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ADULTs 1 > Pain > Flashcards

Pain Flashcards

1
Q

What is pain?

A

Warning of potential tissue damage

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1
Q

How should a nurse consider a patient’s stated pain scale?

A

The patient’s pain is always accurate

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2
Q

What timeframe defines acute pain?

A

duration less than 1 month

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3
Q

What timeframe defines chronic pain?

A

duration grate than 3 months

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4
Q

What timeframe defines subcute pain?

A

duration 1-3 months

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5
Q

Define visceral pain

A

internal organ pain. Often called referred pain when originating in the abdomen. Ex: Pain in the ovary or testis felt in the umbilicus or abdomen
Pain in the gallbladder or liver felt in the epigastric region or right shoulder

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6
Q

Define acute pain

A

Sudden onset and relatively short duration. Has anticipated/predictable end.

Recurrent acute pain means acute pain episodes come back through an extended period of time.

Can be an indicator that the body is in danger. usually doesn’t last more than 6 months. Greater than 6 months it turns into chronic pain

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7
Q

Difference between chronic malignant and chronic nonmalignant pain?

A

Malignant: occurs as a result of progressive tissue injury

Nonmalignant: occurs in people who do not have progressive tissue injury.

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8
Q

Define nociceptive pain

A

Nociceptive pain is a type of pain caused by damage to body tissue.

It feels sharp, aching, or throbbing, and is often caused by an external injury, like stubbing your toe, having a sports injury, or a dental procedure2.

Nociceptive pain involves the activation of pain receptors by a stimulus that normally causes pain3.

Most pain you experience is nociceptive pain, and it commonly affects your muscles, joints, and bones

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9
Q

Describe somatic pain

A

Somatic is a type of nociceptive pain. You will experience somatic pain if you cut your skin, stretch a muscle too far, exercise for a long period of time, or fall down onto the ground and hurt yourself1.

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10
Q

What are the four phases of nociceptive pain?

A

Transduction (involves the changing of noxious stimuli in sensory nerve endings to energy impulses), Transmission (involves the movement of impulses from site of origin to the brain/reflex arc), Perception (when the pain impulse has been transmitted to the cortex and the person develops conscious awareness of the intensity, location, and quality of pain), Modulation (refers to the activation of descending neural pathways that inhibit the transmission of pain).

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11
Q

Describe Pain Transduction

A

1Transduction (involves the changing of noxious stimuli in sensory nerve endings to energy impulses)

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12
Q

Define Pain Transmission

A

2Transmission (involves the movement of impulses from site of origin to the brain/reflex arc)

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13
Q

Define Pain Perception

A

3Perception (when the pain impulse has been transmitted to the cortex and the person develops conscious awareness of the intensity, location, and quality of pain)

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14
Q

Define Pain Modulation

A

4Modulation (refers to the activation of descending neural pathways that inhibit the transmission of pain).

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15
Q

What kind of patient tends to have neuropathic pain?

A

Nerve pain: Described as intense burning or itching/needles and pins

Diabetic neuropathy
Phantom limb pain
Spinal cord injury pain

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16
Q

Describe cancer pain

A

Includes tumor, bone, chemotherapy, radiation, and post surgical pain.

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17
Q

What factors influence the pain experience

A

Age/gender, stress, anxiety, previous experience with pain, cultural norms/attitudes.

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18
Q

Describe the PQRSTU acronym

A

provocative/palliative, quality/quantity, region/radiation, severity, timing/treatment, understanding

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19
Q

How does this class what you to remember PQRST

A

precipitating factors, quality, region, severity, timing

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20
Q

What pain assessments should you document in their chart?

A

location, intensity (0-10), quality (nature/characteristics of pain), associated symptoms (anxiety, fatigue, and depression)

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21
Q

What’s the FLACC pain scale?

A

Face, Legs, Cry, Consolability used for children and disabled people

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22
Q

Whats the CRIES scale

A

FOR INFANTS crying, requires O2, increased vital signs, expressions, sleepiness

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23
Q

Describe the NVPS

A

Non-verbal pain scale. You score face, activity, guarding, physiologic 1, physiologic 2 on scale 0-2.

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24
Q

numeric pain scale

A

1-10

25
Q

wong baker FACES pain scale

A

has a bunch of cute faces you pick

26
Q

Define breakthrough pain

A

transient, moderate to severe pain that occurs in patients with baseline chronic pain

27
Q

How do you pharmalogically manage moderate to severe pain?

A

Opioids (usually immediate release oral, IV, or PCA)

Combine analgesics to maintain therapeutic serum levels

28
Q

How do you treat mod-severe chronic pain?

A

Opioids, usually extended release or long acting. Immediate release/IV for breakthrough pain

29
Q

Define multimodal analgesics

A

the use of 2 or more classes of analgesic agents to take advantage of the various mechanisms of action. Goal is minimizing adverse effects and can be used for both chronic/acute pain

Ex: Rx morphine, NSAID, gabapentin

30
Q

Name five classes of pain meds

A

nonopioids, opioids, adjuvant, analgesic, therapy.

31
Q

Examples of nonopiods

A

acetametaphen, aspirin/other salicytes

32
Q

Define the analgesic ceiling

A

The drug ceiling effect refers to a particular phenomenon in pharmacology where a drug’s impact on the body plateaus. At this point, taking higher doses does not increase its effect.

33
Q

List some adverse effects of NSAIDS

A

higher risk of cardiovascular events 9MI, stroke, HF,) risk of hypersensitivity (allergic reaction) to NSAID

34
Q

What are some examples of adverse reactions to Nonselective (inhibit COX-1 and COX-2 Enzymes)

A

Ibuprophen, naproxen, others can cause renal impairment, bleeding tendencies, GI irritation/bleeding. To avoid give with food or milk

35
Q

What is a common example of a selective (inhibits COX-2 enzymes) drug

A

Celecoxib used for pain and stiffness with arthritis

36
Q

How do opioids work in the body?

