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Exam 3 > Comfort > Flashcards

Comfort Flashcards

(42 cards)

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1
Q

Transduction

A

Activated nociceptor converts energy produced by stimuli (mechanical, thermal, or chemical) into an action potential

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2
Q

Transmission

A

Pain signals move from the periphery to the level of the spinal cord and then to the brain

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3
Q

Perception

A

Conscious awareness of pain and perceiving it

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4
Q

Modulation

A

Last phase of the pain process; built-in mechanisms to slow or stop processing painful stimulus

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5
Q

Nociceptive pain

A
  1. Somatic pain: musculoskeletal tissues or body surface
  2. Visceral pain: internal organs ( heart attack=>shoulder pain
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6
Q

Neuropathic pain

A
  1. Difficult to assess
  2. Difficult to treat

Does not adhere to typical pain phases
-not detected by x-ray, CAT, or MRI
Abnormal processing of pain message
Pain perceived long after an injury healed
Evolves into a chronic condition

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7
Q

Breakthrough pain

A

Occurs in pts whose baseline persistent pain is usually mild to moderate and fairly well-concentrated
-transient
-moderate to severe pain
-avg. peak can be 3-5 minutes
-sometimes 30 min or longer
Can be predictable or unpredictable

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8
Q

Treatments of breakthrough pain

A

Lifestyle changes
Management of reversible causes
Modification of pathological processes
Nonpharmacologic management
Pharm management

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9
Q

Gate Theory of Pain

A

Suggests pain perception is influenced by “gate” in spinal cord.

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10
Q

Things that OPEN the gate

A

Stress and tension - anxiety, worry, pain feel worse)
Mental factors - focusing all attention on the pain
Boredom and lack of activity

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11
Q

Things that CLOSE the gate

A

Relaxation and contentment - feeling happy and optimistic
Mental factors - involved - interest in life - focus elsewhere - not on pain
Activity/exercise
Counter stimulation - heat, massage, TENS, acupuncture
Distraction

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12
Q

Acute pain

A

Sudden
Mild to severe
<3 months or as long as it takes to heal
Usually can identify the cause
Pain decreases over time

Ex. Post-op, labor pain, trauma, pain from infection (UTI)

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13
Q

Acute pain behaviors

A

Increased HR, BP, RR
diaphoresis
Pallor
Anxiety
Agitation
Confusion
Urine retention

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14
Q

Chronic pain is persistent

A

Is not protective
Can be gradual or sudden (may start as acute)
Lasts longer than 3 months or past time of normal healing
Does NOT always have identifiable cause
Feels endless to pt
Can lead to depression or suicide
Can lead to opioid dependence or addiction

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15
Q

Chronic pain behaviors

A

Flat affect - try not to give an outward indication of pain
Decreased physical activity
Fatigue/hopelessness
Withdrawal from social interaction

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16
Q

Physiological changes for uncontrolled pain

A

-Cardia: tachycardia, HTN
- Pulmonary: hypoxia, decreased cough, Atelectasis
-GI: N/V, ileus
-Renal: Oliguria, urinary retention
-Musculoskeletal: spasms, joint stiffness
-CNS: fear, anxiety, fatigue
-Immune: impaired cellular immunity, wound healing

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17
Q

Aging Adult

Study These Flashcards
A

NOT a normal process of aging
Does NOT feel pain less than others
Pain indicates injury

Clenched fist may = pain
Agitation may = hunger or cold

Pain assessment in Advanced dementia - PAINAD Scale

18
Q

Principles of Pain Management

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A
  1. Pt has right to pain management
  2. Pain is always subjective
  3. Physiological and behavioral signs of pain are NOT reliable
  4. Pain is unpleasant sensory and emotional experience
  5. Assessment approaches and tools - appropriate for age
  6. Pain can exist even if no physical cause can be found
  7. Pain experiences are different
  8. Pts w/ chronic pain may be more sensitive to pain and other stimuli
  9. Unrelieved pain has adverse consequences
19
Q

Barriers to effective pain management

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A

Fear of addiction
Fear of tolerance
Concern about side effects
Fear of injections
Desire to be good pt
Medication compliance - forgetting to take medication
Pain may indicate disease progression
Sense of fatalism or stoicism
Ineffective medication

20
Q

Pain the 5th vital
PQRST

Study These Flashcards
A

-Provocation- what makes it worse better
-Quality: sharp, burning, dull, stabbing
-Radiates: to another area
-Severity
-Timing/Treatment : when did it start?- how long does it last? - what has helped?

