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pain management Flashcards

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1
Q

pain often goes _____ because it is subjective.

A

unrecognized

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2
Q

overview of pain

A

-most common reason that people seek healthcare.
-under recognized
-misunderstood
-inadequately treated
-purely subjective
-misreported or under reported

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3
Q

effects of pain

A

-decreased energy
-emotional and cognitive components
-effects interpersonal relationships
-decreased QOL
-may lead to serious physical, psychosocial, social, and financial burdens.

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4
Q

steps of nocicpetion

A
  1. transduction
  2. transmission
  3. perception
  4. modulation
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5
Q

transduction

A

activation of pain receptors.

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6
Q

transmission

A

conduction of pain sensations from injury or inflammation site along nerve pathways to the spinal cord.

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7
Q

perception

A

involves sensory process that occurs when a stimulus for pain is present. influenced by past experiences of pain. culture can also influence this.

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8
Q

modulation

A

process by which the sensation of pain is inhibited or modified. exaggerated response to combat the pain. body tries to adapt and compensate

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9
Q

tissue injury triggers _____________ to be released.

A

neurotransmitters

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10
Q

histamine and substance P

A

released to produce vasodilation and edema

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11
Q

bradykinin and prostaglandins

A

released to increase pain stimuli or sensitivity.

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12
Q

prostaglandins are inhibited by _____.

A

NSAIDs (non steroidal anti-inflammatory drugs)

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13
Q

Gate Control Theory of Pain

A

pain has emotional, cognitive, and physical components.
-non-oxious stimuli have the ability to distract the perception of noxious stimuli.

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14
Q

sympathetic responses to pain

A

-increased heart rate
-increased blood pressure
-increased blood sugar
-diaphoresis
-increased muscle tension
-dilated pupils
-decreased gastric motility

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15
Q

parasympathetic responses to pain

A

-decreased heart rate
-decreased blood pressure
-vomiting
-pallor
-nausea

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16
Q

sympathetic responds to _______ pain.

A

low or moderate

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17
Q

parasympathetic responds to ______ pain.

A

severe or deep

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18
Q

behavioral responses to pain

A

-grimacing, clenching teeth, or guarding
-decrease in activity, withdrawal
-agitation or restlessness

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19
Q

classifications of pain by duration

A

acute, chronic, and chronic episodic

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20
Q

acute pain

A

-short duration, transient, temporary
-usually identifiable cause (surgery, trauma, MI)
-predictable ending
-can inhibit recovery, so it needs to be treated

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21
Q

chronic pain

A

-prolonged, usually beyond 3-6 months
-not always from an identifiable cause. (idiopathic)
-often associated with significant psychological and cognitive effects.

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22
Q

chronic, episodic pain

A

-occurs sporadically over an extended period of time.
-migraines (frequent, same type of pain)
-sickle cell anemia

