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56 Cards in this Set

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Discuss the
concept of comfort
central to the art of nursing.
Each individual has
physiological, social,
spiritual, psychological, and
cultural characteristics that
influence how comfort is
interpreted and experienced.
The context of comfort is the
umbrella under which pain and
pain management options are
viewed. Factors affecting:
illness, nutrition, exercise,
environment, meds, stress
Explain the pn
mgmt policy
by Ca BRN
1-assess, document, treat pain
2-begin interventions before
pain is severe - early
3-pain mgmt should include
non-pharmocological means
4-RN uses judgement with PRN
schedule
Define:
Addiction
Physical dependence on med,
has psychological, environmental
and genetic etiology. Using
med despite negative impact on
life.
antagonist
blocks receptor - no response
analgesic
medications that relieve
pain
opioid tolerance
pt no longer gets same
desired effect of medication
must increase dose/amt
to get that effect
long term use
opioid withdrawl
after 2 weeks stop using med:
eyes + nose watery
n/v/d
hot, diaphoretic
irritable, restless
pain threshold
how much pain a person
can tolerate
level of stimulus that
results in perception of pn
agonist
fits perfectly on receport
sites - desired effect
causes response
Cultural
factors/responses
associated with pain
the meaning that a person
associates with pain effects the
experience of pn and how one
adapts. Ethnicity- cultural
beliefs/values
learned behavior
gender - females more verbal
Psychological
factors/responses
associated with pain
anixety over pain can lead
to fatigue that begins the
pain cycle. pt can't sleep,
muscles tense = more pain
cycle repeats itself
Physiological
factors/resonses
associcated with pain
age
nervous system
pain impulses
low to moderate pain
continuous, sever, deep pain
geriatric considerations
of pain control
and nursing implications
elderly are vague, tend to deal
with pain more before they
speak up.
believe that nothing can be done
for pain, fear of meds
define pain
and dicuss what is
meant by experience of pn
unpleasant subjective
sensory and emotional
experience associated with
either actual or potential
damage. 5th vital sign.
whatever the experiencing
person says it is, existing
whenever s/he says it does
common
misconcpetions about
pain
drug abusers/alcoholics
overreact to discomfort
minor illnesses=less pain than
others
pain meds lead to addiction
chornic pn is psychological
characteristics
of acute pain
onset is quick
intensity levels vary
signs - sympathetic nervous sys
duration - less than 6 months
has predictable ending
characteristics
of chronic pain
recurrent, duration - lasts
longer, parasympathetic nervous
system involved, uncertain
cause/duration, can lead to
depression, isoloation
break through
pain
pain that extends
beyond treated steady
chronic pain:
incident pain
end-of-dose failure pain
spontaneous pain
Stages of PAIN:
Transduction
peripheral pn stimulus
chemical mediators are
transducted from action
potential to potential for pain
Ibuprofin works with
prostaglandins so they don't
get transduced to pain signal
Transmission
substance P
stimuli transferred
across synapse by substance P
so that it can go to a higher
brain function
Perception
conscious of pn
pn senstation
can treat with distraction
guided imagery
Modulation
neurons originating in
brainstem descend to spinal
cord and release substances
-analgesic effectiveness
-tricyclic antidepressants
Somatic pain
originates from
skeletal muscles, ligaments,
joints
easy to pinpoint
Visceral pain
deep organs, intermittent,
not easily localized.
central pain
resulrting from an d/o that
causes CNS damage
referred pain
common phenom in visceral pain
because many organs have no
pain receptors - pain is felt
in part of body separate from
source of pain an may assume
characteristic
radiating pain
place of orgin and going
somewhere else
back pn radiating to legs
phantom pain
pain experienced in a body
part that has been surgically
or traumatically removed
neuropathic pain
pain that results from a
disturbance of function or
pathologic change in a nerve
organic
physiologic reason
Psychogenic pain
psychologic in nature but is
truly real pain - stress,
mental health
Gate control theory
of pain transmission
and perception
pain has obligatory emotional
and cognitive components. In
addition, pain impulses can be
regulated or even blocked by
gating mechanisms located
along the central nervous
system. The theory suggests
that pain impulses pass
through when a gate is open
and that impulses are blocked
when a gate is closed.
