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Fundamentals 2 Exam 4 Flashcards > Pain Mangement Part 3 Flashcards > Flashcards

Pain Mangement Part 3 Flashcards

1
Q

How many categories of pain medication are there?

A

3

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2
Q

Any medication used to relieve pain =

A

Analgesic

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3
Q

What are the 3 categories of pain meds?

A

Nonopioid Analgesics

Opioids

Adjuvant Drugs

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4
Q

What are Adjuvant Drugs?

A

Drugs that are used alone or in combo with other analgesics

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5
Q

What severity of pain are Nonopioid Analgesics used to treat?

A

Mild to Moderate Pain

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6
Q

What severity of pain are Opioid Analgesics used to treat?

A

Moderate to Severe Pain

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7
Q

This category of Analgesics is over the counter (OTC) =

A

Nonopioid Analgesics

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8
Q

This category of analgesic is controlled, and you need a Prescription to take it =

A

Opioid Analgesics

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9
Q

A pharmacologic method of pain management which combines various groups of medications for pain relief =

A

Multimodal Analgesia

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10
Q

The most commonly combined medication groups for Multimoble Analgesia include-

A

Local Anesthetics, Opioids, NSAIDS, Acetaminophen, & Alpha-2 Agonists

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11
Q

What are the drugs of choice for mild to moderate pain?

A

Nonopioid Analgesics:
Acetaminophen (Tylenol)
Salicylates (Aspirin / ASA)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS):
Ibuprofen

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12
Q

Ibuprofen is an-

A

NSAID

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13
Q

Why are the drugs of choice for mild to moderate pain NSAIDS, Acetaminophen, and Salicylates?

A

These all act on Peripheral Nerve Endings & Block Prostaglandins (NSAIDS are the only anti-inflammatory drugs that do this)

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14
Q

What are some Side Effects to look out for whenever it comes to NSAIDS, Acetaminophen, and Salicylates?

A

GI Side Effects (Heartburn + Indigestion)

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15
Q

Aspirin + NSAIDS are contraindicated with-

A

Bleeding Disorders

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16
Q

ASA is the same thing as-

A

Aspirin

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17
Q

What meds for mild to moderate pain are contraindicated with Infection?

A

NSAIDS

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18
Q

People who take NSAIDS are at a higher risk for-

A

CV Problems

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19
Q

Nonopioid Analgesics and NSAIDS can be combined with what meds to increase therapeutic effect?

A

Co-Analgesics (Adjuvants) or Opioids

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20
Q

Analgesic Ceiling =

A

Despite increased dosages, the patient obtains no additional pain relief and is more likely to suffer adverse drug reactions

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21
Q

What are some Opioid-Nonopioid Analgesic combinations for Moderate Pain?

A

Codeine + Acetaminophen

Hydrocodone + Acetaminophen

Hydrocodone + Ibuprofen

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22
Q

What are some Pure Opioid Agonists that can be used for moderate to severe pain?

A

Morphine
Oxycodone (OxyContin)
HYDROcodone
HYDROmorphone (Dilaudid)
Codeine
Methadone

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23
Q

A pt who is taking a Pure Opioid Agonist is at a higher risk of-

A

Respiratory Depression & Sedation

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24
Q

What is an opioid to AVOID for moderate to severe pain?

A

Meperidine (Demerol)

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25
Q

Pain that’s rated 3 to 6 =

A

Moderate

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26
Q

Pain below 3 =

A

Mild

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27
Q

Pain rated 7+ =

A

Severe Pain

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28
Q

Why avoid Meperidine?

A

Meperidine can cause neurotoxicity, due to the accumulation of a metabolite (Normeperidine)

It also only provides limited pain relief

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29
Q

Pure Opioid Analgesics bind to -

A

Opioid Receptor Sites in the Brain

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30
Q

Whenever giving an opioid analgesic, always monitor for-

A

Sedation + Respiratory Depression

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31
Q

Stable Sedation =

A

Less than 3 on the Sedation Scale + Respirations Greater than 10

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32
Q

The risk of Respiratory Depression is greater in-

A

Opioid Naive pt’s (People who’ve never taken opioids before)

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33
Q

Unintended sedation is greatest within how long after leaving the PACU?

