pain management Flashcards
(162 cards)
1
Q
What is pain?
A
Pain is whatever the patient says it is.
2
Q
What are the classifications of pain?
A
- Acute pain: Sudden onset, several hours-weeks, sharp, intense, well-defined, specific location, responsive to pain treatments, result of trauma, injury, or surgery.
- Chronic pain: Gradual, more than 3-6 months, achy, dull, stabbing, burning, diffuse, nonspecific area, resistant to many pain managements, no biological purpose.
3
Q
What are 3 examples of nociceptive pain?
A
- Cutaneous: Superficial skin/tissues; tender, sharp, achy. (Sunburn, minor cuts/scrapes)
- Somatic: Deeper tissue, joints, muscle and bones; dull and achy, cramping, crushing, or stabbing. (Arthritis fractures, myalgias)
- Visceral: Hollow organs in abdominal or thoracic cavity; cramping, achy, or dull. (Appendicitis, biliary or pancreatic obstruction)
4
Q
What is neuropathic pain?
A
Neuropathic pain is pain from the peripheral and central nervous system; symptoms include numbness, tingling, shooting, ‘pins & needles.’ (Phantom limb, diabetic neuropathy, carpal tunnel)
5
Q
What is allodynia?
A
Allodynia is a painful response to normally innocuous stimuli.
6
Q
What is hyperalgesia?
A
Hyperalgesia is an exaggerated response to already painful stimuli.
7
Q
What are the organs of immunity?
A
- Innate immunity, 1st line of defense: skin.
- Primary lymphoid or central organs: thymus and bone marrow.
- Secondary lymphoid or peripheral organs: spleen, lymph nodes, tonsils, adenoids, and Peyer’s patch.
8
Q
What factors shape pain?
A
Factors that shape pain include prior experience, expectations, anxiety, sociocultural influences, gender, genetics, and age.
9
Q
What is persistent pain?
A
Persistent pain reoccurs after therapeutic interventions, examples include wounds, arthritis, back pain, and some headaches.
10
Q
What is breakthrough pain?
A
Breakthrough pain refers to short-term bursts of acute pain caused by patient movements or by being near the end of a medication dose.
11
Q
How can a patient’s cultural experience influence pain?
A
A patient’s cultural experience can influence their pain experience.
12
Q
What is the prevalence of pain in men versus women?
A
Pain syndromes more prevalent in women include inflammatory arthritis, migraine headaches, and irritable bowel syndrome. Pain syndromes more prevalent in males include cluster headaches, back pain (slightly more prevalent), visceral pain from nonreproductive organs including the heart and pancreas, and chronic orofacial pain.
13
Q
How can you assess pain & intensity?
A
Using numeric, verbal, or visual rating scales.
14
Q
What is a focused pain assessment?
A
OPQRST-AAA: Provocation, Quality, Radiation & region, Severity, Time/duration.
15
Q
What does ‘Provocation’ refer to in pain assessment?
A
Asking what factors make pain worse.
16
Q
What are the different qualities of pain?
A
Sharp, dull, stabbing, burning.
17
Q
What is the FACES scale?
A
A visual scale used to assess pain.
18
Q
What is an example of assessing aggravating factors in pain?
A
In assessing a patient’s pain, the nurse asks, ‘What makes the pain worse?’
This determines the aggravating factors of pain.
19
Q
What are some nursing diagnoses related to pain management?
A
Acute pain, chronic pain, ineffective respiratory function, risk for injury, ineffective management of therapeutic regimen.
20
Q
What are pharmacological options for pain management?
A
Non-opioid analgesics, local anesthetics, topical rubefacients, opioids.
21
Q
What are NSAIDs?
A
Non-steroidal anti-inflammatory drugs that vary in potency & half-life.
22
Q
What is the role of corticosteroids in pain management?
A
They are anti-inflammatory and used for conditions like arthritis and bone pain.
23
Q
What is acetaminophen used for in pain management?
A
It can be combined with opioids to potentiate their effect.
24
Q
What are local anesthetics?
A
Pharmacological agents that are topically applied or injected into nerves and tissues.
25
What are topical rubefacients?
Topically applied agents that cause local vasodilation and produce a cooling sensation.
26
What are topical rubefacients?
Topically applied substances that cause local vasodilation and produce a cool sensation. Examples include rubbing alcohol and Icy Hot, which contain chili pepper ingredients for a hot sensation.
27
What are opioids used for?
Opioids bind to opioid receptors in the brain and are used for severe to moderate pain, commonly post-operative. Morphine (roxanol) is the gold standard for acute pain.
28
What are the side effects of opioids?
Common side effects include respiratory depression, nausea/vomiting, constipation, urinary retention, pruritus, and increased pain with chronic pain.
