery)
Muscle Spasm
How can Tissue Ischemia (Like a Blocked Coronary Artery) cause a Chemical Stimulus?
Stimulation of pain receptors because of accumulated lactic acid (and other chemicals like Bradykinin and Enzymes) in tissues
How can cause a Muscle Spasm case a Chemical Stimulus?
Muscle spasms can be caused by tissue ischemia
What is the second phase of Nociception called?
Transmission
Pain is transmitted from what to where?
From Periphery to the Thalamus
These carry pain signals to the spinal cord =
Primary Afferent Fibers
These conduct fast, initial sharp, local pain =
Small A-Delta Fibers
These conduct slow, aching, throbbing, unlocalized, persistent pain =
Small C Fibers
These are a Neurotransmitter that move impulses across a synapse =
Substance P
Name some types of Primary Afferent Fibers?
The Small A-Delta Fibers
The Small C Fibers
What occurs during the Transmission Phase?
The Primary Afferent Fibers carry pain signals to the Spinal Cord.
Substance P moves those signals from the Spinal Cord towards the brain.
The signal goes up to the Brain Stem, Thalamus, & Cortex.
What do Phase 2 Pain Control Meds do?
They Block Transmission
The best meds for Phase 2 Pain Control are-
Opioid Analgesics
How are Opioid Analgesics the best meds for Phase 2 Pain Control?
They bind to Opioid Receptors, this blocks the release of the Substance P
What is the third phase of Nociception called?
Perception Phase
What occurs during phase 3 of Nociception?
The pt becomes aware of pain, the perception is related to the intensity of the stimuli and the cause of the pain
What is Phase 3 Pain Control like?
It’s all Behavioral (Distraction, Relaxation Techniques, Positive Imagery, & Meditation)
This is when your pt will be able to recognize, define, and assign meaning to the pain =
The Perception Phase
What is Phase 4 of Nociception called?
The Modulation Phase. You could also call it The Descending Phase
This is the activation of descending pathways to either inhibit or decrease pain transmission or to help pain transmission =
Modulation
What occurs during the Modulation Phase?
Signals from the Brain are sent to the Spinal Cord.
Once they reach the Spinal Cord, Inhibitors are released (Serotonin & Endorphins).
The Inhibitors will Inhibit the ascending pain impulse.
What are some Phase 4 Pain Control Meds?
Tricyclic Antidepressants (like Amitriptyline / brand name: Elavil)
How do Tricyclic Antidepressants aid in Phase 4 Pain Control?
They slow the uptake of Serotonin and Norepinephrine. This can inhibit or slow pain reception in the brain.
What is Central Sensitization?
The hyper-excitability of Neurons. This can cause Hyper-Algeria.
What is Hyper-Algesia?
An Exaggerated Pain Response
Acute, unrelieved pain can lead to-
Why?
Chronic Pain.
Because of a prolonged Central Sensitization.
Always manage acute pain in order to -
Prevent Chronic Pain
What are some Sympathetic Physiological Reactions to Pain?
Bronchial Tube Dialation
Increased HR
Peripheral Vasoconstriction
Increased Blood Glucose
Diaphoresis
Muscle Tension Increase
Pupil Dilation
Decreased GI Motility
What are some Parasympathetic Physiological Reactions to Pain?
Pallor
Nausea
Vomiting
Decreased HR
Decreased BP
Rapid, Irregular Breathing
What is the cause/effect of Bronchial Tube Dilation?
Provide increased oxygen intake
What is the cause/effect of Increased HR?
Provides increased oxygen support
What is the cause/effect of Peripheral Vasoconstriction (Pallor + Elevated BP)?
Elevates the BP with a shift of blood supply from periphery to viscera to skeletal muscles & brain
(To simplify it takes blood away from the limbs via vasoconstriction. The body then spends it where it may be needed elsewhere, such as the internal organs, skeletal muscles, and brain)
What is the cause/effect of Increased Blood Glucose?
Provides Additional Energy
What is the cause/effect of Diaphoresis?
Controls the body temp during stress
What is the cause/effect of Increased Muscle Tension?
Prepares muscles for action
What is the cause/effect of Pupil Dilation?
Affords better vision
What is the cause/effect of Decreased GI Motility?
Frees energy for more immediate activity
What is the cause/effect of Pallor?
Causes blood supply to shift away from periphery
What is the cause/effect of Nausea & Vomiting?
Vagus nerve sends impulses to chemoreceptors trigger zone in the brain
What is the cause/effect of Decreased HR + BP?
Results from vagal nerve stimulation
What is the cause/effect of Rapid, Irregular Breathing?
Causes body defenses to fail under prolonged stress of pain
Factors that influence pain:
Age + Fatigue + Genetic Activity + Cognitive Function + Prior Experiences + Anxiety & Fear + Support Systems & Coping Styles + Culture
How does Fatigue, Anxiety, & Fear affect pain?
Increases Sensitivity
Can either decrease or increase pain tolerance =
Genetics
Impaired cognition =
Impaired ability to report pain
Affects how a person gives meaning to their pain and expresses it =
Culture
What are some reasons for the undertreatment of pain?
Cultural & Societal Attitudes
Lack of Knowledge
Fear of Addiction
Exaggerated Fear of Respiratory Depression
Populations at risk for the undertreatment of pain:
Infants
Children
Older Adults
Pt’s with Substance Abuse Disorder
The main thing to remember with Opioids is that the number 1 thing to make sure to monitor is-
Respiratory and Airway (Respiratory Depression) and Addiction
A nurse is planning care for an older-adult patient who is experiencing pain.
Which statement made by the nurse indicates the supervising nurse needs to follow up?
A.) “As adults age, their ability to perceive pain decreases.”
B.) “Older patients may have low serum albumin in their blood, causing toxic effects of analgesic drugs.”
C.) “Patients who have dementia probably experience pain, and their pain is not always well controlled.”
D.) “It is safe to administer opioids to older adults as long as you start with small doses and frequently assess the patient’s response to the medication.”
A
What are some of the expected findings for a pt in pain?
Facial Expressions (Grimacing & Wrinkling Forehead)
Body Movements (Restlessness, Pacing, Guarding)
Moaning & Crying
Decreased Attention Span
Increased BP, Pulse, & Respirations (With Acute Pain)
Hyperalgesia
Hyperalgesia =
Heightened Sense of Pain
Should you include pharmacological or nonpharmacological treatments for a pt in pain?
Use Both
What is an example of something that’d require nursing judgement whenever treating a pt in pain?
You need to use nursing judgment to administer which analgesic is appropriate when more than one are prescribed
You have a pt who is prescribed Morphine and Acetaminophen. Their pain level is a 3.
Which would you give?
Acetaminophen (Because their pain isn’t very severe)
You have a pt who is prescribed Morphine and Acetaminophen. Their pain level is an 8.
Which would you give?
Morphine (Because their pain is severe)
What would be considered mild pain on the numerical pain scale?
1-3
What would be considered moderate pain on the numerical pain scale?
4-6
What would be considered severe pain on the numerical pain scale?
7+
You have a pt in pain. They rate their pain as a 3. Should you wait for it to get a little bit higher before providing pain meds?
No, administer analgesics before the pain amps up
Every patient plan of care needs to be-
Individualized
How can you separate pain into categories?
By Duration (Acute or Chronic)
By Origin (Nociceptive or Neuropathic)
By the disease/condition that causes the pain (Cancer)