21
Q

Comprehensive pain assessment

Study These Flashcards
A

Location
Intensity
Quality
Onset/duration
Pattern
Contributing symptoms
Effects of pain
Comfort - function (pain) goal

22
Q

Pain assessment tools

Study These Flashcards
A

Brief pain inventory
Initial pain assessment
Universal pain assessment 😃😬
Numeric, simple, visual

Wong-Baker faces
FLACC - useful w/ children between 2 months - 7 years

23
Q

Pain treatment

Study These Flashcards
A

Follow principles of pain assessment
Every pt deserves adequate pain management
Base the treatment plan on the pts goals
Use both drug and non-drug therapies
When appropriate- use multimodal analgesia
Use an inter professional approach
Prevent or manage medication SE
Include pt and caregiver teaching

24
Q

Non-opioid pharmacological interventions

Study These Flashcards
A

Analgesics for MILD to MODERATE pain

Acetaminophen
NSAIDs : ibuprofen, aspirin
Alone - mild pain reliever
High doses - moderate pain relief
Combo w/ opioids - can reduce high levels of pain and actually reduce the opioid level required

25
Drug ALERT
NSAIDs (except for aspirin (ASA): - higher risk for cardiovascular events MI Stroke Heart failure - pts w/ recent heart surgery should NOT take NSAIDs
26
Opioids pharmacological intervention
Analgesics moderate to severe pain - used for chronic and acute pain -sedation (always comes first) -respiratory depression -monitor & intervene for side effects BUT TREAT THE PAIN
27
DRUG alert
Morphine - may cause respiratory depression, if <12 contact provider Methadone - may cause respiratory depression, can cause cardiac toxicity, specifically QT prolongation
28
Fentanyl
Very potent Dosage is in micrograms (mcg) For procedures IV fentanyl often combined w/ benzos for analgesia and sedation Transdermal patch used only for chronic pain Do not give to naive pts
29
Common side effects of opioid
Constipation Nausea (can take anti-emetic, usually resolves on about a week) Sedation (respiratory depression high in: smokers, obesity, over 65, history of sleep apnea) Pruritus (usually common with epidural, intrathecal routes)
30
Naloxone
Opioid reversal Given IV, sun-Q, or intra-nasally Caution in pts taking opioid a lot - can precipitate severe, agonizing pain -profound withdrawal symptoms -Hypertension -Pulmonary edema
31
Adjuvants analgesics
Adrenergic agonists Tricyclic antidepressants Antihistamines Glucocorticoids Antiemetic Anticonvulsants Anesthetics Anti-anxiety agents
32
Non-Drug therapies for pain
Exercise TENS Heat/cold therapy Distraction and/or guided imagery Hypnosis Relaxation strategies Acupuncture
33
Massage
Useful for acute and chronic pain Relaxes muscles Promotes sleep Enough to lower heart rate Decreases anxiety Produces physical and mental relaxation Can enhance the effectiveness of pain medication
34
Acute Pain - Procedural Pain
GOAL: maintain adequate pain comfort to increase pts willingness and ability to participate in care Wound care: dressing changes, pain assessment, severity/acuity (pain scales) , character (sharp, stabbing), what provides most relief Provide appropriate pain meds: wait 30-60 min. Before changing dressing
35
Acute Pain - total joint arthroplasty
Preoperative management: careful history to determine pain tolerance, management preferences, allergies to medications Post-op: perform regular neurovascular assessments, administer anticoagulant medication, administer antibiotics Perform continual pain management: assess, pt teaching, may include epidural or intrathecal analgesia, oral opioids, NSAIDs
36
Chronic Pain - Osteoarthritis
Slowly progressive non-inflammatory disorder or the synovial joints May hv acute or chronic pain Impaired physical mobility Difficulty coping GOAL: use drug and non-drug strategies to manage pain
37
Osteoarthritis pain management
Drug therapy- depends on severity Mild to moderate pain- acetaminophen Topical agents - I.e capsaicin (. combine with acetaminophen) OTC products: camphor, eucalyptus oil, menthol, BenGay Moderate to severe pain or signs of joint inflammation NSAID- ibuprofen
38
Complementary & Alternative Therapies
Carefully approach alternative therapies Acupuncture, massage, tai chi for joint Massage, medication, yoga Splints to stabilize and rest painful inflamed joints
39
Neuropathic - DDD
Results from loss of fluid in the discs Discs lose elasticity, flexibility, and shock absorbing abilities UNLESS accompanied with pain - DDD is normal process of aging
40
Neuropathic pain management
Usually lower back pain Radiates down the buttock and below the knee along the distribution of the sciatic nerve Numbness, tingling, and/or muscle weakness in legs, feet, or toes
41
DDD - conservative therapy
Restrict activity for days, limited total bed rest Limitation of extreme spinal movement (belt, corset, brace) Local heat/ice Ultrasound and massage TENS
42
DDD medication
Analgesics - Tramadol Tylenol, NSAIDs Muscle relaxants Adjuvants (anti-seizure, anti-depressants) Epidural corticosteroid injections

Exam 3 (6 decks)

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