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ADN002 MED SURG > Week 2 Pain > Flashcards

Week 2 Pain Flashcards

1
Q

What is Pain?

A

CNS reaction to potential harmful stimuli

Acute - Sudden onset
Early warning to seek treatment to prevent damage to the body

Chronic- Lasting long time or frequent recurrence.

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2
Q

What is pain

A

May result from inflammatory response that cause tissue injury and release of

Histamine
Prostaglandins
Serotonin
Bradykinin
Intiate action potential along sensory fiber

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3
Q

Nociceptors

A

Activated pain receptors
- Messages sent to brain cortex
- Appropriate Autunomic and reflect responses activated

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4
Q

Pain Stimuli

A

Nociception

chemical, mechanical, thermal stimulation
More only small fiber
Inhibitory neuron activated
Neuron sends message to brain
Gate is open

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5
Q

After Pain Stimuli

A

No input
-Inhibitory neuron prevents projection neuron from sending signals to brain

Normal Somatosensory Input
- More only large stimulation
Gate also called

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6
Q

Reflex responses to pain

A
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7
Q

What is Pain?

A

Neurotransmittters
- Endorphins and enkephalins
Bind to with opiate receptors in the CNS
Inhibit pain impulses

Natural Analgesic Effect
- After painful stimuli affect the body
- Pain is subjective
Everyone is different
Same injury but different response

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8
Q

Endogenous Analgesics Released After Painful Stimuli

A
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9
Q

Pain

A

Unpleasant sensory, emotional experience with actual or potential tissue damage

Common reason for seeking care

5th Vital

Pain assessed in all patients and have right to appropriate assessment and management of pain

Pain is what person says

Pain is present in whenever a person says it is.

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10
Q

Nociceptors

A

Peripheral Pain receptors

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11
Q

Ability to Feel Pain

A

Nociception

  1. Transduction- activation of pain receptors
  2. Transmission- Painful stimuli message reaches spinal cord and higher brains
  3. Perception- Sensory process from pain stimulus. Personal interpretation- pain threshold
  4. Modulation- Process of inhibiting or modifying sensation of pain
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12
Q

Patho of Pain

A

Bradykinin- vasodilator, histamine release

Prostaglandins- Increases sensitivity of pain

Neuromodulators- Endorphins, enkephalins and suppress pain reception

Substance P- Increases rate of firing and sensitivity of nerves

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13
Q

Acute Pain

A

Now

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14
Q

Chronic Pain

A

More than 3 months ago

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15
Q

Exacerbation

A

Old pain that returned

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16
Q

Cutaneous Pain

A

Localized to the skin

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17
Q

Referred Pain

A

Pain felt in another part of the body

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18
Q

Nociceptive

A

Pain caused by injury or inflamamtion of some of the body

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19
Q

Intractable Pain

A

Severe, constant, relentless, and debilitating pain not curable by any means

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20
Q

Breakthrough Pain

A

Severe Pain that erupts while a patient is already medicated with long lasting pain killer

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21
Q

Neuropathic Pain

A

Damage to PNS or CNS as result of abnormal processing

Neuroplasticity- ability of brain to adjust to pain

Peripheral Sensitization- Increased sensitivity to an afferent nerve stimuli after cellular damage.

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22
Q

Central Sensitization

A

Changes to Nervous system

Allodynia- Stimuli not painful prior to injury

Hyperalgesia- normal painful stimuli is perceived as more painful than it should

May be hypersensitve to light

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23
Q

Factors that Influence Pain

A

Past
Anxiety
Stress
Depression
Culture
Religion
Age
Gender
Medical History

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24
Q

Gabapentin

A

Treats neuropathy. Neurotonin. anticonvulsant

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25
Q

Acute Pain Effects

A

Can affect respiratory, cardiovasuclar, endorcrine, and immune systems

Stress response increases metabolic rate, cardiac output, risk for physiological disorders

Sleep Deprivation

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26
Q

Effects of Chronic Pain

A

Depression
Suicide
Self Medication
Increased disability
Supression of immune function slow healing time

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27
Q

Characteristics of Pain

A

PQRST
P- what makes it worse or better
Q- Quality describe
R- region where it is located and radiation
S- Severity
T- Timing of it

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28
Q

Indicators of Pain

A

Restlessness or irritability
Crying and screaming and other verbal expression
Grimacing and grinding teeth
Touching or grabbing body part
Kicking or thrashing or attempting to move away
Facial Expressions
Verbalizations and vocalizations
Body movements
Changes in interpersonal interactions
Changes in activity patterns and routine
Changes in mental status

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29
Q

Indicators of Pain

A

Can be affected by
Culture
Religion
Age
Ethnicity
Language

Be sensitive tp pt that have barriers to expressing their pain

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30
Q

Non Pharmacological Interventions

A

CAM

Cutaneous Stimulation
- Massage
- Thermal Therapies
- TENS Unit
- Acupressure/ Acupuncture
- Biofeedback- Teaching to self to decrease pain
- Therapeutic touch

