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NURSING 3 > Pain > Flashcards

Pain Flashcards

(63 cards)

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1
Q

Reasons for acute pain

A

Trauma
surgery
burns

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2
Q

Reasons for chronic pain

A

Cancer

Peripheral

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3
Q

Breakthrough pain

A

Someone who has chronic pain, but they have an exacerbation of their pain

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4
Q

Cancer related pain

A

Acute or chronic
Direct or indirect
Increase pain can indicate progression of their disease

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5
Q

Physiological response to acute pain: endocrine and metabolic response

A

Activation of sympathetic nervous system and an increase in glucagon secretion, which causes hyperglycemia, increased lipolysis (fat breakdown), accelerated protein breakdown, and nitrogen loss.

The stress response presents as hypertension, tachycardia, arrhythmias, myocardial ischemia, protein catabolism, immune system suppression, and impaired renal excretory function.

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6
Q

Physiological response to acute pain: pulmonary function

A

Decreased phrenic nerve activity and diaphragmatic dysfunction manifested as…

  1. decrease in functional residual capacity
    - – the volume remaining in the lungs after a normal, passive exhalation
  2. decrease in tidal volume
    - – amount of air that moves in or out of the lungs with each respiratory cycle
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7
Q

Physiological response to acute pain: cardiovascular

A

Increased sympathetic tone, which causes an increase in heart rate and blood pressure as well as redistribution of blood to and within various organs. The redistribution predisposes patients to myocardial ischemia in the presence of coronary artery disease and may induce arrhythmias.

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8
Q

Physiological response to acute pain: GI motility

A

Decreased gastric motility, especially in the colon. The stomach and small intestines recover within 12–24 hours after abdominal surgery; however, the colon is inhibited for at least 48–72 hours.

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9
Q

Physiological response to acute pain: immune system

A

Decreased responsiveness to antigens, delayed hypersensitivity, natural killer cell activity, and antibody response.

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10
Q

Nociceptive pain

A

Normal functioning of physiologic system that leads to the perception of noxious stimuli as being painful

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11
Q

Nociceptive pain: transduction

A

Noxious stimuli activate primary afferent neurons

Located throughout the body – skin, subcutaneous tissue, visceral organ, somatic

Prostaglandins initiate inflammatory response that increase tissue swelling and pain at the site of injury

NSAIDs – block the formation of prostaglandins in the periphery

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12
Q

Nociceptive pain: transmission

A

Transduction that is transmitted along the A-delta and C fibers

– A-delta – largest and respond to touch, movement, vibration – rapid withdrawal from pain

– C fibers – slow impulse and respond to mechanical, thermal and chemical stimuli

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13
Q

Nociceptive pain: perception

A

Requires activation of higher brain structures for the occurrence of awareness, emotions and drives associated with pain

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14
Q

Nociceptive pain: modulation

A

Information generated in response to noxious stimuli

Different neurochemicals

Body alters a pain signal

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15
Q

Nociceptive pain: somatic

A

Bone, joint, muscles, skin, or CT

– achy, throbbing

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16
Q

Nociceptive pain: visceral pain

A

arises from visceral organs

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17
Q

Nociceptive pain: treatment

A

Nonopioids, opioids, and local anesthetics

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18
Q

Neuropathic pain

A

Pathologic and results from abnormal processing of sensory input by the nervous system as a results of damage to the peripheral or CNS

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19
Q

Neuroplasticity

A

hyperexcitable nerve endings that are damaged and reorganize

– type of neuropathic pain

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20
Q

Allodynia

A

pain from a normally nonnoxious stimulus

– type of neuropathic pain

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21
Q

neuropathic pain – examples

A

phantom paon
post stroke pain
spinal cord injury

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22
Q

What are examples of polyneuropathies?

