Pain Management (analgesic drugs)
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| An unpleasant sensory or emotional experience associated with actual or potential tissue damage | Pain
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| Examples of non-pharmacologic pain management | companionship, exercise, heat/cold application, lotions/massage therapy, meditation/visualization, music, art & drama therapy, pet therapy, positioning
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| Examples of cultural implications that should be considered | prayer, amuletss, use of herbs, acupuncture, reluctance to express pain, belief that pain is "punishment from god"
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| A level of stimulus needed to produce a painful sensation that is individualized | pain threshold
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| Conditions than can alter pain | Increase in: sympathy, diversion, rest, analgesics, empathy
Decrease in: anger, anxiety, fear, depression, isolation
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| The amount of pain a patient can endure without its interfering with normal function that is individualized | pain tolerance
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| What is acute pain? | sudden onset, subsides w/ treatment, usually occurs over 6 week period
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| What is chronic pain? | persistent, difficult to treat, typically lasts longer than 3 months
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| Name some classifications of pain according to their source: | Neurpathic Pain
Somatic Pain
Superficial Pain
Referred Pain
Visceral Pain
Vascular Pain
Phantom Pain
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| What is the best way to assess for and collect data on pain? | Onset
Location
Duration
Characteristics
Aggrevating factors
Relief measures
Treatment
(OLD CART)
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| How does the acronym PQRST also aid in assessing pain? | Provokes (what causes pain, makes it better, worse)
Quality (what does it feel like)
Radiates (does it travel anywhere)
Severity (scale 1-10)
Timing (when did it start)
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| Name a naturally occuring Opiate analgesic that is the prototype for all opiod drugs | Morphine
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| Name some morphine like drugs | Hydromorphine, oxymorphone, hydrocodone, oxycodone
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| Name some methadone like drugs | methatdone, proposyphene (darvon)
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| Name some meperidine like drugs | meperdine,fentanyl
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| a drug that binds to a receptor site to elicit a response | agonist
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| a drug that binds to a receptor and causes activation response that is LESS than the full agonistic effect-imperfect fit | partial agonist (agonists-antagonists)
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| a drug that binds to a receptor and PREVENTS a response | antagonist
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| drugs that are added as a second drug for combined therapy with a primary drug | adjuvant
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| constipation, urinary retention, euphoria, venodilation, respiratory depression, rash/pruritus, physical & psychological dependence, tolerance, are all side effects of what? | opiods
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| withdrawl starts about how long after not having the drug? and peaks when? | 6-12 hrs
24-72 hrs
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| anxiety, irritability, chills/hot flashes, diaphoresis, nausea & vomitting, abodominal cramps, rhinorrhea, and lacrimation are all examples of what? | withdrawl
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| medications that relieve pain without causing loss of consciousness (aka painkillers) | analgesics
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| what are some indicating behaviors that a pediatric patient is in pain? | muscular rigidity, restlessness, screaming, fear of moving, & withdrawn behavior
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| Name some interventions than should be used when administering opioids to a pediatric patient | recheck dosages, use exact dosage, monitor response, look for adverse effects, give with meals
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| Evaluation of pediatric patients after given opiods are: | evaluate allergic responses, therapeutic effect, and for withdrawl symptoms
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| Pain r/t: nausea risk for injury risk for constipation risk for infection r/t bladder retention knowledge deficit r/t new medication are all examples of what? | nursing diagnoses
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| give some examples of goals that can be used in planning | identifies rationales & side effects of meds
states measures to enhance effect
states measures to decrease side effects
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| give some examples of outcomes that can be used in planning | experiences minimal side effects
demonstrates increased comfort
uses non-pharmacologic measures
manages side effects
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| analgesics that are not classified as opioids | nonopioid analgesics
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| synthetic drugs that bind to opiate receptors to relieve pain but are not themselves derived from the opium plant | opioid analgesics
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| Name some examples of acute pain | myocardial infarction, appendicitis, dental procedures, kidney stones, surgical procedures
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| name some examples of chronic pain | arthritis, cancer, lower back pain, peripheral neuropathy
