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Stack #181944
HCC 2008 pain management
| Question | Answer |
|---|---|
| Acute pain | mild to severe, recent onset, usually associated with a specific injury, indicates damage or injury has occured, drwas attention to its existence, lasts from seconds to weeks, stimulates stress response which negatively affects health status |
| effective pain management can result in | faster recovery and improved outcomes |
| Chronic pain | can be limited intermittent or persistent, periods of remission and exacerbation, usually last 3-6 mo. or longer, can seldom be attributted to specific cause or injury, may be poorly defined onset, difficult to treat bc the cause or origin may be unclear |
| adverse effects of chronic pain | fatigue, depression, disability |
| Cancer related pain | may be acute or chronic, most pain related to cancer is a direct result of tumor involvement |
| pain classified by location | ex. headache, pelvic pain, chest pain, healpful in communication and treating |
| pain classified by etiology | burn pain, post-herpetic neuralgia, helps predict course of pain and directs plan for treatment, neuropathic eg phantom limb pain, diabetic neuropathy, trigeminal neuralgia |
| unrelieved pain can affect the | pulmonary, cardiovascular, GI, endocrine and immune systems |
| urelieved pain can | triggor the stress response, increase metabolic ration, increase cardiac output, impair insulin response, increase fluid retention |
| effects of chronic pain | suppresses immune function, may promote tumor growth, can cause depression fatigue and disability, may result in high doses of opioid meds to control chronic progressive pain |
| Cutanous(superficial pain) | involives skin and sub-Q tissue |
| Somatic pain | bone, muscle and ligaments Visceral pain, occures when organs are abnormally stretched and becomes inflammmed; abdominal area and chest |
| Neuropathic pain | injury of abnormal functions or peripheral nerves or the CNS, causes chronic pain burning stabbing pain, diabetic neuropaty; metabolic and vascular changes, sensory loss |
| phantom pain | painful sensation perceived in a missing body part |
| Intractable | pain that is resistant to treatment |
| Referred | pain perceived in an area distant from the point of origin |
| threshold | the smallest stimulus for which a person reports pain |
| Four stages of Pain | transduction, transmission, perception, modulation |
| gate control theory | area in dorsal horn acts as a gate; can increase or decrease the # of nerve impulses from the PNS to the brain, ^ activity of small fibers opens gate allowing pain to enter brain, ^ activity of large fibers close the gate |
| pain perceived when stimuli to brain _______ a threshold limit | surpass |
| factors affecting the pain experience | culture, ethnicity, family, gender, age, religious beliefs, environment and support, anxiety and other stressors, past experience |
| behavioral responses to pain | moving away, grimacing, moaning, crying, restlessness, protecting the painful area |
| physiologic responses to pain | tachycardia, hypertension, tachypnea, dilated pupils, muscle tension |
| pain guidelines for children | avoid Im, careful calculations, check contraindications for children some meds safe for adults are not for children |
| Faces sale and Visual Analogue Scale(VAS) | |
| Faces Scale | 0-5 with a face that describes level of pain, used for children and adults who dont speak the language |
| 0-10 primarily adults, 0=no pain 10= worst pain you ever felt | |
| pain diagnosis | look at cause, acute or chronic, symptoms, factors influencing the pain |
| planning main management | goals for the pt vary depending on diagnosis: relieve pain and suffering and improve quality of life; determin clients need, stregth and rescources, disscuss location of near pain center, document |
| Implementing and Evaluation | implement actions, evaluate attainment of goals and effectiveness of actions, revise terminate of alter plan of care |
| Analgesics | drugs used to relieve pain, work by reducing an individual perception of pain and alters persons discomfort |
| Catergories of Analgesics | poiods and carcotic, non-opiod, adjucant |
| Opiod Analgesics | used to treat moderate to sever pain, inhibit relese of substance "P" in the peripheral and central nereves by reducing the perception of pain sensation in the brain, provide a sense of euphoris by binding opiates receptors, derived from opium |
| major side effects of Opioid analgesics ar ______ related | CNS |
| Unacceptable potential of abuse; Heroin cocaine LSD | |
| Schedule II | high potential for abuse and dependence: opioids, amphetamines |
| Schedule III | Intermediate potential for abuse; codeine+ acetaminophen, hydrocodone+ acetaminophen |
| Schedule IV | less abuse potential than schedule III, minimal dependence; lorazepam alprazolam daixepam(valum) |
| Schedule V | minimal abuse potential: codiene cough syrup, lomotil |
| Commonly used Opioid analgesics | morphine: prototype, Fentanyl, Meperidine(Demerol) |
| Routes of Analgesic Administration | Oral(PO)-preferred route, IM, IVP, Epidural analgesia(PCEA), Patient Controled Analgesia(PCA), transdermal patch fentanyl(duragesic), Nasal(Stadol), rectal |
| Remember when the route of a med is changed the _____ must also be changed | dose |
| Common side effects of opioid narcotics | resp depression, sedation: drowsiness, slurred speech, impaired mobility, coordination, hypotension, nausea and vomiting, constipation, pruritis(itching), urinary retention |
| Nursing Implications w/ pt on Analgesics | monitor vital signs, respiratory status level of consciousness, affectiveness of pain management, catheter insertion site(epidural,IV), narcan availability(opioid), PREVENT CONSTIPATION (stool softener or laxative up front) |