A

Diabetic neuropathy
Postherpetic neuralgia
Guillain-Barre pain

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23
Q

Neuropathic pain treatment

A

Adjuvant analgesic agents – antidepressants, anticonvulsants, local anesthetics

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24
Q

Factors that influence pain

A 
Past experience 
Anxiety and depression
Culture 
Age
Gender
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25
Pain assessment
COLDSPA | Character, onset, location, duration, severity, pattern, associated factors
26
What are examples of different pain scales?
``` Numeric rating Wong-Baker FACES Faces pain scale - revised Verbal discriptor scale Visual analog scale ```
27
What are examples of pain scales
FLACC PAINAD CPOT
28
Pain reassessment: what is pain reassessed in the PACU and when is pain reassessed if it is stable?
PACU - q 10 minutes | Stable pain - 4-8 hours
29
Pharmacologic management of pain: Multimodal Analgesia
Combine drugs with different mechanisms to lower each dose and reduce side effects and create greater pain relief
30
Multimodal pain: oral route
1st choice
31
Multimodal analgesia: IV route
post-operative | - PCA is an example
32
Multimodal analgesia: rectal route
palliative
33
Multimodal pain: transdermal route
long lasting | -- requires absorption into the systemic circulation to achieve effects
34
Multimodal pain: topical route
effets in the tissues immidiately under the site of application
35
She is going to test on what pain scale we think is being used in questions
go look up
36
Intraspinal analgesia (neuraxial)
look up
37
Peripheral nerve block
go look
38
Go look up/ read about the Critical Care Pain Observation Tool
book and slides
39
What are dosing regimens nurses may follow when treating pain
Around the clock, PRN, or PCA
40
Nonopioid analgesic agents: Acetaminophen - route
Oral, rectal, IV | -- there is a max dose per day
41
nonopioid analgesic agents: NSAIDS sfx
More side effects than acetaminophen GI issues An increase in bleeding
42
Opioid analgesics: what to consider?
Age, pain intensity, coexisting diseases, current drug regimen, prior treatment outcomes, patient preference.
43
Opioid analgesics: Mu agonist
Morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and methadone
44
Opioid analgesics: Mu agonist - monitor
CNS depression
45
Opioid analgesics: Mu agonist -- antidote
Naloxone (narcan)
46
Complications with opioids: addiction
Chronic, relapsing, treatable neurological disease Genetic, psychosocial and environmental factors
47
Complications of opioids: Physical dependence
Normal response if taking opioids for 2 or more weeks Withdrawal symptoms may be suppressed by natural reduction of opioids - tapering
48
Complications with opioids: tolerance
Normal response that occurs with regular administration of opioid and decrease in effect
49
Complications with opioids: pseudoaddiction
When pain is not well controlled but symptoms suggest addiction
50
What are the several complications of opioids?
``` addiction physical dependence tolerance pseudoaddiction CNS depression n/v Puritus Urinary retention endocrine deficiencies ```
51
Lidocaine patch administration
on for 12 hours, off the 12 hours
52
Oxycodone, hydrocodone, oxymorphone administration considerations
must be taken on an empty stomach
53
Methadone - what is it
Long acting (over 20 hours) - used for those with addiction
54
PCA adminstration considerations
Need 2 nurses to sign of | -- no LPN
55
Tramadol: dual mechanism
mu opioid and block reuptake neurotransmitters pathway – allows them more available to fight pain
56
Tramadol: complications
– lowers seizure threshold, SSRIs – risk for serotonin syndrome – agitation, diarrhea, heart and BP changes, loss of coordination
57
Facts about fentanyl
Given in mcg Best for a hemodynamically unstable pt. Does not have the same effect on BP
58
Local anesthetic: example and sfx
Lidocaine patch circumoral tingling and numbness bradycardia Cardiac dysrhythmias CV collapse
59
Adjuvant Analgesic agents: anticonvulsants -- exampels and sfx
Gabapentin and Prebalin sedation and dizziness
60
Adjuvant Analgesic agents: antidepressants examples and sfx
Nortriptyline & duloxetine, Venlafaxine dry mouth, sedation, dizziness, weight gain, impaired memory, seating, tremors
61
Adjuvant Analgesic Agents: Ketamine | - what does it do and what are sfx
Prevents transmission of pain to the brain Hallucinations, dreamlike feelings
62
Gerontological considerations for medications:
CNS effects GI toxicity (NSAIDS) Falls/injury
63
What are examples of nonpharmacological methods of pain managements?
Physical modalities Cognitive and behavioral methods Biologically based therapies (herbs, vitamins, proteins) Energy therapies (yoga, tai chi, reiki)

NURSING 3 (16 decks)

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