Test 2 Pain and Analgesia Flashcards
1
Q
What are the barriers to pain management?
A
- Inadequate knowledge of healthcare professionals
- Cultural and social barriers
- Government regulations
2
Q
What are the basic approached to assessing pain?
A
- assess
- treat
- reassess
3
Q
Principles of Good Pain Managers
A
- Ask about pain regularly
- Approach pain systematically. Look for multiple causes
- Believe the patient
- Choose an option appropriate for the patient, family and setting
- Chart the pain
- Deliver interventions in a timely, logical, and coordinated fashion
- Empower the patients and their families
- Enable patients to control the course of their lives as much as possible
4
Q
Evaluation of Pain
A
PQRSTU
- P - Precipitates? Palliates?
- Q - Quality?
- R – Region? Radiating?
- S – Severity?
- T – Time?
- U – happened to U before
5
Q
objective evaluations of pain
A
- ↑ BP
- ↑ HR
- ↑ RR
- sweating
- facial expression
- vocal behavior
- changes in activities of daily living
6
Q
general principles of non-opioid analgesia
A
- Agents should be dosed around the clock
- Use the maximum doses of each agent
- Switch to agents of a different class
- All agents have a “ceiling effect”
- Dependence absent
7
Q
common AE of APAP
A
- rash
- hepatotoxicity if doses greater than 4000mg per day
8
Q
max dose of APAP
A
3 g/day
9
Q
max dose for IBP
A
3200mg
10
Q
max dose for naproxen
A
1500mg
11
Q
max dose for ASA
A
3900mg
12
Q
common AE of NSAIDs
A
- Coagulation defects
- Renal toxicity
- Closure of ductus arteriosus
- GI toxicity of NSAIDs
13
Q
for chronic NSAID use, what is the best thing you can recommend?
A
- PPI
- they protect against duodenal and gastric ulcer
14
Q
NSAID selection
A
- potential toxicity is same between agents
- Sulindac: renal sparing
- Indomethacin: increase CNS toxicity in elderly
- Piroxicam: increase GI effects
15
Q
General principles of opioid use
A
- Choose the appropriate route
- Start with the lowest dose possible
- Titrate quickly to desired effect or intolerable adverse effects
- Schedule agents around the clock
- Use PRN doses for breakthrough pain
- Use equianalgesic doses
- Anticipate and manage adverse effects
- Understand tolerance and dependence versus addiction
