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Funds II Theory > Module 4: Comfort and Pain Management & Rest and Sleep > Flashcards

Module 4: Comfort and Pain Management & Rest and Sleep Flashcards

1
Q

Acute Pain

A

short term
less than 3 months

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2
Q

Chronic Pain

A

long term
more than 3 months

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3
Q

Effects of Chronic Pain on Patient

A

normal or decreased vital signs
depression is a major concern
anxiety, irritability, suicide

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4
Q

Patient responses to acute pain

A

increased vital signs
severe can cause reflex action to escape the cause
anxiety
pain is not all-consuming

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5
Q

Patient responses to chronic pain

A

normal or decreased vital signs
tends to consume entire person (demands total attention)
physically and emotionally exhausting
ongoing irritability, fear, isolation, anger, fatigue, helplessness, stress/anxiety, DEPRESSION

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6
Q

Somatic pain

A

pain perceived by muscles, joints, tendons/ligaments, bones

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7
Q

Visceral pain

A

pain perceived by internal organs

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8
Q

Cutaneous pain

A

pain perceived by skin
burn, incision, tear, bruise

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9
Q

Neuropathic pain

A

pain perceived by nerves/nervous system
diabetic neuropathy, phantom pain

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10
Q

Radiating pain

A

pain that travels from one body part to another

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11
Q

Referred pain

A

pain is perceived in an area distant from its point of origin
gallbladder/pancreas pain can refer to back
jaw pain during a MI (mainly females)

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12
Q

Rebound pain

A

pain upon removal of pressure
sign of peritonitis

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13
Q

Phantom pain

A

pain that often occurs with an amputated leg where receptors and nerves are clearly absent

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14
Q

Psychogenic pain

A

cause of pain cannot be identified
associated w/ psychological factors; mental or emotional problems can make pain worse
ex: back pain

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15
Q

Intractable pain

A

when pain is resistant to therapy and persists despite a variety of interventions

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16
Q

When should pain assessments be done/when are they warranted

A

when patient is complaining of pain
during vitals
upon admission
in ED

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17
Q

OPQRST scale

A

onset, provoking factors, quality, region/radiating, severity, time
used for adults when they are able to verbalize

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18
Q

Wong-Baker FACES scale

A

adults and children (>3 years) in all patient care settings

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19
Q

FLACC Scale

A

face, legs, activity, cry, consolability
infants and children (2 mo-7 yrs) who are unable to validate the presence of or quantify severity of pain

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20
Q

Numbers scale

A

adults/children (> 9 years) in all patient care settings who are able to use numbers to rate the intensity of their pain

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21
Q

Common pain responses: cardiovascular

A

increased HR and BP
increased need for oxygen
water retention, potential fluid overload

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22
Q

Common pain responses: respiratory

A

increased RR
shallow breathing
increased risk of infection

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23
Q

Common pain responses: immune

A

increased susceptibility to infection
increased or decreased sensitivity to pain
activation of HPA (hypothalamic, pituitary, adrenal) axis

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24
Q

Common pain responses: endocrine

A

increased BS
increased cortisol production (fight or flight)

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25
Q

Common pain responses: gastrointestinal

A

reduced gastric emptying and intestinal motility
nausea and vomiting
constipation

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26
Q

Common pain responses: urinary

A

urge to urinate/incontinence

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27
Q

Common pain responses: musculoskeletal

A

tense muscles local to injury
shaking or shivering
pilo-erection (goose bumps)

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28
Q

Common pain responses: nervous

A

changes in pain processing
risk of pain becoming chronic

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29
Q

Common pain responses: brain

A

anxiety/fear
depression
poor concentration
inhibition or promotion of pain

30
Q

Complications of pain/harmful effects that can be caused by unrelieved pain

A

decreased quality of life
reduced productivity
worsening of chronic disease
psychiatric disorders (depression, anxiety, substance abuse disorders)
hormonal abnormalities
weaken the immune system
fatigue

31
Q

When are opioids appropriate?

