Week 2 Pain Flashcards
What is Pain?
CNS reaction to potential harmful stimuli
Acute - Sudden onset
Early warning to seek treatment to prevent damage to the body
Chronic- Lasting long time or frequent recurrence.
What is pain
May result from inflammatory response that cause tissue injury and release of
Histamine
Prostaglandins
Serotonin
Bradykinin
Intiate action potential along sensory fiber
Nociceptors
Activated pain receptors
- Messages sent to brain cortex
- Appropriate Autunomic and reflect responses activated
Pain Stimuli
Nociception
chemical, mechanical, thermal stimulation
More only small fiber
Inhibitory neuron activated
Neuron sends message to brain
Gate is open
After Pain Stimuli
No input
-Inhibitory neuron prevents projection neuron from sending signals to brain
Normal Somatosensory Input
- More only large stimulation
Gate also called
Reflex responses to pain
What is Pain?
Neurotransmittters
- Endorphins and enkephalins
Bind to with opiate receptors in the CNS
Inhibit pain impulses
Natural Analgesic Effect
- After painful stimuli affect the body
- Pain is subjective
Everyone is different
Same injury but different response
Endogenous Analgesics Released After Painful Stimuli
Pain
Unpleasant sensory, emotional experience with actual or potential tissue damage
Common reason for seeking care
5th Vital
Pain assessed in all patients and have right to appropriate assessment and management of pain
Pain is what person says
Pain is present in whenever a person says it is.
Nociceptors
Peripheral Pain receptors
Ability to Feel Pain
Nociception
- Transduction- activation of pain receptors
- Transmission- Painful stimuli message reaches spinal cord and higher brains
- Perception- Sensory process from pain stimulus. Personal interpretation- pain threshold
- Modulation- Process of inhibiting or modifying sensation of pain
Patho of Pain
Bradykinin- vasodilator, histamine release
Prostaglandins- Increases sensitivity of pain
Neuromodulators- Endorphins, enkephalins and suppress pain reception
Substance P- Increases rate of firing and sensitivity of nerves
Acute Pain
Now
Chronic Pain
More than 3 months ago
Exacerbation
Old pain that returned
Cutaneous Pain
Localized to the skin
Referred Pain
Pain felt in another part of the body
Nociceptive
Pain caused by injury or inflamamtion of some of the body
Intractable Pain
Severe, constant, relentless, and debilitating pain not curable by any means
Breakthrough Pain
Severe Pain that erupts while a patient is already medicated with long lasting pain killer
Neuropathic Pain
Damage to PNS or CNS as result of abnormal processing
Neuroplasticity- ability of brain to adjust to pain
Peripheral Sensitization- Increased sensitivity to an afferent nerve stimuli after cellular damage.
Central Sensitization
Changes to Nervous system
Allodynia- Stimuli not painful prior to injury
Hyperalgesia- normal painful stimuli is perceived as more painful than it should
May be hypersensitve to light
Factors that Influence Pain
Past
Anxiety
Stress
Depression
Culture
Religion
Age
Gender
Medical History
Gabapentin
Treats neuropathy. Neurotonin. anticonvulsant
Acute Pain Effects
Can affect respiratory, cardiovasuclar, endorcrine, and immune systems
Stress response increases metabolic rate, cardiac output, risk for physiological disorders
Sleep Deprivation
Effects of Chronic Pain
Depression
Suicide
Self Medication
Increased disability
Supression of immune function slow healing time
Characteristics of Pain
PQRST
P- what makes it worse or better
Q- Quality describe
R- region where it is located and radiation
S- Severity
T- Timing of it
Indicators of Pain
Restlessness or irritability
Crying and screaming and other verbal expression
Grimacing and grinding teeth
Touching or grabbing body part
Kicking or thrashing or attempting to move away
Facial Expressions
Verbalizations and vocalizations
Body movements
Changes in interpersonal interactions
