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ADN002 MED SURG > Week 2 Pain > Flashcards

Week 2 Pain Flashcards

(73 cards)

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1
Q

What is Pain?

A

CNS reaction to potential harmful stimuli

Acute - Sudden onset
Early warning to seek treatment to prevent damage to the body

Chronic- Lasting long time or frequent recurrence.

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2
Q

What is pain

A

May result from inflammatory response that cause tissue injury and release of

Histamine
Prostaglandins
Serotonin
Bradykinin
Intiate action potential along sensory fiber

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3
Q

Nociceptors

A

Activated pain receptors
- Messages sent to brain cortex
- Appropriate Autunomic and reflect responses activated

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4
Q

Pain Stimuli

A

Nociception

chemical, mechanical, thermal stimulation
More only small fiber
Inhibitory neuron activated
Neuron sends message to brain
Gate is open

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5
Q

After Pain Stimuli

A

No input
-Inhibitory neuron prevents projection neuron from sending signals to brain

Normal Somatosensory Input
- More only large stimulation
Gate also called

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6
Q

Reflex responses to pain

A
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7
Q

What is Pain?

A

Neurotransmittters
- Endorphins and enkephalins
Bind to with opiate receptors in the CNS
Inhibit pain impulses

Natural Analgesic Effect
- After painful stimuli affect the body
- Pain is subjective
Everyone is different
Same injury but different response

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8
Q

Endogenous Analgesics Released After Painful Stimuli

A
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9
Q

Pain

A

Unpleasant sensory, emotional experience with actual or potential tissue damage

Common reason for seeking care

5th Vital

Pain assessed in all patients and have right to appropriate assessment and management of pain

Pain is what person says

Pain is present in whenever a person says it is.

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10
Q

Nociceptors

A

Peripheral Pain receptors

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11
Q

Ability to Feel Pain

A

Nociception

  1. Transduction- activation of pain receptors
  2. Transmission- Painful stimuli message reaches spinal cord and higher brains
  3. Perception- Sensory process from pain stimulus. Personal interpretation- pain threshold
  4. Modulation- Process of inhibiting or modifying sensation of pain
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12
Q

Patho of Pain

A

Bradykinin- vasodilator, histamine release

Prostaglandins- Increases sensitivity of pain

Neuromodulators- Endorphins, enkephalins and suppress pain reception

Substance P- Increases rate of firing and sensitivity of nerves

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13
Q

Acute Pain

A

Now

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14
Q

Chronic Pain

A

More than 3 months ago

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15
Q

Exacerbation

A

Old pain that returned

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16
Q

Cutaneous Pain

A

Localized to the skin

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17
Q

Referred Pain

A

Pain felt in another part of the body

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18
Q

Nociceptive

A

Pain caused by injury or inflamamtion of some of the body

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19
Q

Intractable Pain

A

Severe, constant, relentless, and debilitating pain not curable by any means

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20
Q

Breakthrough Pain

A

Severe Pain that erupts while a patient is already medicated with long lasting pain killer

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21
Q

Neuropathic Pain

A

Damage to PNS or CNS as result of abnormal processing

Neuroplasticity- ability of brain to adjust to pain

Peripheral Sensitization- Increased sensitivity to an afferent nerve stimuli after cellular damage.