31
Q

Nonpharmacological Interventions

A

Alternative Therapies
- Herbal remedies
- Acupuncture

Distraction
-Humor
- Music
-TV

Relaxation Techniques
- Hypnosis
- Guided Imagery

32
Q

Analgesics

A

Releive pain without

Disturbing conciousness
Altering actions of sensory nerves

Antipyertics reduces fever

Some have inflammatory responses

33
Q

Basics of Pain Relief

A

Opiods- Act on CNS to inhibit activity of ascending nociceptive pathways
NSAIDS- decrease pain by inhibiting COX- 1 and COX 2 enzymes involved in production in prostaglandins

Local anesthetics- Block nerve conduction applied to nerve fibers

34
Q

Pain Relief Interventions Phamacological

A

Routes

PRN meds
ATC- Around the Clock
PCA- Patient Controlled Analgesia
Local Anesthetics
Topicals, Patches
Intraspinal administration

35
Q

Gerontologic Considerations

A

More likely to have adverse effects, drug interactions

Increased likelihood of chronic illness

May need to have more time between doses of medication due to decreased excretion, metabolism, related to aging changes

Start low and go slow

36
Q

Acetaminophen

A

Action- Analgesic, antipyertic
Less association with nausea and vomitting than NSAIDS
Does NOT cause GI bleeding or interefere with blood clotting

Equal to ASA in analgesic and antipyertic effects

Metabolized in the liver, small amounts remain in the body as toxic metabolite

Liquid 160/ 5 ml
325 mg

PR c Acetaminophen

37
Q

Nursing Implications of Acetaminophen

A

Liver Function, alcohol use, and last dose taken

38
Q

Acetaminophen Uses

A

General pain mild to moderate

Contraindications
- Acute or chronic overdose can result in liver damage or fatal liver necrosis
Usual therapeutic doses may cause and increase liver damage in those who abuse alcohol

39
Q

Acetaminophen Toxicity

A

Max dose 4 g

Overdose causes hepatoxicity
May be accidental or intentional
S/S nonspecific

Livers levels increased

Later manesfestations include jaundice, vomiting, CNS excitement with delerium

Increased Ammonia Levels
Hepatic Encephalopathy chronic liver damage- Lactulose

40
Q

Overdose Toxicity Acetaminophen

A

Gastric Lavage

within 4 hours

Acetylcysetine
Oral or IV
Does not reverse damage already

41
Q

NSAID

A

Used for
Headache
Dysmennorhea
Myalgias
Neuralgias
Fever
Common Cold
Viral Infections
Arthiritic and Rheumatoid Conditions

42
Q

Acetaminophen interactions

A

Alcohol
Barbituates
Carbamazepine
Phenytoin
Rifampin

43
Q

NSAIDs include

A

Salicylates
Antipyertics

Used to treat painful conditions:
Arthritis - Inflammation of the swelling of the joints, stiffness, and pain
Menstrual attacks
Gout Attacks
Bursitis
Sprains

44
Q

NSAIDs

A

Acetylsalicylic acid
Diclofenac
Diflunisal
Etodolac
Fenoprofen
Flurbiprofen
Indomethacin
Keterolac
Nabumetone
Naproxen
Oxaprozin
Piroxicam

45
Q

NSAIDs

A

Differentiate by COX 1 nonselective and COX 2 Inhibitors or COX 2 Inhibitors 9 selective

COX officially known as prostaglandins endoperoxide synthase

46
Q

Acetaminophen Adverse Effects

A

Sensitivity reactions
Skin eruptions
Urticaria
Hypotension
Hepatotoxicity
Increases HTN c daily use

47
Q

NSAIDS Acetaminophen

A

Contraindications
-Hypersensitivity
- Anemia
- Children under age 3
-Alcoholism
- Malnutrition
- Thrombocytopenia
- Hepatic or renal impairment
- Childhood rheumatoid conditions

48
Q

NSAIDs

A

Include
-Salicylates
-Antipyretics

Used to treat painful conditions
Arthritis- inflammation, swelling, stiffness, joint pain
- Menstrual Cramps
- Gout attacks
- Bursitis, tendonitis
- Sprain, muscle strains

49
Q

Commonly used NSAIDs

A

Aspirin ( acetylsalicylic acid)
- Diclofenac
- Diclofenac- misoprostol
- Diflunisal
- Etodolac
- Fenoprofen
- Flurbiprofen
- Ibuprofen
- Indomethacin
- Ketorlac
- Nabumetone
- Naproxen
-Oxaprozin
- Piroxicam

50
Q

Cyclooxygenase

A

Enzyme maintains normal lining of stomach and intestines
Protecting stomach juices
Involved in kidney and PLT function

