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NUR 131 > TLO 2.7a Pain/sleep > Flashcards

TLO 2.7a Pain/sleep Flashcards

1
Q

Pain defined

A

Multidimensional consisting of sensory, physiological, cognitive, affective, behavioral and spiritual components. It may be an invisible problem that you can not see

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2
Q

Painful Stimuli

CHEMICAL EX.

A

Ischemia
Tissue trauma
Inflammation

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3
Q

Painful Stimuli

MECHANICAL EX.

A

Spasms
Compression
Extreme muscle stretch/contraction

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4
Q

Painful stimuli

THERMAL EX

A

Contact with extreme heat or cold

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5
Q

Pain Assessment

PQRST

A 
Precipitating factors
Qualities
Region or location
Severity
Timing
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6
Q

Assessment

SUBJECTIVE VS OBJECTIVE

A

Subjective: communicate by client/family, feelings, beliefs, sensations
Objective: physical assessment, labs, test, measurable

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7
Q

Factors affecting responses to pain

A

Age
Gender
Sociocultural
Psychological influences

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8
Q

How body reacts to pain

PHYSIOLOGIC RESPONSES

A 
Muscle tension
Tachycardia
Rapid shallow resp
Increase BP
Dilated pupils
Sweating/Pallor
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9
Q

How body reacts to pain

BEHAVIORAL RESPONSES

A

Facial grimacing
Bracing/guarding painful part
Crying
Moaning

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10
Q

What is Nociceptive pain?

A

Occurs when pain receptors respond to stimuli caused by trauma, surgery, inflammation

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11
Q

Two types of nociceptive pain?

A

Visceral: organs, internally
Somatic: skin, muscle, bone, connective tissue

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12
Q

What is neuropathic pain?

A

Pain that arises when injury to nerves result in repeated transmission of pain signal in absence of pain stimuli
ex: diabetes, tumors, vial infections, chemotherapeutic agents

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13
Q

Pain duration

ACUTE PAIN

A 
Varies in intensity
Short duration
Limited tissue damage
Eventually resolves w/wo treatment after area heals
ex: acute injury, disease, surgery
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14
Q

Pain duration

CHRONIC PAIN

A

Dramatic effect on person’s quality of life
Prolonged
Varies in intensity
Usually last longer than 6 mo
Not always have identifiable cause
ex:arthritis, low back, HA, fibromyalgia, peripheral neuropathy

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15
Q

Pain duration

INTRACTABLE PAIN

A 
Doesn't go away
Difficult to treat/manage
Is not curable
Frustrating to pt
Multiple method approach to relief
ex: muscle spasms
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16
Q

Three types of Acute Pain?

A

Somatic
Visceral
Referred Pain

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17
Q

What is referred pain?

A

Tenderness or increased pain away from the area of injury or disease involving visceral organs

18
Q

Three categories of chronic pain?

A

Recurrent acute pain: migraine
Chronic malignant pain: cancer
Chronic nonmalignant pain: lower back

19
Q

What is Breakthrough pain?

A

Pain that exceeds baseline chronic or persistent pain.

Unpredictability and inconsistency can be debilitating

20
Q

Non-pharmacological interventions for pain

A 
Relaxation/guided imagery
Distraction
Hypnosis
Music
Cutaneous stimulation (TENS)
Herbs (check med interactions)
Promote comfort
21
Q

Pharmacological interventions for pain

A

Analgesics:
non-opioids (acetaminophen, NSAIDs)

opioids (morphine, hydromorphone, fentanyl, oxycodone, hydrocodone

adjuvants (variety of medication that enhance analgesics)

22
Q

Physical pain relief strategies

A 
Massage
Exercise
Acupuncture
TENS
Cold/hot therapy
23
Q

Things to consider when choosing appropriate medications

A

Pt’s in severe pain should start at step 3
Pt’s monitoring should be regular & continuous
Assess pain and determine where on ladder to start
Important to know potential interactions and side effects along the way

24
Q

Choose appropriate medication steps 1, 2, 3

A

Sept 1: pain persisting or increasing
nonopioid/adjuvant
Step 2: pain persisting/increasing
Opioid for moderate to severe pain, nonopioid/adjuvant
Step 3: freedom from cancer pain
Opioid for moderate to severe pain, nonopioid/adjuvant

25
Q

Opioid side effects?