Changes in activity patterns and routine
Changes in mental status
Indicators of Pain
Can be affected by
Culture
Religion
Age
Ethnicity
Language
Be sensitive tp pt that have barriers to expressing their pain
Non Pharmacological Interventions
CAM
Cutaneous Stimulation
- Massage
- Thermal Therapies
- TENS Unit
- Acupressure/ Acupuncture
- Biofeedback- Teaching to self to decrease pain
- Therapeutic touch
Nonpharmacological Interventions
Alternative Therapies
- Herbal remedies
- Acupuncture
Distraction
-Humor
- Music
-TV
Relaxation Techniques
- Hypnosis
- Guided Imagery
Analgesics
Releive pain without
Disturbing conciousness
Altering actions of sensory nerves
Antipyertics reduces fever
Some have inflammatory responses
Basics of Pain Relief
Opiods- Act on CNS to inhibit activity of ascending nociceptive pathways
NSAIDS- decrease pain by inhibiting COX- 1 and COX 2 enzymes involved in production in prostaglandins
Local anesthetics- Block nerve conduction applied to nerve fibers
Pain Relief Interventions Phamacological
Routes
PRN meds
ATC- Around the Clock
PCA- Patient Controlled Analgesia
Local Anesthetics
Topicals, Patches
Intraspinal administration
Gerontologic Considerations
More likely to have adverse effects, drug interactions
Increased likelihood of chronic illness
May need to have more time between doses of medication due to decreased excretion, metabolism, related to aging changes
Start low and go slow
Acetaminophen
Action- Analgesic, antipyertic
Less association with nausea and vomitting than NSAIDS
Does NOT cause GI bleeding or interefere with blood clotting
Equal to ASA in analgesic and antipyertic effects
Metabolized in the liver, small amounts remain in the body as toxic metabolite
Liquid 160/ 5 ml
325 mg
PR c Acetaminophen
Nursing Implications of Acetaminophen
Liver Function, alcohol use, and last dose taken
Acetaminophen Uses
General pain mild to moderate
Contraindications
- Acute or chronic overdose can result in liver damage or fatal liver necrosis
Usual therapeutic doses may cause and increase liver damage in those who abuse alcohol
Acetaminophen Toxicity
Max dose 4 g
Overdose causes hepatoxicity
May be accidental or intentional
S/S nonspecific
Livers levels increased
Later manesfestations include jaundice, vomiting, CNS excitement with delerium
Increased Ammonia Levels
Hepatic Encephalopathy chronic liver damage- Lactulose
Overdose Toxicity Acetaminophen
Gastric Lavage
within 4 hours
Acetylcysetine
Oral or IV
Does not reverse damage already
NSAID
Used for
Headache
Dysmennorhea
Myalgias
Neuralgias
Fever
Common Cold
Viral Infections
Arthiritic and Rheumatoid Conditions
Acetaminophen interactions
Alcohol
Barbituates
Carbamazepine
Phenytoin
Rifampin
NSAIDs include
Salicylates
Antipyertics
Used to treat painful conditions:
Arthritis - Inflammation of the swelling of the joints, stiffness, and pain
Menstrual attacks
Gout Attacks
Bursitis
Sprains
NSAIDs
Acetylsalicylic acid
Diclofenac
Diflunisal
Etodolac
Fenoprofen
Flurbiprofen
Indomethacin
Keterolac
Nabumetone
Naproxen
Oxaprozin
Piroxicam
NSAIDs
Differentiate by COX 1 nonselective and COX 2 Inhibitors or COX 2 Inhibitors 9 selective
COX officially known as prostaglandins endoperoxide synthase
Acetaminophen Adverse Effects
Sensitivity reactions
Skin eruptions
Urticaria
Hypotension
Hepatotoxicity
Increases HTN c daily use
NSAIDS Acetaminophen
Contraindications
-Hypersensitivity
- Anemia
- Children under age 3
-Alcoholism
- Malnutrition
- Thrombocytopenia
- Hepatic or renal impairment
- Childhood rheumatoid conditions
NSAIDs
Include
-Salicylates
-Antipyretics
Used to treat painful conditions
Arthritis- inflammation, swelling, stiffness, joint pain
- Menstrual Cramps
- Gout attacks
- Bursitis, tendonitis
- Sprain, muscle strains
Commonly used NSAIDs
Aspirin ( acetylsalicylic acid)
- Diclofenac
- Diclofenac- misoprostol
- Diflunisal
- Etodolac
- Fenoprofen
- Flurbiprofen
- Ibuprofen
