*Unit 5 - Comfort Flashcards
Goal of pain management:
to get to a pain level so a person can perform ADL’s
T/F: Pain is whatever and whenever the patient says it is
T
who are the experts of pain
the patient
T/F: patient report of pain is enough for a nursing diagnosis of pain-there does not need to be any other objective signs or symptoms
T
What are these:
- health care providers are good at recognizing pain
- you have to see objective S&S to know someone is in pain
- you don’t feel pain if you can sleep
- pain control leads to addiction
- people who report chronic pain are addicts
- the more pain you have, the better your can tolerate it
- emotions don’t contribute to pain perception
pain myths
Type of pain:
occurs suddenly, short-lived and responds to treatment, usually caused by injury
acute
Type of pain:
persisting for more than 6 mos., can be difficult to treat, interferes with daily activities
chronic
Type of chronic pain:
tumor, metastasis, complications, surgery, treatments, chemotherapy, and radiation; end with remission or death
malignant
Type of chronic pain:
not life-threatening
nonmalignant
Type of pain:
stimulation of pain receptors
noniceptor
Type of noniceptor pain:
skeletal muscles, ligaments, and joints
somatic (sharp)
Type of noniceptor pain:
smooth muscles and organs
visceral (dull, throbbing, aching)
Type of pain:
injury to nerves
neuropathic (burning, shooting, numbing)
Which type of pain is the most difficult to treat? Why?
??????
Type of pain transmission:
peripheral nerve endings are stimulated
transduction
Type of pain transmission:
nerve impulse travels to spinal cord and then brain-*Gate Control Theory
Transmission
Type of pain transmission:
brain says pain
perception
Type of pain transmission:
impulses from brain to spinal cord to inhibit pain and/or react to pain
modulation
T/F: if we can stop the stimulation of the pain stimulus, then we can stop a person from feeling pain
T
very commonly use theory for pain; reason massage works to relieve pain; transmission
Gate Control Theory
any med that acts on the brain or spinal cord (CNS)
A centrally acting drug
any med that acts beyond the spinal cord/CNS
peripheral acting drug
the result of excess heat production caused by changes in the hypothalamus
fever
the body’s response to tissue damage and injury
inflammation
the result of stimulation of pain nerve endings, usually caused by damage or trauma
pain
how do meds help a fever
meds help changing the heat-regulation center
how do meds help inflammation
they block prostaglandins (which cause many of the effects of inflammation)
how do meds help pain
they block pain sensations or prostaglandins
symptoms of localized inflammation (ex. sliver) (3)
- redness : caused by vasodilation
- swelling: (edema) leakage of plasma into extracellular spaces
- pain: prostaglandin irritation of nerve endings and pressure of edema
symptoms of generalized symptoms (ex. flu) (6)
- increase leukocytes
- elevated erythrocyte sedimentation rate (ESR)
- fever
- headache
- loss of appetite
- lethargy/weakness
What type of inflammation:
- immediate onset
- lasts 1-2 weeks
- involves neutrophils
- anaphylaxis (type of ___ inflammation)
- may lead to formation of scar tissue
acute
what type of inflammation:
- slow onset
- involves lymphocytes and macrophages
- increases scar tissue
chronic
T/F: inflammation is a natural response
T…it helps the body fight antigens and heal injuries
T/F: inflammation is NOT a disease
T
T/F: do not use topical drugs even if appropriate to avoid systemic adverse affects for inflammation
FALSE! Topical drugs SHOULD be used when appropriate to avoid systemic adverse affects for inflammation
Which drug:
reduction of fever and pain
acetaminophen (tylenol)
contraindications of acetaminophen
- sever liver or kidney disease
- alcoholism
potential interactions for acetaminophen
- increase effect with caffeine
- alcohol increases heptotoxicity
nursing consideration for acetaminophen
assess for alcohol use because alcohol affects the liver which is affected by tylenol
patient/family teaching for acetaminophen
- look for yellow skin (jaundice)
- look for difference in stool/urine color
- drugs use in the treatment of pain, fever and inflammation
- these drugs achieve their desired effect through inhibiting the production of prostaglandins
Non-steroidal Anti-inflammatory drugs (NSAIDS)
T/F: is tylenol an NSAID
No, they act differently
What drug:
- reduced pain, inflammation, and fever by inhibiting prostaglandin synthesis; prevent platelet aggregation = decreases clotting by making platelets “slippery” (platelets have to die and get rejuvinated before affects of clotting go away = can’t have it a couple weeks before surgery)
- new research: preventing colorectal cancer
Aspirin (ASA)
common side effects of aspirin
heart burn
ulceration
stomach pains/bleeding
**tinnitus
(common because of effects of prostaglandin on stomach)
alcohol + aspirin =
GI bleeding
tylenol + aspirin =
nephrotoxicity
caffeine + aspiring =
(anacin) increased absorption rate of aspirin = helps it work better
Patient teaching for aspirin
- avoid giving children aspirin if suspected to have cold/flu/fever
Can you chew enteric coated pills or SR (sustained release) pills
NO!
