X Oncology - Pain / Cancer (Burke 8, 12) Flashcards
Methods of heat loss
- sweating
- vasodilation
Methods of heat conservation
- vasoconstriction
- curling up (fetal position)
result of heat applied to large body area
Excessive Peripheral Vasodilation
-diverts lots of blood from internal organs
DOWN BP (Orthostatic Hypotension)
Effects of HEAT
- vasodilation
- UP capillary permeability (leaky)
- UP local cellular metabolism
- UP blood flow in area
- UP lymph flow
Effects of COLD
- vasoconstriction
- DOWN capillary permeability
- DOWN local cellular metabolism
- DOWN nerve conduction
- DOWN blood flow
- DOWN lymph flow
What part of brain senses temperature and reacts
Hypothalmus
Body will adapt to hot and cold in a short time, but rarely adapts to what kind of pain?
DEEP pain
Rebound Phenomenon: HEAT
- cells w vadodilate with applied heat.
- Max vasodilation 20-30min
- after 30-45min, tissue becomes congested and blood vessels constrict
- 1 hr recovery time before reapplication
Rebound Phenomenon: COLD
-max vasoconstriction at skin temp 15c, 30min - 60min
-DOWN blood flow
recovery time, 1 hr advised
30min on, 30min off (Ms Green said)
Therapeutic uses of heat
- relax muscles
- reduce swelling (open capillaries, lymph picks up interstitial)
- UP inflammatory process to fight infection
- UP cellular metabolism to promote healing and new tissue growth
- DOWN pain
Therapeutic uses of cold
- prevent edema on new injuries
- DOWN pain
- vasoconstriction to reduce bleeding
DO NOT use Heat or Cold on….
- neuro-sensory impairment (diabetic neuropathy)
- impaired mental status
- impaired circulation (PVD, Buergers disease)
- right after surgery
- hemorrhage
PVD: peripheral vascular disease
Buergers: blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene.
Complication of Heat/Cold
HEAT
- pain
- blotching
- numbness
COLD
- masceration (wet, wrinkly, pruny skin)
- ischemia
- burns
when applying temp therapy, DO NOT allow patient to ….
- adjust temp
- move an application
- move away from temp source (proper positioning)
- do not leave alone if patient has impaired ability to sense temp.
***What # Vital Sign is PAIN?
5th Vital Sign
description of Pain
subjective response to physical and phsychologic stressors
Nocicepters
nerve endings in skin activated when NOXIOUS stimuli applied
NOXIOUS stimuli
unpleasant stimuli
What causes pain process to begin?
Noxious Stimuli
once tissue damage from noxious stimuli occurs, what begins?
Inflammation
Inflammation causes release of what?
nociceptors
Four steps of PAIN impluses
1) transduction
2) transmission
3) perception
4) modulation
Transduction
noxios stimuli change into electrical action potential stimulus that send implulses through CNS
through mylenated fibers (white matter)
Transmission
2nd step, sending impulses from AFFERENT neurons (towards CNS) to dorsal horn in spinal cord where they synapse (transmit an impulse)
Perception
processing of pain impulse to thalamus and cerebral cortex. Pain perceived and interpreted.
When sensation reaches a conscious level, patient experiences pain
Pain Threshold
point which person recognizes pain. (varies little between people)
Closely related to actual tissue damage
Pain Tolerance
amount and duration one can stand before seeking relief. (varies among all)
each person’s tolerance is NOT to be judged as acceptable or unacceptable. Should be accepted as basis for pain management
Modulation
last step in pain conduction
bodies attempts to decrease perception of pain by releasing endorphins.
Efferent fibers run from cerebral cortex to dorsal horn.
Pain inhibited or modulated. ENDORPHINS released.
** How do ENDORPHINS stop pain process
Endorphins bind with opiate receptors on neurons and inhibit release of substance P. STOPS pain impulse transmission
Gate-Control Theory of Pain
when pain travels from skin to substantia gelatinosa from dorsal horn of spinal cord, substantia gelatinos can OPEN or CLOSE the gate to transmit pain impulses to brain
when small Cfibers stimulated, gate OPEN andpain transmitted
when large ADelta fibers stimulated, gate CLOSED, pain inhibited
Whichever sensation makes it through far first is the sensation that is perceived .
Types of Pain
1) ACUTE: temporary, sudden onset, localized. 6mos or less.
