pain meds Flashcards
what is pain
- a sensory and emotional experience associated with actual or potential tissue damage
- most common symptom to seek health care
- the fifth vital sign
- acute or chronic
name two types of pain
- nociceptive
- neuropathic
describe nociceptive pain
r/t tissue injury
- somatic (bones, muscle, and joints)
- visceral (organs)
describe neuropathic pain
produced by nerves
- peripheral
- central
describe the pathphysiology of pain
- tissue damage activates pain receptors (heat, cold, pressure, ischemia, chemical): slow and fast fibers
- nociceptors transmit to spinal cord
- signal then goes to brain stem and cerebrum
- endorphins and enkephalins released from pituitary (short term blockage of pain signals)
is pain subjective or objective
subjective
name some of the many factors that may influence pain
- mood
- sleep disturbances
- medications
- age
- gender
what are some pain measurement tools
- numeric scales
- visual scales
- observational scales
what are some nonpharmacologic treatments of pain and how do they work
- massage
- heat/cold therapy
- physical therapy
- cognitive therapy
- guided imagery
kinda distract from the pain and make you think about other shit
how do opioid analgesics work
- relieve moderate-severe pain
- block pain signal from getting to the brain
- inhibit prostaglandins (inflammatory cascade)
- schedule II (high risk for abuse)
describe multimodal therapy for pain
- drugs from different classes to change pain
- reduced opioid use
- improved outcomes
give an example of an opioid agonist
morphine sulfate
also codeine, fentanyl, hydromorphone, all the good stuff
describe the action of opioid agonists
binds to pain receptors in the brain, blocks pain impulse
what are opioid agonists used for
- prevent or relieve moderate to severe pain (acute or chronic)
also:
- antitussive (codeine)
- heart failre/pulmonary edema (relaxes the heart)
- adjuncts to anesthesia
describe the pharmacokinetics of opioid agonists
- IV: 10-20 minute onset
- PO: 60 minute onset
start with a low dose and use caution in old people
what are some adverse effects of opioid agonists
- resp depression
- CNS depression
- constipation
black box warning: resp failure is used in combo with benzos or other CNS depressants and risk for abuse and dependence
what are some contraindications of opioid agonists
- resp compromise
- liver/kidney disease (bad metabolism and excretion)
- increased ICP/head injury (increased confusion)
describe administration of opioid agonists
- reversal agent: naloxone
- PO can be given with/without food
- IV: dilute and push slow (5ml/5min)
- pre/post pain assessment (based on route and onset)
- closely monitor resp status (RR<8 and lethargy = bad)
what are some nursing implications of opioid agonists
- use caution with combination of opioids and other CNS depressants: antidepressants, sedatives, antihistamines, alcohol
- use caution with long acting vs short acting onset (maintenance vs breakthrough)
- utilize nonpharmacologic options
- wean to oral medication
describe patient education for opioid agonists
- chronic pain - take around the clock (avoid peaks and valleys)
- take only as prescribed
- high fiber diet
- encourage fluids (2-3L/day)
- stoll softeners PRN
- do not crush or chew pills
- dispose properly
- do not drive
give an example of an opioid agonist/antagonist
butorphanol
describe the action of opioid agonist/antagonists
activate some receptors and block some receptors, blocking pain sensation with lower risk for abuse
what are opioid agonist/antagonists used for
- second line moderate - severe pain
- pain during labor
- perioperatively
what are some adverse effects of opioid agonist/antagonists
- CNS depression
- resp depression
- risk for abuse and dependence
whats a contraindication of opioid agonist/antagonists
use of opioid agonist
what are some nursing implications of opioid agonist/antagonists
- avoid combination with other CNS depressants
- pre/post pain assessment
- is used during labor monitor for fetal effects
- monitor for s/sx opioid agonist withdrawal
describe patient education for opioid agonist/antagonists
- do not stop abruptly
- avoid driving
- change position slowly
give an example of an opioid antagonist
naloxone
describe the action of opioid antagonists
reverses analgesia, displaces opioids at receptor sites
what are opioid antagonists used for
- treat opioid overdose - antidote
- reverses CNS and resp depression
what are some adverse effects of opioid antagonists
immediate withdrawal symptoms:
- tremors
- sweating
- hypertension and tachycardia
- agitation
what are some nursing considerations for opioid antagonists
- only reverses opioid agonists
- short half life ad may need multiple doses
- available in several routes: IV (2min onset) and intranasal (8min onset)
- available with and without Rx
- naltrexone (vivitrol) long acting effects to treat opioid abuse
when caring for a patient receiving morphine it is most important that the nurse regularly assess which of the following?
- respirations
- bowel sounds
- urination
- mental status
- respirations
while others are important, remember ABCs. airway is always the most important assessment
a man is difficult to arouse after receiving IV morphine sulfate. he has a resp rate of 7. which of the following is your priority nursing action?
- place a nasal cannula
- administer naloxone
- increase IV fluid rate
- place patient in semi fowlers
- administer naloxone
nothing else matters if theyre not breathing
