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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
Pain that’s rated 3 to 6 =
Moderate
26
Pain below 3 =
Mild
27
Pain rated 7+ =
Severe Pain
28
Why avoid Meperidine?
Meperidine can cause neurotoxicity, due to the accumulation of a metabolite (Normeperidine) It also only provides limited pain relief
29
Pure Opioid Analgesics bind to -
Opioid Receptor Sites in the Brain
30
Whenever giving an opioid analgesic, always monitor for-
Sedation + Respiratory Depression
31
Stable Sedation =
Less than 3 on the Sedation Scale + Respirations Greater than 10
32
The risk of Respiratory Depression is greater in-
Opioid Naive pt’s (People who’ve never taken opioids before)
33
Unintended sedation is greatest within how long after leaving the PACU?
Within 4 Hours
34
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
35
What is Naloxone?
An opioid antagonist to reverse the effects of opioids
36
When do you give Naloxone?
Whenever the pt is overly-sedated or unresponsive
37
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
38
Negligent act by the nurse =
Malpractice
39
Failing to perform what a responsible person would do =
Negligence
40
What is Beneficence?
Doing good & acting in the best interest of the pt Decrease suffering of pt’s
41
What is Nonmaleficince?
Working to do no harm Failing to manage pain = harm
42
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)
43
What is Justice?
Treat all pt’s equally (Relieve pain equally regardless of ethnic background or history)
44
Effective pain management is a -
Basic Human Right
45
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
46
Hospice care and Palliative care both provide-
Pain Management
47
What does the raising of edematous extremities promote?
Promotes Veinous Return + Decreases Edema
48
What route is best for Acute Pain?
Parental Route
49
Which route is best for Chronic Pain?
PO
50
What is important to keep in mind about Acetaminophen?
Acetaminophen has Hepatoxic Effects Patients should be aware of Opioids with Acetaminophen (Hydrocodone)
51
Acetaminophen has Hepatotoxic effects, meaning that it can cause-
Liver Toxicity
52
With NSAID’s like Ibuprofen, what should you be sure to monitor for with long-term use?
Bleeding
53
When a patient takes a Salicylate, be sure to monitor for-
Salicylism (Tinnitus, Vertigo, Decreased Visual Acuity)
54
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
55
Morphine Sulfate, Fentanyl, & Codeine are all-
Opioid Analgesics
56
Opioid Analgesics can be used for what kind’s of patient’s?
Post-Op pt’s, Heart Attack pt’s, Cancer pt’s
57
What are all of the things that you should monitor with Opioid Administration?
Sedation Respiratory Depression Orthostatic Hypotension Urinary Retention Nausea + Vomiting Constipation
58
What typically comes before Respiratory Depression when taking Opioid Analgesics?
Sedation
59
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
60
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
61
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
62
What is Bethanechol?
It’s a med that’s taken to treat certain disorders of the urinary tract or bladder
63
What can you administer for Nausea & Vomiting?
Antiemetics
64
This is a common side effect of Opioid Administration and does not resolve with continued use of the opioid =
Constipation
65
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
66
A pt taking opioid analgesics is having constipation, you can administer gentle laxatives such as-
Senna Docusate Sodium
67
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
68
What do Adjuvant Analgesics enhance?
Enhance the effects of Nonopioid Analgesics
69
What do Adjuvant Analgesics help?
Help to alleviate other manifestations that aggravate pain (Depression, Seizures, Inflammation)
70
What do Adjuvant Analgesics treat?
Neuropathic Pain
71
What are the different categories of Adjuvant Analgesics?
Anticonvulsants Antianxiety Agents Tricyclic Antidepressants (TCA’s) Anesthetics Antihistamines Glucocorticoids Antiemetics Bisphosphonates & Calcitonin
72
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)
73
Patient controlled analgesia is also called-
On Demand Analgesia
74
A PCA pump can be used for-
Acute pain or chronic pain (like cancer pain)
75
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
76
Good candidates for a PCA Pump would be -
People who can understand directions and push their button on their own
77
Poor candidates for a PCA Pump would be -
Infants, Young Children (That can’t understand the directions), Confused People
78
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
79
Whenever a nurse presses the dosage button on a PCA pump, it is called-
Nurse Controlled Analgesia
80
NCA is for-
Whenever the pt themself is unable to push the button and are in pain
81
This is recommended to monitor Ventilatory Respiration =
Capnography Monitoring
82
What does Capnography Monitoring assess?
Patency if the airway + the presence of breathing (It won’t assess Oxygenation or Hypoxemia)
83
Capnography monitoring is used for what group of people?
People who are at a greater risk of Respiratory Sedation
84
Capnography monitoring will monitor and measure what?
Ventilation

Fundamentals 2 Exam 4 Flashcards (12 decks)

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