UNIT 2 PAIN INTERVENTIONS Flashcards
Effective treatment of pain includes?
- Pharmacological therapies
- Adress the actual tissue damage
- Non-pharmacological therapies
- Address the sensory and emotional experiences associated with the tissue damage.
Who or what is the single most powerful nonpharmacologic method of pain relief available to children?
Parents
What is the purpose of non- pharmacolgic intervention?
- Helps reduce the perception of pain
- Helps provide a sence of control
- Helps make pain more tolerable
- Decreases anxiety
- Enhances the effectiveness of analgesics
- Learn the intervention prior to the need
How are the specific non-pharmacological therapies categorized?
- Sensory
- Cognitive behavioral and relaxation
- Imagery
How does sensory techniques work?
They are used to alter one’s perception of pain by stimiulating receptors involved by the senses
What senses might be utilized in non-pharmacological treatment?
- Sight
- smell
- taste
- feeling
- hearing
What is tactile stimulation of cutaneous fibers?
May compete with percieved pain sensations
What is distractng stimulation?
Sensory technique that may refocus attention away from the pain
What are some examples of tactile stimulation?
- Rubbing, stroking, patting, hugging, hand-holding
- Squeezing a soft object (clay or soft ball)
- Using a small vibrating device (buzzy bee)
- Alternating application of heat and cold
- if direct application to the painful area is contraindicated, apply to opposing extremity
- TENS unit
What should we know about the buzzy bee?
Review nothing major
- Buzzy bee uses cold and vibration
- uses natural “gate control pain relief” by confusing the body’s own nerves —> dulling or eliminating sharp pain
- “use between the brain and the pain”
What are some distraction techiniques that can be utilized to distract infants and young children?
- Objects that move or change shape or colors
- Pinwheels, kaleidoscopes, videos, magic wands
- Pop up books; seek and find books
- Puppets
- Rocking
- Non-nutritive sucking
- Music and/or singing
- Play therapy
- Art therapy
What are some distraction techniques we could use for older children/adoescent
- Electronic activites such as video games or tv
- Books/Reading
- Music or singing
- Art therapy
- Aromathrerapy
What are some cognitive behavioral and relaxation techniques that we can use as non-pharmacological interventions?
- Bubble blowing
- counting
- Sometimes backwards or in patterns/groups
- Deep breathing
- progressive muscle relaxation
- Biofeedback
- Mindfulness-based stress reduction (MBSR) and/or meditation
What is MBSR?
Mindfulness-based stress reduction and or mediatation: A program that teaches a patient to calm their mind and body as a method to help control pain and stress
What is imagary techiniques in terms of non-pharmacological interventions?
- A form of distraction by allowing one to redirect his or her attention away from the pain to a mental representation of an image
- The key is to let the child or adolescent choose the image or setting to ensure that it is image or setting to ensure that it is one that they enoy and find relaxing
What are different types of imagery ?
- Guided imagery- examples include taking a trip, pain switch, and magic gloves
- hypnosis
- Storytelling and pretending
How can we initate guided imagery by using the “take a trip” technique?
Begin by asking the child/adolescent about a place where he or she would like to go, as this technique works best when the child/adolescent goes, in his or her mind, to a palce where he or she desires to be
How can we initate guided imagery by using the “Pain switch” method?
Ask the child/adolescent to visualize his or her pain as a light or electrical current, and then to describe a switch that can be used to turn off the pain
How can we initate guided imagery by using the magic gloves method?
- Explain to the child that you will be teaching him or her a way to bring comfrot to the body part where a procedure (needle stick, IV start) will occur by placing a “magic glove” on that body part
- Suggest to the child that he or she visualize a magic glove as an article or protective clothing going on the childs body
What are some additional non-pharmacological therapies?
- Yoga
- Tai chi
- physical therapy
- massage
- accupuncture
- energy therapies
- aromatherapy
True or false: Non-Opiods used in conjunction with opioids require less opioid usage?