A

moderate to severe pain
preoperative meds
analgesia during anesthesia

32
Q

Side Effects of opioids

A

sedation, decreased RR and other vitals, constipation, pruritis
orthostatic hypotension
neurologic effects (light-headedness, dizziness, anxiety)
urinary retention/hesitancy

33
Q

Nursing interventions to help with opioid side effects

A

constipation: high fiber diet, increased fluid intake, increased physical activity, daily stool softener in addition to regular use of stimulant laxatives
nausea: antiemetic if significantly affected
sedation: reviewing and minimizing polypharmacy in older adults
pruritis: antihistamines
provide oxygen if SPO2 is low

34
Q

Nursing considerations/concerns for opioids

A

allergies
don’t give for pt with diarrhea
don’t give for recent GI/GU surgery or GI problems
oxycodone for pregnancy is okay
respiratory dysfunction
head injuries/CVD
liver/renal dysfunction
lactation/pregnancy
addiction

35
Q

When to reassess pt after opioid administration?

A

IV: 15-30 min
PO: 45-60 min

36
Q

What to do if pain was not relieved upon reassessment?

A

non-pharmacological (distraction, etc)
talk to HCP about different route/type of opioid
administer NSAID

37
Q

antidote/medication used for reversal of opioid

A

narcan/naloxone

38
Q

Physical dependence

A

Phenomenon in which the body physiologically becomes accustomed to an opioid and suffers withdrawal symptoms if the opioid is suddenly removed or the dose is rapidly decreased

39
Q

Psychological dependence

A

The drug is so central to the person’s life that the need to keep using becomes a craving or compulsion, even if the person knows that using is harmful
like addiction

40
Q

Tolerance

A

Occurrence of the body’s becoming accustomed to an opioid and needing a larger dose each time for pain relief

41
Q

When are NSAIDs appropriate?

A

acetaminophen/paracetamol - mild pain/fever
ibuprofen/motrin - mild pain/anti-inflammatory
aspirin - effective anticoagulant effect/mild pain

42
Q

NSAID side effects

A

acetaminophen/paracetamol - risk of hepatotoxicity
ibuprofen/Motrin - GI bleeding/ kidney damage
aspirin - monitor use of other anticoags given along with aspirin/monitor for bleeding

43
Q

Nursing considerations/concerns NSAIDs

A

acetaminophen/paracetamol - max daily dose 3,000 mg/24 hr period / lacks anti-inflammatory effects
ibuprofen/Motrin - max daily dose 3,200 mg/24 hr period / lacks effective antipyretic effects
aspirin - given in 81 mg or 325 mg doses

44
Q

Appropriate nursing diagnoses for pain

A

should include type, etiology, pt’s response
acute pain, chronic pain, labor pain

45
Q

Expected outcomes for pain

A

goals for acute and chronic pain
decrease pain severity

46
Q

Interventions for pain

A

establishing trusting nurse-pt relationship
manipulating factors that affect pain experience
initiating nonpharmacologic pain relief measures
managing pharmacologic interventions
reviewing additional pain control measures
ensuring ethical and legal responsibility to relieve pain
teaching pt about pain

47
Q

What is the purpose of adjuvant meds?

A

enhance the effects of pain meds

48
Q

Examples of adjuvant meds

A

anti-depressants/anti-anxiety
anticonvulsants (gabapentin, pregabalin)
muscle relaxers

49
Q

Non-pharmacological pain relief measures

A

distraction
humor
music
imagery
relaxation
cutaneous stimulation
acupuncture
hypnosis
biofeedback
therapeutic touch
animal-facilitated therapy

50
Q

Nursing interventions to promote sleep

A

Prepare a restful environment
Promote bedtime rituals
Offer appropriate bedtime snacks and beverages
Promote relaxation and comfort
Respect normal sleep-wake patterns
Schedule nursing care to avoid disturbances
Use medications to produce sleep
Patient education to promote sleep

51
Q

Questions to ask patient to assess sleep/rest

A

recent changes in sleep
do you set an alarm and hit snooze before getting up?
usual sleeping and waking times
number of hours of undisturbed sleep
quality of sleep
number and duration of naps
effect of sleep pattern on everyday functioning
energy level (ability to perform ADLs)
sleep aids
bedtime rituals
sleep environment
sleep disturbances and contributing factors

52
Q

Tools/ diagnostic tests used to diagnose sleep problems

A

Polysomnography: records brain waves, oxygen level, heart rate, breathing, eye and leg movements during sleep (aka sleep study)
sleep study: dx narcolepsy, sleep apnea, rls
sleep diary: dx insomnia and circadian rhythm disorders