- Indomethacin
- Ketorlac
- Nabumetone
- Naproxen
-Oxaprozin
- Piroxicam
Cyclooxygenase
Enzyme maintains normal lining of stomach and intestines
Protecting stomach juices
Involved in kidney and PLT function
Salicylates
Action- Decreases platelet aggregation
antipyretic, analgesic
Side effects - delayed clotting= bleeding
Contra- Pregnant, day of surgery, other anticoags, and bleeding
Nursing Implications - Assess for contras and proper order use, and PLT count
Aspirin
Nonslective COX 1 and COX 2
Salicytate
ANtipyeric and analgesic factors
Decrease PLT aggregation
Used for
Headache
Fever
Muscular aches and pains
Safest and effective drugs for surgery
Adverse Uncommon effects of Aspirin
Dyspepsia
Nausea, vomiting
Blood in stool
Anemia
GI hemorrhage (elderly)
Asprin Contras
Hypersensitivity
GI hemmorrhaging
Interactions
Anticoags
Uricosurics- Uric acid
Antidiabetics
NSAIDS
Aspirin
Avoid if menstrual bleeding is heavy
Pregnancy women avoid in last trimester and during lactation
Avoid one week before or after surgery
Avoid alcohol while taking aspirin
NSAIDs Propionic Acid Derivatives
Ibuprofen
Action- Analgesic, antipyertic
Use- General Pain, joints, swelling, and fever
Adverse effects- bleeding
COntras- bleeding, pregnant and chronic kidney disease
Nursing implication- Proper order use, and PLT count
Ibuprofen
Non- selective, COX-1 and COX- 2 inhibitor
Nonsalicylate Analgesic
-Anti flammatory
- Antipyertic
Used to treat pain:
RA
Osteoarthritis
Arthritis
Mild to moderate pain
Dysmenorrhea
Fever
Ibuprofen Adverse Effects
Nausea
Occult blood loss
Peptic Ulceration
Diarrhea
Constipation
Abd pain
Dyspepsia
Flatulence
Heartburn
Ibuprofen HTN in women
Higher risk 78 percent
Ibuprofen
Contraindications
Hypersensitivity
Angioedema
Nasal Polyps
Pregnancy
Bronchospasm reaction NSAIDs
Ibuprofen Interactions
Antihypertensives
Furosemide
Diuretics
Avoid if breastfeeding
Notify HCP if blood appears in stool, vomitus, and urine
New skin rash, itching, jaundice
Avoid alcohol, aspirin, and other NSAIDs
Meloxicam Oxicam
Oxicam Derivatives
Same as other Nsaids
Use for RA and OA
Used for short period of time and at a low dose
Easier on stomach due to higher activity of COX2
Indomethicin
Use
Moderate to severe OA, RA, gouty arthritis, or ankylosing spondylitis
Shoulder pain caused by bursitis or tendinitis
Used to treat PDA
Not be used for minor pain
Action- Same as other NSAIDs
Adverse Effects-
GI ulcerations
Bleeding
Increased pain in UC
Gastritis
Nausea, vomiting
Many others
Indomethacin Contras
Hypersenstivity
Pregnancy
Breastfeeding
In neonates
Bleeding
Renal impairment
NSAID- induced asthma, rhinitis, hives
Indomethacin
Interactions-
Aminoglycosides
Cyclosporine
Methotrexate
Antihypertensives
Furosemide
Thiazide Diuretics
Notify Physician Indomethacin effects
Skin rash
Breathing problems
Visual Disturbances
Signs of hypersenstivity to NSAIDs
Celecoxib
Decreased risk for gastric bleeding
200mg to 400mg
Action COX 2 inhibitor
Use - Joint Pain- OA- RA
Adverse Effects- coughing blood, jaundice, AKI, anemia
Nursing Implications- Liver and kidney function, signs of GI bleed.
Selective COX 2 Inhibitors Adverse Effects
Abdominal Pain
Dyspepsia
Diarrhea
CV thrombotic events
Selective COX 2 Inhibitors Contraindiactions
Hypersensitivity
Asthma
Urticaria
In the elderly
Anaphylactic Reactions
In children
Third Trimester of pregnancy
Lactation
Selective COX 2 Inhibitors Interactions
ACEs
Fluconazole
Lithium
NSAIDs Selective Cyclooxygenase 2 Inhibitors
Report-
Weight gain
Rash
Nausea
Fatigue
Lethargy
Jaundice
Flu Like Symptoms
Black Tarry stools
Upper GI distress
Selective Cyclooxygenase 2 Inhibitors
Avoid celecoxib during 3rd trimester
Avoid:
Aspirin
Other NSAIDs
Alcohol
Tobacco
Opiates are derived from
Opium poppies
Opioids
-Natural Synthetic, or endogenous morphine- related substances
Analgesic effects
- Bind to opioid receptors ( mu, kappa, delta)
- Mostly effects mu receptors
