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Chronicity-1

Comfort and Pain

QuestionAnswer
Pain Unpleasant sensory and emotional experience associated with actual or potential damage
Acute Pain Lasts only through the expected recovery period; sudden or slow onset, regardless of intensity
Chronic Pain Lasts beyond usual course for recovery. >6 months interval
Chronic Malignant Pain Associated with cancer or other life-threatening condition
Chronic Nonmalignant Pain Etiology is a non-progressive disorder
Sympathetic Nervous System Responses to Acute Pain Increased pulse and respiratory rate Elevated blood pressure Diaphoresis Dilated pupils
Parasympathetic Responses to Chronic Pain Vital signs normal Dry, warm skin Pupils normal or dilated Client appears depressed/withdrawn
Cutaneous Pain Originates in the skin or subcutaneous tissue
Deep Somatic Pain Arises from ligaments, bones, blood vessels, nerves
Visceral Pain Diffuse and often feels like deep somatic pain that is burning aching or a feeling of pressure, caused by stretching of the tissues, ischemia, or muscle spasm
Radiating Pain Perceived at the source of pain and extends to nearby tissues.
Referred Pain Felt in a prt of the body that is considerably removed from the tissues causing the pain
Intractable Pain Extremely difficult to relieve despite therapeutic interventions
Neuropathic Pain May or may not be associated with an ongoing tissue damaging process
Phantom Pain Perceived in body part that is missing
Post-herpetic Neuralgia After vesicular eruption, neuralgic pain encircles the body. Mild to severe. Persists for months or years with lightning like pain in the area of the original eruption.
Trigeminal Neuralgia Intense stab like pain distributed by one or more branchse of the 5th cranial nerve. Experienced on parts of the face and head.
Cancer Pain Syndrome Result from progression of the disease or efforts to cure or control the disease
Myofacial Pain Syndrome Occurs in muscles and fascia. Frequently severe, characterized by muscle spasm, tenderness, stiffness, limitation of movement and weakness. Intensity varies from mild to disabling.
Pain Threshold The amount of pain stimulation a person requires in order to feel the pain.
Hyperalgesia Excessive sensitivity to pain.
Pain Tolerance Maximum amount and duration of pain that an individual is willing to endure. Widely influence by psychologic and socio-cultural factors.
Nociceptors Receptors that transmit pain sensation.
Bradykinin Causes direct activation of the nociceptors, the release of histamine and vasodilation and icreased capillary permeability.
Substance P Acts on blood vessels in the damaged area to release chemicals that contribute to the conduction of nociception.
A-delta Large fibers that are myelinated and rapidly conduct pain impulses
C fibers Smaller fibers that conduct pain more slowly. Cause long lasting, burning pain.
Endogenous Opioids Inhibit pain signal transmission. Enkephalins, dynorphins, and beta endorphins.
Gate Control Theory Melzack and Wall 1965. Peripheral nerve fibers carrying pain to the spinal cord can have their input modified at the spinal cord level before transmission to the brain. Synapses in the dorsal horn act as gates that close.
Ascending Modulation Can occur with stimulation of large fibers through massage, heat and cold application, or use of TENS unit.
Descending Modulation Release of endorphins and enkephalins provides biochemical descending inhibition of pain impulses. Includes use of relaxation/guided imagery.
Factors Affecting the Pain Experience Ethic and cultural values Developmental stage Environment and support people Past pain experiences Meaning of pain Anxiety and stress
Collecting A Pain History Location, Intensity (0-10), Quality, Pattern, Precipitating Factors, Alleviating Factors, Associated Symptoms, Effects on ADLs, Past Pain Experiences, Meaning of Pain, Coping Resources, Affective Response, Observe Behavioral and Physiologic Response
Key Factors in Pain Management Acknowledging and Accepting Assisting Support Persons Reducing Misconceptions Reducing Fear and Anxiety Preventing Pain
Opioid Analgesics Relieve pain by binding to opiate receptors (mu, delta, and kappa) and activating endogenous pain suppression.
Opioid Side Effects Pruritus, urinary retention, nausea, vomiting, constipation, respiratory depression, sedation.
Full Agonist Analgesics Bind tightly to mu receptors: Morphine, codeine, hesperidins (Demerol), propoxyphene (Darvon), and hydromorphine (Dilaudid).
Mixed Agonists Antagonist Analgesic. Can block or inactivate other opioids. Blocks mu receptor site. Not recommended for terminally ill.
Partial Agonists Block mu receptors or are neutral at receptor but bind at kappa receptor site.
Non-opioids/NSAIDs Anti-inflammatory, analgesic, and antipyretic effects. Act on peripheral nerve endings a tthe injury site. May decrease prostaglandin release at site. Contraindicated in clients with impaired blood clotting, GI bleed or ulcer risk, and renal disease.
Adjuvant Analgesics Developed for uses other than analgesia. Valium, Tegretol, Klonopin.
WHO 3 Step Ladder Sequential approach to manage cancer pain 1. Non-opioid +/- adjuvant 2. Weak opioid, +/- non-opioid, +/- adjuvant 3. Opioid for moderate to severe pain, +/- non-opioid, +/- adjuvant
Nasal Delivery of Pain Medication Rapid action because of direct absorption thru the vascular nasal mucosa. Stadol for acute HA.