## Footnote
Respiratory depression is the most critical adverse effect of opioids.
29
How can opioids be made more effective?
Opioids are more effective when combined with NSAIDs, as most acute pain has an inflammatory component.
30
What is the goal of pain management?
The goal is to improve functional engagement, not to relieve all pain.
31
What are atypical analgesics?
Atypical analgesics include clonidine, tricyclic antidepressants, glutamate receptor antagonists, and ion-channel blockers.
32
What are nonpharmacological pain management techniques?
Techniques include positioning, heat (hot pack or heating pad for 5-15 min), cold (ice pack or cold bath for 15-30 min), ROM exercises, distraction therapies, and invasive treatments like TENS stimulation or deep brain stimulation.
33
What is the effect of cold and heat on pain?
Cold increases peristalsis and reduces inflammation, while heat reduces peristalsis, acid production, and reflex muscle spasms.
34
What should be done prior to painful procedures?
Premedicate prior to painful procedures to minimize breakthrough pain and keep pain manageable.
35
What should be considered when choosing a treatment plan?
Refer to a pain specialist for decision-making regarding effective dose, route, and medication choice, aiming for the best pain relief with fewer adverse effects.
36
What are the WHO pain guidelines?
Oral analgesics should be administered at regular intervals according to intensity, with a goal to improve functional quality of life and individualized dosing.
37
How is pain managed in special populations?
Older adults may be underdiagnosed or undertreated, and adults with cognitive or communication impairments require self-reporting, cognition tests, and behavioral observations.
38
What are the goals of complementary/alternative medicine (CAM) therapies?
The goals include promoting wellness, preventing illness, reducing side effects, improving the immune system, and enhancing quality of life.
39
What are the classifications of CAM therapies?
Classifications include whole medical systems/alternative medicines, ancient arts/practices, Ayurvedic medicine, Chinese/Native American medicine, and naturopathy.
40
What are mind/body therapies in naturopathy?
Mind/body therapies include meditation, prayer/spirituality, yoga, guided imagery, tai chi, and zero balancing.
41
What are manipulative and body-based therapies?
Manipulative and body-based therapies include massage therapy, chiropractic, osteopathic medicine, and reflexology.
42
What is reflexology?
Reflexology involves massaging reflex points on the feet, which can help relieve tension and treat illness.
43
What are energy healing therapies?
Energy healing therapies include therapeutic touch and Reiki.
44
What are dietary supplements in naturopathy?
Dietary supplements include herbal medicine and botanicals.
45
What should be avoided during massage therapy?
Avoid massage where there are radiation sites, burns, direct tumor sites, fractures, varicose veins, open wounds, areas with lymphedema, and in patients taking Coumadin or heparin due to increased risk of bleeding. Caution is advised during pregnancy.
46
What is rheumatoid arthritis (RA)?
RA is a chronic, systemic autoimmune disease characterized by inflammation of connective tissue in joints.
47
What are DMARDS used for rheumatoid arthritis?
DMARDS that help RA include methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, or tofacitinib.
48
What are the clinical manifestations of rheumatoid arthritis?
Clinical manifestations include joint pain, swelling, erythema, morning stiffness > 30 min, symmetrical symptoms, swan-neck and boutonniere deformities, and irreversible joint damage.
49
What are the management strategies for rheumatoid arthritis?
Management strategies include nutrition & weight management, exercise, rest & joint protection, heat/cold applications, CAM therapies, reconstructive surgery, and PT/OT/social worker involvement.
50
What teaching points are important for rheumatoid arthritis patients?
Teaching points include adhering to the treatment plan, monitoring for signs of infection, avoiding treatment in patients with active infections, and keeping current with vaccinations.
51
What should be monitored in patients taking DMARDS?
Watch for increased levels secondary to NSAID use, increased liver enzymes, constipation with decreased activity and narcotic analgesic use, nausea, oral ulcers, eye inflammation, and lung disease.
52
What is Osteoarthritis (OA)?
OA is a slowly progressive noninflammatory disorder of joints and the leading cause of chronic disability.
53
What is the pathophysiology of Osteoarthritis?
It involves gradual loss of articular cartilage, bony outgrowths at joint margins, and unprotected bone.
54
What symptoms are not present with Osteoarthritis?
Fatigue, fever, and organ involvement are not present with OA.
55
What are the clinical manifestations of Osteoarthritis?
Bony enlargement or swelling of joints, joint stiffness < 30 min, tenderness to touch, swelling, and crepitus. Usually asymmetrical.
56
What are the management strategies for Osteoarthritis?
Weight loss, rest, joint protection, heat for joint stiffness, cold for acute inflammation, aerobic exercise, and assistive devices.
