Week 4 Comfort & End of Life Flashcards
Which healthcare professional is solely responsible for the holistic care of the ct?
Nurses
A ct. has many HCP’s on their team, however, most are specialized. For example, a knee surgery physical focused therapist will work on the ct.’s leg movement of the knee in recovery. What is our job?
Get the entire person moving
—— is a complete state of ease and relief from distress. “We relieve suffering”
Comfort
—– is an unpleasant sensory and emotional experience associated with actual or potential tissue damage
pain
What stimulates pain receptors in the brain?
nociceptors that respond to noxious stimuli
How might the pain of a woman experiencing painful menstruations (dysmenorrhea) be influenced by her past experiences?
If her family was celebratory of her first menstruation vs. bothered and sad for her.
Some were told to exercise, others were told to lay in bed with a warm pad and read a book.
How do our experiences influence pain perception?
Perceptions and past experiences can cause the interpretation of pain to be more positive or negative.
What proves that pain is somewhat psychological?
The fact that some people can distract themselves from pain
What are some examples of how we distract ourselves from pain?
-hold our pee when we want to do something
-we are so exhausted but are able to perk up and have a fun night out if we get a call from a distant friend who happens to be in town.
Who is the priority when it comes to nursing attending to patients?
A ct experiencing physiologic pain (likely acute), is priority over someone who is just having unknown pains
What is the goal when it comes to a ct. who is experiencing physiologic pain?
To find the source of the pain, so to treat the root cause.
—— is a holistic approach to addressing physical, emotional, social, and spiritual well-being to promote health
Nursing
According to the WHO, —– is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Health
Whenever helping someone to manage pain, which theory of pain should I consider?
the Gate-Control Theory of Pain, using all the senses
How can I use the Gate-Control Theory of Pain through touch?
-effleurage or “light touch”
-integumentary stimulation “tapping”
-massage
How can I use site to utilize the Gate Control Theory of Pain?
-place a motivation picture on ct.’s ceiling: motivates them to heal; relaxes them; puts them in PNS
How to use taste in the Gate Control Theory of Pain.
Giving them foods they enjoy or prefer, that perhaps takes them back to a fond memory
How to use hearing in the Gate Control Theory of Pain?
Music- what puts them at peace?
Hypnosis
Guided meditations
What does it mean to be an advocate for a client and to “always make the correction”?
Speak up always if a pt. needs advocation. If the charge nurse is discussing one pt., but has mixed up the pt’s name with another, correct her.
What are the main types of pain?
neuropathic, nociceptive, psychogenic, acute, and chronic
What are the types of pain categorized under Nociceptive pain?
-somatic
-visceral
—— is pain when nerves from tissues, bones, skin, muscle, and blood vessels are activated
somatic nociceptive pain
Examples of somatic nociceptive pain:
-arthritis
-surgical pain
-burn pain
——- pain involves internal organs or body cavity linings
visceral nociceptive pain
Example of visceral nociceptive pain?
-heart (heart attack)
-lungs
-abdomen
-liver
-pancreas
-appendix
-gallbladder
——- is pain that is used to describe pain for which no pathologic condition has been found, or in which the pain appears to have a greater psychologic basis than a physical.
psychogenic pain
Examples of psychogenic pain:
COVID
Being a labor alone
What are the classifications of pain categorized under neuropathic pain?
-centrally generated
-peripherally generated
-mixed
—— —— pain involves the spinal cord, peripheral nerve injury (phantom pain), and pain following a CVA
neuropathic centrally generated pain
—– —— pain is pain associated with neuropathies, neuralgia, trigeminal nerve pain (facial pain), Guillain Barre Syndrome
neuropathic peripherally generated pain
—— ——– is pain that can be associated with headaches, some neck/ shoulder/ back pain, and fibromyalgia
neuropathic mixed pain
—- —– is defined by messages from a limb that is gone but is still sent up the nerves to the spinal chord
phantom pain or “peripheral nerve injury”
Neuropathies feel like
walking on pins and needles
neuralgia feels like
electric or burning pain
When someone expresses “I don’t think I’m going to live much longer.” How can I respond?
“Tell me what makes you think that?”
“We all will have our time, and the truth is, we may not know when it’s our time, even when we think we do. What are some important things in your life that you want to focus on with the time of life you do have?”
What is the hope when treating acute pain?
If we treat it well, it hopefully will not turn into chronic pain. Inadequate treatment can turn into chronic pain.
What is sometimes referred to as the fifth vital sign?
pain assessment
What is the most common reason for seeking healthcare?
pain
Pain is highly —— and a reflection of ——- ———.
personalized; past experiences
—— pain is tiring and may cause decreased coping skills in other areas of life.