what drug:
reduction of inflammation, pain, and fever by inhibiting synthesis
ibuprofen
overdose of ibuprofen =
renal failure
Potential reactions of ibuprofen
- alcohol, other ensets, & steroids increase GI side effects
aspirin + ibuprofen =
GI side effects: GI bleeding, discomfort, etc.
Patient teaching for ibuprofen
- look for GI bleeding
- DO NOT TAKE IF PREGNANT!
what drug:
reduction of inflammation, pain, and fever, used for arthritis
celecoxib
CBC
complete blood count
LFTs
liver function test
BUN
blood urea nitrogen
creatinine labs
used to assess kidney function
a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effect rather than pain management
addiction
a larger dose of opioid analgesic is requires to maintain the original effect
tolerance
when the abrupt discontinuation of an opioid produces withdrawal symptoms
physical dependence
T/F: respiratory depression is often a side effect of morphine = wanting to breathe less = asthma
T
ICP
intracranial pressure
common side effects of morphine
- increased ICP
- respiratory depression
- constipation
what is the antagonist of morphine/any narcotic
narcan (naloxone)
what to do when rpr <12 when taking morphine
hold the med
what to do when rpr <10 when taking morphine
report to MD
T/F: you should push narcotics (morphine) quickly in IV
FALSE! they should be pushed slowly!
what drug:
reverse ALL effects of narcotics/opioids (including therapeutic effects)
narcan (naloxone)
What schedule is tramadol
IV
what drug:
has weak opioid activity, prevents norepinephrine and serotonin reuptake -> blocks pain transmission for moderate pain reliefe
tramadol
T/F: tramadol can be fatal
T…should not be used for people who are suicidal
T/F: alcohol can cause death with tramadol
true
2 types of headaches
- tension
- migraine
Migraines:
occasional with no functional impairment
mild
Migraines:
nausea and some functional impairment
moderate
Migraines:
> 3 times a month, N&V, functional impairment
severe
headaches are cause by
vasodilation
T/F: sumatription is a vasodilater
F! It’s a vasoconstrictor = takes away headaches (like caffeine)
common side effect of sumatripton
- tingling/warm sensation down the arm
- scary: coronary artery spasm
contraindication of sumatripton
- those who have seizures
- can’t on those who are on MAOIs and SSRIs
what drug:
antimigraine by constricting cranial blood vessels
sumatriptan
T/F: it is most helpful to put someone in a dark room and administer before getting a migraine when taking sumatripton
T
T/F: you can’t use SQ > 2 injections in 24 hours for sumatriptan
T, and they must be atleast 1 hr apart
- caused by increased uric acid production
- caused by reduced uric acid secretion by kidneys
- causes pain and inflammation
gout
goals of anti-gout meds (3)
- stop acute episodes
- prevent future attacks
- avoid complications (kidney stones)
what drug:
- used primarily in acute gout attacks (profilacted (small doses every day) or acute attack (take asap))
- prevents inflammation process from reacting to crystals
colchicine
colchicine dose for acute attack
1.2 mg po then 0.6 mg qh until pain is resolved )max: 1.8 mg/h)
do NSAIDS increase or decrease risks for serious GI effects when taking colchicine
increase
what drug:
blocks action of xanthine oxidase -> prevents formation of uric acid -? lowers serum uric acid levels
will take as a preventative measure for gout
allopurinol
nursing consideration/patient teaching for gout (5)
- increase fluid intake: 3-4 L/day
- avoid purine rich foods
- take meds as prescribed
- take meds with food
- report adverse s/s of meds
Q: the best description of chronic pain?