57
What is the goal of teaching for Osteoarthritis patients?
The goal is to decrease pain and improve/maintain joint mobility while avoiding toxic effects of pharmacological therapy.
58
What should be monitored in Osteoarthritis patients?
Be aware of constipation due to decreased physical activity and narcotic analgesics.
59
What is Gout?
Gout is an arthritis characterized by an elevation of uric acid (hyperuricemia) and deposits of uric acid crystals in one or more joints, causing painful flares lasting days to weeks.
60
What can cause increased levels of uric acid?
Prolonged fasting or excessive alcohol use may lead to increased uric acid levels due to overproduction of keto acids which inhibit uric acid excretion.
61
What are the phases of Gout?
Acute phase: 1 joint with acute onset of pain, redness/swelling. Intercritical phase: asymptomatic period between attacks. Chronic phase: repeated attacks leading to tophi and joint destruction.
62
What are the common clinical manifestations of Gout?
Inflammation of the great toe (podagra) is most common. Affected joints appear dusky or cyanotic and are extremely tender.
63
What are the teaching points for Gout management?
Decrease weight, maintain proper nutrition, stay hydrated, splint affected joints, and avoid triggers.
64
What are the risk factors for Gout?
Obesity, hypertension, a diet high in meat and seafood, thiazide diuretics, and consuming large quantities of alcohol.
65
What are the treatments for Gout?
For acute attacks: decrease pain and inflammation using NSAIDs or glucocorticoids. For intercritical periods: NSAIDs and colchicine.
66
What is the focus of chronic gout treatment?
Chronic gout treatment focuses on lowering uric acid using allopurinol or febuxostat.
## Footnote
Acute gout is never treated with uric acid lowering agents.
67
What is SLE?
SLE (Systemic Lupus Erythematosus) is a multisystem inflammatory autoimmune disease affecting the skin, joints, and serous membranes.
68
What systems are affected by SLE?
SLE affects renal, hematologic, and neurologic systems.
69
What are common clinical manifestations of SLE?
Common manifestations include fatigue, difficulty concentrating, joint pain, rash, photosensitivity, nasal/oral ulcers, dry eyes & mouth, hypertension, leukopenia, and thrombocytopenia.
70
What are general symptoms of SLE?
General symptoms include fever, weight loss, joint pain, and excessive fatigue.
71
What management strategies are recommended for SLE?
Management includes avoiding prolonged sun exposure, maintaining a frequent rest/sleep schedule, regular exercise, immunizations, and referrals to specialists as needed.
72
What are some complications of SLE?
Complications include renal failure, lung disease, premature heart disease, hypercoagulation/stroke, avascular necrosis of joints, and increased risk for infections.
73
What are the risk factors for SLE?
Risk factors include genetics, being female in childbearing years, being African American, Hispanic, or Asian, smoking, and UV light exposure.
74
What is fibromyalgia?
Fibromyalgia is a chronic central pain syndrome characterized by widespread, monoarticular musculoskeletal pain.
75
What are common clinical manifestations of fibromyalgia?
Common manifestations include generalized musculoskeletal pain, stiffness, malaise, fatigue, depression, cognitive problems, headaches, insomnia, and fever.
76
What medications are used to treat fibromyalgia?
Medications include serotonin, sleep aids, nonopioid medications, or norepinephrine.
77
What is a notable characteristic of pain in fibromyalgia?
Pain typically presents with a normal physical examination with no evidence of joint or muscle inflammation.
78
What are the risk factors for fibromyalgia?
Risk factors include rheumatoid arthritis (RA), lupus, Sjogren's syndrome, genetics, and being female.
79
How does osteoarthritis pain differ from RA pain?
Osteoarthritic pain tends to worsen with activity, while RA pain often improves with activity.
80
What is scleroderma?
Scleroderma is a disorder of connective tissue characterized by autoimmune, inflammatory changes in skin, blood vessels, and internal organs.
81
What causes scleroderma?
The cause of scleroderma is unknown, but it involves collagen overproduction leading to progressive tissue fibrosis and occlusion of blood vessels.
82
What is the primary difference in pain between osteoarthritis and RA?
Osteoarthritic pain tends to get worse with activity, but RA gets better with activity.
83
Are both RA and osteoarthritis autoimmune diseases?
No, only RA is an autoimmune disease.
84
What are the extra-articular manifestations associated with RA?
Patients with RA are at risk for developing eye inflammation and lung disease.
85
How does morning stiffness differ between osteoarthritis and RA?
Patients with osteoarthritis typically have morning stiffness lasting less than 30 minutes, whereas RA patients typically complain of morning stiffness lasting greater than 30 minutes.
86
Do RA and osteoarthritis affect joints symmetrically?
No, only RA affects joints in a symmetrical pattern.
