PCCN behavioral

Question 1

Nociceptive pain

Answer 1

SOMATIC: arise from
–bone, joint, muscle, skin, connective tissue
»aching, throbbing, WELL LOCALIZED

VISCERAL: arises from visceral organs

• -tumor involving organ (aching and well localized)
• -obstruction of hollow viscus (interm cramping, poorly localized pain)

Question 2

Neuropathic pain

Answer 2

CENTRAL:

• -phantom pain, burning below level of spinal injury
• -reflex sympathetic dystrophy (Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack)

PERIPHERAL:

• -painful neuropathies (DM-burning/numb/tingling, alcohol-nutritional neuropathy, Guillain Barre syndrome)
• -painful mononeuropathies (nerve root compression, trigeminal neuralgia)

Question 3

Analgesics for Neuropathic pain

Answer 3

Antidepressants:
–SNRI (ex. cymbalta), tricyclic depressants (Elavil)

Antiepileptics:
–gapapentin, pregabalin (lyrica)

Others- clonidine, baclofen, emla cream

Question 4

Initial pain assessment

Answer 4

Location, Intensity (0-10), Quality (think nociceptive or neuropathic), duration, aggravating/alleviating factors

Question 5

Assessing tolerable pain level:

Answer 5

Acute:
“what pain rating would make it easy for you to (most important recovery activity)? (i.e. use your IS, participate in PT)

Chronic: QOL indicator
“what is it that you can do and want to do, but pain keeps you from doing it? What pain rating would allow you to do it? (i.e. walk the dog around neighborhood)

Question 6

what does behavioral pain scale measure?

Answer 6

presence of pain, not intensity

> > if pt unable to self-report, review chart for sources of pain and analgesic use prior to admission; trial a dose of opioid to see if agitation and grimacing resolve.
Increased BP and HR are late signs of pain, and if pt has chronic pain the VS ↑ doesn’t happen anymore

Question 7

Tolerance vs physical dependence vs addiction

Answer 7

TOLERANCE: need higher dosage to produce same level of analgesia that previously existed

PHYSICAL DEPENDENCE: w/d symptoms after opioid use is stopped or quickly decreased w/o titrating (can occur if antagonist is administered)

ADDICTION: psychological dependence on the use of substances for their psychic effects, compulsive use

Question 8

physiologic causes of anxiety

Answer 8

hypoxia, pain, hypoglycemia

Question 9

s/s of delirium (hyper- and hypoactive)

Answer 9

sudden decline from previous level of functioning…

hyper:
visual and auditory hallucinations, disorientation, self-injurous, impulsive, agitation/restless, emotional lability

hypo: flat affect, withdrawal, apathy, lethargy, decr responsiveness

Question 10

s/s of Delirium Tremens

Answer 10

> > ETOH withdrawal occur 12-48hrs after stop of alcohol intake
DT 48-96 hrs after last drink; occurs in 5% of pt w/d from ETOH

> > w/d of alcohol causes excessive ANS excitabilty (breathing, heart beat, digestion) when substances that have been suppressed are suddenly re-released (pt can die!)

–tachycardia, tachypnea, profuse diaphoresis, dilated pupils; anxious, auditory hallucinations, trying to climb out of bed, agitation, global confusion…. denies pain

GIVE LORAZEPAM (ATIVAN)

Question 11

reversal agent for benzodiazepines

Answer 11

flumazenil (romazicon)