| Naloxone(Narcan) is the drug of choice for | opioid overdose |
| Naltrexone(ReVia) is used for | opioid and alcohol dependence |
| Nalmefene(Revex) similar to narcen but longer lasting action is mainly used for treatment of | methadon overdose |
| Adjuvant Drugs | does not provide analgesia by itself it is usually used in conjunction with another drug to enhance its medical effectiveness |
| threshold | the msallest stimulus for which a person reports pain |
| addiction | behavioral patterns of substance use characterized by compulsion to take the drug primarily to experience its psychic effects |
| tolerance | the max amount of pain a person can tolerate |
| dependence | withdrawal symptoms may occur if medication is stopped. |
| principles of administering analgesics | goal is to relieve pain, frequent and ongoing pain assessment, nursing must review pain scale, discuss benefits of pain scale, try various pain control methods, be open minded about alternative pain relief measures |
| pharmacologic measures | ongoing assessment, evaluates whether med is working or not, monitor adverse effects, know peak action of the drug, administer in timely fashion at regular intervals, remember to the the client to ask of med before pain becomes severe |
| acute pain management--surgery | discuss pain control alternatives w/pt before surgery, assist post op pts by helping to maintain a steady serun level (PCA pump), be advocate, individualize treatment, medicate prior to anticipated pain (dressing change, ambulation, physical therapy) |
| Postoperative pain management | frequent regular dosing intervals in early post op period, then PRN (PCA, Epidural, IV, switch to oral ASAP) |
| Advantage of Postoperative pain management | shorter hospitalization, reduce cost, early mobilization |
| Chronic pain management goal | maximize function, enhance quality of life |
| Chronic pain managemnt | medicate pt around the clock rather than prn, if possible give PO, allow client to control med regimen whenever possible |
| steps of pain control | 1 NSAID or acetaminophen( ibuprofen, Naprosyn, tylenol), 2 add opioid analgesic to 1(codeine, hydrocodone, oxycodone), 3 increase potency of opioid (morphine, Fentanyl, hydromorphone) |
| PCA pumps | designed with safety mechanisms to prevent overdose and narcotic theft, most frequently perscriped is morphine, frequently given IV route howver it may be via and epidural catheter or subQ, lockout interval |
| Advantage of PCA | consistent analgesic blood level maintained, client decides when a doses of opioid is needed, adminitered IV therfore absorption is faster and more predictable, client tends to use less medication bc can administer med before in severe pain |
| Bolus dose | administered all at once into the vein |
| Continuous dose | 2nd lower dose |
| lockout interval | wont give more if pushed to much (ex. can only press ever 10 min) |
| Time Limit | can only have so much med in certain amount of time |
| Nursing responsibility | check allergy, monitor vitals sedation level pain control & side effects, verify correct settings, observe IV site(infiltration), monitor every 2 hrs for 24 hrs, Benadryl and Narcan avalible, teach pt & fam to use machine, family dont push for pt |
| other pain relief measures | topically or mucous membranes(transdermal patch, subQ or near the surgucal site to relieve post operative pain, may be via epidural catheter |
| Epidural Administration | catheter inserted into epidural space by ACP(acute care practitioner) analgesic is administered as a bolus or intermittenly via a continuous pump (PCEA), drug is usualy preservative free morphine or fentanyl, NO alcohol around insertion site |
| Nursing responsibilities with an Epidural | catheter properly fastened, no alcohol at insertion site, elevate HOB 30 degrees, monitor site for infection, observe for headache hypotension, urinary retention and infection |
| Non opioid analgesics examples | acetaminophen, prostoglandin inhibitor, antipyretic(reduces fever), analgesic (controls pain) |
| adverse affects of non opioid analgesics | liver toxicity, rash, antidote mucomyst, precautions, DONT exceed 4 g per day |
| NSAIDs examples | ibuprofen(motrin, Advil), Naproxen(Aleve), Keterolac(Tradol), Celecoxib(Celebrex), Anti-inflammatory(will cause fever to break), antipyretic(will cause fever to break), Aspirin |
| Uses for NSAIDs | Analgesic:treatment of mild to moderate pain, reduce inflammation, adjunct to opioids in severe pain, anti-inflammatory; reduce fever, antipyretic |
| NSAID effects | anti-inflammatory, Antipyretic, analgesic: prostoglandin inhibitor, Cox-2 inhibitor |
| NSAID side effects | gastrointestinal irritaion, gastrointestinal bleeding, platelet dysfunction, kidney dysfunction, worsening of heart failure, liver dysfunction |
| Contraindications and Precautions of NSAID | Contraindications: aspirin hypersensitivity/allergy...Precautions: history of bleeding disorders, ulcer, severe kidney, liver or heart disease |
| Nursing implications for NSAIDs | administer w. food or milk, avoid history or ulcer, GI bleed, etc, risk of bleeding:surgery, drug interactions, pt education |
| Older Adults | medicate with 50-75% of the normal averae adult doe the increase as necessary, obserev closely for over sedation, discourage self medications, monitor for behavioral changes that may be due to medication; can become sedated easily watch for falls |
| NON Pharmacological Measures | imagery, relaxation, distraction, humore, music therapy, cutaneous stimulation, tens unit, hypnosis, acupressure, therapeutic touch, biofeedback, heat and cold |
| Ethical Issues regarding pain management | clients must be medicated in a timely manner, have right to their pain control, have right to be treated with respect at all times, should not be treated like a drug abuser |
Created by:
jaed008
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