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NURS200 > Pain > Flashcards

Pain Flashcards

(52 cards)

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1
Q

Spiritual needs of pt in pain

A

Consideration that ots may be experiencing spiritual distress in ADDITION to pain (punishment belief)

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2
Q

FICA

A

F: Faith or Beliefs
I: Importance and influence
C: Community
A: Address the issue.

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3
Q

HOPE

A

H: Sources of hope, meaning, comfort, strength, peace, love and connection
O: Organized religion
P: Personal spirituality/practices
E: Effects on medical care and end-of-life issues

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4
Q

Questions relevant to spiritual care

A

Know when to refer to spiritual care.
Pg. 144 O’Brien text: “Has your illness affected your faith/belief system?
Do you pray?
What do you think the power of prayer means?
Is God or other power important to you?
How can I assist you in maintaining spiritual strength?
Are their religious rituals that are important to you now

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5
Q

Spiritual Care Matrix

A

Broad generalist spiritual care
- Atends to and accompanies a pt through presenting events or circumstances

Compassionate presence

Narrow generalist
-Responding to pt reuest

Do not offere spiritual or religious counsel

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6
Q

A ___________ of pain is considered the “gold standard” and as such is the single most reliable indicator of the existence and intensity of pain

A

patient’s self report

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7
Q

Nociceptive pain

A

Results from injury to tissues
Called somatic or visceral pain
Can respond well to opioids depending on tissue type (most tissues and organs)
Can respond well to NSAIDS or Tylenol (bone pain) or steroids if inflammation is a key player in the pain

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7
Q

Neuropathic pain

A

Results from injury to peripheral nerves
Responds poorly to opioids

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7
Q

Clinical apprpach to pain mangement ABCDE

A

Ask and assesss
Believe
Choose
Deliver
Empower and enable

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8
Q

Non-pharm techniques for pt management

A

Heat
Cold
Massage
Acupuncture
Art
Music
Distraction (Children)
Transcutaneous electrical nerve stimulation
Exercise

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9
Q

Cognitive techniques for pain managment

A

Distraction and Imagery
Hypnosis
Relaxation strategies (music, breathing, meditation, art)
Self management- conducted in groups with a focus on increasing daily pain management skills and decrease the negative consequence of social isolation.

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10
Q

Opioid analgesics

A

Opioids are narcotic substances that can produce numbness and stupor-like symptoms.

They are the drugs of choice for moderate to severe pain that cannot be controlled with other analgesics.

  • Mod-severe pain
  • Suppress cough and GI motility
  • CNS depressants
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11
Q

Moderate pain opioids

A

Codeine
Tramadol/ Tramacet

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12
Q

Moderate-severe pain opioids

A

Hydromorphone
Morphine
Fentanyl
Methadone HCl (Dolophine): requires special prescribers with a license (will discuss more in a later class

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13
Q

Opioid receptors

A

specific cell surface receptors within the central and peripheral nervous system, which combine with naturally occurring opioid compounds (e.g. endorphins) to reduce pain and increase euphoria

Mu (1 and 2)
Kappa
Delta

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14
Q

Mu types one and two

A

Opioid receptors

Brain, spinal chord, peripheral nervous system, intestinal tract
produces analgesia, respiratory depression, euphoria, sedation, reduced GI motility

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15
Q

Kappa receptors

A

Opioid receptors
Brain, spinal chord, peripheral nervous system
produces analgesia, and sedation

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16
Q

Delta receptors

A

Opioid receptors

Located in the brain and peripheral nervous system
Analgesia, antidepressant effects

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17
Q

Morphine

A

Mechanism of action: binds to both Mu and Kappa receptors to produce profound analgesia

Used for relief of moderate and severe pain

Decreases the sensation AND emotional reaction to pain

  • Resp depression
  • Constipation
  • Urinary retention
  • Cough suppression
  • Nausea/vomiting
  • Dependence
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18
Q

Do opioids have similar effects

A

yes

Resp depression
- Constipation
- Urinary retention
- Cough suppression
- Nausea/vomiting
- Dependence

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19
Q

Why is fentanyl so dangerous

Study These Flashcards
A

It is odourless and tasteless. You may not even know you are taking it.

It can be mixed with other drugs such as heroin and cocaine. It is also being found in counterfeit pills that are made to look like prescription opioids.

20-40x more potent than heroin and 100x more potent than morphine

20
Q

Opioid agonist - Codeine

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A

Codeine, is an opioid that naturally occurs in the opium poppy.

Found in cough syrups, tyloneol T1, T2, T3, T4

Once codeine enters your system, the body breaks it down and converts it into morphine. Codeine is classified as a depressant, which means it slows down your nervous system, including your breathing rate.

Normally taken PO, but can be injected or snorted

21
Q

Opioid agonsist Oxycodone and (Percocet)

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A

Oxycodone

a semi-syntheticopioidused medically for treatment of moderate to severepain
.highly addictive and a commonlyabused drug.

Oxycodone/paracetamol (Percocet),
acombination of the opioidoxycodonewithparacetamol(acetaminophen),used to treat moderate to severepain.

22
Q

Hydromorphone

Study These Flashcards
A

Indications
Moderate-to-severe pain (alone and in combination with nonopioid analgesics); extended-release product for opioid-tolerant patients requiring around-the-clock management of persistent pain. Antitussive (lower doses).

Action
Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Suppresses the cough reflex via a direct central action.

