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50 Cards in this Set
- Front
- Back
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In an assessment, pain is?
If a patient is no eliciting pain they may still have it How often should pain be assessed? |
Whatever the patient says it is
Pain is consdiered a fifth vital sign and should be assessed on a regular basis. |
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What are some of the general aspects of pain that can become a patient and those close to them during a time of pain?
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it alters physical and mental status
can be be draining causes a decreased quality of life is exhausting and demands energy can have a huge financial impact on an individual and their family |
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Thermal, chemical, or mechanical stimuli usually cause pain. Energy of these stimuli are converted to electrical energy. This energy conversion is transduction (phase 1). During ___________ the pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor) beginning the __________ of pain (phase 2).
Ask students to recall physiology. When cellular damage occurs by thermal, mechanical, or chemical stimuli, neurotransmitters such as prostaglandin, bradykinin, potassium, histamine, and substance P are released. These substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response. ________ is the point at which the client experiences pain. Recall that no one single pain center exists (phase 3) The inhibition of the pain impulse is known as ________(phase 4). |
transduction
transmission Perception modulation |
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What is the gate theory of pain?
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The Gate-Control Theory suggests that pain impulses pass through when a gate is open and are blocked when the gate is closed. The gates can be physiological, emotional, or cognitive processes.
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What is the physiological pathway of pain?
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Physiological Response occurs when pain impulses ascend the spinal cord toward the brain stem and thalamus. The ANS becomes stimulated. Pain thus triggers the fight-or-flight reaction of the GAS. Stimulation of the sympathetic branch of the ANS results in physiological response (see Table 43-1). It will be important to remember that a client in pain will not always experience a change in vital signs!
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What is the behavioral theory regarding pain?
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Behavioral responses to pain will vary. If pain is untreated, the client’s life will be altered. Pain threatens a client’s physiological and psychological well-being.
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What is considered acute pain and what is considered chronic pain?
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Acute: temporary (less than 6 months)
anticipated clear cause of pain, usually deals with tissue damage, and is expected to heal. chronic: long term (more than 6 months) Chronic cancer pain Chronic Non-cancer pain- neuralgia, neuropathic pain Chronic Episodic Pain- Migraines, sickle cell crisis |
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What is the most reliable indication of pain?
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pt. report of pain
pain is whatever the patient says it is and occurs whenever the patient says it does |
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What demographics are at the highest risk for under diagnosed pain?
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infants, elderly, addicts, people who cannot speak or who are disabled.
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What two age groups may not be able to adequately express pain?
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young and the old
box 43.3 table 43.3 |
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In an assessment, pain is?
If a patient is no eliciting pain they may still have it How often should pain be assessed? |
Whatever the patient says it is
Pain is consdiered a fifth vital sign and should be assessed on a regular basis. |
|
|
What are some of the general aspects of pain that can become a patient and those close to them during a time of pain?
|
it alters physical and mental status
can be be draining causes a decreased quality of life is exhausting and demands energy can have a huge financial impact on an individual and their family |
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Thermal, chemical, or mechanical stimuli usually cause pain. Energy of these stimuli are converted to electrical energy. This energy conversion is transduction (phase 1). During ___________ the pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor) beginning the __________ of pain (phase 2).
Ask students to recall physiology. When cellular damage occurs by thermal, mechanical, or chemical stimuli, neurotransmitters such as prostaglandin, bradykinin, potassium, histamine, and substance P are released. These substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response. ________ is the point at which the client experiences pain. Recall that no one single pain center exists (phase 3) The inhibition of the pain impulse is known as ________(phase 4). |
transduction
transmission Perception modulation |
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What is the gate theory of pain?
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The Gate-Control Theory suggests that pain impulses pass through when a gate is open and are blocked when the gate is closed. The gates can be physiological, emotional, or cognitive processes.
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What is the physiological pathway of pain?
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Physiological Response occurs when pain impulses ascend the spinal cord toward the brain stem and thalamus. The ANS becomes stimulated. Pain thus triggers the fight-or-flight reaction of the GAS. Stimulation of the sympathetic branch of the ANS results in physiological response (see Table 43-1). It will be important to remember that a client in pain will not always experience a change in vital signs!
