Pain Mangement Part 3 Flashcards
How many categories of pain medication are there?
3
Any medication used to relieve pain =
Analgesic
What are the 3 categories of pain meds?
Nonopioid Analgesics
Opioids
Adjuvant Drugs
What are Adjuvant Drugs?
Drugs that are used alone or in combo with other analgesics
What severity of pain are Nonopioid Analgesics used to treat?
Mild to Moderate Pain
What severity of pain are Opioid Analgesics used to treat?
Moderate to Severe Pain
This category of Analgesics is over the counter (OTC) =
Nonopioid Analgesics
This category of analgesic is controlled, and you need a Prescription to take it =
Opioid Analgesics
A pharmacologic method of pain management which combines various groups of medications for pain relief =
Multimodal Analgesia
The most commonly combined medication groups for Multimoble Analgesia include-
Local Anesthetics, Opioids, NSAIDS, Acetaminophen, & Alpha-2 Agonists
What are the drugs of choice for mild to moderate pain?
Nonopioid Analgesics:
Acetaminophen (Tylenol)
Salicylates (Aspirin / ASA)
Nonsteroidal Anti-Inflammatory Drugs (NSAIDS):
Ibuprofen
Ibuprofen is an-
NSAID
Why are the drugs of choice for mild to moderate pain NSAIDS, Acetaminophen, and Salicylates?
These all act on Peripheral Nerve Endings & Block Prostaglandins (NSAIDS are the only anti-inflammatory drugs that do this)
What are some Side Effects to look out for whenever it comes to NSAIDS, Acetaminophen, and Salicylates?
GI Side Effects (Heartburn + Indigestion)
Aspirin + NSAIDS are contraindicated with-
Bleeding Disorders
ASA is the same thing as-
Aspirin
What meds for mild to moderate pain are contraindicated with Infection?
NSAIDS
People who take NSAIDS are at a higher risk for-
CV Problems
Nonopioid Analgesics and NSAIDS can be combined with what meds to increase therapeutic effect?
Co-Analgesics (Adjuvants) or Opioids
Analgesic Ceiling =
Despite increased dosages, the patient obtains no additional pain relief and is more likely to suffer adverse drug reactions
What are some Opioid-Nonopioid Analgesic combinations for Moderate Pain?
Codeine + Acetaminophen
Hydrocodone + Acetaminophen
Hydrocodone + Ibuprofen
What are some Pure Opioid Agonists that can be used for moderate to severe pain?
Morphine
Oxycodone (OxyContin)
HYDROcodone
HYDROmorphone (Dilaudid)
Codeine
Methadone
A pt who is taking a Pure Opioid Agonist is at a higher risk of-
Respiratory Depression & Sedation
What is an opioid to AVOID for moderate to severe pain?
Meperidine (Demerol)
Pain that’s rated 3 to 6 =
Moderate
Pain below 3 =
Mild
Pain rated 7+ =
Severe Pain
Why avoid Meperidine?
Meperidine can cause neurotoxicity, due to the accumulation of a metabolite (Normeperidine)
It also only provides limited pain relief
Pure Opioid Analgesics bind to -
Opioid Receptor Sites in the Brain
Whenever giving an opioid analgesic, always monitor for-
Sedation + Respiratory Depression
Stable Sedation =
Less than 3 on the Sedation Scale + Respirations Greater than 10
The risk of Respiratory Depression is greater in-
Opioid Naive pt’s (People who’ve never taken opioids before)
Unintended sedation is greatest within how long after leaving the PACU?
Within 4 Hours
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?
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
What is Naloxone?
An opioid antagonist to reverse the effects of opioids
When do you give Naloxone?
Whenever the pt is overly-sedated or unresponsive
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?
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
Negligent act by the nurse =
Malpractice
Failing to perform what a responsible person would do =
Negligence
What is Beneficence?
Doing good & acting in the best interest of the pt
Decrease suffering of pt’s
What is Nonmaleficince?
Working to do no harm
Failing to manage pain = harm
What is Autonomy?
Freedom of choice by the pt but must be informed decisions
(Nurse’s role is to provide that education for the informed decisions)
What is Justice?
Treat all pt’s equally
(Relieve pain equally regardless of ethnic background or history)
Effective pain management is a -
Basic Human Right
What are some Non-Pharmacological Pain Management Strategies?
