Chapter 18

Question 1

What to assess for pain

Answer 1

grimace, crying, shaking, splinting
assess location, duration, intensity, quality (dull, sharp), what brings it on, what decreases it, effects on ADL
need to provide coping strategies

Question 2

Physiologic consequences of unrelieved pain

Answer 2

increased HR, increased SNS, adrenaline
decreased sleep, mobility, strength,
decreased immune reactions and can lead to disease

Question 3

Psychologic consequences of unrelieved pain

Answer 3

depression
anxiety
decreased QOL
dependence
suffering

Question 4

Acute pain

Answer 4

abrupt onset

short duration

Question 5

Chronic pain

Answer 5

3-6 months
can indicate a life threatening underlying disease like cancer
acute pain without treatment becomes chronic pain

Question 6

Intractable pain

Answer 6

no cure at this time

Question 7

Nociceptor Pain

Answer 7

Due to injury to tissues
Sharp, localized
Dull, throbbing, aching

Question 8

Neuropathic Pain

Answer 8

Due to injury to nerves

Burning, shooting, numbing

Question 9

Cutaneous pain

Answer 9

skin, paper cut

Question 10

Somatic pain

Answer 10

caused by trauma to ligament, tendon, bones, blood vessels, nerves

Question 11

Visceral pain

Answer 11

associated with an organ
stretched tissues, ischemia, muscle spasm- pain receptors deep in the abdominal cavity or brain or thorax
(appendicitis, kidney stone, pancreatitis, cancer, heart attack)

Question 12

Radiating pain

Answer 12

extends beyond painful affected area (jaw from MI)

Question 13

Referred pain

Answer 13

felt in remote part of the body

Question 14

Neuropathic pain

Answer 14

along nerve fibers: diabetic neuropathy, painful fingers & toes, plantar fasceitis

Question 15

Phantom pain

Answer 15

can be reduced by treating pain before amputation using neuropathic pain medication Gabapentin or pregambin (lyrica)

Question 16

Transmission of pain

Answer 16

Nociceptor stimulated by noxious stimuli
Spinal cord receives pain impulse through
A∂ fibersand C fibers

Question 17

Pharmacological Techniques

Answer 17

Analgesics
CNS level (Opioids)
Narcotic

Question 18

Analgesics

Answer 18

meds used to relieve pain

NSAIDS

Question 19

CNS level (Opioids)

Answer 19

natural or synthetic Obtained from opium from poppy plant with >20 chemicals
Opium consists of 9%-14% morphine & 0.8%-2.5% codeine (natural opiates)

Question 20

Narcotic

Answer 20

refers to morphine like drugs that produce analgesia & CNS depression

Question 21

Opioid agonist drugs

Answer 21

interact with 6 opioid receptors: mu, kappa, sigma, delta, epsilon

Question 22

Opioid antagonist drugs

Answer 22

block receptors

Naloxone (Narcan) inhibits mu & kappa receptors

Question 23

Mixed Opioid Agonist-Antagonist

Answer 23

Pentazocine (Talwin) mixed agonist/antagonist (analgesia w/o withdrawal s/s)

Question 24

Opioid drug route

Answer 24

IV PO or SQ

no IM

Question 25

Opioid (Narcotic) Analgesic mechanism of action

Answer 25

bind to opioid receptors throughout CNS & peripheral tissues

Question 26

Opioid (Narcotic) Analgesic use

Answer 26

to relieve moderate to severe pain; some used for anesthesia Suppress cough reflex Slow motility of GI tract May increase intracranial pressure

Question 27

Opioid (Narcotic) Analgesic monitoring

Answer 27

severe heart, liver or kidney disease, respiratory disease or seizures, ELDERLY VS, LFTs, BUN, Cr, GFR caution in pregnancy: Cross blood-brain barrier, placental barriers and enter breast milk

Question 28

Fentanyl ½ life

Answer 28

1-2hr

Question 29

Dilaudid ½ life

Answer 29

2-4 hr

Question 30

Morphine ½ life

Answer 30

3-4hr

Question 31

Meperidine ½ life

Answer 31

2.5-4hr

Question 32

Phenergan

Answer 32

must be diluted in 10mL of NS and given over 2 minutes | can cause phlebitis

Question 33

Adverse Effects of Opioids

Answer 33

Respiratory depression Increased ICP Constipation, nausea, urinary retention, depression Orthostatic hypotension

Question 34

Opioid Toxicity

Answer 34

Pinpoint pupils ↓ BP ↓ O2 sat Coma | Priority action is to open airway, give oxygen and give opioid antagonist ASAP

Question 35

Addiction

Answer 35

craving substances for mood altering effect rather than pain relief -- continue to use the substance despite harmful or negative consequences

Question 36

Tolerance

Answer 36

need for more medication to control pain over a period of time occurs within 2 weeks

Question 37

Dependence

Answer 37

physiological need for the drug the body needs the drug to feel OK-abrupt withdrawal results in S&S

Question 38

Pseudoaddiction

Answer 38

iatrogenic syndrome of abnormal behaviors developing as a direct consequence of inadequate pain management