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Chapter 4

Unit 2: Nursing care of clients with neurosensory disorders

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!