Pain Management (Fundamentals Ch 41) Flashcards Preview

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Nonpharmacological pain management

-cutaneous (skin) stimulation--transcutaneous electrical nerve stimulation (TENS), heat, cold, therapeutic touch, massage
-reduction of painful stimuli in environment
-elevation of edematous extremities to promote venous return and decrease swelling


Substances that increase pain transmission and cause an inflammatory response

-Substance P


Substances that decrease pain transmission and produce analgesia



Pain Categories

-Acute pain
-Chronic pain
-Nociceptive pain
-Neuropathic pain


Acute pain

-protective, temporary, usually self-limiting, and resolves with tissue healing
-physiological responses (SNS) fight-or-flight responses: tachycardia, hypertension, anxiety, diaphoresis, muscle tension
-behavioral response: grimacing, moaning, flinching, guarding
-interventions: treatment of underlying cause


Chronic pain

-not protective; ongoing or recurs frequently, lasting longer than 6 months and persisting beyond tissue healing.
-physiological responses to not usually alter vital signs; clients may have depression, fatigue, decreased level of functioning.
-psychosocial implications may lead to disability
-may not have known cause, may not be responsive to interventions
-management aims at symptomatic relief (control of symptoms, rather than cure)
-can be malignant (also known as cancer pain; caused by a tumor or may be the result of cancer treatment) or nonmalignant (may result from injury or disease)


Nociceptive pain

-arises from damage to or inflammation of tissue other than that of peripheral and central nervous systems
-usually throbbing, aching, and localized
-typically responds to opioids and nonopioid meds
-Types: a) somatic--in bones, joints, muscles, skin, or connective tissue; b) visceral--in internal organs, can cause referred pain in other body locations separate from stimulus; c) cutaneous--in skin or subcutaneous tissue


Neuropathic pain

-arise from abnormal or damaged pain nerves
-phantom limb pain, pain below level of spinal cord injury, diabetic neuropathy
-usually intense, shooting, burning, or described as "pins and needles"
-pain typically responds to adjuvant meds (antidepressants, antispasmodic agents, skeletal muscle relaxants)


Pharmacological Interventions

-Analgesics: a) nonopioid analgesics; b) opioid analgesics; and c) adjuvant analgesics
-Patient-controlled analgesia (PCA)


Nonopioid analgesics

-acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS)--including salicylates
-treat mild to moderate pain
*be aware of hepatotoxic effects of acetaminophen. Clients with healthy liver should take no more than 4g/day.
*monitor for salicylism (tinnitus, vertigo, decreased hearing acuity)
*monitor bleeding with long-term NSAID use


Opioid analgesics

-morphine sulfate, fentanyl (Sublimaze), and codeine
-treat moderate to severe pain (postop pain, myocardial infarction pain, cancer pain)


Adverse effects of opioid analgesics to monitor

1. constipation: use preventative approach (monitor bm, fluids, fiber intake, exercise, stool softeners, stimulant laxatives, enemas)
2. orthostatic hypotension: advise clients to sit or lie down if symptoms of light-headedness or dizziness occur; avoid sudden changes in position; provide assistance with ambulation
3. urinary retention: monitor I&O, assess for distention, administer bethanechol (Urecholine), and catheterize
4. nausea/vomiting: administer antiemetics, advise clients to lay still and move slowly, eliminate odors
5. sedation: monitor loc and take safety precautions (usually precedes respiratory depression)
6. respiratory depression: monitor rate prior to and following administration. Initial treatment is generally reduction of opioids.
*If necessary slowly administer diluted naloxone (Narcan) to reverse opioid effects


Adjuvant analgesics

-enhance effects of nonopioids
-help alleviate other symptoms of pain (depression, seizures, inflammation)
-useful for treating neuropathic pain


Adjuvant analgesics

-anticonvulsants: carbamasepine (Tegretol)
-antianxiety agents: diazepam (Valium)
-tricyclic antidepressants: amitriptyline (Elavil)
-antihistamine: hydroxyzine (Vistaril)
-glucocorticoids: dexamethasone (Decadron)
-antiemetics: ondansetron (Zofran)


Patient-controlled analgesia (PCA)

-medication delivery system allows clients to self-administer safe doses of opioids
-morphine and hydromorphone (Dilaudid) typically used
-client is the only person who should push PCA button to prevent inadvertent overdosing