WEEK 9 Flashcards
as well as flashcards from the two slide shows from week 8
pain
Subjective and can be caused by stimuli that are actual or anticipated; official IASP definition: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Merkel’s definition of pain
not only subjective, but also linked to both the physical and emotional–psychological experiences of individuals.
pain threshold
the point at which a stimulus causes the client perceive pain
pain tolerance
how much of a stimulus the client is willing to accept
biopsychosocial model categories of pain
biological- diesase severity, nociception, inflammation, brain function
psychological- mood/affect, catastrophizing, stress, coping
social-cultural factors, social environment, economic factors, social support
Descriptive characteristics of pain
Aching
Throbbing
Stabbing
Pounding
Sharp
Gripping
Dull
Tearing
Radiating
Cutting
Burning
Scalding
types of pain
duration (acute versus chronic)
by origin (nociceptive versus neuropathic)
by the disease or condition that causes it (e.g., cancer)
acute pain vs chronic pain
acute- has a sudden or slow onset of any intensity and an anticipated or predictable end. By definition, acute pain is pain that lasts less than six months. Examples include pain that results from tissue damage caused by trauma or injury, incisional pain from surgery, and pain from environmental factors such as heat or cold
chronic pain- has a sudden or slow onset of any intensity and is constant or recurring without an anticipated or predictable end. By definition, chronic pain usually has a duration of lasting longer than six months. Examples of chronic pain include arthritis, back pain, and headaches. Chronic pain can be both physically and emotionally debilitating. If acute pain is not addressed, it can become chronic.
nociceptive pain
Pain that is felt in the tissue, an organ, a damaged part of the body, or a referred pain.
nociceptors- Found in multiple parts of the body (skin, joints, muscles, viscera) and activated by many different chemical substances, extreme temperature and pressure changes, and tissue damage
types of nociceptive pain
somatic (with pain occurring in the skin, bones, joints, muscles, or connective tissues)
visceral (with pain occurring in the internal organs and referring to other locations of the body,
cutaneous (with pain occurring in the skin or subcutaneous tissue).
neuropathic pain
Nerve pain that arises from the somatosensory system, described as intense, burning, and shooting.
nclude diabetic neuropathy, phantom limb pain, and pain associated with a spinal cord injury. Neuropathic pain is frequently described as intense, shooting, or burning. Some clients may describe the pain as numbness, “pins and needles,” and even an intense itching.
pins and needles pain
neuropathic pain
examples of neuropathic pain
trigeminal neuralgia
sciatic pain
below-the-knee amputation
examples of nociceptive pain
back pain
broken rib
three categories of pain
acute, chronic, and cancer pain
cancer pain
A newly recognized category of pain that can involve tumor pain, bone pain, and treatment-associated pains such as chronic post-surgical pain.
include tumor pain, bone pain, and treatment-associated pain such as chronic postsurgical pain, radiation-induced pain, and neuropathies related to chemotherapy. Each type of cancer pain requires special considerations and treatments.
subjective indicators of pain vs objective indicators of pain
Subjective indicators of pain: pain scale score, along with quantity and quality of pain
Objective indicators of pain: grimacing, guarding, crying
PQRST Mnemonic
nurses use to determine client’s pain
Precipitating cause
Quality
Region
Severity
Timing
questions of statements with PQRST
P: “What were you doing when the pain started?”
Q: “Describe what your pain feels like.”
R: “Show me the location where you are experiencing pain.”
S: “On a scale of 1 to 10, how would you rate your pain?” (Use one of the pain scales discussed in the next section.)
T: “When did your pain first begin? Have you experienced this pain before?”
A nurse is discussing the challenges of assessing pain in children with a group of parents. Which of the following statements should the nurse include?
Children may deny pain to avoid IM injection or bad tasting oral medicine.
Nonpharmacological Pain Interventions: Positioning
reposition every 2 hours
pad bony prominences (coccyx, sacrum, heels, and scapula)
Nonpharmacological Pain Interventions: Cutaneous Stimulation
Therapy applied to the skin such as heat and cold, touch, massage, acupuncture, acupressure, or TENS.
cold therapies: no more than 15-30 mins at a time and up to 2-3 times per day
Nonpharmacological Pain Interventions: Cognitive Strategies
Therapy to help clients learn to manage and target negative thoughts to help reduce pain, especially chronic pain.
distraction to reduce pain in recieving IM injections in little kids, music for intraoperatively and postoperatively in decreasing postoperative pain
Nonpharmacological Pain Interventions: Therapeutic Touch
modality in which the nurse utilizes the hands either on or near the body of the client to balance the client’s energy and thereby promote healing
cancer or fibromyalgia
Pharmacological Interventions: Opioids
The most common pain medications, which have the risk of sedation and depression, e.g.. morphine, hydromorphone, fentanyl.
hese agents suppress pain by activating opioid receptors in the brain, spinal cord, and central nervous system. Because opioids can lead to addiction if misused, careful titration and monitoring are required.
how to administer opioid medications
PO, IV, IM, PR, TOP
Pharmacological Interventions: Pain controlled analgesia (PCA)
A computerized pump controlled by the client capable of delivering pain medication through a syringe to their IV line.
