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Pain management
Lpn fall 2008
| Question | Answer |
|---|---|
| Pain | an unpleasant sensation usually associated w/ disease or injury. |
| Transduction1 | refers to conversion of chemical information @ cellular level into electrical impulses that move towards the spinal cord. |
| Transduction2 | begins when injured cells release chemicals such as substance P, prostaglandins, bradykinin, histamine, & glutamate. Chemicals excite nociceptors. |
| Nociceptors | type of sensory nerve receptors activated by noxious stimuli located in skin, bones, joints, muscles, & internal organs. |
| Transmission1 | Phase during which stimuli move from peripheral nervous system toward the brain. Impulses via the fast pain pathway result in sharp, acute initial sensations like those felt when touch a hot |
| Transmission2 | Occurs when peripheral nociceptors form synapses w/ neurons w/in spinal cord that carry pain impulses & other sensory info such as pressure & temp changes via fast & slow nerve fibers. |
| Transmission3 | result is the person withdraws from the pain-provoking stimulus. Following fast transmission, impulses from small unmyelinated fibers (C-fibers) carry impulses @ a slower rate 0.5-2 meters per sec. |
| C-fibers | responsible for throbbing, aching, or burning sensation that persists after the immediate discomfort. |
| A-delta fibers | large myelinated fibers that carry impulses rapidly @ a rate of approx 5 to 30 meters/per sec. |
| Perception | conscious experience of discomfort occurs when pain threshold is reached. Once pain is perceived, structures w/in brain determines its intensity, attach meaningfulness to the event & provoke emotional responses. |
| Pain threshold | point @ which sufficient pain-transmitting stimuli reach the brain. Pain thresholds tend to be same among healthy people but each person tolerates or bears the sensation of pain differently. |
| Pain tolerance | amount of pain a person endures, influenced by genetics learned behavior specific to gender age, & culture. |
| Modulation1 | last phase of pain impulse transmission during which brain interacts w/ spinal nerves in a downward fashion to subsequently alter pain experience. |
| Modulation2 | the release of pain-inhibiting neurochemicals reduces painful sensation. Ex: GABA (gamma-aminobutyric acid), endogenous opioids. |
| Endogenous opioids | naturally produced morphine-like chemicals. |
| Cutaneous pain1 | discomfort that originates @ the skin level is a commonly experienced sensation resulting from some form of trauma. Depth of trauma determines type of sensation felt. |
| Cutaneous pain2 | damage confined to epidermis produces a burning sensation. @ dermis level, pain is localized & superficial. Subcutaneous tissue injures produce an aching, throbbing pain. |
| Somatic pain | discomfort generated from deeper connective tissue, develops from injury to structures such as muscles, tendons, & joints. |
| Visceral pain(poorly localized)1 | discomfort arising from internal organs is associated w/ disease or injury. |
| Referred pain | discomfort perceived in a general area of the body, usually away from site of stimulation. |
| Visceral pain2 | other autonomic nervous system symptoms such as nausea, vomiting, pallor, hypotension, & sweating accompany visceral pain. |
| Neuropathic pain | pain w/ atypical characteristics also called functional pain is often experienced days, weeks, or even months after the source of pain has been treated & resolved. |
| Example of Neuropathic pain | Phantom limb pain or phantom limb sensation, a person w/amputated limb perceives the limb still exists & feels burning, itching, & deep pain in tissues that been removed. |
| Acute pain1 | discomfort that has a short duration last for a few seconds to less than 6 mths. Associated w/ tissue trauma, including surgery, eases w/ healing & eventually disappears. |
| Pain a&c | both acute & chronic pain result in physical & emotional distress & can be intermittent incorporating periods of relief. |
| Chronic pain1 | discomfort that lasts longer than 6 mths are almost totally opposite from those of acute pain. |
| Acute pain2 | recent onset, symptomatic of primary injury or disease, specific & localized, severity associated w/ acuity of injury or disease process. |
| Acute pain3 | Favorable response to drug therapy, diminishes w/ healing, suffering is decreased, associated w/ sympathetic nervous system responses such as hypertension, tachycardia, restlessness, anxiety. |
| Chronic pain2 | Remote onset, uncharacteristic of primary injury of disease, nonspecific & generalized, severity out of proportion to the stage of the injury or disease. |