Chronic
What should be assessed EVERY time I go into a room?
Pain
When should I reassess a ct. who has received a pain medication?
30 minutes- reassess and document (they can sue if not reassessed).
What are some objective examples of how I can assess the pain of a ct.?
-elevated pulse/ resp.
-ct. agitated/ teary/ emotional/ quiet
-ct. guarding/ wincing/ moving very slow
OPQRT is what?
questions to ask when performing a pain assessment
What does O stand for in OPQRT?
onset: when did the pain start? What was happening at the time?
What does P stand for in OPQRT?
Provocation/palliation: What makes the pain better or worse?
What does Q stand for in OPQRT
Quality: What does the pain feel like? Sharp, dull, burning, aching, throbbing
What does R stand for in OPQRT
Region and radiation: Where is the pain? Does it spread to other areas?
What does T stand for in OPQRT?
Timing: When does the pain occur? Has it changed since onset?
Three types of pharmacological pain management:
non-opioid analgesics
opioids
adjuvant medications
What are the most commonly used non-opioid analgesics?
NSAIDs (non-steroidal anti-inflammatory drugs)
4 examples of NSAIDS:
-acetaminophen
-aspirin
-celecoxib
-ibuprofen
What levels of acetaminophen are linked to liver toxicity?
Greater than 3.4 g
What will one deal with if ever attempting to commit suicide by overdosing on acetaminophen?
Liver failure: will kill liver but not the person
If someone is taking aspiring consistently, what actions should be recommended?
-pressure if a bleed occurs
-use a soft-bristled tooth brush
??? 2 at 600 mg?
What other NSAID is considered to be an anticoagulant?
celecoxib
Which NSAID is anti-inflammatory and anti-pyretic?
Ibuprofen
Which NSAID is an anti-pruritic?
acetaminophen
Which two NSAIDs can be given together?
acetaminophen and ibuprofen
Why might an NSAID be prescribed?
Even though they are over the counter, sometime insurance will cover the cost
Why is it important to know if a ct. can afford a drug?
They may not abide by treatment requirements if not affordable. Know resources, as well as other drugs that do the same things that may be more affordable. Many of the older drugs are more affordable because they have already payed off their researching ventures.
Why are NSAIDs over the counter and sometimes preferred to manage pain in some ct.s?
low-risk profile
What is a risk of using opioids?
resp. depression
What to do if post-op (PACU) a ct. is breathing at 8 bp?
Give flumazenil to reverse benzo.
In ineffective, use a bag and mask to assist them in their breathing. (Do not want to reverse all of the pain medications they are on post-op). *** do not want to reverse anesthesia.
When using a bag or mask to assist them in breathing, what is the settings?
hook up to 100% o2 and ventilate (should be a short time before their own body kicks in and they can ventilate for themselves)
How can we assist a mother who comes in with a child having open heart surgery, who says addiction runs in the family, and she does not want to give any opiates to her child?
Understand, and educate her on the fact that in this circumstance, opiates far outweigh any other measures that could be used in aiding acute pain.
Which situations will we likely deal with pain, without an order?
ICU, ED, PACU
What does giving o2 do?
It does not improve respiratory rate, only how much oxygen they are getting into their lower resp. tract.
7 examples of adjuvant medications:
-antidepressants
-anticonvulsants
-corticosteroids
-muscle relaxers
-cannabinoids
-topical anesthetics (lidocaine)
-topical therapies (voltaren cream)
——- are adjuvant medications that can increase serotonin and dopamine, helping one to feel better about their situation (even chronic pain)
Antidepressants
-chronic pain can be depressing
—— is an adjuvant medication that can help with nerve pain, or pain from the CNS (where receiving and responding to pain)
anticonvulsants
These adjuvant medications help to fight inflammation and swelling
corticosteroids
How do muscle relaxers work as an adjuvant to pain?
tense muscles cause pain and makes pain worse, which ultimately adds to their perception of pain. Muscle relaxers allow muscles to relax, stopping additional pain from occuring
which adjuvant medication class helps to increase appetite and is great for weening off of opioids
cannabinoids
What is the best route for THC?
Ingestion: according to the cannabis nurses association, “if you need it, you eat it.”
Which adjuvant medication class is available OTC?
Topical pain analgesics: lidocaine
topical pain therapies: voltaren cream (great for arthritis)
What are important considerations when it comes to nonpharmacological pain management using hot and cold therapies?
Alternate; cold = most effective with acute pain, and within first 24-48-72 hours. heat = most effective after 48-72 hours (increases circulation so may create pain if given too soon)
Which condition demands that no heat be given?
appendicitis
Nursing intervention when it comes to using ice therapy?