Subcutaneous Delivery of Pain Medication Continuous subcutaneous infusion (CSCI) catheter and infusion pump
Intravenous Delivery of Pain Medication IV route is rapid and effective. IV bolus or by PCA pump.
Intra-spinal Delivery of Pain Medication Epidural or intra-thecal. Acts directly on opiate receptors in the dorsal horn.
Interventions for Epidural Label tubing, bag and pump epidural. Tape over ports when not in use. Secure cath with tape, aspirate prior to med admin. Strict aseptic technique, sterile occlusive dressing. Monitor I/O. Prevent respiratory depression. Keep naloxone HCL at bedside.
Cutaneous Stimulation Relieves acute or chronic pain through techiniques such as acupressure, massage, contra-lateal stimulation, vibration, heat, cold, and plain and menthol ointments.
Transcutaneous Electrical Nerve Stimulation (TENS) Stimulates A beta fibers to block A delta and unmyelinated C fibers to block noxious stimuli from the periphery by stimulating endorphins in the dorsal horn. Not used with pacemakers. Electrodes should not be placed over eyes, anterior neck or mouth.
Alternative Treatments for Pain Acupuncture Humor Massage and therapeutic touch Hydrotherapy Aromatherapy
Nerve Block Chemical interruption of nerve pathway. Injection of local anesthetic into nerve.
Cordotomy Obliterates pain and temp sensation below level of spinothalaamic portion of anterolateral tract. Usually done for pain in the legs and trunk.
Rhizotomy Interrupts anterior or posterior nerve root between ganglion and cord. Stops spasmodic mvmt accompanying paraplegia. Alleviates pain of head and neck from cancer or neuralgia.
Neurectomy Peripheral or cranial nerves interrupted to alleviate localized pain.
Sympathectomy Pathway of the sympathetic division of the ANS severed. Eliminates vasospasm, improves peripheral blood supply. Angina and Raynaud's disease.
Spinal Cord Stimulation (SCS) Used with nonmalignant pain that has not been controlled with lesser therapies. Insertion of electrode directly on spinal cord.
Agonist Substance that when combined with the receptor produces the drug effect or desired effect. Endorphins and morphine are agonists on the opioid receptors.
Antagonist Substance that blocks or reverses the effects of the agonist by occupying the receptor site without producing the drug effect.
Biochemical Mediators of Pain Serotonin, histamine, K+, Bradykinin, and substance P.
Characteristics of Pain Location, intensity, quality, onset, and duration.
Dependence Occurs when Pt who has been taking opioids experiences withdrawal when they are discontinued. Does not indicate an addiction.
Diabetic Neuropathy Decreased sensation to pain associated with peripheral nerve disease.
Dorsal Horn Location in the spinal cord that prevents or permits pain impulses to reach the brain.
Endorphins and Enkephalins Morphine-like substances produced by the body. Provide biochemical descending inhibition.
Modulation Restraining of the nociceptive process inhibiting the pain signal transmission. Endorphins, enkephalins, massage, heat, cold, and biochemical mediators of pain.
Opioid Antagonists Reverse the depressant effects of opioids, tx of opioid overdose.
Prostaglandins Chemical substances that increase the sensitivity of pain receptors by enhancing the pain-provoking effect of Bradykinin.
Tolerance Occurs when a person who has been taking opioids becomes less sensitive to their analgesic properties.
Alternate Definition of Pain Whatever the person experiencing the pain says it is, existing whenever the person says it does
Consequences of Untreated Pain Unnecessary Suffering Physical and Psychosocial Dysfunction Impaired Recovery From Illness and Injury Immunosuppression Sleep Disturbances
The Nursing Role Regarding Pain Assess pain and communicate to other health care providers. Ensure initiation and coordination of relief measures. Evaluate effectiveness of relief measures. Advocate for people with pain.
Suffering The state of severe distress associated with events that threaten the intactness of the person.
Culture's Impact on Pain Affects the pain expression, medication use, and pain-related beliefs and coping.
Transduction The conversion of a mechanical, thermal, or chemical stimulus into a neuronal action potential.
Transmission The movement of pain impulses from the site of transduction to the brain.
Dermatomes Areas on the skin that are innervated primarily by a single spinal cord segment.
Perception Occurs when pain is recognized, defined, and responded to by the individual experiencing the pain.
Causes of Neuropathic Pain Trauma, inflammation, metabolic disease, infections of the nervous system, tumors, toxins, and neurologic disease.
Narcan Naloxone. An opioid antagonist administered intravenously or subcutaneously to reverse respiratory depression and somnolence.
Equianalgesic Dose A dose of one analgesic that is equivalent in pain-relieving effects compared with another analgesic.
Neuroablative Interventions Performed for severe pain that is unresponsive to all other therapies.
Neuroaugmentation Involves electrical stimulation of the brain and the spinal cord.
Percutaneous Electrical Nerve Stimulation (PENS) Stimulates deeper peripheral tissues through a needle with an attached stimulator.
Created by: rjsnowrn