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| For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember the best type of dosage schedule is to administer pain meds: | A) as needed
B) around the clock
C) on schedule during waking hours only
D) around the clock, with additional doses as needed for breakthrough pain
(d)
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| A pt is receiving an opioid via PCA pump as part of postoperative pain management program. Nurse finds him unresponsive with respirations of 8 bpm and bp of 102/58. after stopping opiod infusion what should nurse do next? | A) notify the charge nurse
B) administer oxygen
C) adminsiter an opiate antagonist per standing orders
D) perform a through assessment, including mental status exam
(c)
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| A pt with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The pt asks the nurse what benefits these patches have. the best response by the nurse is: | A) more analgesia for longer periods
B) less constipaton and minimal dry mouth
C) less drowsiness than with oral opioids
D) lower dependency potential and no major adverse effects
(a)
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| The nurse suspects that a pt is showing signs of respiratory depression. Which drug could be the cause of this complication? | A) naloxone (narcan)
B) hydromorphone (dilaudid)
C) acetaminophen (tylenol)
D) ziconotide (prialt)
(b)
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| Several pts have standard orders for acetomenophen PRN. When nurse reviews histories and assessments, nurse discovers that one of the pts has a contraindication to acetomenophen therapy. Which pt should get alternate meds? | A) pt w/ fever of 103.4
B) pt admitted w/a deep vein thrombosis
C) pt admitted with severe hepatitis
D) A pt who had abdominal surgery 1 wk earlier
(c)
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| What three receptors are believed to be involved in pain? | Mu, Kappa, Delta
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| A subclass of sensory nerves (A & C fibers) that transmit pain signals to the central nervous system from other body parts. | nociceptors
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| True/False when the number of mu receptors is high, pain sensitivity is diminished. Conversely, when the receptors are reduced or missing altogether, relatively minor noxious stimuli may perceived as pailful. | True
More mu=less pain
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| Processing of pain signals in the brain that gives rise to the feeling of pain | nociception
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| These patients are expected to express their pain openly and anticipate immediate relief, preferably through injections or IV drugs. | Arab Culture
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| Their treatments of pain include massage, the application of heat, sweat baths, herbal remedies, and being in harmony with nature. | Native Americans
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| ________, in which cones or cylinders of pulverized wormwood are burned on or near the skin over specific meridian points, is another form of healing for the Chinese. | Moxibustion
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| some of their traditional methods of healing include acupuncture, herbal remedies, yin and yang balance, and cold and hot | Chinese
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| believe in prayer, the wearing of amulets, and the use of herbs and spices to maintain health and wellness. Specific herbs and spices | Hispanic americans
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| believe in the power of healers who rely strongly on the religious faith of people and often use prayer and the laying of hands for | African Americans
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| Pain resulting from any disorder that causes central nervous system damage. Occurs with tumors, trauma, inflammation or disease (cancer, diabetes, stroke, multiple sclerosis affecting CNS tissue) | central pain
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| Pain that occurs in tissue below skin level | deep pain
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| pain that occurs between doses of pain medication | breakthrough pain
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| What occurs when a given pain drug no longer effectively controls pain despite the administration of the highest safe dose | analgesic ceiling effect
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| The most common and well described theory of pain transmission and pain relief. Used to explain how impulses from damaged tissue are sensed in the brain. proposed by Melzack & Wall | Gate theory
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| pain experienced in the area of a body that has been surgically removed or traumatically removed. | phantom pain
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| pain occurring in an area away from the organ of origin; an example is the pain associated with cholecystitis | referred pain
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| pain that originated from skeletal muscle, ligaments. or joints | somatic pain
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| pain that originates from the skin or mucous membranes | superficial pain
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| pain that results from pathology of the vascular of perivascular tissue; thought to account for a large percent of migraine headaches | vascular pain
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| pain that originates from organs or smooth muscles | visceral pain
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| Visceral and superficial pain usually requires _______ for relief, whereas somatic pain (including bone pain) usually respond better to ________ analgesics such as NSAIDs. | opioids
nonopioid
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