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MT pain
MT NHCC pain management
| Question | Answer |
|---|---|
| What is an analgesic ceiling? | a dose wherein no additional analgesia is produced regardless of further dose increases |
| What is breakthrough pain? | transient moderate to severe pain that occurs above the pain treated by current analgesic treatment protocol |
| What is a ceiling effect? | a property of a drug in which increasing the dose beyond an upper limit provides no greater analgesia |
| What are Dermatomes? | the areas of skin innervated by the sensory fibers of a single dorsal root of a spinal nerve |
| What is an equianalgesic dose? | a dose of one analgesic that is equivalent in pain-relieving effects to another analgesic |
| What is modulation? | the activation of descending pathways that exert inhibitory or faciliatory effects on the transmission of pain |
| What is neuropathic pain? | pain caused by damage to nerve cells or changes in spinal cord processing |
| What is nociception? | activation of the primary afferent nerves with peripheral terminals (free nerve endings) that respond to noxious (tissue-damaging) stimuli |
| What is nociceptive pain? | pain that is caused by damage to somatic or visceral tissue and occurs abruptly after an injury or disease, persists until healing occurs, and often is intensified by anxiety or fear |
| What is titration? | Analgesic titration is dose adjustment based on assessment of the adequacy of analgesic effect versus the side effects produced. An analgesic can be titrated upward or downward depending on the situation. |
| What is transduction? | the conversion of a mechanical, thermal, or chemical stimulus into a neuronal action potential |
| What is transmission? | movement of pain impulses from the site of transduction to the brain |
| What is a trigger point? | a circumscribed hypersensitive area within a tight band of muscle that is caused by acute or chronic muscle strain |
| What are some non invasive, non phaarmacological pain controls? | comfort measures such as repositioning, range of motion exercises, use of heat or cold, use of padding or cushions, massage, splinting, distraction, and music therapy. |
| What are some behavior techniques for controling pain? | such as biofeedback, relaxation therapy, guided imagery, hypnosis, therapeutic use of humor, and psychotherapy can benefit the patient. |
| How does a Transcutaneous electrical nerve stimulation (TENS) Unit control pain? | provides a low-voltage pulsating electric current that innervates the painful area and is thought to block the electrical message of pain. |
| How does a Rhizotomy control pain? | ablation (total block or destruction) of effected nerve root for denervation of pain region is useful for severe chest or abdominal wall pain |
| How does a Cordotomy control pain? | Severing of the spinal cord for intractable pain that does not respond to conventional methods. Most commonly used for severe bone pain. |
| How does a Hypophysectomy control pain? | Removal or ablation of the pituitary gland for diffuse or multifocal pain |
| What is Step 1 of the WHO Analgesia Ladder? | drugs are used for mild pain – provide appropriate and concurrent treatment for cause of pain. Use adjuvant drugs as needed. |
| What is the WHO Analgesia Ladder? | Calls for a concurrent treatment of the cause of pain when possible and uses a tree step ladder approach. |
| What drugs are used in step one of the WHO ladder? | · Nonopioids for mild pain (aspirin, acetaminophen, NSAIDs) |
| What drugs are used in step two of the WHO ladder? | · Opioids for mild to moderate pain (codeine, oxycondone) |
| What drugs are used in step three of the WHO ladder? | · Opioids for moderate or severe pain (morphine, hydromorphone, methadone) |
| What is step two of the WHO ladder? | for mild to moderate pain – Pain persists or increases, add step 2 opioid, continue step 1 drugs and adjuvant drugs as needed. |
| What is step three of the WHO ladder? | for moderate to severe pain – pain persists or increases, replace step 2 opioid with step 3 opioid, continue step 1 drugs and adjuvant drugs as needed |
| What is the goal of titration? | to use the smallest dose of analgesic that provides effective pain control with the fewest side effects. |
| How are drugs usually titrated for post operative patients? | the analgesic generally decreases over time as the acute pain resolves. |
| How are drugs usually tittated for patients with chronic or severe cancer pain? | Opioidsmay be titrated upward many times over the course of therapy to maintain adequate pain control. |
| What is an Opiate? | Any drug containing or derived from opium |
| What is an Opioid? | Any synthetic narcotic not derived from opium |
| What is an Adjuvant? | Drugs used in conjunction with opioid and nonopiods analgesics. Sometimes referred to as co analgesics. They include drugs that enhance pain therapy through one of three mechanisms |
| What are the three mechanisms of adjuvants? | Enhancing the effects of opioids and nonopioids, Possessing analgesic properties of their own, Counteracting the side effects of other analgesics |
| What is the Sensory Component of pain? | pattern, area, intensity , and nature (PAIN) of the pain |
| What are some examples of breakthrough pain? | dressing changes, movement, eating, position changes, and certain procedures such as cauterization. |
| What are some Affective, Behavioral, Cognitive and Sociocultural Components of pain? | effects of pain on patient’s sleep and daily activities, relationships with others, physical activity, and emotional well being should be assessed. As well as Ways in which the patient expresses the pain, Strategies the patient has used to control pain |
| What is are Nonopioids? | Analgesics that are not classified as opioids - |
| What are examples of Nonopioids? | Acetaminophen (Tylenol), paracetamol, |
| What are examples of opioids? | Codeine Sulfate, Meperidine HCL (Demerol, Pethidine), Morphine Sulfate (Astramorph, Duramorph), Methadone HCL (Dolphine |
| What are some examples of adjuvants? | Opioid/acetaminophen combination – Percocet, (OXY / APAP ratios), Vicodin, |
| Describe the use of anticipatory analgesia | Plan your care activities and other therapeutic interventions when analgesic med is at peak effect. Helpful to pre-medicate a client approximately 30 minutes before any procedure or activity that is likely to cause pain and to evaluate its effectiveness |