51
Q

Salicylates

A

Action- Decreases platelet aggregation
antipyretic, analgesic

Side effects - delayed clotting= bleeding

Contra- Pregnant, day of surgery, other anticoags, and bleeding

Nursing Implications - Assess for contras and proper order use, and PLT count

52
Q

Aspirin

A

Nonslective COX 1 and COX 2

Salicytate

ANtipyeric and analgesic factors
Decrease PLT aggregation

Used for
Headache
Fever
Muscular aches and pains
Safest and effective drugs for surgery

53
Q

Adverse Uncommon effects of Aspirin

A

Dyspepsia
Nausea, vomiting
Blood in stool
Anemia
GI hemorrhage (elderly)

54
Q

Asprin Contras

A

Hypersensitivity
GI hemmorrhaging

Interactions
Anticoags
Uricosurics- Uric acid
Antidiabetics

55
Q

NSAIDS

A

Aspirin

Avoid if menstrual bleeding is heavy

Pregnancy women avoid in last trimester and during lactation
Avoid one week before or after surgery
Avoid alcohol while taking aspirin

56
Q

NSAIDs Propionic Acid Derivatives

A

Ibuprofen
Action- Analgesic, antipyertic
Use- General Pain, joints, swelling, and fever
Adverse effects- bleeding
COntras- bleeding, pregnant and chronic kidney disease

Nursing implication- Proper order use, and PLT count

57
Q

Ibuprofen

A

Non- selective, COX-1 and COX- 2 inhibitor

Nonsalicylate Analgesic
-Anti flammatory
- Antipyertic

Used to treat pain:
RA
Osteoarthritis
Arthritis
Mild to moderate pain
Dysmenorrhea
Fever

58
Q

Ibuprofen Adverse Effects

A

Nausea
Occult blood loss
Peptic Ulceration
Diarrhea
Constipation
Abd pain
Dyspepsia
Flatulence
Heartburn

59
Q

Ibuprofen HTN in women

A

Higher risk 78 percent

60
Q

Ibuprofen

A

Contraindications

Hypersensitivity
Angioedema
Nasal Polyps
Pregnancy
Bronchospasm reaction NSAIDs

61
Q

Ibuprofen Interactions

A

Antihypertensives
Furosemide
Diuretics

Avoid if breastfeeding

Notify HCP if blood appears in stool, vomitus, and urine

New skin rash, itching, jaundice

Avoid alcohol, aspirin, and other NSAIDs

62
Q

Meloxicam Oxicam

A

Oxicam Derivatives
Same as other Nsaids

Use for RA and OA

Used for short period of time and at a low dose

Easier on stomach due to higher activity of COX2

63
Q

Indomethicin

A

Use
Moderate to severe OA, RA, gouty arthritis, or ankylosing spondylitis
Shoulder pain caused by bursitis or tendinitis

Used to treat PDA

Not be used for minor pain

Action- Same as other NSAIDs

Adverse Effects-
GI ulcerations
Bleeding
Increased pain in UC
Gastritis
Nausea, vomiting
Many others

64
Q

Indomethacin Contras

A

Hypersenstivity
Pregnancy
Breastfeeding
In neonates
Bleeding
Renal impairment
NSAID- induced asthma, rhinitis, hives

65
Q

Indomethacin

A

Interactions-
Aminoglycosides
Cyclosporine
Methotrexate
Antihypertensives
Furosemide
Thiazide Diuretics

66
Q

Notify Physician Indomethacin effects

A

Skin rash
Breathing problems
Visual Disturbances
Signs of hypersenstivity to NSAIDs

67
Q

Celecoxib

A

Decreased risk for gastric bleeding
200mg to 400mg

Action COX 2 inhibitor

Use - Joint Pain- OA- RA

Adverse Effects- coughing blood, jaundice, AKI, anemia
Nursing Implications- Liver and kidney function, signs of GI bleed.

68
Q

Selective COX 2 Inhibitors Adverse Effects

A

Abdominal Pain
Dyspepsia
Diarrhea
CV thrombotic events

69
Q

Selective COX 2 Inhibitors Contraindiactions

A

Hypersensitivity
Asthma
Urticaria
In the elderly
Anaphylactic Reactions
In children
Third Trimester of pregnancy
Lactation

70
Q

Selective COX 2 Inhibitors Interactions

A

ACEs
Fluconazole
Lithium

71
Q

NSAIDs Selective Cyclooxygenase 2 Inhibitors

A

Report-
Weight gain
Rash
Nausea
Fatigue
Lethargy
Jaundice
Flu Like Symptoms
Black Tarry stools
Upper GI distress

72
Q

Selective Cyclooxygenase 2 Inhibitors

A

Avoid celecoxib during 3rd trimester

Avoid:
Aspirin
Other NSAIDs
Alcohol
Tobacco

73
Q

Opiates are derived from

A

Opium poppies

Opioids
-Natural Synthetic, or endogenous morphine- related substances

Analgesic effects
- Bind to opioid receptors ( mu, kappa, delta)
- Mostly effects mu receptors

ADN002 MED SURG (18 decks)

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