pain management
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| physiologic pain | -experienced when an intact, properly functioning nervous system signals that tissues are damaged, requiring attention and proper care -transient -persisent -subcategories -somatic -viceral
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| neuropathic pain | -experienced by people who have damaged or malfunctioning nerves -types -peripheral -central -sympathetically maintained
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| four processes involved in nociception | transduction transmission perception modulation
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| gate control theory | look at hand outs
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| clinical application of gate control theory | stop nociceptor firing apply topical therapies address client's mood address client's goals
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| factors affecting perception of pain | -ethnic and cultural values -developmental stage -environment and support people -past pain experiences -meaning of -spiritual -social
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| pain assessment subjective data | comprehensive pain history includes COLDERR -Charater -Onset -Location -Duration -Exacerbation -Relief -Radiation
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| additional data | -associated symptoms -effect on ADLs -past pain experiences -meaning of the pain to the person -coping resources -affective response
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| pain assessment ojective data | nonverbal responses to pain -facial expression -vocalizations like moaning and groaning or crying and screaming -immobilization of the body or body part -purposeless body movements -behavior changes such as confusion and restlessness
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| pain assessment ojective data | rhythmic body movements or rubbing EARLY PHYSIOLOGIC responses: -increased BP, HR, RR -pallar -diaphoresis -pupil dilation -may be absent in people with chronic pain pain diary
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| treatment plan | goals vary according to the diagnosis and its defining characteristics select pain relief measures appropriate for the client based on assessment data and input from the client or support persons
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| practice guidelines | establish a trusting relationship consider client's abililty and willingess to participate use a veriety of pain relief measures provide pain relief before pain is severe use pain relief measures the client believe are effective
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| practice guidelines | align pain relief measures with report of pain severity encourage client to try ineffective measures again before abandoning maintain unbiased attitude about what may relieve pain keep trying prevent harm educate client and caregiver about pain
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| pain treatment plan | include variety of pharmacologic and nonpharm interventions plan with wide range of strategies document plan in client record and for home care involve client and support persons
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| barriers to effective plan management | -lack of knowledge of the adverse effects of pain -misinformation regarding the use of analgesics -misconceptions about pain -may not report pain -fear of becoming addicted
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| addiction | primary, chronic, neurobiolic disease genetic, psychosocial, and environment are influential factors behavior can include -impaired control over drug use -compulsive use -craving -continued use despite harm
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| dependence | state of adaptation manifested by withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decrease blood level of the drug and administration of an antagonist
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| tolerence | state of adaptation exposure to a drug induces changes result in a diminution of one or more of the drugs effects
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| pharmacologic interventions for pain | -opiods (narcotics -nonopioids/nonsteroidal anti-inflammatory drugs (NSAIDS) -co-analgesic drugs
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| opiods | full agonists -no ceiling on analgesia -dosage can be steadily increased to relieve pain -e.g. morphine, oxycodone, hydromorphone mixed agonist-antagonists -act like opiods and relieve pain -can block or inactivate other opioid analgesics
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| opiods | mixed agonist-antagonists -act like opiods and relieve pain -can block or inactivate other opioid analgesics -e.g. dezocine, petazocine, butorphanol tartrate, nalbuphine hydrochloride partial agonist -have a ceiling effect -e.g. buprenorphile
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| NSAIDS | vary little analgesic potency but do vary in anti-inflammatory effects, metabolism, excretions, side effects have a ceiling narrow therapeutic index e.g. acetaminophen, ibuprofen, aspirin
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| coanalgesic drugs | antidrpressants antoconvulsants local anesthetics others
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| WHO ladder step approach for cancer pain control | step 1 -for clients with mild pain (1-3 on a 0-10 scale) -use of nonopiod analgesics (with or without a coanalgesic)
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| WHO ladder step approach for cancer pain control | step 2 -client has mild pain that persists or increases -pain is moderate (4-6 pain scale) -use weak opioid (Codeine, tramadal, pentazocine) or a combination of opioid and nonopioid medication
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| WHO ladder step approach for cancer pain control | step 3 -client has moderate pin that persists or increases -7-10 -strong opiods e.g. morphin,hydromorphone, fentanyl
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| rational polypharmacy | -evolved from WHO three step approach -demands health professionals be aware of all ingredients of medications that alleviate pain -uses combinations to reduce the need for high doses of any one medication
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| rational polypharmacy | -maximize pain control with a minimum of side effects or toxicity -combined with mulimodel therary e.g. nondrug approaches
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| oral administration | -preferred becouse of ease of administration -duration of action os often only 4-8 hours -must awaken during night for medication -long-acting preparations developed -may need rescue dose of immediate release medication
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| transmucosa/transnasal and transdermal administration | transmucosa and transnasal -enters blood immediately -onset of action is rapid transdermal -can be unpredictable dosing and plasma drug level -noninvasive
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| medication administration | rectal -useful for clients with dysphagia or nausea/vomiting continuous subcutaneous infusion -uses for pain poorly controlled by oral medication
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| medication administration | intramuscular -should be avoided -variable absorption -unpredictable onset of action and peak effect -tissue damage intravenous -provides rapid and effective relief with few side effects
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| medication administration | intraspinal -provides superior analgesia with less medication used
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| belefits/risk routes and technology | patient-controlled analgesia -minimizes peaks of sedation and valleys of pain that occur with prn dosing -elecronic infusion pump -safety mechanisms
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| nonpharmacologic pain control interventions | consists of variety of pain managment strategies -physical -cognitive-behavioral -lifestyle pain management target body, mind, spirit, and social
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| physical modalities | -cutaneous stimulation -immobilizationor therapeutic exercises -transcutaneous electrical nerve stimulation TENS
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| cognitive behavioral (mind-body) | -providing comfort -eliciting relaxation response -repatterning thinking -facilitating coping with emotions
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| lifestyle management | -stress management -exercise, nutrition -pacing activities -disability management
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| spiritual | -feel part of a community -bond with universe -religious activities
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| nonpharmacologic invasive techniques | -cordotomy -rhizotomy -neurotomy -sympathectomy -spinal cord stimulation
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