23
Tramadol
An opioid effective for both general and nerve related pain It can cause dependence and use may be limited by side effects such as nausea and sedation. Prescribed for Back Pain, Chronic Pain, Anxiety, Depression, Pain, Fibromyalgia, Obsessive Compulsive Disorder, Restless Legs Syndrome.
24
Toradol
NSAID (Cox1 and 2 inhibitors) (kertolac) is a very strong NSAID that should only be considered for the short-term relief of acute, moderately severe pain that occurs following surgery. It carries a high risk of severe gastrointestinal side effects and can increase bleeding. Treatment with Toradol should not exceed five days.
25
Opiod agonist methadone
a long-acting synthetic opioid medication that is used to reduce withdrawal symptoms in people addicted to heroin or other narcotic drugs, and it can also used as a pain reliever. It reduces withdrawal symptoms and drug cravings without causing the "high" associated with the drug addiction. Highly regulated med, must be watched during administration
26
Gabapentin
a medicine used to treat neuropathic pain (nerve pain). It works in different ways to stop seizures (epilepsy) and to block pain messages reaching the brain. may make cause feel dizziness, sleepiness, or decreased alertness. CAUTION - Gabapentin should be used with caution in patients with kidney disease
27
Medications for nerve pain
triculic antidepressants Seritonin-norepinepthrine inhibitors
28
Opioid adminsteration key principals
Start low Go slow By mouth (Safest, least invasive) By the clock (Regualr/fixed admin) Plan for adverse effects (Anticipate, monitor and manage : START laxative proactively) Plan for breakthrough pain
29
Why do we titrate doses gradually
to manage side effects
30
Why do we start opiods by mouth
Safest, least invasive
31
What does planning for breakthrough pain look like
use immediate release with breakthrough doses (BTD) until dose is stabilized to enable timely and effective titration.
32
What does managing by the clock imply
- Regular/fixed administration schedule, such as every 4 or 6 hours, rather than only “on demand”, including waking from sleep for a scheduled dose. Once pain control achieved, switch to long acting agents to improve compliance and sleep.
33
Key principles for opioid admin
Start with regular short-acting opioids and titrate to effective dose over a few days before switching to slow-release opioids. * Once pain control is achieved, long-acting (q12h oral or q3days transdermal) agents are preferred to regular short-acting oral preparations for better compliance and sleep.
34
Titration
Use practice tools to monitor pain rating, adverse effects, and track patient goal attainment. A suitable numerical or descriptive pain rating scale should be used consistently. Follow sedation levels using a tool such as the Pasero Opioid-Induced Sedation Scale, especially during titration of opioid doses. Adjustment may require a dose adjustment of both the regular dose as well as the BTD.
35
It is common to combine an opioid with an analgesic for pain relief because it requires a ______of the narcotic (opioid).
smaller dose
35
POSS
Pasero Opioid induced sedation Scale
36
Tolerance
(a physical, not a psychosocial, response to a drug) Increases doses to obtain same response Cross-tolerance to other opioid agonists Not the same as addiction!!!
37
Addiction
the continued use of a substance despite its negative health and social consequences (1) a ‘high’, and (2) the addicted person’s life is NOT improved by continuing the addiction!
38
Physical dependence
physically dependent clients attempt to discontinue the drug, they experience highly uncomfortable symptoms that make them want to continue use. Methadone, buprenorphine, or Suboxone maintenance
39
Psychological Dependence
Addiction is a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief (euphoria and psychological escape from life): getting ‘high’ is the goal/drive the addicted person’s family and/or social life is spiraling downwards as a result of this behavior There is detrimental effects to key relationships in the addicted person’s life
40
Addiction is NOT a typical concern with opioid use in patients with persistent pain T or F
True
41
OD Signs
Resp depression, coma, pinpoint pupils
42
Opioid OD tx
Ventilatory support Opioid antagonist -- naloxone (NARCAN)
43
Naloxone- Narcan Naloxone - Canada.ca
Naloxone is a fast-acting drug used to temporarily reverse the effects of opioid overdoses. It is a competitive opioid antagonist. It can restore breathing within 2 to 5 minutes. Naloxone only works if you have opioids in your system. Naloxone only works temporarily - Effects of opioids are likely to outlast nalaxone, so another dose will be necessary
44
Non-opioid Analgesics
Acetaminophen (LFTs) Non-steroidal inflammatory drugs (NSAIDS) - GI dysfunction, kidney funciton Ibuprofen Acetylsalicylic Acid Naproxen
45
How to use of non-opioids
Weigh risks versus benefits Start low to determin pt rxn
46
Adjuvant Analgesics: Indications
Often given with opioid analgesic agents to assist the primary agents with pain relief NSAIDs (non-steroidal anti-inflammatories) – ie Ibuprofen Antidepressants (TCAs, SSRIs) – ie Amitryptiline Anticonvulsants (neuropathic pain) – ie Gabapentin Corticosteroids (inflammatory pain)
47
Optimizing Adjuvant Medications for Analgesia: KEY Principles
The adjuvant analgesic with the greatest benefit and least risk should be administered as first-line treatment. Often this is an anticonvulsant such as gabapentin, or an antidepressant such as nortriptyline for treatment of cancer-related neuropathic pain. Consider combination therapy with two or more drugs in the event of partial response to single drug therapy.
48
NSAIDs should be used cautiously in patients with a hx of _________ and always taken with food/ milk
GI Bleeds
49
Migraine tx
Begin w/ Acetaminphoen or NSaids If unsuccessful, drug of choice is triptans (Constrict intercranial vessels) Sumatriptan (constrict vessels, can cause coronary vasospasm)

NURS200 (30 decks)

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