| Chronic pain3 | Poor response to drug therapy, requires more & more drug therapy, persists beyond healing stage, suffering is intensified, absence of autonomic nervous system responses; manifests depression & irritability. |
| 5th vital sign | pain assessment. |
| Analgesic | pain-relieving drug. |
| Pain assessment data | a basic or brief pain assessment includes the pt’s description of the onset, quality, intensity, location, & duration pain. |
| Wrong-baker FACES Pain Rating Scale | scale used to assess pain by showing pt faces & explaining how begins w/ happy face meaning no pain 0 to face that hurts as bad as u can imagine 5. |
| Pain management | techniques for preventing, reducing or relieving pain. |
| Drug therapy | cornerstone of pain management whether in alone or in combination w/ other therapeutic measures. |
| Standards 1 | acute pain & cancer pain are recognized & effectively treated. |
| Standards2 | info about analgesics is readily available. |
| Standards3 | Pt’s are informed on admission, both orally & in writing that effective pain relief is an important part of their treatment, that their communication of unrelieved pain is essential, & that health professionals will respond quickly to their reports of pai |
| Standards4 | Explicit policies for use of advanced analgesic technologies are defined. |
| Standards5 | Adherence to standards is monitored by an interdisciplinary committee. |
| Pain relief ladder | 3 nonopioid (pain persisting or increasing) +/- adjuvant, Opioid for mild to moderate pain +/- adjuvant +/- nonopioid, Opioid for moderate to severe pain +/- nonopioid, +/- adjuvant. |
| Nonopioids1 | nonnarcotic drugs, aspirin, acetaminophen (Tylenol), & nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil, Nuprin), ketoprofen, (Orudis KT), & naproxen sodium (Naprosyn, Aleve). |
| Nonopioids | Drugs relieve pain by altering neurotransmission peripherally @ the site of injury. |
| Opioids | narcotic drugs, when no longer controlled w/ a nonopioid is combined w/ an opioid. Cause sedation, nausea, constipation, & respiratory depression. |
| Adjuvant | drugs that assist in accomplishing the desired effect of a primary drug. Analgesic drugs |
| Controlled substances | drugs whose prescription & dispensing are regulated by federal law b/c they have potential for being abused. |
| Ex of controlled substances | Morphine sulfate, codeine sulfate, meperidine (Demerol), fentanyl (duragesic, sublimaze). |
| Pt-controlled analgesia (PCA) | Intervention that allows pts to self administer narcotic pain medication through use of an infusion device. PCA is used primarily to relieve acute pain after surgery, but this technology is finding its way into the home health arena where non-hospitalized |
| Bolus/loading dose | larger dose of drug administered initially or when pain is exceptionally intense & additional lower doses @ frequent intervals depending on the pts level of discomfort depending on the pt’s level of discomfort. |
| Botulinum Toxin Therapy1 | an agent made from the bacterium clostridium botulinum, whish is found in soil & water. When injected into a muscle, the toxin blocks action of acetylcholine. |
| Botulinum Toxin Therapy2 | Blocking acetylcholine results in temporary paralysis of the injected muscle. When the muscles are paralyzed, spasms & nociceptive transduction are inhibited, resulting in pain relief. |
| Botulinum Toxin Therapy3 | duration of each injection effect tends to become shorter over time. Candidates for botulinum toxin therapy may experience local pain, bruising, or infection @ inject site. |
| A(BTX-A) | been approved to treat painful musculoskeletal conditions & various types of headaches. |
| Intractable pain | pain unresponsive to other methods of pain management. |
| Rhizotomy | surgical sectioning of a nerve root close to the spinal cord. |
| Cordotomy | Surgical interruption of pain pathways in the spinal cord. |
| Education | pts about pain & methods for pain management supports principle that pts who assume an active role in their treatment achieve positive outcomes, sooner than others. |
| Pain management nurse teaching1 | ask Dr. what to expect from ad disorder or its treatment, discuss pain-control methods that have worked well or not so well before, talk w/ Dr. & nurses bout any concerns u have bout pain meds, Identify any drug allergies u have. |
| Pain management nurse teaching2 | Inform Dr. & nurses bout other meds u take in case they interact w/ pain meds, help Dr. & nurses measure ur pain on pain scale by stating # or word dat best describes, ask for or take pain-relieving drugs whn pain begins or before an activity that causes |