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23
Q

classifications of pain by pathology

A

nociceptive, neuropathic, and cancer pain

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24
Q

nociceptive pain

A

“aching, throbbing”
-somatic
-visceral

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25
somatic pain
type of nociceptive pain -bone, joint, muscle, skin
26
visceral pain
type of nocicpetive pain -organs (stimulating the PNS) -referred pain
27
referred pain
pain in a separate part of the body from source. -kidney stones: may present with back or groin pain. -MI: may present with jaw pain or left arm pain
28
neuropathic pain
"shooting, burning, pins, and needles" -diabetic neuropathy -phantom pain -spinal cord injury
29
phantom pain
patients with paralysis feeling pain in a part of their body that is no longer there
30
cancer pain
often caused by tumor progression or as a result of treatment -more often nociceptive but can be either.
31
factors influencing pain
-physiological -social -psychosocial -cultural
32
physiological influence on pain
-age -developmental changes -nuerological -threshold tolerance -genes
33
social influence on pain
previous experience, labor (expected pain)
34
psychosocial factors influence on pain
attention or distraction from the pain
35
cultural factors influencing pain
verbalizing pain, stoic, what is within the patients ____.
36
impacts of pain
quality of life (QOL), self care, work and school, social support
37
assessing pain
-Provocative / palliative -Quality -Region / radiation -Severity -Timing -Understanding effect
38
provocative/palliative assessment of pain
what makes it better or what makes it worse?
39
quality assessment of pain
describe your pain. aching, shooting, burning
40
region / radiation assessment of pain
where is your pain? does it spread or radiate?
41
severity assessment of pain
how much pain do you have now? how bad has it been in the past 24 hours?
42
timing assessment of pain
when did it start? how long has it lasted? how often do you experience the pain?
43
understanding effect assessment of pain
describe what you cannot do as a result of the pain. how does it impact your life?
44
tools for the assessment of pain
-numerical -FACES -unable to self report: FLACC, PAINAD, NVPS, CPOT
45
FLACC tool pain assessment
pain tool for infants and children (Face, Legs, Arms, Cry, Consolability)
46
PAINAD tool pain assessment
pain tools for patients with dementia (breathing, negative vocalization, facial expression, body language, consolability)
47
NVPS pain assessment tool
pain tool for general nonverbal pain scale (face, activity, guarding, vital signs)
48
CPOT pain assessment tool
pain scale for critical care patients (Face, muscle tension, body movements, compliance with ventilator)
49
key concepts of implementation
-requires holistic approach -multimodal therapy may be needed -refer to practice guidelines and stay current with EVP
50
pharmacological therapy implementation
-around the clock (ATC) -PRN -Breakthrough pain multimodal analgesia
51
analgesics implementation
-opiods -non opiods -adjuvant
52
opiods
morphine, codeine, oxycodone, hydromorphone
53
non opiods
acetaminophen, ibuprofen, lidocaine
54
adjuvants
antidepressants, anticonvulsants, corticosteroids
55
opiod analgesics
SE: nausea, constipation, confusion, somnolence, respiratory depression -start low, go slow -monitor for drug tolerance if taken long term -assess current or past substance abuse / addiction -reversal agent: naloxone (narcan)
56
reversal agent for opiods
Naloxone (Narcan)
57
acetaminophen
Tylenol. max dose is 4,000 mg in 24 hours. cautious use with liver disease
58
ibuprofen
Advil. max dose is 3,200 mg in 24 hours. may cause gastric upset. increase risk for bleeding, kidney injury
59
lidocaine
often used transdermal or via local anasthesia
60
pharmacological therapy routes
PO, IM, IV, topical. -local anesthesia: peri neural infusion -regional anesthesia: epidural infusion -patient controlled analgesia (PCA)
61
PCA pharmacological therapy
-IV or subcutaneous infusion -locked system -allows patients to self administer opioids -physically able to push button -set dose with lockout for time / frequency -patient and family education -verification by two nurses
62
non pharmacological therapies
-cognitive and behavioral approach -cutaneous stimulation -complementary and integrative modalities
63
cognitive and behavioral approach
-relaxation -guided imagery -distraction -music
64
cutaneous stimulation
-cold and heat application -TENS (transcutaneous electrical nerve stimulation)
65
complementary and integrative modalities
-acupuncture -acupressure -chiropractic -massage -movement therapy (yoga) -therapeutic touch -aromatherapy -herbals
66
restorative and continuing care
-pain clinics -palliative care -hospice
67
patient barriers
-fear of addiction -dont want to be a bother -lack of knowledge -cultural beliefs -language barrier
68
provider barriers
-inadequate assessment -concern for addiction -fear of legal repercussions -dont believe patient report of pain -time constraint -concern for side effects or overdose
69
pediatric considerations
-infants DO have the ability to feel pain -infants and young children express pain differently -infants and young children may require different pain assessments -infants and children process medications differently (pharmacokinetics), so need to monitor more frequently
70
geriatric considerations
-pain is NOT a normal part of aging -older adults may be less likely to report pain -older adults are at increased risk of side effects from medications -adults with cognitive decline may express pain differently
71
evaluation of pain management
-nursing process is ongoing -variations in expression of pain -holistic evaluation
72
holistic evaluation of pain management
what is the effect of pain on ADLs, sleep, appetite, work, etc.

3105 (4 decks)

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