Module 1B Part 2: Pain, Comfort and Sleep. Complementary and Alternative Therapies COPY Flashcards
(88 cards)
1
Q
What are the Categories of pain?
A
- Pain
- Acute pain
- Chronic pain
- Nociceptive pain
- Neuropathic pain
2
Q
What is Pain?
A
- The feeling of distress and discomfort
- Affects or interferes with normal activity
- No accurate objective measurement of pain
3
Q
What is Acute Pain?
A
- Protective; temporary; usually self-limiting; has a direct cause; resolves with tissue healing.
- Physiological responses (sympathetic nervous system) -fight-or-flight responses
- Behavioral responses: grimacing, moaning, flinching, and guarding.
- Interventions focus on the treatment of underlying problems.
- If unrelieved -can lead to chronic pain
4
Q
What is Chronic Pain?
A
- Not protective; ongoing or recurs frequently; lasting > 6 months and persisting beyond tissue healing.
- Typically, no change seen in Vital Signs
- Psychological responses: depression, fatigue, and a decreased level of functioning. It is not usually life-threatening.
- Psychosocial implications can lead to disability.
- Management aimed at symptomatic relief.
- Pain is not always responsive to interventions.
- Can be malignant or nonmalignant
- Idiopathic pain
- Interventions
- Long-acting or controlled-release opioid analgesics (including the transdermal route).
- Around-the-clock analgesics (vs. PRN)
5
Q
What is Nociceptive Pain?
A
- Damage to or inflammation of the tissue (noxious stimulus triggers pain receptors [nociceptors] causing pain sensation)
- Throbbing, aching, and localized
- Interventions: Opioids and non-opioid medications.
- Types of Nociceptive Pain:
- Somatic: In bones, joints, muscles, skin, or connective tissues.
- Visceral: In internal organs (the stomach or intestines). It can cause referred pain in other body locations separate from the stimulus.
- Cutaneous: In the skin or subcutaneous tissue.
6
Q
What is Neuropathic Pain?
A
- Arises from abnormal or damaged pain nerves
- Includes phantom limb pain, pain below the level of a spinal cord injury, and diabetic neuropathy.
- Intense, shooting, burning, “pins and needles.”
- Interventions: Adjuvant medications (antidepressants, antispasmodic agents, skeletal muscle relaxants). Topical medications can provide relief for peripheral neuropathic pain.
7
Q
What is the Physiology of Nociceptive Pain?
A
- Transduction
- Transmission
- Pain threshold
- Pain tolerance
- Perception
- Modulation
8
Q
What is Transduction?
A
Transduction is a conversion of painful stimuli to an electrical impulse through peripheral nerve fibers (nociceptors).
9
Q
What is Transmission?
A
Transmission is the electrical impulse travels along the nerve fibers, where neurotransmitters regulate it.
10
Q
What is the Pain Threshold?
A
Pain threshold is the point at which a person feels pain.
11
Q
What is the Pain Tolerance?
A
Pain tolerance is the amount of pain a person is willing to bear.
12
Q
What is Pain Perception?
A
Perception or awareness of pain occurs in various areas of the brain, with influences from thought and emotional processes.
13
Q
What is Modulation?
A
Modulation occurs in the spinal cord, causing muscles to contract reflexively, moving the body away from painful stimuli.
14
Q
What substances increase pain transmission?
A
- Substance P
- Prostaglandins
- Bradykinin
- Histamine
15
Q
What substances decrease pain transmission?
A
- Serotonin
- Endorphins
16
Q
What is Referred Pain?
A
- Pain from a deep organ in the body often “referred” to another place on the body’s surface.
- Caused when pain signal comes into the spinal cord and nerves not directly affected are stimulated (shared pathways in spinal cord transmission).
17
Q
What is the Gate Control Theory?
A
- Pain transmission controlled by a gate mechanism in the central nervous system.
- The opening gate allows transmission of pain sensation; closing the gate blocks this transmission.
- The gate may be opened by activity in the small-diameter nerve fibers from such things as tissue damage. Activity in the large-diameter nerve fibers, such as that provided by massage or vibration, closes the gate
- Brainstem impulses caused by a high sensory input closes the gate, whereas a lack of this input allows the gate to open.
- The cerebral cortex and thalamus play a role by opening the gate with impulses originating from an increase in anxiety, or by closing it with impulses originating from a decrease in anxiety.
18
Q
How is Pain Managed?
A
- Pharmacological and nonpharmacological pain management therapies are part of effective pain management.
- Invasive therapies (nerve ablation) can be appropriate for intractable cancer-related pain.
- Clients have a right to adequate assessment and management of pain.
- Assessment performed with VS; considered “5thVital Sign.”