2) CHRONIC: prolonged pain, longer than 6mos. may not know cause (causes depressed, withdrawn, immobile, irritable, controlling) Body adapts to constant pain. (i.e. arthritis, migraine etc)
3) NEUROPATHIC: damage/dysfunction of CNS or PNS (CNS result from brain lesions/stroke, PNS nerve compression from tumor, trauma, trigeminal neuralgia, long term ETOH use)(numbness, burning, shooting, tingling
4) PSYCHOGENIC: from emotional causes. often accompanied by depression
Type of Acute Pain
1) Cutaneous pain: skin/superficial (sharp, cutting, burning, localized) Throbbing when blood vessels involved
2) Deep somatic pain: injury to deep body structures (muscles, bones, ligaments, tendons, joints) Dull, diffuse
3) Visceral pain: from body organs lined w viscera. Deep, dull, poorly localized (nausea, vomiting, hypo tension, weakness)
* ** 4) Referred pain: unpleasant sensation starts onsite but perceived in another area distant from site and stimuli
*** Referred Pain
pain begins on one side but felt in another area. (i.e. inflamed gallbladder felt in shoulder. Angina form Ischemia of heart felt in left arm or jaw.)
Chronic Malignant Pain aka
Cancer Pain
pain resulting from Cancer disease. tumor pressing on nerves or other structures, stretching of Viscera, metastasis to bones)
Acute vs Chronic Pain:
Automonomic Responses
Autonomic Responses
ACUTE:
- UP BP, Pulse, Resp
- pupils dilated
- skin diaphoretic, pale, cool
CHRONIC:
- Vital signs normal
- pupils normal
- skin dry, warm, normal color
Acute vs Chronic Pain:
Psychologic Responses
Phsychologic Responses
ACUTE: Anxious, facial grimacing, guarding, crying
CHRONIC: depression, hopelessness, frustration
DOWN sleep and appetite
Allodynia
pain resulting from stimulus hat usually would not cause pain. (in neuropathic pain)
Phantom Limb pain
occurs after surgical or traumatic amputation of a limb. steel feel itching, tingling, pressure, burning or stabbing. may be due to stimulation of severed nerves at site of amputation. treatment often complex and unsuccesful
Types of Pain meds
- analgesics: releive/reduce pain
- nonopioids: pain releif NOT derived from Opium (Tylenol (analgesic w NO anti inflammatory effects, and NSAIDs)
- opioids
- adjuvant analgesics
NON Opioid / NSAIDs
MILD pain
Non steroidal anti-inflammatory drugs
ACT of peripheral nervous sytsem.
reduce pain by interfering w prostoaglandin synthesei. (ie.e aspirin, ibuprofen, ketorolac)
DO have an analgesic ceiling
Analgesic Ceiling
increasing dose beyond certain dose will NOT increase pain relief effect.
Opioids
MILD - SEVERE pain
derived from opium plant
analgesia by binding to opioid receptors in CNS (brain /spinal cord)
types: Agonist (morphine, hydromorphone, codeine) / Antagonists (buprenorphine, nalbuphine)
Adjuvent Analgesics
drugs with other specific used that provide analgesia in clients w chronic nonmalignant and cancer pain.
i.e.
Anticunvulsants for diabetic neuropathy and neuralgia
Antidepressants used to promote sleeping patterns
Systemic anesthetics for cancer pain
Corticosteroids for mestatic bone cancer pain
Giving Meds Safely - p155
review Table 8-3
** NOTE: Client teaching on Opioids: used to treat severe pain and unlikely to case ADDICTION
Routes of Pain Med administration
Oral Rectal Transdermal IM IV SubQ Intraspinal Nerve Blocks
Equianalgesic doses
See chart pg 156, Burke
different narcotics given by different routes have same analgesic effect
Surgery as a pain relief measure only performed when? Types
after all other methods have failed.
Cordotomoy: cut nerve. message doesn’t travel
Neurectomy: removal of nerve
Sympathectomy: destroy involved sympathetic nerve
Rhizotomy: sever dorsal spinal roots (relieve cancer pain of head, neck, lungs)
TENS unit
Transcutaneous Electrical Nerve Stimulation (Gate Control Theory)
relieve chronic benign pain and acute post-op pain. sends low voltage to muscles.
Relaxation Techniques
- Diaphragmatic breathing
- Progressive muscle relaxation (squeeze, release)
- Guided imagery
- mediation
Addiction
condition of seeking drugs habitually and of not being able to give them up without adverse effects
Physical dependence
occurs when body adapts to chemical substances over an extended period of time. abrupt cessation causes withdrawal
Prostaglandins
Released from damaged tissue
Afferent
Towards brain
WHITE MATTER
Efferent
Away from brain to limb
Grey matter
Why is pain beneficial?
Warns us of tissue damage
Factors affecting pain
- past experience w pain
- pain tolerance LOW because of stress, fatigue, anxiety
- pain tolerance UP when warm?
- ETOH - distration
- Spiritual Practice
The Meaning of pain has an affect on patient as well
child birth - baby (positive)
cancer - surgery (negative)
