Pain Management Post Op Flashcards
Adjuvants?
Drugs used in conjunction with opioids and non opioids
- remove side effects of analgesics
- properties assist and relieve pain
Sometimes referred to as coanalgesic
Adjuvants are used at every step in the WHO ladder
Breakthrough pain?
Pain that occurs despite treatment
PCA?
Patient controlled analgesia
Method of pain control designed to allow the patient to administer pre set dosages of an analgesic I
Nociceptive pain?
Pain caused by damage to somatic or visceral tissue
Neuropathic pain?
Pain caused by damage to nerve cells of changes in spinal cord processing
Pain threshold vs tolerance?
Threshold: the point beyond which a stimulus causes pain
Tolerance: max level of pain a person is able to tolerate
What’s is a sedation scale?
A number to assess level of sedation of a patient
The higher the number the more sedated they are
0-4
-RASS
(Richmond agitation sedation scale)
True of false
Nociceptive pain occurs when there is damage to somatic and/or visceral tissue?
True
Neuropathic pain vs Nociceptive pain?
Neuropathic:
- burning, shooting, electric pain
- difficult to treat
- involves nerves
Nociceptive:
- aching/throbbing pain
- responsive to opioids and non opioids
- involves tissue
Why is the WHO ladder a little different for surgical patients?
You start high and titrate down
(3) strong opioid
(2) weak opioid
(1) non opioid
Examples of adjuvants?
Corticosteroids
Antidepressants
Muscle relaxant
Anti inflammatory
What is pain?
Multidimensional
Objective and subjective
Pain is what the person says it is
Complex
Pain assessments?
PQRST
Faces, 0-10
Non verbal body language
What effects a persons pain goal?
Individualized based on patient needs
Different pain tolerance/threshold
Gender, age
Cultural considerations
2 types of Nociceptive pain?
Somatic: skin, mucosa, muscles, joints, bone
-sharp, constant, throbbing, gnawing, aching
Visceral: organ, GI tract
-dull, cramping, squeezing, deep, aching
Multimodal pain management?
The use of more than than 1 form of analgesia at the same time that is satisfactory to the patient
Can Nociceptive and neuropathic pain be chronic?
Both types can become chronic
Typically surgical patient pain is more acute
Physiological effects of untreated pain?
Increase in vitals Changes in cognition Decrease sleep or bed seeking Decrease appetite Delayed healing Diaphoretic Nausea Photosensitivity Increase risk of infection GI and GU changes
Consequences of untreated pain?
Decrease patient satisfaction Decrease compliance Increased recovery time Hospital readmissions Decreased QOL
Factor contributing to poor pain management?
Inadequate assessments Failure to consider available pain therapies Attitudes/beliefs Poor pt compliance Fear of addiction Misconceptions Lack of education
How is post op pain different?
Pain is d/t tissue and nerve endings being traumatized
Pain is normally localized to the incision because it’s the primary location of trauma
Perception of post op pain is individualized
Post op pain assessment?
PQRST
Pain assessment at rest and movement
Break through pain ex. During dressing changes
Non pharmacological pain management tools commonly used in surgical units?
Explanation and reassurance Warm blankets Ice Limb elevation Ensuring drains are not pulling
Pharmacological postoperative pain management?
WHO analgesic ladder
Around the clock dosing
Mixed analgesic drugs
-holistic pain management