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22
Q

Central Sensitization

A

Changes to Nervous system

Allodynia- Stimuli not painful prior to injury

Hyperalgesia- normal painful stimuli is perceived as more painful than it should

May be hypersensitve to light

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23
Q

Factors that Influence Pain

A

Past
Anxiety
Stress
Depression
Culture
Religion
Age
Gender
Medical History

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24
Q

Gabapentin

A

Treats neuropathy. Neurotonin. anticonvulsant

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25
Acute Pain Effects
Can affect respiratory, cardiovasuclar, endorcrine, and immune systems Stress response increases metabolic rate, cardiac output, risk for physiological disorders Sleep Deprivation
26
Effects of Chronic Pain
Depression Suicide Self Medication Increased disability Supression of immune function slow healing time
27
Characteristics of Pain
PQRST P- what makes it worse or better Q- Quality describe R- region where it is located and radiation S- Severity T- Timing of it
28
Indicators of Pain
Restlessness or irritability Crying and screaming and other verbal expression Grimacing and grinding teeth Touching or grabbing body part Kicking or thrashing or attempting to move away Facial Expressions Verbalizations and vocalizations Body movements Changes in interpersonal interactions Changes in activity patterns and routine Changes in mental status
29
Indicators of Pain
Can be affected by Culture Religion Age Ethnicity Language Be sensitive tp pt that have barriers to expressing their pain
30
Non Pharmacological Interventions
CAM Cutaneous Stimulation - Massage - Thermal Therapies - TENS Unit - Acupressure/ Acupuncture - Biofeedback- Teaching to self to decrease pain - Therapeutic touch
31
Nonpharmacological Interventions
Alternative Therapies - Herbal remedies - Acupuncture Distraction -Humor - Music -TV Relaxation Techniques - Hypnosis - Guided Imagery
32
Analgesics
Releive pain without Disturbing conciousness Altering actions of sensory nerves Antipyertics reduces fever Some have inflammatory responses
33
Basics of Pain Relief
Opiods- Act on CNS to inhibit activity of ascending nociceptive pathways NSAIDS- decrease pain by inhibiting COX- 1 and COX 2 enzymes involved in production in prostaglandins Local anesthetics- Block nerve conduction applied to nerve fibers
34
Pain Relief Interventions Phamacological
Routes PRN meds ATC- Around the Clock PCA- Patient Controlled Analgesia Local Anesthetics Topicals, Patches Intraspinal administration
35
Gerontologic Considerations
More likely to have adverse effects, drug interactions Increased likelihood of chronic illness May need to have more time between doses of medication due to decreased excretion, metabolism, related to aging changes Start low and go slow
36
Acetaminophen
Action- Analgesic, antipyertic Less association with nausea and vomitting than NSAIDS Does NOT cause GI bleeding or interefere with blood clotting Equal to ASA in analgesic and antipyertic effects Metabolized in the liver, small amounts remain in the body as toxic metabolite Liquid 160/ 5 ml 325 mg PR c Acetaminophen
37
Nursing Implications of Acetaminophen
Liver Function, alcohol use, and last dose taken
38
Acetaminophen Uses
General pain mild to moderate Contraindications - Acute or chronic overdose can result in liver damage or fatal liver necrosis Usual therapeutic doses may cause and increase liver damage in those who abuse alcohol
39
Acetaminophen Toxicity
Max dose 4 g Overdose causes hepatoxicity May be accidental or intentional S/S nonspecific Livers levels increased Later manesfestations include jaundice, vomiting, CNS excitement with delerium Increased Ammonia Levels Hepatic Encephalopathy chronic liver damage- Lactulose
40
Overdose Toxicity Acetaminophen
Gastric Lavage within 4 hours Acetylcysetine Oral or IV Does not reverse damage already
41
NSAID
Used for Headache Dysmennorhea Myalgias Neuralgias Fever Common Cold Viral Infections Arthiritic and Rheumatoid Conditions
42
Acetaminophen interactions
Alcohol Barbituates Carbamazepine Phenytoin Rifampin
43
NSAIDs include
Salicylates Antipyertics Used to treat painful conditions: Arthritis - Inflammation of the swelling of the joints, stiffness, and pain Menstrual attacks Gout Attacks Bursitis Sprains
44
NSAIDs
Acetylsalicylic acid Diclofenac Diflunisal Etodolac Fenoprofen Flurbiprofen Indomethacin Keterolac Nabumetone Naproxen Oxaprozin Piroxicam
45
NSAIDs
Differentiate by COX 1 nonselective and COX 2 Inhibitors or COX 2 Inhibitors 9 selective COX officially known as prostaglandins endoperoxide synthase
46
Acetaminophen Adverse Effects