A

Opioids bind to receptors in the central nervous system resulting in:

inhibition of the transmission of nociceptive input from the periphery to the spinal cord

altered limbic system activity

activation of descending inhibitory pathways that modulate transmission in the spinal cord

37
Q

Name most common opioids

A

morphine, hydromorphone, methadone, fentanyl, oxycodone, hydrocodone, codeine

38
Q

How do you give narcan to a patient?

A

0.4-2mg IV/SC, repeat every 2-3min PRN NO MORE THAN 10MG can also use with nasal infuser.

39
Q

What is the basal rate of a PCA?

A

Basal rate is the amount of pain reliever that is infused independent of any demands made by the patient1. In patient-controlled analgesia (PCA), the basal rate of drug infusion is often set at zero to ensure that all doses of pain medication are dictated by the patient’s individual needs for pain control12. However, a basal/continuous infusion rate may be necessary for severe pain, opioid tolerant patients, or those patients who are unable to activate the PCA button

40
Q

How does PCA dosing work?

A

There is a time delay in minutes before another dose is given.

41
Q

How does the 1 hour limit of a PCA work?

A

One hour limit: To be manually calculated based on basal dose, PCA dose and lockout interval. The prescriber can choose a lower hourly limit if the clinical situation warrants.

42
Q

How does the lockout interval of a PCA work?

A

This is the time the patient must wait after giving themselves a PCA dose before their click can deliver another PCA dose of medication. If the Lockout interval is 15 minutes, it means, the patient may click when it’s not 15 minutes from their last dose.

43
Q

Difference between a PCA and nurse bolus

A

Blous: nurse controls prn dosing for severe breakthrough of pain to be administered through the pump.

PCA; nurses may not push the patient operated button

44
Q

What is the 1 hour mas dose limit for a PCA

A

The 1-hour maximum dose limit for a Patient-Controlled Analgesia (PCA) is the pre-determined maximum drug amount that can be delivered during any one hour period1. It includes the demand dose, continuous dose, and breakthrough/incident pain bolus doses2. The specific limit may vary depending on the patient’s condition and the type of opioid used. For example, at one institution, the limit is set to zero3. Another source suggests that the one-hour limit is often set to deliver 3-5 times the estimated required hourly dose4. In general, it is important to consider factors such as patient tolerance, comorbidities, and the risk of over-sedation and respiratory depression when determining the appropriate PCA dosing2.

45
Q

What should you teach your patient when the PCA is hooked up

A

Try to get ahead of pain and don’t let anyone but you push the button.

46
Q

What is opioid stacking

A

When a patient’s liver/kidneys don’t work well so the opioid stays in the body longer.

47
Q

T/F: Opioid side effect diminish with tolerance

A

T

48
Q

What side effect might a opioid naive pt experience

A

sedation, decreased gut motility, respiratory depression, and pruritic

49
Q

When is risk for opiod sedation highest

A

4 hours after leaving PACU

50
Q

What opioid is associated with neurotoxicity (seizures)

A

Demerol

51
Q

What medications do you use for adjunctive therapy

A

Corticosteroids to decrease inflammation.

Tricyclic antidepressants-Neuropathic pain

SNRI (serotonin norephedrine reuptake inhibitor) antidepressants for neuropathic pain, multimodule acute pain, and fibromyalgia

Antiseizure drugs: neuropathic pain, multimodal acute pain, fibromyalgia,

Local/oral/systemic anesthetics: neuropathic pain, arthritis, topical application prior to painful procedures

52
Q

What are the three major principles of the CDC Guidelines for prescribing opioids

A
  1. Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, and end of life care.
  2. when opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose. start with immediate release formulations first.
  3. Clinicians should always exercise caution when prescribing opioids and monitor all patients closely.
53
Q

Define tolerance in pain management

A

Occurs with chronic exposure, is expected need for an increased dose to maintain the same degree of analgesia

54
Q

Define physical dependence in pain management

A

Occurs when the body adjusts it normal functioning around regular opioid use. Withdrawal or unpleasant physical symptoms occur when the opioid is stopped.

55
Q

Define drug misuse in pain management

A

The use of illegal and/or the use of rx drugs in a manner other than directed by a physician such as using greater amounts, more often, or longer than told to take the drug. Misuse can also be taking someone else’s Rx.

56
Q

Define drug addiction (opioid use disorder) in pain management

A

Occurs when attempts to cut down or control use are unsuccessful. Can create social problems and a failure to fulfill obligations at work, school, and home. Opioid addiction often comes and the individual has developed opioid tolerance and dependence, making it challenging to stop opioid use and increasing the risk of withdrawal.

57
Q

List the cognitive behavioral interventions

A

distraction, reframing biofeedback, cutaneous stimulation, transcutaneous stimulation, exercise

58
Q

What are pain management considerations for the older adult

A

metabolize drugs slower

higher risk of adverse effects

start low, go slow

increased risk of drug-drug interactions

analgesics can exacerbate cognitive impairment and ataxia

Use the least invasive route

Tailor nonpharmacologic needs to the indv

59
Q

Describe the rule of double effect

A

The principle of double effect is used to justify the administration of medication to relieve pain even though it may lead to the unintended, although foreseen, consequence of hastening death by causing respiratory depression1. However, opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life1. Therefore, no secondary “double” effect is brought about

60
Q

What receptors do opioids attach to

A

mu opiod receptors

61
Q

Levels of prevention

A

primary: prevention of opioid addiction

secondary: early identification of opioid addiction

tertiary prevention: ensures access to treatment

ADULTs 1 (21 decks)

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