Naloxone
given IV to quickly reverse adverse effects of opioids
Pharmacological Interventions: Nonopioids
Can be administered for the treatment of pain by the nurse and include local anesthetics, nonsteroidal anti-inflammatory medications (NSAIDs), and acetaminophen.
how do NSAIDS work
a complex process of inhibiting prostaglandin synthesis by blocking two cyclooxygenase enzymes (COX 1 and COX 2). Prostaglandins play a major role in the inflammatory process.
reduce inflammation and fever
Pharmacological Interventions: Adjuvant Analgesics
Aid in pain relief by working on underlying pain generators, such as antidepressants, corticosteroids, and botulinum toxin.
corticosteriods, antidepressents, and botulinum toxin
Adjuvant analgesics: Corticosteriods
that are used as adjuvants for the relief of pain include hydrocortisone, cortisone, and prednisone.
Although these medications can be helpful in reducing the inflammation associated with pain, corticosteroids can have many adverse effects, such as increased blood glucose levels, suppression of immunity, weight gain, mood swings, fluid retention, and elevated blood pressure.
adjuvant analgesics: antidepressants
can also be used as adjuvants and often work well for nerve-related pain, migraines, and arthriti
Antidepressants can cause sedation, cardiac problems, and dry mouth, and should be used cautiously. Nurses should educate clients that consistent use, as prescribed, may produce positive results in time.
examples of opioids
morphine
fentanyl
codeinee
examples of nonopioids
acetaminophen
examples of adjuvant
carbamazepine
gabapentin
SBIRT
mnemoic method to screen clients for opiod addiction
Screening
Brief
Intervention
Referral to
Treatment
hospice care
Care services for clients and families that focus on comfort and support; not curative when it is determined the client has less than six months to live.
center of medicare and medicaid services for eligible hospice services
(1) a hospice provider and the primary care provider must officially state the client is terminally ill, (2) the client must agree to palliative care as opposed to curing their illness, and (3) the client is required to sign a statement that they are choosing hospice care in place of other benefits to treat their illness.
respite care
A service or agency that provides primary caregivers with a short-term break from the responsibilities of client care.
palliative care
A multidisciplinary care approach that is focused on the management of symptoms for chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client.
examples of when palliative care would be appropriate
advanced stages of cancer, refractory cardiac disease (heart failure), renal or respiratory failure, and neurodegenerative conditions such as Alzheimer’s disease and Parkinson’s disease.
physiological changes as death approaches
dyspnea
death rattle (retention of secretions in the respiratory tract)
Cheyne-stokes respirations
first choice is treating dysnpea (which is most related to what)
opioids are most likely first choice to treat
dyspnea is most related to advanced-stage cancer, ascites, chronic obstructive respiratory disease, a physical decline in respiratory functioning, and pneumonia.
death rattle
caused by the accumulation of secretions in the lungs and throat, causing congestion and a “rattling” sound as the secretions become trapped, and the client is unable to clear these secretions.
Death rattle is an indication of approaching death, often within hours or days.
how to help with death rattle
Turning the client’s head to the side or rolling the client to the side can assist with drainage of the secretions from the throat and lungs. Medications such as oral atropine drops or scopolamine patches may also be used to dry up the secretions. A moist washcloth and oral suctioning can be used to eliminate secretions from the mouth.
what to not do to treat death rattle
Deep suctioning is ineffective in removing the accumulated secretions that are pooled in the lungs.
cheyne-stokes breathing
This manner of breathing typically occurs within three days of impending death.
The client’s rate of respiration becomes irregular, fluctuating between several quick breaths, followed by periods of apnea.
how to help cheyne-stokes breathing
The nurse can provide relief by positioning a fan to blow lightly in the direction of the client. The family should be educated that this type of breathing pattern is typical and expected.
three-step latter in palliative care with pain mangement medications
- begins with NSAIDs
- codeine or tramadol
- morphine
what causes temp changes
the use of opioids, blood transfusion reactions, pain, hypoxia, fear and anxiety, and a warm environment result in temperature change
mottling
Physical change of the skin marked by purple or reddish marbling; caused by the heart’s inability to pump blood effectively, leading to decreased blood perfusion throughout the body.