87
What is scleroderma?
Scleroderma is a disorder of connective tissue characterized by autoimmune inflammatory changes in skin, blood vessels, and internal organs.
88
What causes tissue fibrosis in scleroderma?
Collagen overproduction leads to progressive tissue fibrosis and occlusion of blood vessels.
89
What are the risk factors for scleroderma?
Environmental or occupational exposure to coal, plastics, or silica dust.
90
What are some clinical manifestations of scleroderma?
Calcinosis, Raynaud Phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia.
91
Is there a single treatment for scleroderma?
No, treatment is focused on specific organ involvement.
92
What are some complications of scleroderma?
Infection, renal or heart failure, pulmonary fibrosis, and death.
93
What is immunity?
Immunity is the body's ability to resist infection and disease.
94
What are the types of white blood cells?
The five different leukocytes are neutrophils, basophils, eosinophils, monocytes, and lymphocytes.
95
What is the function of neutrophils?
Neutrophils are granulocytes that are involved in early inflammation and destroy bacteria.
96
What do basophils release?
Basophils release heparin for anticoagulation and histamine for inflammation.
97
What is the role of eosinophils?
Eosinophils destroy allergens and combat parasitic infections.
98
What do monocytes do?
Monocytes are agranulocytes that present pathogens to T cells for destruction.
99
What are the functions of lymphocytes?
Lymphocytes are active in both humoral and cell-mediated immune responses.
100
What are the types of T lymphocytes?
Cytotoxic, suppressor, and helper T cells.
101
What do natural killer cells target?
Natural killer cells target virus-infected and tumor cells.
102
6. Lymphocytes - active in both humoral and cell-mediated
103
D Iumphocytes: immunoglobulins/antibodies
104
›hocytes: elimination of cells infected by pathogens.
105
xic
suppressor
106
retural killer cells. (NK) target virus-infected and tumor cells.
107
Monocytes: dendritic cells & mast cells.
108
8. Erythrocytes (red blood cells): responsible got transportation of gases and nutrients throughout
109
9. Cytokines: interleukins
interferons
110
10. Complement system provides cell killing effects for both innate and acquired immunity.
111
11. What are the different immune function responses.
112
Innate: provides protective barriers and an inflammatory response that is immediate
113
nonspecific
and w/out memory. First and second lines of defense. Determine if invader
114
is self or non-self-antigen. Rapid response
115
First line of defense: physical
mechanical
116
Second line of defense: inflammatory response. Goal is to prevent and /or limit
117
infection and further damage.
118
Adaptive: cellular and humoral responses. Slow response.
119
Cellular mediated: T cells
cell-to-cell contact
120
microorganisms
viruses
121
> Humoral mediated: antibody
B cells
122
extracellular microorganisms. (Bacteria and viruses)
123
12. What are the 5 cardinal signs of inflammation?
124
The document a rail or studocu
125
• Swelling (edema)
126
• Redness (erythema)
127
Warmth
128
Loss of function
129
13. Note: corticosteroids
NSAIDs
130
14. Vascular response -> cellular response -> formation of exudate -> healing.
131
15. What is active immunity: The body actively produces antibodies.
132
• Active natural immunity: antibodies in response to live pathogens.
133
Active artificial immunity: antibodies in response to vaccine.
134
16. What is passive immunity?
135
Passive natural immunity: mother passes antibodies to baby via placenta or milk
136
Passive artificial immunity: patient is administered antibodies to fight an infection (IV)
137
17. What is a CBC w. Diff? - complete blood cell count with differential.
138
Patients with chronic bacterial infection need CBC w/ diff test to evaluate leukocyte
139
count.
140
Patient fighting infection a CBC evaluate WBC count and inflammatory markers.
141
• WBC: neutrophils
lymphocytes
142
18. What is age related changes in the immune system? (Immunosenescence)
143
Decreased WBC response
even with infection.
144
Increased autoantibodies
145
Lowered cell-mediated immunity.
146
• Thymus shrinks
less activity (T cell
147
Delayed hypersensitivity reaction decreased or absent.
148
Reduced primary and secondary antibody response.
149
Therapy induced deficiencies.
150
1. What are immunodeficiency disorders? - absent or depressed immune response.
151
• Causes: meds
infections
152
Involves impairment of one or more immune mechanisms.
153
• Primary disorder: immune cells are improperly developed or absent.
154
• Secondary disorder: when an illness or treatment causes deficiency. (HIV)
155
• High risk for infection.
156
2. Medication induces immunosuppression (most common)
157
Immunosuppressive therapy.
158
• Chemotherapy
159
Corticosteroids suppress the immune system.
160
• Radiation therapy.
161
• Surgery.
162
3. Medical management