- Nurse: Priority responsibility to the assessment of pain
- Routinely measure pain level
- Provide individualized interventions
- Evaluation: reassess pain 10-60 minutes after administering medication (depending on medication route)
19
Q
What are the Risk Factors for Undertreatment of Pain?
A
- Undertreatment of Pain
- At-Risk Populations
20
Q
What causes pain undertreatment?
A
- Cultural and societal attitudes
- Lack of knowledge
- Fear of addiction
- The exaggerated fear of respiratory depression
21
Q
What populations are at risk for undertreatment of pain?
A
- Infants
- Children
- Older adults
- Clients who have substance use disorder
22
Q
What are the factors that affect the Pain Experience?
A
- Age
- Fatigue
- Genetic sensitivity
- Cognitive function
- Prior experiences
- Anxiety and fear
- Support systems and coping styles
- Culture
23
Q
What are the Age Factors that affect the pain experience?
A
- Age
- Infants cannot verbalize or understand their pain.
- Older adult clients can have multiple pathologies that cause pain and limit function.
24
Q
What are the Fatigue Factors that affect the pain experience?
A
Fatigue: Can increase sensitivity to pain.
25
What are the **Genetic Factors** that affect the pain experience?
Genetic sensitivity: Can increase or decrease pain tolerance.
26
What are the **Cognitive Factors** that affect the pain experience?
Cognitive function: Clients who have cognitive impairment might not be able to report pain or report it accurately.
27
What are the **Prior Factors** that affect the pain experience?
Prior experiences: Can increase or decrease sensitivity depending on whether clients obtained adequate relief.
28
What are the **Anxiety Factors** that affect the pain experience?
Anxiety and fear: Can increase sensitivity to pain.
29
What are the **Support/Coping Factors** that affect the pain experience?
Support systems and coping styles: The presence of these can decrease sensitivity to pain.
30
What are the **Culture** Factors that affect the pain experience?
Culture: Can influence how pain is expressed or the meaning they give to pain.
31
Mnemonic for Pain Assessment (**PQRST**)
**P**recipitating Events
**Q**uality
**R**adiation of pain
**S**everity
**T**iming
32
How does a nurse **assess pain**?
* Pain is whatever a person experiencing it says it is; exists whenever a person says it does
* Client’s report of pain most reliable diagnostic measure
* Self-report using standardized pain scale –useful for clients \> 7 yrs. old (scale examples on next slide)
* Assess and document pain (the fifth vital sign)
33
What should a nurse **expect to find when assessing pain**?
* Behaviors complement self-report and assist in pain assessment of nonverbal clients.
* Facial expressions (grimacing, wrinkled forehead), body movements (restlessness, pacing, guarding)
* Moaning, crying
* Decreased attention span
* Blood pressure, pulse, and respiratory rate increase temporarily with acute pain. Eventually, increases in vital signs will stabilize despite the persistence of pain. Therefore, physiologic indicators might not be an accurate measure of pain over time.
* Clients might experience hyperalgesia (a heightened sense of pain).
* Allodynia is a condition in which the client experiences pain following experiences that are not usually painful (when wearing clothes or feeling the wind blow).
34
What are **nonpharmacological** pain management strategies?
* Cognitive-behavioral measures:
* Cutaneous (skin) stimulation
* Distraction
* Relaxation
* Imagery
* Acupuncture and acupressure
* Reduction of pain stimuli in the environment
* Elevation of edematous extremities
35
What are **Cognitive-behavioral measures**?
Cognitive-behavioral measures: changing the way a client perceives pain, and physical approaches to improve comfort
36
What is **Cutaneous (skin) stimulation**?
Cutaneous (skin) stimulation: transcutaneous electrical nerve stimulation (TENS), heat, cold, therapeutic touch, and massage.
* Interruption of pain pathways
* Cold for inflammation
* Heat to increase blood flow and to reduce stiffness
37
What is a **Distraction** in pain management?
* Includes ambulation, deep breathing, visitors, television, games, prayer, and music
* Decreased attention to the presence of pain can decrease
38
What is **Relaxation** in pain management?
Relaxation: Includes meditation, yoga, progressive muscle relaxation; biofeedback
39
What is **Imagery**?
* Focusing on a pleasant thought to divert focus
* Requires an ability to concentrate
40
What are **Acupuncture and Acupressure**?
Acupuncture and acupressure: Stimulating subcutaneous tissues at specific points using needles (acupuncture) or the digits (acupressure)
41
What are Pharmacological Pain Interventions?
* Analgesics are the mainstay for relieving pain.
* The three classes of analgesics are non-opioids, opioids, and adjuvants.
42
What are **non-opioid analgesics**?
* Non-opioid analgesics (acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs], including salicylates) are appropriate for treating mild to moderate pain.