| Pain management nurse teaching3 | Set pain-control goal such as having no pain worse than 4 on scale of 0 to 10, inform Dr. & nurses if pain meds is not working, perform simple techniques such as abd breathing & jaw relaxation to increase comfort. |
| Pain management nurse teaching4 | Consult w/Dr. & nurses bout using cold or hot packs or other nondrug techniques to enhance pain control. |
| Heat/cold | (thermal therapy), well established techniques for relieving pain, never used longer than 20 mins @ any 1 time, skin always protected w/ insulating layer (cloth or towel), never sleep w/ app. |
| Cold | pain caused by injury best treated initially w/ cold applications (ice bay or chemical pack), believed cold relieve pain faster & sustain pain relief longer. |
| Heat | (hot water bottle, rice bag or moist packs) placed over painful area 24 to 48 hrs after injury. |
| Menthol | & capsaicin (zostrix) compound in red peppers, are chemicals applied topically. Both increase blood flow in area of app, creating a warm or cool feeling that last for several hrs. |
| Meditation | concentrating on word or idea that promotes tranquility & is similar to imagery except the subject matter tends to be more spiritual. |
| Distraction | intentional diversion of attention to switch the person’s focus from an unpleasant sensory experience to 1 that is neutral or more pleasant. |
| Relaxation | technique for releasing muscle tension & quieting the mind that helps to reduce pain, relieve anxiety, & promote a sense of well being, relaxing breaks circuit among neurons that are overloading the brain w/ distressing thought & painful stimuli. |
| Transcutaneous electrical nerve stimulation(TENS) | A medically prescribed pain management technique that delivers bursts of electricity to skin & underlying nerves, an intervention implemented by nurses. |
| TENS2 | Pt perceives electrical stimulus, generated by a battery-powered stimulator, as a pleasant tapping, tingling, vibrating or buzzing sensation. |
| TENS3 | used intermittently for 15-30 mins or longer whenever pt feels and for it. |
| Acupuncture | pain management technique in which long, thin needles are inserted into skin. |
| Acupressure | technique that involves tissue compression rather than needles to reduce pain. |
| Percutaneous electrical nerve stimulation(PENS) | pain management technique involving a combination of acupuncture needles & TENS. |
| PENS2 | Needles are inserted w/in soft tissue, & electrical stimulus is conducted thru needles. Considered superior to TENS in providing pain relief b/c needles are located closer to nerve endings. |
| PENS3 | therapy done 3 times a wk for 30 mins for 3 wks. Successful on pts w/low back pain, pain caused by spread of cancer to bones, shingles (acute herpes zoster viral infection), & migraine headaches. |
| Relaxation teaching1 | Assume a comfortable position, either sitting or lying down, close ur eyes & clear ur mind, let chair or bed effortlessly support ur body, become aware of how ur body feels. |
| Relaxation teaching2 | Take a deep abd breaths, focus on the rhythm of ur breathing, relax w/ each breath in & out. Release ur worries & discomfort as it passes thru. Let ur self sleep, if possible. |
| Relaxation teaching3 | Tighten & then release muscles in sequential parts of ur body such as the toes, feet, lower legs, thighs & buttocks. Progress toward the face & scalp. Visualize healing energy flowing from ur feet thru ur head. At end of session, wake up or begin to move |
| Biofeedback | pt learns to control or alter a physiologic phenomenon(e.g. pain, blood pressure, headache, heart rate & rhythm, seizures as an adjunct to traditional pain management. |
| Hypnosis | a therapeutic technique in which a person enters a trancelike state resulting in an alteration in perception & memory. |
| Nursing diagnosis | Acute pain, chronic pain, anxiety, fear, ineffective coping, deficient knowledge: Pain management. |
| Addition | 1 leading factors interfering w/ adequate pain management is the fear of addiction. “a pattern of compulsive drug use characterized by a cont. craving for an opioid for effects other than pain relief. |
| Nursing note | Nurses may undertreat pain or may convince the dr. to prescribe a placebo. It’s wrong to assume a pt whose pain is relieved w/ placebos is addicted or a malingerer. |
| Placebo | an inactive substance sometimes prescribed as a substitute for an analgesic drug. |
| Malingerer | some1 who pretends to be sick or in pain. |
Created by:
posiniv
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