True: Pain control is better achieved through this combonation method
The patient will experience (More or Fewer) adverse side effects from opiods, since the amount of opioid dose needed for pain control is (Greater or Lessened)
- Fewer
- Lessened
Non-Opiods is great for managing what severity of pain?
Mild to moderate
Non-opiods target the…
PNS
What are the most comon types of non-opioids?
- Acetaminophen (Tylenol)
- IV acetaminophen (Ofirmev)
- Ibuprofen (Motrin, Advil)
What is the ceiling effect we see with non-opiods?
Basically you can only give a set amount that is effective.. any more doesnt help.
What severity of pain are opioids used to treat?
Moderate to severe
Opioids target the…
CNS
True or false: Opiods also have the ceiling effct like non opiods?
False– “more is always better”
Opioids are typically tritrated
What are some of the most effective opioids?
- Morphine sulfate (morphine)
- Fentanyl citrate (sublimaze)
- 100 x more potent than morphine
- Hydromorphone hydrochloride (dilaudid)
- 6x more potent than morphine
What might we use methadone for?
Methadone may be used to wean them from opiods and to treat severe or chronic pain
What are some other effective medications
different from the most effective opiods
- oxycodone/OxyContin (extended release)
- Hydrocodone combined with acetaminophen or iburprofen
- Narco, lortab, vicoden, vicoprofen
What are some coanalgesic adjuvant therapies we might see in pain interventions?
-
Anticonvulsants
- Gabapentin (neurontin): neuropathic pain
2. NSAIDs- Anti-inflammatory for use before or after medical procedures/surgery
- Gabapentin (neurontin): neuropathic pain
-
Tricyclic antidepressants
- Amitriptyline, imipramine (tofranil): Neuropathic pain
4.** Sedatives**
- Midazolam (versed): relaxation or sedation prior to medical procedure/surgery
- Amitriptyline, imipramine (tofranil): Neuropathic pain
- **Skeletal Muscle relaxants **
- Baclofen (lioresal): Alleviates musculoskeltal pain and spasms and reduces spasticity
-
Antianxiety medication
- Lorazepam (ativan): Muscle relaxant or to lessen anxiety before medical procedures/surgery
-
Corticosteriods
- Methylprednisolone (solu-medrol): Reduce pain and inflammation
What should we know about placebos?
Not recommeneded by the American society of pain management nursing
1. Considered unjustified and unetihical
2. Raise serious ethical and legal questions
What should we know about therapeutic range
Very generalized anwser
- Safe starting dose
- Can titrate upward to achieve optimal pain relief
- May have differnt safe, starting ranges based on diagnosis
What are range orders?
give an example
example; 1-2 mg every 3 hour for pain…
What should we know about the oral route of med admin
- Preferred route if tolerating PO intake
- Longer duration and least invasive
- Liquid form
- pill form- dont assume they can swallow a pill based on age
- lollipop form (transmucosal)
- Fentanyl oralet (actiq)
- tetracain lolipop
What should we know about the intravenous route of med admin?
Recommended for brief, moderate to severe pain in children unable to take oral mediations
What are the differnt types of intravenous admin?
- Bolus “push”
- Continuous
What should we know about a PCA pump?
- Self-Admin
- can be a bolus, continuous (basal) infusion, or combination
- Usually by **5-6 years **of age if **they understand the concept of cause and effect **
- Has lockouts to prevent overdosing
- May have a primary pain manager other than the patient with specific guidelines
- Family-controlled analgesia
- Nurse activated analgesia
What should we know about the intramusclular med admin route?
Not recomended for pain control: Not current standarded of care
1. Should be avoided if possible
2. Causes pain and has variability in absorption
What should we know about the rectal route of administration?
- Tramatic
- Abosrption affected by stool
- many drugs can be compounded into rectal suppositories
What should we know about the intradermal route of administration?
- Used primarily for skin anesthesia
- Local anesthetics (lidocaine) which may be buffered with sodium bicarb
- Examples: Lumbar puncture, bone marrow, aspirations, arterial punctures, skin biopsies
What should we know about the inhalation route of administration?