* Be aware of the hepatotoxic effects of acetaminophen. Clients who have a healthy liver should take no more than 4 g/day. Make sure clients are aware of opioids that contain acetaminophen (hydrocodone bitartrate 5 mg/acetaminophen 500 mg).
* Monitor for salicylism(tinnitus, vertigo, decreased hearing acuity).
* Prevent gastric upset by administering the medication with food or antacids.
* Monitor for bleeding with long-term NSAID use.
43
What are **opioid analgesics**?
Opioid analgesics (morphine sulfate, fentanyl, and codeine) are appropriate for treating moderate to severe pain (postoperative pain, myocardial infarction pain, cancer pain).
44
What are the potential **adverse effects of opioids**?
* Sedation
* Respiratory Depression
* Orthostatic hypotension
* Urinary retention
* Nausea/vomiting
* Constipation
45
What is **Sedation** in regards to opioid analgesics?
Sedation: Monitor level of consciousness and take safety precautions. Sedation usually precedes respiratory depression.
46
What is **Respiratory Depression** in regards to opioid analgesics?
Respiratory depression: Monitor respiratory rate prior to and following administration of opioids (especially for clients who have little previous exposure to opioid medications).
* Initial treatment generally a reduction in opioid dose.
* If necessary, slowly administer diluted naloxone to reverse opioid effects until the client can deep breathe with a respiratory rate of at least 8/min.
47
What is **Orthostatic hypotension** in regards to opioid analgesics?
Orthostatic hypotension: Advise clients to sit or lie down if lightheadedness or dizziness occurs. Instruct clients to avoid sudden changes in position by slowly moving from a lying to a sitting or standing position. Provide assistance with ambulation.
48
What is **Urinary retention** in regards to opioid analgesics?
Urinary retention: Monitor I&O, assess for distention, administer bethanechol, and catheterize.
49
What is Nausea/vomiting in regards to opioid analgesics?
Nausea/vomiting: Administer antiemetics, advise clients to lie still and move slowly, and eliminate odors.
50
What is **Constipation** in regards to opioid analgesics?
Constipation: Use a preventative approach (monitoring of bowel movements, fluids, fiber intake, exercise, stool softeners, stimulant laxatives, enemas).
51
What is the purpose of **Adjuvant analgesics or co-analgesics**?
**Adjuvant analgesics, or co-analgesics**–enhance non-opioid effects; help alleviate other aggravating manifestations (depression, seizures, inflammation), and are useful for treating neuropathic pain.
52
What **Anticonvulsants** are used in pain management?
* carbamazepine
* gabapentin
53
What **Antianxiety agents** are used in pain management?
* diazepam
* lorazepam
54
What **tricyclic antidepressants** are used in pain management?
* amitriptyline
* nortriptyline
55
What **Anesthetics** are used in pain management?
* infusional lidocaine
56
What **Antihistamines** are used in pain management?
* Hydroxyzine Glucocorticoids
* Dexamethasone
57
What **Antiemetics** are used in pain management?
* Ondansetron
58
What are Bisphosphonates and calcitonin used for in pain management?
* for bone pain
59
What does PCA stand for?
Patient-controlled analgesia (PCA): medication delivery system that allows clients to self-administer safe doses of opioids.
* Morphine, hydromorphone, and fentanyl are typical opioids for PCA delivery.
* To prevent inadvertent overdosing, the client is the only person who should push the PCA button.
60
What are the stages of the human Sleep Cycle?
* Stage 1 NREM
* Stage 2 NREM
* Stage 3 NREM
* REM
61
What does **Stage 1 NREM** consist of?
* Very light sleep
* Only a few minutes long
* Muscle relaxation
* Loss of awareness of surroundings
* Vital signs and metabolism beginning to decrease
* Awakens easily
* Feels relaxed and drowsy
62
What does **Stage 2 NREM** consist of?
* Deeper sleep
* 10 to 20 min long
* Vital signs and metabolism continuing to slow
* Requires slightly more stimulation to awaken
* Increased relaxation
63
What does **Stage 3 NREM** consist of?
* Slow-wave sleep or delta sleep
* Vital signs decreasing
* More difficult to awaken
* Psychological rest and restoration
* Reduced sympathetic activity
64
What does **REM** consist of?
* Vivid dreaming
* About 90 min after falling asleep, recurring every 90 min
* Longer with each sleep cycle
* The average length of 20 min
* Varying vital signs
* Very difficult to awaken
* Cognitive restoration
65
What is the **average sleep duration** for a human?
* newborns at least 16 hr../day
* infants and toddlers 9-15 hr/day
* Adolescents 9-10 hr/day
* Adults 7-8 hr/day
66
What are common **sleep disorders?**
* Insominia
* Sleep Apnea
* Narcolepsy
* Hypersomnolence Disorder
67
What is **Insomnia**?