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What is the behavioral theory regarding pain?
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Behavioral responses to pain will vary. If pain is untreated, the client’s life will be altered. Pain threatens a client’s physiological and psychological well-being.
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What is considered acute pain and what is considered chronic pain?
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Acute: temporary (less than 6 months)
anticipated clear cause of pain, usually deals with tissue damage, and is expected to heal. chronic: long term (more than 6 months) Chronic cancer pain Chronic Non-cancer pain- neuralgia, neuropathic pain Chronic Episodic Pain- Migraines, sickle cell crisis |
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What is the most reliable indication of pain?
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pt. report of pain
pain is whatever the patient says it is and occurs whenever the patient says it does |
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What demographics are at the highest risk for under diagnosed pain?
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infants, elderly, addicts, people who cannot speak or who are disabled.
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What two age groups may not be able to adequately express pain?
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young and the very old
box 43.3 table 43.3 |
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How does fatigue affect a client's perception of pain?
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it can increase the perception of pain and cause problems with sleep and rest.
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T/F genetic make up may affect a persons pain threshold
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true
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The following can have an effect on the perception and reception of pain cuasing innacurate reporting?
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spinal chord injuries, nueropathy, neurological diseases
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Repeated subjection to pain may increase the individuals ability to handle the pain. Additionally having pain may increase an individuals dependence upon others.
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It is important to remember that spirituality stretches beyond religion.
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The following are different subsections of how an individual may cope with pain
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physiologically
psychologically socioculturally- attention, previous experiences, family support or what is acceptable display in that culture (stoicism vs open presentation) spiritually |
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In order to treat pain effectively it is important the hcp develop a trusting relationship with the pt. and their family. They have to feel that if they are experiencing pain that you will do what you can to relieve thier pain.
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The pain management approach needs to improve the pt.'s quality of life.
Clinical guidelines are available for managing pain. American Pain Society National Guideline Clearing House |
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P
Q R S |
palliative or prevocative precipitating factors (what causes pain, what makes it worse)
Quality (sharp, dull, etc) Region (depth and breadth) Severity (1-10 scale) Encourage clients to report their pain In a cognitively impaired client assume pain is present (APP) |
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Aside from PQRST what else is important to ask when assessing pain?
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How does it affect ADL's, how has it affected work school or play, relief measures (anything that makes it better), anything that makes pain worse (aside from cause), When does the pain begin, how long does i last, how often does the pain occurr, has this ever happened before or anything like it, family history of pain similar to this.
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Assessment should not only identify present pain but also the potential for pain and from there a pain diagnosis and planning should include what key factors...
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it should be a NANDA diagnosis
mandata a thorough assessment and reassessment address the specific nature of the pain interventions should be established after the patient specific goals and outcomes have benn identified |
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There are pharmacological and non pharmacological approaches to reducing or managing pain. The patient should be made an active particpant in this relief or mangement as much as possible.
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Cutaneous stimulation will require a physicians order (massage, TENS (transcutaneous electrical nerve stimulation, heat, cold, accupressure)
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pain approaches can be used in combination.
Patients will not like all of the methods of pain management even though it is meant to reduce pain. See if it is possible to do it through a different route and explain to them the differences in what each method offers and entails. (risks, effects , etc.) |
blah blah
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chronic use of NSAIDS is known to cause?
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renal insufficiency and GI bleeding
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Opioids are indicated for what types of pain?
What are the AE's of opioids? |
moderate to severe pain
nausea, vomiting, constipation, urinary retention, and altered mental processes |
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Adjuvants and analgesics are known to be helpful in collaboration with other pain meds but have indications on their own as well. Examples of some that are used include?
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TCA's and anticonvulsants
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PCA stands for and is used for what purpose? What are the most commonly used PCA drugs?
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Patient Controlled Analgesia (only they can push the button)
Fentanyl, Morphine, and hydropmorphone |
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Topical agents such as Lidocaine and EMLA produce analgesia where?
