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Chapter 4
Unit 2: Nursing care of clients with neurosensory disorders
| Question | Answer |
|---|---|
| When should nurses assess pain interventions after? (Pg. 41) | 30-60 mins |
| Physiology of pain: Transduction | Conversion of painful stimuli to an electrical impulse through nociceptors (peripheral nerve fibers) |
| Transmission: | Electrical impulse travels along nerve fibers regulated by neurotransmitters |
| Pain threshold & pain tolerance | -Point at which person feels pain -Amount of pain a person is willing to bear |
| Substance P, prostaglandins, bradykinin, histamine | Substances that increase pain transmission & cause inflammatory response |
| Serotonin & endorphins | Decrease pain transmission and produce analgesia |
| Modulation: | Occurs in the spinal cord; causes muscles to contract away from painful stimuli |
| Pain categories: (pg. 42) 1. Acute pain | Protective, temporary, resolves w/ tissue healing -SNS acts -Tx |
| 2. Chronic pain | Not protective, ongoing >6 months, persists beyond tissue healing -decrease LOF, fatigue, depression possible -can have limited response to interventions |
| 3. Nociceptive pain | Damage to/inflammation of tissue other than peripheral & CNS -Throbbing, aching, localized Somatic (bones/joints/muscles/con tissues), visceral (internal organs), cutaneous (skin/subq) |
| 4. Neuropathic pain | Arises from abnormal/damaged pain nerves Ex. phantom limb, diabetic neuropathy -shooting/burning/stinging/ "pins, needles" |
| Report of pain is good for children over age of ___ | 7 |
| 5th VS | Pain; PQRST (perception, quality, radiation, severity, timing) |
| Nonpharmacological management of pain (pg. 45) -Cutaneous stimulation (heat, cold, TENS, massage), distraction, relax, imagery, acupuncture, etc. | Cold for inflammation, heat to increase BF & reduce stiffness -TENS; transcutaneous electrical nerve stimulation |
| Pharmacological intervention: Analgesics -Name the 3 types | Nonopioids, opioids, and adjuvants |
| Nonopioid examples | Acetaminophen, NSAIDs, & salicylates -For mild to moderate pain |
| Acetaminophen (tylenol) major effect to worry about | Hepatotoxic effects. Healthy liver, take no more than 4g/day. -Be aware of opioids that contain acetaminophen.. Ex: Hydrocodone bitartrate (vicodin) |
| Monitor salicylates for | Tinnitus, vertigo, decreased hearing acuity |
| Long term NSAID use, monitor for | Bleeding |
| Opioid analgesic examples (Pg. 46) | Morphine, fentanyl (sublimaze), codeine -Moderate to severe pain |
| What route is best for opioids managing acute pain? | Parenteral, vs. oral for chronic |
| Common adverse effects of opioids | Constipation, orthostatic hypotension, urinary retention, nausea/vomiting, sedation, respiratory depression |
| Antidote/antagonist to opioids | Narcan (Naloxone) |
| Adjuvant analgesics (pg. 46) | Enhance effects of nonopioids -Help alleviate other symptoms that aggregate pain (depression, seizures, inflx) |
| Examples of adjuvant analgesics | Anticonvulsant: Carbamazepine (Tegretol) Antianxiety: Diazepam (Valium) Tricyclic antidepressants: Amitriptyline (Elavil) Antihistamine: Hydroxyzine (Vistaril) Glucocorticoids: Dexamethasone (Decadron) Antiemetics: Odansetron (Zofran) |
| What is PCA? | Patient-controlled analgesia (pump) -Clients can self administer safe doses of opioids Client is only person who should push button* |
Created by:
mary.scott260!
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