A 
Sedation
Drowsiness
Dizziness
Itching
Constipation
CNS/Respiratory depression
26
Q

Patient controlled analgesia (PCA)

A 
Self administration of med
Patient control
Programmable pump w/ lockout
Patient only button
Narcan available
27
Q

What does local anesthesia do?

A

Interrupts the generation of nerve cells by altering the flow of sodium into the nerve cells through cell membranes. Can be topical, ophthalmic, nebulized or injected

28
Q

Assessment pain according to developmental level

NEWBORNS

A

NB can feel pain
By 6 mo demonstrate anticipatory fear of pain if had prior experience
Children in acute pain may behave in similar ways with anxiety/fear

29
Q

Assessment pain according to developmental level

TODDLERS

A

Cry longer than infants, verbalize discomfort by saying ouch/hurt, associate discomfort with procedure, face may show anger/fear

30
Q

Assessment pain according to developmental level

PRESCHOOL

A

Egocentric and relate only to the present, difficulty associating pain with positive outcome, thinks it will magically go away or that they are being punished

31
Q

Assessment pain according to developmental level

SCHOOL AGE

A

Can describe pain and relate to body part, quantify pain intensity, beginning to understand painful procedures, fear body harm, awareness of death

32
Q

Assessment pain according to developmental level

ADOLESCENT

A

Can think abstractly, understand cause and effect, are able to perceive/understand pain, egocentric, think that others focus on their behavior, won’t report pain

33
Q

Non pharmacological management of pain in children

A

Form trusting relationship with family
Prepare the child for painful procedures w/o planting idea of pain
Stay with child during procedures
Educate the child about pain
Give the child doll allow the child to do everything to the doll that will be done to the child

34
Q

Non pharmacological management of pain in children pt 2

A 
Distraction
Relaxation
Guided imagery
Positive self talk
Hypnosis
Behavioral contracting
35
Q

Pharmacological management

A

Nonopioids are used for mild to moderate pain
Children over 6 mo metabolize drugs faster than adults therefore younger children need higher doses to achieve same effect
Children’s doses are calculated according to body weight

36
Q

Pain scale

FLACC

A 
Face
Legs
Activity
Cry
Consolability
Numeric scale, 0-10 points, higher the points the more pain
Best used: nonverbal, preverbal, infants
37
Q

Pain scale

FACES

A

Six cartoon faces from no pain to worse pain. Words and faces a child can easily point to the picture that bests describes their pain.
Best used with 3+ years old

38
Q

Pain scale

NUMERIC/VERBAL

A

Patient is asked to rate their pain from zero, being no pain to 10 being severe pain.
This is best used with children 9+ year old

39
Q

Pain scale

PAINAD

A 
Pain assessment for advanced dementia
Breathing
Negative vocalization
Facial expression
Body language
Consolability
Numeric scale, higher the score, higher pain level
40
Q

Nursing responsibilities with PCA use

A

Pt education on how to use prior to procedure
Inform pt the purpose of a PCA
Explain the pump reduces risk of overdose
Tell family/friends not to push button for pt
Evaluate pt’s pain while using PCA

41
Q

Nursing care for patients with Epidural Infusions

A 
Prevent catheter displacement
Maintain catheter function
Prevent infection
Monitor for resp depression
Ensure adequate hydration
Notify prescriber if significant change in VS
Assess for N/V
Maintain urinary/bowel function
42
Q

Gate control theory?

A

Emotional, cognitive and physical sensations.
Gating mechanisms located along CNS regulate/block pain impulses.
Pain passes through when open, blocked when closed
Closing the gate is the basis of nonpharmacological pain relief intervention.

NUR 131 (38 decks)

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