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Pain, Sleep, And Rest Flashcards

(34 cards)

1
Q

Classification of pain by origin:
1. Cutaneous/superficial
2. Deep somatic
3. Visceral
4. Radiating/referred
5. Phantom
6. Psychogenic

A
  1. On skin, subQ tissue, may cause significant short-term pain. Ex: paper cut.
  2. Originates in ligament/tendon/bone/muscle, described as achy/tender. Ex: bone cancer/fracture.
  3. Deep, internal pain, abdominal cavity, not localized, tight, pressure/cramping pain. Ex: GI/organ disorders, 经痛
  4. Starts at the origin and extends. Ex: pain in the throat can go to the ear.
  5. Ex: area that’s been surgically removed (amputated leg) can still feel pain.
  6. Believed to arise from mind, no physical causes that can be identified, but can still be as severe as normal pain.
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2
Q

Classify pain by cause:
1. Nociceptive
2. Neuropathy

A
  1. Occur after trauma, surgery, inflammation
  2. Complex and often chronic pain, poorly controlled diabetes, stroke, viral infection, shingles
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3
Q

Classify pain by duration:
1. Acute
2. Chronic
3. Intractable

A
  1. Up to 6 months max, injury/surgery
  2. More than 6 months, interfere w/daily activities, exacerbation and remission. May lead to withdrawal, depression, anger, frustration, dependence
  3. Both chronic and highly resistant to relief
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4
Q

Classify pain by description:
1. Quality
2. Periodicity
3. Intensity

A
  1. Sharp/dull/achy/stabbing/ripping/tingling pain
  2. One-time, intermittent (comes and goes)
  3. Mild, moderate, severe, intolerable
    It’s important to listen to pt’s description!
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5
Q

Physiology of pain:
Transduction

A

Activation of nociceptor by stimuli.
Mechanical: external forces stretching tissues.
Thermal (stimuli): heat and cold
Chemical: internal/external, lemon juice on skin

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6
Q

Physiology of pain:
Transmission

A

Conduction of pain message to spinal cord.
A delta fibers: fast pain impulses
C delta fibers: slow pain impulses

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7
Q

Physiology of pain:
Pain perception

A

Recognizing and defining pain in frontal cortex.
Duration and characteristic of pain, Pain tolerance

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8
Q

Your body release what naturally when experiencing pain?

A

Analgesics

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9
Q

What has to happen before charting pt refused pain med or ant medication?

A

Pt education!

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10
Q

Unrelieved pain impact on endocrine system

A

Insulin level can decrease, protein and fat breakdown, weight loss, tachycardia, resp increase, fever, death

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11
Q

Unrelieved pain impact on cardiovascular system

A

Hypercoagulation (more clotting), pulse up, bp up, increase O2 demand and cardiac workload

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12
Q

Unrelieved pain impact on musculoskeletal system

A

Impaired muscle function, fatigue, immobility, prevent ADL and physical therapy

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13
Q

Unrelieved pain impact on respiratory system

A

Respiratory acidosis, resp shallow

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14
Q

Unrelieved pain impact on genitourinary system

A

Less urine, fluid overload, hypokalemia, hypertension, more cardiac output, urinary retention

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15
Q

Unrelieved pain impact on GI system

A

Gastric motility low

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16
Q

WHATSUP pain assessment method

A

W: where is the pain? Be specific
H: how does it feel? Describe it
A: aggravating factors, what makes the pain better/worse?
T: timing, when does it start? Intermittent/continuous?
S: severity, how bad is it from 0 to 10?
U: useful other data, any other symptoms associated with the pain?
P: perception, what do pt think is causing this pain?

17
Q

When assessing for pain, also remember to assess for what?

18
Q

Does normal vitals shows the pt is not in pain?

A

No! They can be in pain even if their vitals are fine

19
Q

Nonpharmacological pain management:
Cutaneous simulation

A
  1. Transcutaneous electrical nerve simulation (TENS): stimulates A delta fiber, can be intermittent, transdermal
  2. Percutaneous electrical nerve simulation (PENS): combine w/TENS but go through skin, need to pierce skin for this
  3. Spinal cord simulator (SCS): chronic neurological pain (surgically place sth. in spinal cord
  4. Massage, acupuncture, acupressure
  5. Heat and cold: heat promote circulation, dilate, help speed up healing; cold prevent swelling and bleeding, vasoconstriction (avoid skin contact with heat and cold, 15 min. then remove, assess skin for redness, cyanosis, blanching
20
Q

Nonpharmacological pain management:
Oral sucrose

A

Simple sugar solution, PO

21
Q

Pharmacological pain management:
Nonopioid analgesics

A
  1. NSAIDs
  2. Acetaminophen (nonsalicylate)
22
Q

Pharmacological pain management:
Adjuvant analgesics

A

Decrease amount of opioids pt requires.
Antidepressants, local anesthesia, topical agents, muscle relaxants, corticosteroids, anticonvulsants.
Pt with chronic pain or chronic condition may need to increase pain med or add adjuvant.
Ex:
Gabapentin: seizures, restless leg.
Soma: relaxes muscles, alters activity between spinal cords and brain neurons

23
Q

Pharmacological pain management:
Opioid analgesics

A

Common side effects: resp low, constipation, sedation, nausea, vomiting, hypotension, dry mouth, hives, sweating

24
Q

Older adults have what common pain conditions and what are they at risk for?

A

Spinal conditions, arthritis, cancer.
Risk for undertreatment of pain b/c less verbal signs.
Risk for overtreatment due to peak level and duration.

25
Use of placebos:
Sugar pill - not analgesic, but can reduce pain?
26
Sleep vs rest
Sleep: unaware of environment Rest: body disturbed by all external stimuli
27
Stages of sleep:
1. Wakefulness(醒着但是困): early stage of drowsiness, eye blinks. 2. Non-rapid eye movement 1 (NREM 1)(刚闭上眼放松): light sleep, awaken easily, slow eye movements, relaxed but aware of surroundings, 5% of total sleep. 3. NREM 2: easily awakened, vitals go down slowly, 50% of total sleep. 4. NREM 3: deep sleep, difficult to wake up, vitals lower, muscles relaxed, this state is important for healing, growth, and tissue repair!!! 20%-25% of total sleep. 5. REM: highly activated sleep, eyes move, muscles twitch, metabolism and vitals go up, dreaming occurs, 25% of total sleep.
28
Insomnia(失眠)
Causes distress Occurs more than 3 days a week and present for more than 3 months
29
Circadian disorders(昼夜节律紊乱)
Abnormal sleep-wake schedule Time zone change, night shift work, total sleep time change
30
Sleep deprivation(睡眠不足)
Prolonged sleep disturbances, delusion. Result in impaired problem solving/decision making and slow reaction time
31
Hypersomnia(嗜睡症)
Excessive sleeping in daytime, fall asleep when need/want to be awake and alert
32
Sleep apnea(睡眠呼吸暂停)
No air flow through airway during sleep, bp up, pulse up
33
Narcolepsy(发作性睡病)
Blurred distinction between awake and asleep. Chronic disorder, brain can't regulate sleep-awake cycles normally, sleepiness, slurred speech, paralysis, hallucinations
34
Parasomnias(异态睡眠)
Sleepwalking, sleeptalking, bruxism(磨牙症, happens during NREM 2), night terrors(夜惊症), nocturnal enuresis