- Use of anesthetics, such as nitrous oxide, is also used to produce partial or complete analgesia for painful procedures
What should we know about transdermal route of administration? Fentanyl (duragesic) specifically
- Children > 12 years
- no inital relief of acute pain
- provides continous pain control
- used on intact skin
- onset 12-24 hours
- duration 72 hours per patch
- Good as an adjunct to other pain meds/relief but not for inital treatment of acute pain
What should we know about EMLA (Eutectic mixture of local anesthetics {lidocaine and prilocain})
This is a topical anesthetic
- Used on INTACT skin
- Apply 1-2 1/2 hours prior before painful event. Vasocontricts for 1st hour so aoid starting an IV at that time.
What should we know about LMX4 (4% lidocain cream)
This is an topical anesthetic
Apply 30 mins before procedure last 60 mins
What should we know about lidocaine-tetracaine (synera, S-Caine)
This is a transdermal patch
- Apply 20-30 mins prior
- Do not apply to broken skin
- Administers topical analgesia before painful procedures
Lidocain-tetracaine transdermal patches are great for…
- IV insertion
- lumbar puncture
- accessig portaCaths
- Lab Draws
- PICC line insertion
- IM injections/immunizations
What should we know about vapo-coolent (refrigerant spray)
Pain Ease (ethyl chloride)
Intact skin
- An instant topical anesthetic skin refrigerant that temporarily controls pain only lasts up to 1 min
- Used on intact skin, minor open wounds, and intact mucous membrane
- Works for needle procedures and minor surgical procedures
- No Vasocontrictions
- Available from pharmacy (does not require a physican’s order)
- Ask pedi for use in children 4 years or younger
Refrigerant sprays are used for…
- Immunizations
- IV starts
- Joint injections
- blood draws
- incision and drainage of small abscesses
- foriegn body removal
- suturing and suture removal
what are some pain prevention interventions used on INTACT skin
- EMLA
- LMX4
- Transdermal patches: Lidocaine-tetracain (synera, S-caine)
- Vapo-coolent (refridgerant)
What should we know about topical LAT-gel?
Lidocaine-adrenalin-tetracaine
- NON INTACT SKIN
- Used for nonintact skin (for suturing)
- Anesthesia occurs in 10-15 mins
- Adrenalin is not used on end arterioles because of vasocontrictions
True or false: Scheuduled pain medications are preferred with PRN’s given for breakthrough pain
True
True or false: Side effects decrease markedly if the rate of injection is too fast?
False… Increases
What general information should we know about respiratory depression?
- Most serious adverse effect
- Rare
- Most likely to occur with inital doses when there is no history of previous exposure
How do we manage opioid-induced resp. depression?
If respirations are depressed
1. Assess sedation level
2. Stop or reduce infusion if continuous
3. Stimulate patient
4. Admin oxygen
5. Support respirations
If client cannot be aroused or is apneic:
1. Initiate resuscitation efforts as appropriate
2. admin narcan (naloxone)
- Remember that the duration of antagonist action may be shorter than that of the opioid, requiring repeated doses of narcan
Respirator depressio due to benzodiazepines can be reversed with….
Flumazenil (romazicon)
What other adverse reactions can you have with Opiods?
- Resp Depression
- N/V
- Constipation
- Pruitis
What should we know about N/V as a side effect of analgesics?
- Administer non-sedating antiemetics
- Ondansetron
- Promethazine
- Usually subside after two days of opiod administration
What should we know about constipation as a side affect of analgesics?
- Common side effect
- Prevention is more effective than treatment
- Administer stool softner or laxative
- Docusate soidum (colace)
- increase fluid intake
- increase fiber
- increase physical activity
What should we know about pruritis as a side effect of analgesics?
- Give diphenhydramine (benadryl)
- Ondansetron (Zofran) has also been effective for opiod and epidural pruritis