A

Within 4 Hours

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34
Q

What do you do for a pt who has a respiratory rate that’s less than 8-10 who’s also got a sedation score of 4?

A

Vigorously stimulate pt’s with a sedation score of 3 or greater

When dealing with over-sedated pt’s, administer oxygen and an opioid dose reduction
Might have to give Naloxone

35
Q

What is Naloxone?

A

An opioid antagonist to reverse the effects of opioids

36
Q

When do you give Naloxone?

A

Whenever the pt is overly-sedated or unresponsive

37
Q

Situation:
74 yr old male, returned to 8A after surgery. The nurse has difficulty arousing him with verbal command or physical stimulation (touch or shake arm). Wife says, “Let him sleep.” RR: 8-10/min.

How does the nurse analyze and decide what to do?

A

The RR is low and the sedation level is a 4.

Vigorously stimulate the pt, administer Naloxone, and notify the wife of what is going on with their husband

38
Q

Negligent act by the nurse =

A

Malpractice

39
Q

Failing to perform what a responsible person would do =

A

Negligence

40
Q

What is Beneficence?

A

Doing good & acting in the best interest of the pt

Decrease suffering of pt’s

41
Q

What is Nonmaleficince?

A

Working to do no harm

Failing to manage pain = harm

42
Q

What is Autonomy?

A

Freedom of choice by the pt but must be informed decisions

(Nurse’s role is to provide that education for the informed decisions)

43
Q

What is Justice?

A

Treat all pt’s equally

(Relieve pain equally regardless of ethnic background or history)

44
Q

Effective pain management is a -

A

Basic Human Right

45
Q

What are some Non-Pharmacological Pain Management Strategies?

A

Bed linens clean/smooth; not lying on tubes
Positioning
Cognitive-behavioral measures
Cutaneous (skin) stimulation
Distraction
Relaxation
Imagery
Acupuncture/acupressure
Reduction to pain stimuli in the environment
Elevation of edematous extremities

46
Q

Hospice care and Palliative care both provide-

A

Pain Management

47
Q

What does the raising of edematous extremities promote?

A

Promotes Veinous Return + Decreases Edema

48
Q

What route is best for Acute Pain?

A

Parental Route

49
Q

Which route is best for Chronic Pain?

A

PO

50
Q

What is important to keep in mind about Acetaminophen?

A

Acetaminophen has Hepatoxic Effects

Patients should be aware of Opioids with Acetaminophen (Hydrocodone)

51
Q

Acetaminophen has Hepatotoxic effects, meaning that it can cause-

A

Liver Toxicity

52
Q

With NSAID’s like Ibuprofen, what should you be sure to monitor for with long-term use?

A

Bleeding

53
Q

When a patient takes a Salicylate, be sure to monitor for-

A

Salicylism (Tinnitus, Vertigo, Decreased Visual Acuity)

54
Q

In what way is the administration of NSAIDS, Salicylates, and Acetaminophen all similar?

A

All of these meds should be administered with food to prevent GI upset

55
Q

Morphine Sulfate, Fentanyl, & Codeine are all-

A

Opioid Analgesics

56
Q

Opioid Analgesics can be used for what kind’s of patient’s?

A

Post-Op pt’s, Heart Attack pt’s, Cancer pt’s

57
Q

What are all of the things that you should monitor with Opioid Administration?

A

Sedation
Respiratory Depression
Orthostatic Hypotension
Urinary Retention
Nausea + Vomiting
Constipation

58
Q

What typically comes before Respiratory Depression when taking Opioid Analgesics?