Closing the gate is the basis
for pain-relief interventions
differentiate between
pain tolerance and
pain threshold
Tolerance: level a person can
put up with, perception
of pain, lowers because:
emotions, discomfort, fatigue
Threshold: point at which
person feels pain, raise pain
threshold with: diversion,
empathy, sympathy, rest, meds,
anti-anxiety agents
Expalin comfort
care in r/t pain
control outcome
by providing comfort to
patients you can relieve
some of their pain, our
job is to provide comfort
different types
of pain rating
scalses
10 point scale - 0=no pain
10=worst pain ever
Wong-Baker - faces indicating
pain level for non-verbal pt
PRN around
the clock dosing
Nursing judgement to decide
if paitent needs around the
clock medication. one way to
maximize pain relief while
minimizing drug tox
noninvasive
pain relief
measures
music, reading, games,
meditation, guided imagery,
shower/bath, massage,
reposition, transcutaneous
electrical nerve stimulation
TENS - electric current over
painful region
Heat / Cold
therapy
Heat: application of moist or
dry heat to skin, superficial
or deep via heating pad,
bottle, compress, whirpool
Cold: appilaction of moist or
dry cold to skin via ice pack,
bath, running water.
Evidence: cold relieves more
pain than heat therapy, works
faster than heat, provides
longer relief
Morphine
SC, IM, PO, IV, PR, Epidural
moderate to severe pain
s/e: hypotension, decrease RR,
sedation, n/v, constipation,
urinary retention, irching,
euphoria, disorientation
Meperidine
IM, PO, IV, SC
moderate to severe pain
s/e: hypotension, decrease RR,
sedation, n/v, constipation,
urinary retention, irching,
euphoria, disorientation
Hydromorphone
SC, IM, PO, IV, PR
moderate to severe pain
s/e: hypotension, decrease RR,
sedation, n/v, constipation,
urinary retention, irching,
euphoria, disorientation
Hydrocodone
PO, PR
moderate to severe pain
s/e: hypotension, decrease RR,
sedation, n/v, constipation,
urinary retention, irching,
euphoria, disorientation
Codeine
mild to moderate pain
s/e: hypotension, decrease RR,
sedation, n/v, constipation,
urinary retention, irching,
euphoria, disorientation
Aspirin
Acetaminophen
non-narcotic
Aspirin: PO, PR, mild pain,
s/e gastric upset/bleed,
platelet aggregation
Aceta: PO, PR, mild-mod pain
s/e rash n/v
Naloxone (narcon)
IV
Complete or partial reversal
of opioid-induced respiratory
depression - raises BP, HR, RR
Special problems assoc.
with control of chronic
and intractable pain
It is necessary to give
required analgesics on a reg.
basis, prescribing analgesics
prn is ineffective/causes
suffereing, even when pn
subsides, client should
continue taking med,
often a comprehensive tx plan
is needed
Assembly Bill 791
it is the RNs job to:
assess and treat in a timely
fasion/effectively
it is a vital sign
document
DSCR: developmental
stages of pain
Infant - avoidance
Toddler - externalizes
School age - bravery
Adolescent - dramatic
Adult - denial
Elder - vague
sympathetic
and para-sympathetic
nervous system
s+s
Symp: acute pain, fight or
flight, elev HR, RR, pupils
dilate, diaphoretic
Para: chronic pain, skin dry,
HR, RR normal
Durin the trasduction
phase of nociception,
which method of pain
control is most effective?
Ibuprofen
Pin is viewed as a
separate disease
Pain hx
guidelines
OLDCART
onset, location, duration,
character, agg. factors,
radiation, treatment previously
duration, description
The client is c/o of
L shoulder pn. Your
response?
a. request the pt to decribe pn
b. inquire if pn is throbbing
c. ask if pt wants meds
d. instruct pt to
compete pn questionnaire
a. request the pt to describe
pain
Which client problem would
be most appropriate for the
client experienceing
acute physical pain
a. ineffective coping
b. potential for inj
c. alteration in comfort
d. altered sensory input
c. alteration in comfort
When preparint the plan of
care for the pt in acute pn
from post op, the RN
should include:
a. administer pn meds as soon
as time allows
b. use non-pharm methods
c. apply heat (works faster)
d. instruct family give PCA
a. admin pn meds as soon
as time allows
PCA definition
paticnt controlled
analgesia
can or cannot have basal
rate continuously infused
puts pt in charge