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BIO151-PainMngt
Pain Management
| Question | Answer |
|---|---|
| Margo McCaffery defined pain | whatever the person experiencing the pain says it is, existing whenever the person says it does |
| International Association for the Study of Pain (IASP) Define pain as | unpleasant sensory & emotional experience associated w/actual or potential tissue damage, or described in terms of such damage |
| Sociocultural dimension of pain | age, gender, culture – we all look at pain differently |
| Cognitive aspect of pain | How they cope with the pain |
| Physiological factors of pain | Age, fatigue, genes, neurological function |
| __ is not a normal factor of aging | Pain |
| Name some barriers to effective pain management | client, health care provider, health care system, physical dependence, addiction, and drug tolerance |
| Morphine does not have a | ceiling effect – the more you give the more pain management you will achieve |
| Acetomenephine does have a ceiling effect | there is a max amount where giving more than that dose does not provide more effect |
| Tolerance | level of pain a person is willing to put up with - Occurs w/chronic exposure to drugs - Patient will require higher dosages to achieve pain relief |
| Threshold | point at which a person feels pain - stress, exercise, & etc increase release of endorphins, raising pt pain threshold - amount of circulating substances varies so response to pain will be different. |
| Physical Dependence | Expected physiologic response to ongoing exposure to drugs, manifested by withdrawal syndrome when drugs are abruptly stopped – does not mean addiction |
| Addiction | Psychologic dependence, pattern of compulsive drug use characterized by craving opioids for use other than pain relief |
| Unrelieved pain can activate | the sympathetic NS |
| pain assessment | generalized or localized?, Intensity, vitals, quality (what if feels like), associated symptoms like vomiting, how its affected their ADLs |
| Neuropathic pain usually feels like | burning, shooting, or electric-like |
| Pain of surgical incision is often described like | dull, aching, and throbbing – indicating nociceptive pain |
| Transduction | Stimuli converted to electrical energy – Begins in periphery – conversion phase - sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential. |
| Perception | when patient becomes aware of pain - pain stimulus reaches the cerebral cortex & brain interprets quality of pain & processes info from past experience, knowledge, & cultural associations - association cortex, primarily the limbic system-no single pain ce |
| Modulation | Inhibition of pain impulse – body releases endorphins, etc |
| Pain can be classified by | its duration and pathology |
| Acute/transient pain | Protective, identifiable, short duration – defined as less than 6 months – resolves as patient heals |
| Chronic/persistent | Is not productive and has no purpose or may not have identifiable cause – backpain, migranes, peripheral neuropathy |
| Chronic episodic | Occurs sporadically over an extended duration – chronic is more than 6 months – cause may be unknown reason - migrane |
| Cancer | Can be acute or chronic |
| Inferred physiological | Musculoskeletal, visceral, or neuropathic |
| Idiopathic | Chronic pain without an identifiable physical or psychological cause |
| chronic pain in the absence of | an identifiable physical or psychological cause or pain perceived as excessive for extent of an organic pathological condition - complex regional pain syndrome (CRPS). |
| Nociceptive Pain is classified as | somatic and visceral |
| Abnormal processing of sensory input by the peripheral or CNS | Neuropathic pain arises from abnormal or damaged pain nerves |
| Centrally generated | phantom pain – injury to the peripheral NS, pain with reflex sympathetic dystrophy/causalgia |
| Peripherally generated | pt feels pain along distribution of many peripheral nerves – diabetic neuropathy, Guillain-Barre syndrome – associated w/peripheral nerve injury,pain along damaged nerve, nerve root compression, nerve entrapment, trigeminal neuralgia |
| Nonpharmacological interventions | goal of cognitive-behavioral interventions are to change pt perceptions of pain, alter pain behavior, & provide clients w/greater sense of control - distraction, prayer, relaxation, guided imagery, music, & biofeedback |
| Opioids | Opioid or opioid-like analgesics - for moderate to severe pain - act on higher centers of brain & spinal cord by binding w/opiate receptors to modify perception of pain. |
| Adjuvants/coanalgesics | drugs originally developed to treat conditions other than pain but have been shown to have analgesic properties. |
| NSAIDs | help w/inflam.-platelets don’t stick – don’t depress CNS or interfere w/bowel or bladder function - as effective/or more than opioid for some clients if due to inflamm-Naproxin, asprin, advil |
| PCA | patient controlled analgesic – patient presses button to administer dosage |
| Titration | increase or decrease amount of medication – dose they receive – according to adequacy of pain relief. Usually done within a prescribed limit - Range orders. |
| Physiological Response to pain | can stimulate autonomic NS which can stimulate sympathetic NS. increased HR, confusion, muscle Tension, diaphoresis, & increased response to pain |
| Behavioral Response to pain | varies in pt – pain left untreated then their lifestyle is altered, ADLs, cannot interact w/friends & family as they did. angry or depressed |
| Examples of opioids | moderate or severe pain – morphine, doladid, demoral, fentynl |
| What to watch patient for when giving opioids | danger is respiration depression – watch- rate, pattern, and oxygenation. |