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in the soft tissues (pretty much everything but bones and organs)
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______ is the go to antidote for pain med overdose and it should be on hand when pain meds are being administered.
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Narcan
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In addition to having Narcan on hand what else should be done when monitoring a person under pain meds through IV?
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Also you will need to monitor IV insertion sites, lines, and IV controllers to ensure the proper amount of medication is being delivered
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What is the gold stadard for pain relief and how do drugs like these compare?
Codeine- hyrdrocodone- fentanyl- hydromorphone- methadone- meperidine- |
Morphine
Codeine- shorter acting and weaker effect hyrdrocodone- comes in combo with ibuprofen and acetominophen (available only in combo with other ingredients) fentanyl-only use with clients who are opiod tolerant hydromorphone- 8 times stronger than morpheine methadone- long half life meperidine- fast acting weak analgesic not used orally or for more than 24 hours (produces a toxic metabolite) |
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For opioids the AE's can be dealt with by administering what for n/V and what for the constipation?
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anti-emetics should take care of n/v (usually a transient AE)
The use of a laxative and or stool softener should be ordered along with an opioid FOR REGULAR ADMINISTRATION NOT PRN and the patient should be taught proper bowel regiment |
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What is the most commonly given drug for PCA and what stipulations does a pt. need to meet in order to partake in PCA?
What is the patient controlling with the analgesia? What about PCA makes it so worth using that studies have proven? |
Morphine
needs to be taught how to use it properly and needs to be able to press the button and cannot be cognitively impaired. the dosage studies have shown that a patient can treat the pain before it becomes more severe and that less pain medication is used this way while still maintaining pain control. |
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Adjuvant therapy is used with what kind of pain commonly?
Anitepileptics treat= TCA's treat= |
chronic
It can relieve pain by itself and it can potentiate the effects of the analgesics when used with them neuropathic pain, diabetic neuro pain, and postherpetic nerualgia (PHN) treats CHRONIC neuropathic pain |
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How likely is a patient to get addicted to pain meds that are used for cancer?
How is medication for chronic pain given (prn or regularly? With administration of pain meds what is the hierarchy of meds (what do you try first, and last?) |
1-24%
REGULARLY first try NSAIDS/adjuvants then progress to opioids (sustained and immediate release) 3rd spinal/epidural, opioids(clonidine/local anasthetic), nerve blocks, etc. . (see the three step approach on figure 43-15) |
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Breakthrough pain is considered managed but what is it and how is it handled?
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Even when a patient is placed on long-acting, regular timed medication there may still be episodes of pain between doses. This is referred to as "breakthrough pain". A short acting or immediate-release opioid is usually prescribed to be taken at these times.
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What medication is used to treat chronic pain when oral morhphine can not be given?
what is the preferred route for sustained pain relief? |
Fentanyl (100 times stronger than morphine and lasts 48 to 72 hours (can be given trandsdermally or transmucosally)
only given transmucosal with breathrough pain oral |
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Are placebo's used to treat pain?
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it is considered unethical and decietful so NO
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Fear of addiction can cause distribtuion of the pain med to be altered by the HP.
tolerance and physical dependence do not denot addiction because addiction is what? |
addiction is considered to be a neruobiological disease and social environmental and pyschological factors cuase it.
tolerance= is just the diminished reaction of the body to a drug physical dependence= is the state of adaptation that is a cause of drug withdrawal syndrome |
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The joint comission declared 2000- 2010 as the decade for which "Pain Control and Research"
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Pain centers treat clients on an inpatient and outpatient basis and client contracts are kept
palliative care is used to diminish pain the goal is COMFORT and to learn how to LIVE LIFE FULLY WITH THE CONDITION YOU HAVE Hospice is used as end of life care and palliative care is large part of that Palliative care is not only used in Hospice however |
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To evaluate the effectiveness and neccessitry for pain med administration the nurse should assess this how long after initial dose and thereafter.
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15-30 minutes and ongoing thereafter
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It is important to assess if the pt . has met their goals with the use of the pain mgmt techniques
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It is also important to assess the pt. s perception of the nursing interventions
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