Pain Management Flashcards by Madison Gibbons

Physiological effects of pain

Hyperglycemia
Increased cardiac workload
Immune dysfunction
Altered coagulation
Illeus
Urinary retention
Decreased lung volume
Fatigue
Debility — physical weakness
CHANGE IN VITALS AND CHARACTERISTICS
SNS

How well did you know this?

Not at all

Perfectly

Psychological effects of pain

Social isolation
Disability/job loss
Poor QOL
Anxiety
**Depression
Demoralization
Suicide

How well did you know this?

Not at all

Perfectly

How many Americans are effected by chronic pain

100 million experience chronic pain
25 million are limited ADLs
COSTS: 560-630 billion

How well did you know this?

Not at all

Perfectly

What makes pain chronic

Lasts 3-6 months

How well did you know this?

Not at all

Perfectly

What are the four processes of pain

Transduction, transmission, perception, modulation

How well did you know this?

Not at all

Perfectly

What is transduction

Convert noxious stimuli to electrical impulse (brains response)
Mechanical/thermal/chemical response
Nociceptors —> dorsal horn (spinal cord)

How well did you know this?

Not at all

Perfectly

What stimulates nociceptors

Histamine
Lactic acid
Bradykinin
Prostaglandins
Substance P
Serotonin
HELP CREATE NOCICEPTORS

How well did you know this?

Not at all

Perfectly

What is the transmission of pain

A delta - transmitters of pain, FAST conducting, transmits acute localized pain
C fibers - defused or generalized pain

THE REFLEX ARC

How well did you know this?

Not at all

Perfectly

What is the perception of pain, threshold and adaptation

Interpretation of stimuli
Threshold= lowest intensity of stimulus that causes recognition of pain
Adaptation- result of chronic pain

How well did you know this?

Not at all

Perfectly

What can effect a persons perception of pain

PEDS= how their parent reacts
Culture= can appear more stoic
Experience= develop a new threshold

How well did you know this?

Not at all

Perfectly

What is modulation of pain and the neuromodulators related to it

Regulation or inhibition of sensation

Effected by neuromodulators
-endorphins= pain blocking chemicals, prolongs analgesia
Enkephalins= reduces the sensation of pain, inhibits substance P

How well did you know this?

Not at all

Perfectly

What are the two durations of pain

Acute
Chronic
- malignant/non malignant

How well did you know this?

Not at all

Perfectly

What are the 3 sources of pain

Cutaneous
Somatic
Visceral

How well did you know this?

Not at all

Perfectly

What is the mode of transmission of pain

Referred

How well did you know this?

Not at all

Perfectly

What are the three etiology’s of pain

Nociceptive — most common physical damage
Neuropathic — nerve damage
Psychogenic — mental

How well did you know this?

Not at all

Perfectly

How long does acute pain last

No longer than a week

Clear cause and normally corrected

How well did you know this?

Not at all

Perfectly

What is cutaneous pain and give an example

Superficial — paper cut

How well did you know this?

Not at all

Perfectly

What is somatic pain and example

Diffused or scattered pain, musculoskeletal, with generalized area pain

Sprained ankle

How well did you know this?

Not at all

Perfectly

What is visceral pain and give an example

Caused by internal organs, stretching/spasm pain, generalized pain area, REFERRED PAIN

appendicitis

How well did you know this?

Not at all

Perfectly

What is the danger with neuropathy

Risk for unknown injury or severity

How well did you know this?

Not at all

Perfectly

What does neuropathic pain feel like

Burning, electric, tingling, stabbing

How well did you know this?

Not at all

Perfectly

How is psychogenic pain treated

Least to most invasive

How well did you know this?

Not at all

Perfectly

How is psychogenic pain treated

Study These Flashcards

Least to most invasive

What is allodynia

Study These Flashcards

Pain after non painful stimuli

What is intractable pain

Untreatable with interventions and therapy -try distractive techniques or alternative therapy, communication with providers is KEY

Things to know about newborn/infant pain

Lack of pain perception, usually given sugar water for treatment

Things to know about toddler pain

Pain can not be identified -is there but hard to assess

How to ask someone about their pain

Describe Rate What makes it worse/better Location Duration

Describe the verbal rating scale for pain

Used for adults and adolescents -after ask for the pain to be described

Describe the Wong-Baker pain scale

Faces, used for toddlers and children -note: some kids will pick the face they LIKE best

Describe the adult non verbal pain scale NVPS

Based on facial expressions, activity, guarding, vital signs, presentation (eyes, sweating, flushed)

Describe the CRIES observer pain scale

Used for peds C: crying R: requires oxygen I: increased vitals E: expression S: sleeplessness

Describe the FLACC scale

Used in peds F: face L: legs A: activity C: cry C: consilability

What are some drug seeking behaviors

Changing story, changed pain location, demanding specific med/dose/administration

SNS response to moderate pain

HTN Tachycardia/pnea Pallor Increase blood sugar Muscle tension

PNS response to severe pain

N/V Fainting Hypotension Bradycardia Rapid/irregular breathing

Behavioral signs of pain

Grimacing Moaning Restlessness Guarding Moving away Crying

Behavioral signs of pain

Grimacing Moaning Restlessness Guarding Moving away Crying

Affective signs of pain

Withdrawal Stoicism Anxiety/depression Fear/anger Anorexia Fatigue Hopelessness

What are adjuvant analgesics

Will buffer neuro response and causes synergy effect when used with pain reliever

Examples of adjuvant analgesics

Tricyclic antidepressants Antihistamines Caffeine Muscle relaxant Anticonvulsant Antiemetic

Examples of adjuvant analgesics

Tricyclic antidepressants Antihistamines Caffeine Muscle relaxant Anticonvulsant Antiemetic

Dosage of hydromorphone compared to morphine

7-10 times stronger, so smaller dose is needed

Types of administration for PCAs

IV Nerve block Epidural Intrathecal

When are PCAs used and what are the stipulations

Post op, chronic pain, cancer pain Pt can not have altered consciousness, be the only one to push the button, and still be using the prescribed dose

What meds are typically used in PCAs

Fentanyl, morphine, hydromorphine

What are the most serious opioid side effects

Respiratory depression Apnea Respiratory arrest Circulatory depression Hypotension Shock

What are the most common side effects of opioids

Constipation —normally prescribed stool softeners N/V Sedation Dizziness Pruritus HA Dry mouth

When is a person considered in respiratory depression and what do you do

Respirations less than 8 — try to wake up and check other vitals -give narcan — will last only 3-5 minutes *if no response look for other causes

What is the numeric sedation scale and each category

represents effect of opioids S: sleep, easy to arouse no intervention 1: awake and alert, no intervention 2: occasionally drowsy, but easy to arouse, non intervention 3: frequently drowsy, drifts into sleep during conversation REDUCE dose 4: somnolent with minimal or no response to stimulation DISCONTINUE and consider naloxone

What is physical dependence

Withdrawal if drug is discontinued or change in dose

What is physical dependence

Withdrawal if drug is discontinued or change in dose

What is tolerance

Greater amount needed to get therapeutic effect

What is Pseudoaddiction

Behavior is suggestive to addiction, caused by under treatment

What is Pseudoaddiction

Behavior is suggestive to addiction, caused by under treatment

What is Psychological dependence

Psychiatric disorder characterized by compulsive use of substance, despite harm

Pain Management Flashcards

(56 cards)