Week 4 pain Flashcards
(60 cards)
What are the 4 aspects of total pain?
- Emotional pain
- Physical Pain
- Social Pain
- Spiritual Pain
How these all interact with each other. Very individual and sometimes one can be way higher than another domain
What is suffering?
When someone experiences pain in all the domains of “total pain”
How do we provide “culturally comfortable” care ?
-Recognize the client as a unique individual
-Explore the client’s lived experience of pain
-Promote shared decision making
What are options If the patient cannot self-report?
- Observe behavior
- Talk with proxy, family member
- Think about: underlying diagnosis, impact of the illness
- Vitals- not really reliable for pain
- Trial treatment - does it seem to help?
What are the 4 common side effects of Opioids?
Constipation!
Nausea
Sedation
Xerostomia
What are the 2 less common side effects of Opioids?
Pruritus
Urinary retention
What are the 2 rare side effects Opioids?
Respiratory depression
Opioid- induced neurotoxicity
What can cause respiratory depression with Opioids?
- giving too much to someone opioid naive
- Someone chews their long acting meds accidentally
- too many opioids at once
Metabolites are the result of the breakdown of opioids. When too many build up, what happens?
Opioid - induced neurotoxicity (OIN)
What intervention makes OIN worse?
Adding more opioids cuz we’re just adding more metabolites in the body
What is the management of OIN?
Hydration - careful about fluid overload conditions - go slower
Decrease opioid dose
Opioid rotation more common
Calm reassurance - b/c person is confused
Educate the family
What are 6 risk factors for OIN?
Frail/elderly
Impaired renal function
Impaired Kidney function
Rapid dose increase of opioids
Using the same opioid for a long time
Dehydration
What are the clinical manefestations of OIN?
- Delirium/confusion - tends to be subtle
- myoclonus - can lead to seizure
- Hyperalgesia - heightened response to pain
- Allodynia - not typically painful but is for the person (like a blanket on their legs is painful)
- hallucinations
What differentiates total pain with OIN?
The clinical manifestations . If not there, it’s likely Total pain so assess the domains of total pain.
What main thing makes us stop and wonder if someone has OIN even before main clinical manifestations?
If we give opioids and the pain isn’t getting better
What is Tolerance when on opioids ?
Normal and expected
We need more drug to get the same effect
What is physical dependance?
The way our body responds physiologically to the opioids in our system. If they are suddenly withdrawn we get withdrawal symptoms : chills, N&V, insomnia
What is Addiction?
Pscyhological dependends
people want to feel eurphoric
results in negative social and personal consequences. People will do anything to get the opioid and compromise other aspects of their life - that is where the problem is.
when used properly, addiction is rarely an issue for people
How do we help with Emotional Pain?
Active listening
Being present
Relaxation interventions
Pharmacological management when appropriate
Mindfulness meditation/breathing
Use of humor (where appropriate)
Art therapy
Music therapy
Journaling
How do we help with social pain?
Encourage meaningful social connection
Include families in discussions
Reduce social isolation with the use of technology
Therapeutic touch
Pet therapy
Support for family caregiver
Encourage communication to heal damaged relationships
How do we help with spiritual pain?
A caring presence – from us and others
Facilitate connection to outdoors/nature
Give space for personal, spiritual and religious beliefs/rituals
Spiritual/pastoral care
What is a quick definition of emotional pain?
a subjective experience with negative thoughts and feelings because there are negative changes in the person’s self and their function
What is a quick definition of Physical pain?
it’s a sensory response to actual or potential tissue damage that is unpleasant
what is a quick definition of social pain?
a subjective experience where person feels lack of social connection whether that be real or perceived.
