Pain, Sleep, And Rest Flashcards
(34 cards)
Classification of pain by origin:
1. Cutaneous/superficial
2. Deep somatic
3. Visceral
4. Radiating/referred
5. Phantom
6. Psychogenic
- On skin, subQ tissue, may cause significant short-term pain. Ex: paper cut.
- Originates in ligament/tendon/bone/muscle, described as achy/tender. Ex: bone cancer/fracture.
- Deep, internal pain, abdominal cavity, not localized, tight, pressure/cramping pain. Ex: GI/organ disorders, 经痛
- Starts at the origin and extends. Ex: pain in the throat can go to the ear.
- Ex: area that’s been surgically removed (amputated leg) can still feel pain.
- Believed to arise from mind, no physical causes that can be identified, but can still be as severe as normal pain.
Classify pain by cause:
1. Nociceptive
2. Neuropathy
- Occur after trauma, surgery, inflammation
- Complex and often chronic pain, poorly controlled diabetes, stroke, viral infection, shingles
Classify pain by duration:
1. Acute
2. Chronic
3. Intractable
- Up to 6 months max, injury/surgery
- More than 6 months, interfere w/daily activities, exacerbation and remission. May lead to withdrawal, depression, anger, frustration, dependence
- Both chronic and highly resistant to relief
Classify pain by description:
1. Quality
2. Periodicity
3. Intensity
- Sharp/dull/achy/stabbing/ripping/tingling pain
- One-time, intermittent (comes and goes)
- Mild, moderate, severe, intolerable
It’s important to listen to pt’s description!
Physiology of pain:
Transduction
Activation of nociceptor by stimuli.
Mechanical: external forces stretching tissues.
Thermal (stimuli): heat and cold
Chemical: internal/external, lemon juice on skin
Physiology of pain:
Transmission
Conduction of pain message to spinal cord.
A delta fibers: fast pain impulses
C delta fibers: slow pain impulses
Physiology of pain:
Pain perception
Recognizing and defining pain in frontal cortex.
Duration and characteristic of pain, Pain tolerance
Your body release what naturally when experiencing pain?
Analgesics
What has to happen before charting pt refused pain med or ant medication?
Pt education!
Unrelieved pain impact on endocrine system
Insulin level can decrease, protein and fat breakdown, weight loss, tachycardia, resp increase, fever, death
Unrelieved pain impact on cardiovascular system
Hypercoagulation (more clotting), pulse up, bp up, increase O2 demand and cardiac workload
Unrelieved pain impact on musculoskeletal system
Impaired muscle function, fatigue, immobility, prevent ADL and physical therapy
Unrelieved pain impact on respiratory system
Respiratory acidosis, resp shallow
Unrelieved pain impact on genitourinary system
Less urine, fluid overload, hypokalemia, hypertension, more cardiac output, urinary retention
Unrelieved pain impact on GI system
Gastric motility low
WHATSUP pain assessment method
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?
When assessing for pain, also remember to assess for what?
Depression!
Does normal vitals shows the pt is not in pain?
No! They can be in pain even if their vitals are fine
Nonpharmacological pain management:
Cutaneous simulation
- Transcutaneous electrical nerve simulation (TENS): stimulates A delta fiber, can be intermittent, transdermal
- Percutaneous electrical nerve simulation (PENS): combine w/TENS but go through skin, need to pierce skin for this
- Spinal cord simulator (SCS): chronic neurological pain (surgically place sth. in spinal cord
- Massage, acupuncture, acupressure
- 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
Nonpharmacological pain management:
Oral sucrose
Simple sugar solution, PO
Pharmacological pain management:
Nonopioid analgesics
- NSAIDs
- Acetaminophen (nonsalicylate)
Pharmacological pain management:
Adjuvant analgesics
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
Pharmacological pain management:
Opioid analgesics
Common side effects: resp low, constipation, sedation, nausea, vomiting, hypotension, dry mouth, hives, sweating
Older adults have what common pain conditions and what are they at risk for?
Spinal conditions, arthritis, cancer.
Risk for undertreatment of pain b/c less verbal signs.
Risk for overtreatment due to peak level and duration.