A

Sedation

59
Q

Always document the pt’s HR before-

A

Giving Opioid Analgesics (For a baseline)

This way you’ll know to decrease the dosage if Respiratory Depression occurs

60
Q

If a pt takes an opioid analgesic and has Respiratory Depression, you may have to give them Naloxone until-

A

Their breathing is back up to at least 8 BPM

61
Q

What urinary things should you monitor/assess/intervene about a pt who’s taking an opioid analgesic?

A

Monitor I&O + Assess for Bladder Distention + Give the pt a Catheterization + May need to administer Bethanechol

62
Q

What is Bethanechol?

A

It’s a med that’s taken to treat certain disorders of the urinary tract or bladder

63
Q

What can you administer for Nausea & Vomiting?

A

Antiemetics

64
Q

This is a common side effect of Opioid Administration and does not resolve with continued use of the opioid =

A

Constipation

65
Q

What do we do to combat a pt’s potential constipation as a result of opioid administration?

A

Give the pt a bowel regimen immediately upon prescription of opioid prescriptions

Give dietary roughage / fiber
Ensure the intake of fluids
Ensure the pt remains active

May give a gentle stimulant laxative & a stool softener like Docusate Sodium

Give other gentle laxatives PRN
Monitor for frequency & consistency of stool
Enemas can be given for constipation

66
Q

A pt taking opioid analgesics is having constipation, you can administer gentle laxatives such as-

A

Senna

Docusate Sodium

67
Q

Whenever your pt is having too many problems with Constipation due to Opioid Analgesics, you may have to give other stimulants, such as-

What do you have to do after giving these?

A

Milk of Magnesia or Miralax

Monitor for increased bowel movements, reduce the dosage if diarrhea occurs

68
Q

What do Adjuvant Analgesics enhance?

A

Enhance the effects of Nonopioid Analgesics

69
Q

What do Adjuvant Analgesics help?

A

Help to alleviate other manifestations that aggravate pain (Depression, Seizures, Inflammation)

70
Q

What do Adjuvant Analgesics treat?

A

Neuropathic Pain

71
Q

What are the different categories of Adjuvant Analgesics?

A

Anticonvulsants
Antianxiety Agents
Tricyclic Antidepressants (TCA’s)
Anesthetics
Antihistamines
Glucocorticoids
Antiemetics
Bisphosphonates & Calcitonin

72
Q

How many ways can a Patient Controlled Analgesia (PCA) Pump be used?

What are they?

A

Three.

It could be PCA only (The pain med dosage is controlled by the pt)

It could be continuous only (only 1 mg per hour for example)

It could be continuous + PCA (Getting a continuous dosage on top of the dosages controlled by the pt)

73
Q

Patient controlled analgesia is also called-

A

On Demand Analgesia

74
Q

A PCA pump can be used for-

A

Acute pain or chronic pain (like cancer pain)

75
Q

What are some things that you need to keep in mind in regards to safety checks for a PCA Pump?

A

• Two RNs check/document settings and dose changes

• RN monitors at least every 4 hours

• Assess pain rating, client understanding, function of device

• Assess sedation, respiratory status, vital signs

76
Q

Good candidates for a PCA Pump would be -

A

People who can understand directions and push their button on their own

77
Q

Poor candidates for a PCA Pump would be -

A

Infants, Young Children (That can’t understand the directions), Confused People

78
Q

Can a pt have their family help push the dose button on a PCA Pump?

A

No, it has to be the pt themself that does it

79
Q

Whenever a nurse presses the dosage button on a PCA pump, it is called-

A

Nurse Controlled Analgesia

80
Q

NCA is for-

A

Whenever the pt themself is unable to push the button and are in pain

81
Q

This is recommended to monitor Ventilatory Respiration =

A

Capnography Monitoring

82
Q

What does Capnography Monitoring assess?

A

Patency if the airway + the presence of breathing

(It won’t assess Oxygenation or Hypoxemia)

83
Q

Capnography monitoring is used for what group of people?

A

People who are at a greater risk of Respiratory Sedation

84
Q

Capnography monitoring will monitor and measure what?

A

Ventilation

Fundamentals 2 Exam 4 Flashcards (12 decks)

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