| how pain is tolerated and how pain is expressed by African Americans/Hispanics? | pain and suffering are inevitable and should be endured. Believe in power of healers – religious faith, prayer and laying of hands. |
| how pain is tolerated and how pain is expressed by Filipinos? | acceptance of pain as living an honorable life. May not ask for meds, don’t want to bother busy health care providers |
| how pain is tolerated and how pain is expressed by Arabs? | pain is something to be controlled and would expect immediate relief |
| how pain is tolerated and how pain is expressed by Chinese? | describe in different terms – dull vs. stabbing. Treat pain externally using oils & massage. Imbalances of yin and yang. Acupuncture, herbal remedies, |
| how pain is tolerated and how pain is expressed by Native Americans? | massage, application of heat, sweat baths, herbal remedies and being in harmony w/ nature |
| What are some Healthcare system barriers to good pain relief? | Cost, insurance, knowledge |
| What are some of the patients barriers to good pain relief? | fear of addiction, believe no chemicals in body, fear feeling out of control, cost, cultural –language and meanings, physical tolerance |
| What are some barriers caused by Professionals to good pain relief? | fear we might cause addiction, Pt populations not being able to handle dose/side effects, lack belief in patient pain description, under staffing, protocol, knowledge – Demerol ½ life = ½ hr. order every 4 hrs = pain could be increasing |
| What are the basic principles of Treatment plans? | should use a combination of drug and non-drug therapies. |
| What are the basic principles of patients in pain treatment? | Pt. must always be believed. Subjective, best judge of pain and effectiveness of tx. 2. Every patient deserves adequate pain management. Be aware of biases, treat all respectfully. |
| What are the basic principles of all pain therapies? | therapies must be evaluated to ensure that they are meeting the patient’s goals. Individual, trial & error |
| What are the basic principles thatTreatment must be based on? | on the patient’s goals. Assess goals and expectations at beginning – scale 0/10, level of functioning, no pain w/ chronic needs to be more realistic |
| What are the basic principles of Drug side effects? | must be prevented and/or managed. Side effects are major reason for Tx failure and non-adherence. |
| What are some methods of managing Drug side effects? | change dose to maintain constant blood levels, different med in same class, adding drug to counteract adverse effect of analgesic, using admin route that minimized drug concentration at s at the site of the side effect |
| What is the ABCDE acronym for principles of Pain assessment & management? | Ask – about pain regularity, Assess- Pain systematically, Believe, Choose, Deliver, Empower, Enable |
| Your patient asks you why you are using more than one type of medication to treat his pain. How do you respond? | Drugs treat different symptoms – e.g. 1 can treat side effect of other (narcotic and softeners, nausea) |
| Would you ever use an opioid when a patient has mild pain? | Yes, morphine = small dose – anti anxiety, bronchodilator, Codeine = cough |
| What is the route of choice w/ functioning GI system? | Oral, it's less expensive |
| What route is absorbed into systemic circulation are exempt from 1st pass effect? | Sublingual and buccal |
| What route is delivered to highly vascular mucosa avoid 1st pass effect? | Intranasal |
| What route is useful when can’t take orally? | rectal |
| What route is useful for can’t take oral, slow absorption thru skin but is not effective for rapid dose? | Transdermal |
| Describe the IM route? | painful, unreliable absorption, chronic use = abscesses & fibrosis |
| What route is widely used for acute pain management ? | PCA |
| What route is most common? | Oral |
| Describe the SC route? | slow onset analgesia – not for acute pain, effective for chronic cancer pain, abnormal GI function and limited venous access |
| Describe the IV route? | steady state anagelsia through stable blood levels |
| What are the implications of IV vs Oral? | acute, immediate |
| What are the indications for Oral vs. IV ? | maintenance, home, chronic |
| 6. When is it appropriate to titrate pain medication? | is dose adjustment based on assessment of the adequacy of analgesic effect vs the side effects produced. The goal is use smallest does of analgesic that provides effective pain control w/ the fewest side effects. |
| Small does of Morphine are used for? | to decrease anxiety, bronchodilate |
| Large does of Morphine are used for? | pain |
| How do are side effects of morphine managed? | start stool softeners don’t wait ‘till constipated |
| How are CNS side effects of Narcotics managed? | typically clear in 24-48 hrs. |
| What is Physical dependence? | a condition characterized by physiologic reliance on a substance, usually indicated by tolerance to the effects of the substance and withdrawal symptoms that develop when used of the substance is terminated. (an opioid in a pt w/ cancer related pain) |
| What is Psychologic dependence? | a condition characterized by behaviors related to obtaining and using a substance. the desire for the euphoric effects of drugs and typically involves the recreational use of various drugs such as benzodiazepines, narcotics, and amphetamines. |
| What is Tolerance? | a decreasing response to repetitive drug doses, |
| What non-pharmacologic strategies could you use for a patient who a. has just sustained a fractured ankle? | rest, ice, compression, elevate (RICE) |
| How will you know if your pain treatment plan has been successful? | Pain scale – 0/10, Facial expressions – grimacing, Guarding, Sleep - restful |
| What is Describe the value of combining analgesics? | Assist primary agents in relieving pain and Allows use of smaller doses of opioid |
| What is the benefit of using Allows use of smaller doses of opioids? | Diminishes some of the side effects with higher doses of opioids ( respl. Depression, constipation, urinary retention), Approaches the pain stimulus from another mechanism and has resulting synergistic beneficial effect in reducing pain |
Created by:
2007Nurse
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