53
Q

Factors that affect sleep

A

Sleep patterns
Motivation
Culture
Activity level
Smoking
Alcohol (decreases sleep quality)
Stress
Illness
Certain meds
Incontinence
Pain
Nausea
Environmental factors (temp and humidity)

54
Q

REM sleep

A

Eyes dart back and forth quickly
Small muscle twitching, such as on the face
Large muscle immobility, resembling paralysis
Irregular RR; sometimes apnea
Rapid/irregular pulse
BP increases or fluctuates
Increase in gastric secretions
Metabolism increases; body temp increases
Encephalogram tracings active
REM sleep enters from stage II of NREM sleep and reenters NREM sleep at stage II: arousal from sleep is difficult
Constitutes about 20 to 25% of sleep

55
Q

Stage 1 NREM

A

Transitional stage between wakefulness and sleep
Relaxed state but still somewhat aware of surroundings
Involuntary muscle jerking may occur
Stage normally only lasts minutes
Person can be aroused easily
Constitutes only about 5% of total sleep

56
Q

Stage 2 NREM

A

falls into a stage of sleep
person can be aroused with relative ease
constitutes 50 to 55% of sleep

57
Q

Stage 3 NREM

A

the depth of sleep increases, and arousal becomes increasingly difficult
composes about 10% of sleep

58
Q

Stage 4 NREM

A

Greatest depth of sleep (delta sleep)
Arousal is difficult
Slow brain waves, slower HR and RR, lower BP, muscles relaxed, slow metabolism, low body temp, constitutes about 10% of sleep

59
Q

When do Alpha waves appear during sleep?

A

Early portion of stage 1 NREM
relaxed/sleepy
Low frequency, high amplitude waves

60
Q

When do Beta waves appear during sleep?

A

REM sleep and waking
awake

61
Q

When do Delta waves appear during sleep?

A

stage 3/4 NREM (deep) sleep

62
Q

When do Theta waves appear during sleep?

A

during stage 1/2 NREM (light) sleep

63
Q

Patient education regarding sleep hygiene

A

Restricting intake of caffeine, nicotine, and alcohol, especially later in the day
Avoiding mental and physical activities after 5 pm that are stimulating
Avoiding daytime naps
Eating a light carb/protein snack before bedtime
Avoiding high fluid intake in evening so as to minimize trips to the bathroom at night
Sleep in a cool, dark room
Eliminating use of a bedroom clock
Taking a warm bath before bed
Trying to keep sleep environment as quiet and stress-free as possible

64
Q

Hypersomnia

A

Condition characterized by excessive sleeping, especially daytime sleeping
When awake are often disoriented, irritated, restless, slower speech and thinking processes
MVA risk due to drowsiness or falling asleep while driving

65
Q

Insomnia

A

Difficulty in falling asleep, intermittent sleep, or early awakening from sleep
Feeling tired, lethargic, irritable, difficulty concentrating, delirium

66
Q

Obstructive sleep apnea

A

Potentially serious sleep disorder in which the throat muscles intermittently relax and block airway during sleep, causing breathing to repeatedly stop and start
Sleepiness, fatigue, insomnia, snoring, observed apnea, irritability, fall asleep during boring activities, difficulty concentrating, slower reaction times
Risk of hypoxia

67
Q

Narcolepsy

A

Condition characterized by an uncontrolled desire to sleep
Hallucinations, sleep paralysis, cataplexy (loss of skeletal muscle tone lasting from seconds to 1 to 2 minutes)
Can fall asleep quickly and during any activity

68
Q

Parasomnias

A

Patterns of waking behavior that appear during sleep (sleepwalking, sleep talking, nocturnal erections)
Risk for injury

69
Q

Somnabulism

A

sleepwalking
risk for injury/falls

70
Q

Restless leg syndrome

A

A condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs
Irresistible urge to move legs when sensations occur

71
Q

Sleep deprivation

A

A decrease in the amount, consistency, and quality of sleep; results from decreased REM or NREM sleep

Loss of concentration, inattention, irritability

72
Q

What are effects of insufficient sleep?

A

obesity = increased appetite and decreased metabolism
anxiety
risk for: DM, HTN, stroke, substance abuse, depression, GI issues
decreased alertness and response time (impaired driving)
fatigue/sleepiness
decreased immunity = increased risk of infections

Funds II Theory (7 decks)

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