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
Hospice care and Palliative care both provide-
Pain Management
What does the raising of edematous extremities promote?
Promotes Veinous Return + Decreases Edema
What route is best for Acute Pain?
Parental Route
Which route is best for Chronic Pain?
PO
What is important to keep in mind about Acetaminophen?
Acetaminophen has Hepatoxic Effects
Patients should be aware of Opioids with Acetaminophen (Hydrocodone)
Acetaminophen has Hepatotoxic effects, meaning that it can cause-
Liver Toxicity
With NSAID’s like Ibuprofen, what should you be sure to monitor for with long-term use?
Bleeding
When a patient takes a Salicylate, be sure to monitor for-
Salicylism (Tinnitus, Vertigo, Decreased Visual Acuity)
In what way is the administration of NSAIDS, Salicylates, and Acetaminophen all similar?
All of these meds should be administered with food to prevent GI upset
Morphine Sulfate, Fentanyl, & Codeine are all-
Opioid Analgesics
Opioid Analgesics can be used for what kind’s of patient’s?
Post-Op pt’s, Heart Attack pt’s, Cancer pt’s
What are all of the things that you should monitor with Opioid Administration?
Sedation
Respiratory Depression
Orthostatic Hypotension
Urinary Retention
Nausea + Vomiting
Constipation
What typically comes before Respiratory Depression when taking Opioid Analgesics?
Sedation
Always document the pt’s HR before-
Giving Opioid Analgesics (For a baseline)
This way you’ll know to decrease the dosage if Respiratory Depression occurs
If a pt takes an opioid analgesic and has Respiratory Depression, you may have to give them Naloxone until-
Their breathing is back up to at least 8 BPM
What urinary things should you monitor/assess/intervene about a pt who’s taking an opioid analgesic?
Monitor I&O + Assess for Bladder Distention + Give the pt a Catheterization + May need to administer Bethanechol
What is Bethanechol?
It’s a med that’s taken to treat certain disorders of the urinary tract or bladder
What can you administer for Nausea & Vomiting?
Antiemetics
This is a common side effect of Opioid Administration and does not resolve with continued use of the opioid =
Constipation
What do we do to combat a pt’s potential constipation as a result of opioid administration?
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
A pt taking opioid analgesics is having constipation, you can administer gentle laxatives such as-
Senna
Docusate Sodium
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?
Milk of Magnesia or Miralax
Monitor for increased bowel movements, reduce the dosage if diarrhea occurs
What do Adjuvant Analgesics enhance?
Enhance the effects of Nonopioid Analgesics
What do Adjuvant Analgesics help?
Help to alleviate other manifestations that aggravate pain (Depression, Seizures, Inflammation)
What do Adjuvant Analgesics treat?
Neuropathic Pain
What are the different categories of Adjuvant Analgesics?
Anticonvulsants
Antianxiety Agents
Tricyclic Antidepressants (TCA’s)
Anesthetics
Antihistamines
Glucocorticoids
Antiemetics
Bisphosphonates & Calcitonin
How many ways can a Patient Controlled Analgesia (PCA) Pump be used?
What are they?
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)
Patient controlled analgesia is also called-
On Demand Analgesia
A PCA pump can be used for-
Acute pain or chronic pain (like cancer pain)
What are some things that you need to keep in mind in regards to safety checks for a PCA Pump?
• 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
Good candidates for a PCA Pump would be -
People who can understand directions and push their button on their own
Poor candidates for a PCA Pump would be -
Infants, Young Children (That can’t understand the directions), Confused People
Can a pt have their family help push the dose button on a PCA Pump?
No, it has to be the pt themself that does it
Whenever a nurse presses the dosage button on a PCA pump, it is called-
Nurse Controlled Analgesia
NCA is for-
Whenever the pt themself is unable to push the button and are in pain
This is recommended to monitor Ventilatory Respiration =
Capnography Monitoring
What does Capnography Monitoring assess?
Patency if the airway + the presence of breathing
(It won’t assess Oxygenation or Hypoxemia)
Capnography monitoring is used for what group of people?
People who are at a greater risk of Respiratory Sedation
Capnography monitoring will monitor and measure what?
Ventilation