It persists for more than 6 months.
Q: True or False: Acetaminophen treats inflammation.
F
Q: Which organ is acetaminophen intoxication most damaging to?
liver
Q: Which of the following is NOT a contraindication of aspirin? A. child with a cold B. pregnant women in third trimester C. a middle-aged man with a fever D. elderly women with GI bleeding
C. a middle-aged man with a fever
Q: Which of the following would NOT be included in the patient teaching about ibuprofen? A. B. C. D.
Report black hairy tongue.
Q: What is celecoxib commonly used for?
arthritis
Q: What is the antidote for opioids?
naloxone (narcan)
Q: Which of the following is NOT a common adverse effect of morphine? A. B. C. D.
tachycardia
Q: How does sumatriptan work to relieve headaches?
It causes intracranial vasoconstriction.
Q: What are TWO drugs used in the treatment of gout?
colchicine, allopurinol
Max dosages per day: ibuprofen acetominophen aspirin sumatriptan
3200 mg
4000mg
4000 mg
100 mg
Q: An 80 year old woman, who is scheduled for a total knee replacement next month, currently takes ibuprofen 600 mg three times per day.
Which client teaching is most important?
A. Continue ibuprofen until surgery
B. Stop ibuprofen today
C. Decrease ibuprofen to two times per day
D. Stop ibuprofen 7 to 14 days before surgery
D. Stop ibuprofen 7 to 14 days before surgery
Q: The nurse should question the order of acetaminophen for which client?
A. client with cirrhosis of the liver
B. client with chronic obstructive pulmonary disease
C. client with breast cancer
D. client who is taking warfarin
A. client with cirrhosis of the liver
Q: What substance is used to treat serious cases of acetaminophen overdose? A. naloxone B. acetylcysteine C. caffeine D. colchicine
B. acetylcysteine
Q: A client has a fever and is allergic to aspirin. Which medication will the nurse anticipate administering to reduce the client’s fever? A. Ibuprofen B. Ketorolac C. Acetaminophen D. Celecoxib
C. Acetaminophen
Q: A client takes aspirin daily for pain in the right knee. Which toxic effect may be present with aspirin overdosage? A. Tinnitus B. Peripheral neuropathy C. Heart arrhythmias D. Seizure activity
A. Tinnitus
Q: The nurse is monitoring the client for adverse effects associate with morphine. Which adverse effect would NOT be expected? A. Respiratory depression B. Hypertension C. Constipation D. Nausea
B. Hypertension
Q: Several days postoperative bowel surgery, the client is eating soft food, ambulating regularly, and using hydrocodone for pain. What should the nursing care plan include?
A. Monitoring for vital signs for respiratory depression
B. Inserting a urinary catheter for urinary retention
C. Weaning pain medication to prevent addiction
D. Increasing dietary fiber and fluids and administering a stool softener if needed
D. Increasing dietary fiber and fluids and administering a stool softener if needed
Q: While assessing a client on a continuous morphine intravenous infusion, the nurse notices the client’s respiratory rate to be 9 breaths per minute. What action should the nurse take next?
A. Do client teaching on the signs and symptoms of hyperventilation
B. Continue monitoring the client
C. Stop the infusion, call the provider and be prepared to give naloxone (Narcan)
D. Sit the client up in a high fowlers position and administer oxygen
C. Stop the infusion, call the provider and be prepared to give naloxone (Narcan)
Q: Sumatriptan, a serotonin agonist, can be potentially dangerous when taken with certain substances. Which of the following substances should a patient who is taking sumatriptan avoid? A. peppermint B. milk C. vitamin K D. MAOI's
D. MAOI’s
Q: The nurse is caring for a client who is taking allopurinol for preventing gout attacks. Client teaching should include all the following EXCEPT:
A. Avoid foods such as legumes, salmon and mushrooms
B. Increase fluid intake to 2-4 liters per day
C. Take with food
D. This medication is safe to take during pregnancy
D. This medication is safe to take during pregnancy
Should you use Sumatriptan within 14 days of surgery
NO!