Sensitivity reactions Skin eruptions Urticaria Hypotension Hepatotoxicity Increases HTN c daily use
47
NSAIDS Acetaminophen
Contraindications -Hypersensitivity - Anemia - Children under age 3 -Alcoholism - Malnutrition - Thrombocytopenia - Hepatic or renal impairment - Childhood rheumatoid conditions
48
NSAIDs
Include -Salicylates -Antipyretics Used to treat painful conditions Arthritis- inflammation, swelling, stiffness, joint pain - Menstrual Cramps - Gout attacks - Bursitis, tendonitis - Sprain, muscle strains
49
Commonly used NSAIDs
Aspirin ( acetylsalicylic acid) - Diclofenac - Diclofenac- misoprostol - Diflunisal - Etodolac - Fenoprofen - Flurbiprofen - Ibuprofen - Indomethacin - Ketorlac - Nabumetone - Naproxen -Oxaprozin - Piroxicam
50
Cyclooxygenase
Enzyme maintains normal lining of stomach and intestines Protecting stomach juices Involved in kidney and PLT function
51
Salicylates
Action- Decreases platelet aggregation antipyretic, analgesic Side effects - delayed clotting= bleeding Contra- Pregnant, day of surgery, other anticoags, and bleeding Nursing Implications - Assess for contras and proper order use, and PLT count
52
Aspirin
Nonslective COX 1 and COX 2 Salicytate ANtipyeric and analgesic factors Decrease PLT aggregation Used for Headache Fever Muscular aches and pains Safest and effective drugs for surgery
53
Adverse Uncommon effects of Aspirin
Dyspepsia Nausea, vomiting Blood in stool Anemia GI hemorrhage (elderly)
54
Asprin Contras
Hypersensitivity GI hemmorrhaging Interactions Anticoags Uricosurics- Uric acid Antidiabetics
55
NSAIDS
Aspirin Avoid if menstrual bleeding is heavy Pregnancy women avoid in last trimester and during lactation Avoid one week before or after surgery Avoid alcohol while taking aspirin
56
NSAIDs Propionic Acid Derivatives
Ibuprofen Action- Analgesic, antipyertic Use- General Pain, joints, swelling, and fever Adverse effects- bleeding COntras- bleeding, pregnant and chronic kidney disease Nursing implication- Proper order use, and PLT count
57
Ibuprofen
Non- selective, COX-1 and COX- 2 inhibitor Nonsalicylate Analgesic -Anti flammatory - Antipyertic Used to treat pain: RA Osteoarthritis Arthritis Mild to moderate pain Dysmenorrhea Fever
58
Ibuprofen Adverse Effects
Nausea Occult blood loss Peptic Ulceration Diarrhea Constipation Abd pain Dyspepsia Flatulence Heartburn
59
Ibuprofen HTN in women
Higher risk 78 percent
60
Ibuprofen
Contraindications Hypersensitivity Angioedema Nasal Polyps Pregnancy Bronchospasm reaction NSAIDs
61
Ibuprofen Interactions
Antihypertensives Furosemide Diuretics Avoid if breastfeeding Notify HCP if blood appears in stool, vomitus, and urine New skin rash, itching, jaundice Avoid alcohol, aspirin, and other NSAIDs
62
Meloxicam Oxicam
Oxicam Derivatives Same as other Nsaids Use for RA and OA Used for short period of time and at a low dose Easier on stomach due to higher activity of COX2
63
Indomethicin
Use Moderate to severe OA, RA, gouty arthritis, or ankylosing spondylitis Shoulder pain caused by bursitis or tendinitis Used to treat PDA Not be used for minor pain Action- Same as other NSAIDs Adverse Effects- GI ulcerations Bleeding Increased pain in UC Gastritis Nausea, vomiting Many others
64
Indomethacin Contras
Hypersenstivity Pregnancy Breastfeeding In neonates Bleeding Renal impairment NSAID- induced asthma, rhinitis, hives
65
Indomethacin
Interactions- Aminoglycosides Cyclosporine Methotrexate Antihypertensives Furosemide Thiazide Diuretics
66
Notify Physician Indomethacin effects
Skin rash Breathing problems Visual Disturbances Signs of hypersenstivity to NSAIDs
67
Celecoxib
Decreased risk for gastric bleeding 200mg to 400mg Action COX 2 inhibitor Use - Joint Pain- OA- RA Adverse Effects- coughing blood, jaundice, AKI, anemia Nursing Implications- Liver and kidney function, signs of GI bleed.
68
Selective COX 2 Inhibitors Adverse Effects
Abdominal Pain Dyspepsia Diarrhea CV thrombotic events
69
Selective COX 2 Inhibitors Contraindiactions
Hypersensitivity Asthma Urticaria In the elderly Anaphylactic Reactions In children Third Trimester of pregnancy Lactation
70
Selective COX 2 Inhibitors Interactions
ACEs Fluconazole Lithium
71
NSAIDs Selective Cyclooxygenase 2 Inhibitors
Report- Weight gain Rash Nausea Fatigue Lethargy Jaundice Flu Like Symptoms Black Tarry stools Upper GI distress
72
Selective Cyclooxygenase 2 Inhibitors
Avoid celecoxib during 3rd trimester Avoid: Aspirin Other NSAIDs Alcohol Tobacco
73
Opiates are derived from
Opium poppies Opioids -Natural Synthetic, or endogenous morphine- related substances Analgesic effects - Bind to opioid receptors ( mu, kappa, delta) - Mostly effects mu receptors

ADN002 MED SURG (18 decks)

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