| Local anesthesia is | local infiltration of anesthetic med to induce loss of sensation to body part– novicane, lidocane |
| Regional anesthesia | injection of local anesth to block group of sensory nerve fibers - tissues are anesthetized layer by layer -epidural anesthesia, pudendal blocks, and spinal anesthesia. |
| Narcotic Antagonists | Naloxone hydrochloride (Narcan) – If client experiences respiratory depress, admin naloxone |
| Narcotic analgesics | Morphine Sulfate, Hydromorphone (Dilaudid), Meperidine (Demerol), Fentanyl |
| What reverses effects of narcotic? | Narcan – respiratory depression |
| Morphine indicated for | moderate to severe pain due to malignancy, MI, trauma, other |
| Action for morphine | Depresses pain impulse transmission at spinal cord level by interacting w/opioid receptors - alters perception & response to painful stimuli, depresses CNS |
| Therapeutic effects of morphine | Decreases severity of pain |
| Morphine is contraindicated in | hypersensitivity, hemorrhage, bronchial asthma, head trauma, increased intercranial pressure |
| Morphine increases | CNS depression w/alcohol, sedatives, barbiturates, tricyclic antidepressants, antihistamines, etc. |
| Morphine side effects | respiratory depression, sedation, constipation |
| NSAIDs | Non-steroidal antiinflammatory drugs - Lg group of chemically diverse drugs - Analgesic, antiinflammatory, antirheumatic, antipyretic |
| NSAIDs – Indications | Reduce pain & inflammation R/T RA, OA, gout, dysmenorrhea, tendinitis - Adjunct in reducing chronic pain, cancer pain - Reduce fever by inhibiting prostaglandin synthesis in the hypothalamus |
| ACTION OF NSAIDS | Block chemical activity of one or both COX 1 OR 2 enzymes |
| COX-1 | synthesis of beneficial PGs that protect GI mucosa – cox 1 inhibiting NSAIDs would not be good for patient with GI problems. |
| COX-2 | inflammation |
| What benefit do COX-2 inhibitors(e.g. Celebrex) have over standard NSAIDS that block both COX-1 & COX-2? | better for pts who have stomach problems |
| Only(aspirin) ASA inhibits | COX-1 in platelets - inhibits platelet aggregation - used to prevent clotting or reinfarction in acute MI or stroke |
| Causes gastritis, bleeding WHY? | because it is a cox 1 inhibitor and that affects stomach mucosa |
| Hx | history |
| Acetominophen Dosage range for maintenance therapy PO 325 - 650 mg 4-6X DAILY - NOT TO EXCEED | 4 GRAMS PER DAY |
| Tylenol does not possess | anti inflammatory properties |
| Basic action of acetaminophen | blocks pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis |
| Diffuse and duration varies | deep visceral pain |
| Results from stimulation of the skin | superficial pain |
| Radiating pain | Extends from the initial site of injury to another body part |
| Common phenomenon with visceral pain | referred pain |
| Feels like pain is traveling along a body part | raidiating pain |
| deep visceral pain | Results from the stimulation of internal organs |
| Superficial pain | Of short duration and localized |
| referred pain | Felt in a part of the body separate from the source of pain |
| What is a symptom in opioid-naïve client is of greatest concern when nurse assesses client 1 hr after administering opioid? | Difficulty arousing client-sedation always occurs before respiratory depression, so nurse should monitor for sedation |
| A pain intensity rating of 5 on a scale of 10 means that the client | probably needs a higher dose of medication. |
| Onset of pain relief can take __ after a fentanyl patch is applied. | 18 to 36 hours |
| Fentanyl patches are used for | long-term management of severe pain, so it is not appropriate order for client who needs immediate, short-term relief. |
| Is it appropriate for a physician to write an order for a Fentanyl patch to relieve pain after a hip replacement? | No – only for long term pain relief |
| All clients receiving opioid therapy should also be placed on a | bowel program to ensure that constipation related to opioid use is avoided – stimulant laxative. |
| An intern new writes order for OxyContin SR 10 mg by mouth every 12 hrs as needed. Which part of the order does nurse question? | time interval – drug is long-acting opioid that requires regular dosing to be effective. |
| Nurse notices client has been receiving Percocet, 2 tablets PO every 3 hrs for past 3 days | max dosage of acetaminophen is 4 g/24 hrs - pt is receiving 5.6 g, which could cause liver damage. |
| Clients who receive naloxone should be reassessed | every 15 min for 2 hrs after drug admin because of risk of renarcotization & return of resp depression. |
| Who should push the button on a PCA | Only the pt because pt is one to decide when medication needed. does prevent accidental overdoses, but most imp feature is pt controls analgesia. |
| Meperidine is typically | not used in more than a single dose. |
| When setting goals for a client with chronic pain, the nurse should begin by | Understanding what pain prevents pt from doing what is important helps in establishing goal that nurse can measure- assists in identifying what is important to pt. |
| Neuropathic pain is usually described as | burning, shooting, or electric-like. important to report to physician because neuropathic pain may not respond as well to opioids. |
| Visceral and somatic pain are often described as | aching, throbbing, and pounding. |
| Idiopathic pain | does not have specific descriptive terms. |
| PCA basal dosing is not recommended for | postoperative treatment of surgical pain. It places pt at increased risk for resp depression. |
| Fentanyl is much more potent than | other opioids & is reserved for clients w/chronic pain stabilized w/opioids over extended period. |
| Small doses of opioid given IV around the clock and as-needed opioids for | pain that exceeds the client goal are acceptable pain-relieving strategies. |
Created by:
Ladystorm