* Most common sleep disorder
* Inability to get an adequate amount of sleep and to feel rested.
* Includes difficulty falling asleep, difficulty staying asleep, awakening too early, or not getting refreshing sleep.
* Acute insomnia lasts a few days possibly due to personal or situational stressors.
* Chronic insomnia lasts a month or more.
* Some people have intermittent insomnia, sleeping well for a few days and then having insomnia for a few days.
* Women and older adults are more prone to insomnia.
68
What is **sleep apnea**?
* More than five breathing cessations lasting longer than 10 seconds per hour during sleep, resulting in decreased arterial oxygen saturation levels.
* Sleep apnea can be a single disorder or a mixture of the following.
* Central: Central Nervous System dysfunction in the respiratory control center of the brain that fails to trigger breathing during sleep.
* Obstructive: Structures in the mouth and throat relax during sleep and occlude the upper airway.
69
What is **Narcolepsy**?
* Sudden attacks of sleep that are often uncontrollable
* Often happens at inappropriate times and increases the risk for injury
70
What is **Hypersommnolence Disorder**?
* Excessive daytime sleepiness lasting at least 3 months
* Impairs social and vocational activities
* Increased risk for accident or injury related to sleepiness
71
What **factors interfere** with Sleep?
* Physiologic disorders: Can require more sleep or disrupt sleep (sleep apnea, nocturia)
* Current life events: Traveling more, change in work hours
* Emotional stress or mental illness: Anxiety, fear, grief
* Diet: Caffeine consumption, heavy meals before bedtime
* Exercise: Promotes sleep if at least 2 hr. before bedtime, otherwise can disrupt sleep
* Fatigue: Exhausting or stressful work makes falling asleep difficult.
* Sleep environment: Too light, the wrong temperature, or too noisy (children, pets, loud noise, snoring partner)
* Medications: Some can induce sleep but interfere with restorative sleep. Others (bronchodilators, antihypertensives) cause insomnia.
* Substance use: Nicotine and caffeine are stimulants. Caffeine and alcohol tend to cause night awakenings.
72
**alternative therapies**
Alternative therapies are treatment approaches that become the primary treatment and replaceallopathic medical care.
73
What are Complementary Therapies?
Complementary therapies are treatment approaches used in addition to or to enhance conventional medical care.
74
What are **whole medical systems**?
Whole medical systems: Complete medical systems outside of allopathic medicinal beliefs (traditional Chinese medicine, Ayurveda, homeopathy)
75
What are **Biological and botanical therapies**?
Biological and botanical therapies: Involve the use of natural products to affect health (diets, vitamins, minerals, herbal preparations, probiotics)
76
**body-based and manipulative methods**
Body-based and manipulative methods: Involve external touch to affect body systems (massage, touch, chiropractic therapy, acupressure)
77
Mind-body Therapies
Mind-body therapies: Connect the physiological function to the mind and emotions (acupuncture, breath work, biofeedback, art therapy, meditation, guided imagery, yoga, psychotherapy, tai chi)
78
Energy Therapies
Energy therapies: Involve use of the body’s energy fields (reiki, therapeutic touch, magnet therapy)
79
Movement Therapies
Movement therapies: Use exercise or activity to promote physical and emotional well-being (Pilates, dance therapy)
80
CAM Practitioners
CAM Practitioners: Specialized licensed or certified practitioners can provide complementary or alternative therapies.
81
Acupuncture/Acupressure
Acupuncture/acupressure: Needles or digital pressure along meridians alter body function or produce analgesia
82
Homeopathic Medicine
Homeopathic medicine: Administering doses of substances (remedies), that would produce manifestations of the disease state in a well person, to ill clients to bring about healing
83
Naturopathic Medicine
Naturopathic medicine: Diet, exercise, environment, and herbal remedies promote natural healing
84
Chiropractic medicine
Chiropractic medicine: Spinal manipulation for healing
85
Massage therapy
Massage therapy: Stretching and loosening muscles and connective tissue for relaxation and circulation
86
Biofeedback
Biofeedback: Using technology to increase awareness of various neurologic body responses to minimize extremes
87
Therapeutic touch
Therapeutic touch: Using hands to help bring energy fields into balance
88
Natural Products and Herbal Remedies
(The FDA does not regulate the most of these products)
* Aloe: Wound healing
* Chamomile: Anti-inflammatory, calming
* Echinacea: Enhances immunity
* Garlic: Inhibits platelet aggregation
* Ginger: Antiemetic
* Ginkgo biloba: Improves memory
* Ginseng: Increases physical endurance
* Valerian: Promotes sleep, reduces anxiety
