Pain - NRSG Fun Ch 30 Flashcards
Name some of the non-verbal cues for pain
decreased activity grimacing sad or frightened expression rapid blinking frowning crying moaning irritability fidgeting increased pacing/ rocking disruptive behavior increased confusion noising breathing profanity or verbally abusive behavior refusing food difficulty sleeping
What are the changes to VS r/t acute (sympathetic) pain?
increased systolic blood pressure
increased heart rate and force of contraction
increased respiratory rate
dilated blood vessels to the brain
dilated pupils
rapid speech
What are the changes to VS r/t Deep or Prolonged (parasympathetic) Pain?
Decreased systolic blood pressure, possible syncope
Decreased pulse rate
Changeable breathing patterns
Withdrawal
Constricted pupils
Slow, monotonous speech
What are some psychological (Affective) Responses to pain?
anxiety depression anger fear exhaustion hopelessness irritability
What are things to consider when assessing for pain?
Take a pain history
Observe for nonverbal indicators of pain
Use a pain scale
What questions could you ask as part of a pain history?
Do you have pain now? When did the pain begin? Where is the pain located? Rate your pain? How would you describe your pain? Sharp, aching etc. How often do you have pain? Is there a pattern to your pain? What makes the pain better/worse? How does the pain affect your ADL? Have you experienced this pain before? Have you used any medications/ alternative therapies? Cultural influences?
Assessing pain in children?
Use art or play to assess pain
Child may deny pain if they think they will have to get a shot
Can use Wong-Baker face pain scale
What pain management tasks can be delegated to a UAP?
re-positioning
back rub or massage
providing darkness and quiet in the room for sleep
straightening sheets
mouth care
soft music of the patients preference
using distraction (talking or setting up a game, giving a book to read etc.)
What are some nonpharmacological measures to treat pain?
-TENS (transcutaneous electrical nerve stimulator)
-PENS (percutaneous electrical stimulation)
-Acupuncture
-Acupressure
-Massage
-Application of heat or cold
-Contralateral stimulation
-Immobilization
-Distraction
-sequential muscle relaxation (SMR)
-Guided imagery
-Hypnosis
-Theraputic touch
-Humor
-
What is TENS?
transcutaneous electrical nerve stimulator
electrical device connected to pads that are placed over the painful area. The unit stimulates A-delta sensory fibers. Can be worn intermittently or over long periods.
What is PENS?
percutaneous electrical stimulation
Combines a TENS with a percutaneously placed (through the skin) needle probes to stimulate peripheral sensory nerves.
Effective in short term management of acute or chronic pain
What is acupuncture?
application of extremely fine needles to specific sites.
Believed to stimulate the endogenous analgesia system.
Well documented to help with dental pain, after surgery and chemotherapy to treat nausea.
Can cause lightheadedness - so consider risk for falls carefully
What is acupressure?
The use of fingertips to provide firm, gentle pressure to pressure points.
May have a calming affect through the release of endorphins.
Can be self-administered.
What is massage?
Pain relief through cutaneous stimulation and relaxing the muscles.
May improve sleep
May increase flow of body fluids and toxins - increases workload of kidneys and liver.
How does application of heat or cold affect pain?
Cold - causes vasoconstriction and can help prevent swelling and bleeding. Especially effective in reducing pain during procedures.
Heat - promotes circulation, which speeds healing
What is contralateral stimulation?
stimulation of the skin in an area opposite to the painful site.
stimulation = scratching, rubbing, applying heat or cold
Good for sites that cannot be accessed.
encased in cast
phantom limb
What are the categories of analgesics?
nonopioids
opioids
adjuvants
In what order should analgesics be given for pain (according to category)?
For mild pain:
nonopiods +/- adjuvants
For mild to moderate pain:
Opioid + Nonopioid +/- adjuvant
For moderate to severe pain:
Opioid +/- Nonopioid +/- adjuvantCharacterisks of Nonopioid analgesics
mild to moderate pain May reduce inflammation and fever for both acute and chronic pain includes NSAIDs and Acetaminophen can be compounded with opioids
NSAIDs
nonsteroidal anti-inflammatory drugs
aspirin and ibuprofen etc
act primarily in the peripheral tissues by interfering with the production of prostaglandins
causes gastric irritation
aspirin also reduces aggregation in blood
acetaminophen
analgesic and anti-fever affects
can cause liver toxicity in those who consume alcohol or liver disease
Opioid analgesics
General side effects are:
nausea, vomiting, constipation and drowsiness
large doses can cause respiratory depression and hypotension
Mu Agonists
stimulate Mu receptors
includes morphine
acute, chronic and cancer pain … breakthrough pain
no maximum level of analgesia
Agonist-Antagonists
stimulate some opioid receptors and block others
for acute moderate to severe pain
not for severe escalating pain or as first-line drug
not to be used with mu agonists (can counteract them)
Has a limit to analgesic effects
Opioids may be administered via
oral nasal transdermal subcutaneous rectal Intramuscular intravenous patient-controlled analgesia (PCA pump) Intraspinal analgesic
Equianalgesia
refers to the approximately equal analgesia that a variety of opioids will provide
Adjuvant analgesics
primary therapy for mild to moderate pain in conjunction with opioids for moderate to severe pain Include anticonvulsants antidepressants local anesthetics topical agents psychostimulants muscle relaxants neuroleptics corticosteroids etc
What are nerve blocks?
a type of regional anesthesia
for short-term pain relief or long-term management of pain
What is Local anesthesia?
injection of local anesthetics into body tissues
Long or short-term use
What is topical anesthesia?
application to the skin
quickly absorbed providing pain relief for mild to moderate pain
What are the types of surgical interruption of pain?
Pain relief by permanent destruction of the nerve pathways. Types include: cordotomy rhizotomy neurectomy sympathectomy
What is a cordotomy?
interrupts pain and temperature sensation below the tract that is severed.
Usually for leg and trunk pain
What is a Rhizotomy?
interrupts the anterior or posterior nerve rout that is located between the ganglion and the cord
Anterior interruption generally used to stop spastic movements accompanying paraplegia
Posterior interruption generally used to eliminate pain in the innervated area
Usually used for head and neck pain produced by cancer
What is a neurectomy?
used to eliminate intractable localized pain
What is sympathectomy?
severs the paths to the sympathetic division of the autonomic nervous system