Set a timer- anything longer than 20 minutes can cause frost-bite/necrosis. = if pt. is on sedative may not realize they have ice on.
What is the pattern of ice therapy?
20 on, 20 off.
Best way to use positioning as a nonpharmaceutical therapy for someone who has abdominal pain?
Put them in dorsal recumbent, which will help to soften their tummy. Same with sims.
What are common things TENS unites are used for?
-back pain
-osteoarthritis
-fibro
-bursitis
-ANYTHING muscular
Physical approaches to non-pharmacological treatments:
-heat/cold therapy
-massaging, positioning, TENS
-acupuncture
-yoga
-tai chi
-chiropractic care
-range of motion exercises
What population does distraction as a cognitive behavioral approach to non-pharm. therapy work best?
children (example: flashlight with glitter/ kaleidoscope.
Which non-pharm pain management is linked to longevity?
mediation- those who meditate live longer than those who do not.
What is self-tapping associated with when used by patients as a non-pharm. pain management?
aligning the chakras
What does it mean to be mindful?
be present. Leave fear of the future and pain of the past to the season they are in. be present.
How to ground?
15-20 minutes outside every day
What activities can be considered cognitive behavioral approaches to pain management?
-relaxation techniques
-aromatherapy
-guided imagery
-tactical breathing
-distraction
-meditation
-music (white, brown, pink noise)
-tapping
-mindfulness
-biofeedback
-crystals
-grounding
What is a great question to better aid a ct. with non-pharm. pain management?
What do you like to do when you relax?
What can cause Guillian Barre’s syndrome (GBS) and how is it being treated?
flu shot. Used to paralyze people for 3-4 months, but with plasmapheresis, people are paralyzed for only 3-4 days.
What is heat used to relieve?
-joint stiffness
-pain
-muscle spasms
Which conditions should use heat cautiously as a pain management therapy?
diabetes and cardiovascular complication
cold is used to control what?
inflammation and pain
What are the 4 nursing roles when it comes to pain management?
-Assessment
-Intervention
-Culture
-Education
What assessment is done as part of a nurse’s role in pain management?
comprehensive pain assessments
What interventions are part of a nurse’s role in pain management?
-individualize the pain management plan
-monitor efficacy and side effects
How is culture part of the nurse’s role in pain management?
-assessing the individual to determine cultural, emotional, and spiritual influences on pain
What is the nurse’s role in pain management when it comes to education?
-teach pt. and families about pain management strategies
-promote self-care techniques
When collaborating with the interdisciplinary team (pain specialists, PTs, pharmacists, and psychologists) what is our goal as nurses?
-implement a holistic, patient-centered approach
-ongoing monitoring and adjustment of the pain management plan
—— is a description of pain that is perceived at the source of the pain and extends to nearby tissues
radiating
—- the type of pain is felt in a part of the body that is considerably removed from the tissues causing the pain signal
referred pain
this type of pain is highly resistant to relief
intractable pain
The type of pain is a painful perception in a missing body part or in a body part paralyzed from a SCI
phantom pain
—— is excessive sensitivity to pain
hyperalgesia
—– is the amount of pain stimulation a person requires to feel pain
pain threshold
—– includes both the autonomic nervous system response and the behavioral responses to pain
pain reaction
—– the maximum amount and duration of pain that an individual is willing to endure
pain tolerance
—— are pain receptors that are located in the superficial layers of the skin, peritoneal surface of the periosteum, arterial walls, pleural surfaces, joint surfaces, and cranial vault.
nociceptors
—— is the point where the person becomes aware of the pain
pain perception
What a pt. has cancer, provide effective pain management using non-pharm and pharm approaches to monitor the client’s response.
What should I assess for?
-body image disturbance
-coping mechanisms
-support system
-make referrals to interdisciplinary team as indicated
Which activity significantly help with labor pain during delivery?
Having attended a childbirth prep class.
What are some sensory stimulation ideas i can implement with a ct. who is in labor?
-aromatherapy
-breathing
-visual imagery
-focal points
-music
What cutaneous strategies help with labor pains?
-massage
-counterpressure
-effleurage
-acupressure
-water therapy
What are some position changes that help with delivery/labor pain?
-semi-sitting
-squatting
-kneeling
-rocking
-hula
** AVOID SUPINE
What are some disadvantages of opioids given during labor?
may slow labor progression and may cause neonatal resp. depression
What are three regional blocks?
-epidural
-pudendal
-intrathecal (spinal) blockers
What should I do to help manage labor pain, prior to an epidural?
Give fluid bolus = reduces risk of hypotension
What should I monitor in a pregnant women in labor?
blood pressure and bladder distention.
