U2.2 Pain Medication Therapy Flashcards
Describe the nursing process in the care of the patient having pain & receiving pharmacotherapy for pain.
- Assess pain or migraine
- Analyze patient’s needs
- Prioritize nursing diagnosis and goals of care
- Implementation of care to achieve pain management
- Compare actual outcome with expected outcome
acute pain
Abrupt onset, but brief duration.
chronic pain
> 6 months, can interfere with daily activities, is sometimes associated with feelings of helplessness or hopelessness.
chronic nonmalignant pain
Not life-threatening and usually responds favorably to a consistent, stable dose of pain medication as a part of the treatment regimen.
chronic malignant pain
Associated with cancer - ends with control of the disease or death.
nociceptor pain
Nociceptors are sensory nerve receptors strategically located throughout the body that initiate pain transmission when stimulated.
further subdivided –> somatic or visceral
somatic pain
Sharp, localized sensations usually experienced in muscles and joints.
visceral pain
A generalized dull, throbbing, or aching pain usually located in internal organs.
neuropathic pain
Injury or irritation to nerve tissue. Typically described as burning, shooting, or numbing pain.
How is pain classified?
By its duration (acute or chronic) and source (nociceptor or neuropathic.)
What is the purpose of classifying pain?
To guide appropriate treatment rationales based on the type of pain reported by the client.
What are the phases of pain physiology?
- Pain transduction
- Pain transmission
- Pain perception
- Pain modulation
pain transduction
1st phase of pain physiology. Trauma stimulates nociceptor.
pain transmission
2nd phase of pain physiology. Pain impulse travels along peripheral nerves to spinal cord along A and C fibers
pain perception
3rd phase of pain physiology. Cerebral cortex recognizes the pain stimulus.
pain modulation
4th phase of pain physiology. Limbic system reacts to pain. Modulating signals sent along descending tracts of the spinal cord. Neurotransmitters can inhibit pain transmission.
opiod agonist
- Relieves moderate to severe pain
- Causes CNS depression
- GI side effects
- Sedation, urinary retention, pruritus
- Respiratory depression (decreased respiratory rate)
- Dizziness, hallucinations, anxiety
- Risk of dependency
What is the action of an opioid agonist?
activates mu and kappa receptors
What is the action of a mixed opioid agonist-antagonist?
Works on one receptor, but blocks or has no effect on another.
mixed opioid agonist-antagonist
- Treats moderate pain with less risk – narcotic analgesics developed for strong analgesia with fewer adverse effects
o Less respiratory depression
o Lower potential for dependence
What is the action of an opioid antagonist?
Blocks mu and kappa receptors.
opioid antagonist
- Therapeutic use for opioid overdose or reversal of opioid effects
- Reversal of constipation cause by opioids
non-opioid analgesic
- Includes NSAIDs, acetaminophen, and a few centrally acting agents
- NSAIDs (aspirin, ibuprofen) drugs of choice
o Have antipyretic and anti-inflammatory properties
o Act as peripheral sites, inhibiting pain mediators at nociceptor level - Do not produce severe adverse effects of narcotics
adjuvant analgesics
Diverse group of drugs used to enhance analgesia for specific indications, all have other primary classifications.
Primary indications for adjuvant analgesics:
- Pain refractory (resistant) to opiods (e.g. intractable cancer pain)
- Neuropathic pain
Type of adjuvant analgesics
- Antidepressants (particularly SSRIs)
- Antiseizure drugs
- Corticosteroids
- Local anesthetics
- Muscle relaxants
mild migraine
Occasional headaches; no other functional impairment.
mild migraine treatment
o NSAIDs
o Acetaminophen combined with NSAID and caffeine
o Oral serotonin 5-HT1 agonists (e.g. tripatnas/ergot alkaloids)
moderate migraine
Moderate headaches, nausea, some functional impairment.
moderate migraine treatment
o Oral, intranasal, subQ serotonin (5-HT) agonists
- If contraindicated or ineffective, then dopamine agonists prescribed
severe migraine
Severe headaches > three time/month; marked nausea or vomiting, functional impairment.
severe migraine treatment
o SubQ, IM or IV serotonin agonists
o 2nd choice parenteral dopamine agonist
o Narcotic analgesics for refractory pain
