Chapter 46 Pain Management

Front 1

Types of Pain

Back 1

Location, Duration, Intensity and etiology

Front 2

Location

Back 2

Radiate-when a pain spreads or extends to other areas

Front 3

Location

Back 3

Referred Pain-pain appears in other parts of the body; in an area remote from the organ causing the pain

Front 4

Location-Visceral

Back 4

Visceral Pain-pain arising from organs or hollow viscera is often perceived in an area remote from the organ causing the pain

Front 5

Duration-acute pain

Back 5

When pain lasts only thru the expected recovery period, whether it has a sudden or slow onset; regardless of intensity.

Front 6

Duration - chronic

Back 6

Prolonged pain, lasting over 6 months and interferes with functioning.

Front 7

Acute Pain

Back 7

Sympathetic nervous system responses; increase pulse, resp. rate, BP, Diaphoresis, Dilated pupils

Front 8

Chronic Pain

Back 8

Parasympathetic Nervous system reponses; VS normal, dry warm skin, pupils normal

Front 9

Cancer pain

Back 9

may result from the direct effects of the disease, or may be unrelated.

Front 10

Intensity

Back 10

Rate pain on 0-10 scale; w/1-3 mild; 4-6 moderate and 7-10 severe.

Front 11

Etiology-Physiological pain

Back 11

When an intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care.

Front 12

Somatic Pain

Back 12

originates in the skin, muscles, bone or connective tissue. (paper cut or sprained ankle)

Front 13

Visceral Pain

Back 13

activation of pain receptors in the organs or hollow viscera. cramping, throbbing, aching

Front 14

Neuropathic pain

Back 14

damaged or malfunctioning nerves (phanton limb, spinal cord injury)

Front 15

Gate Control Theory

Back 15

Higher centers in the brain, esp. those assoc. with affect and motivation are capable of modifying the substantia gelatinosa and influence the opening or closing of the gates. In Dorsal Horn

Front 16

GCT

Back 16

When the subgel is excited, gates open to transmit pain. When subgel is calm thru touch, warmth, moisture; gates close and inhibit further transmission of pain.

Front 17

GCT

Back 17

Nurses use this model to stop nociceptor firing (treat the cause), apply topical therapies (heat, ice, elec, msg) and address clients mood (fear, anxiety, anger) and goals

Front 18

Nonverbal signs of pain

Back 18

Facial expression-Clenched teeth, tightly shut eyes, biting lower lip, facial grimaces

Front 19

Nonverbal

Back 19

Vocalizations moaning, groaning, screaming, crying. Immobilization of a body part.

Front 20

Nonverbal

Back 20

Behavioral changes; confusion restlessness. Older adults w/ chronic pain may get hostile or aggressive.

Front 21

Pharmacologic

Back 21

Opioids (Narcotics), Nonopioids/NSAIDS, coanal- gesic drugs.

Front 22

Pain Mgmt

Back 22

Align proper analgesic with intensity of pain. Use combos to reduc high doses and max pain control w/min side effects.

Front 23

Nonopioids/NSAIDS

Back 23

Acetaminophen (tylenol), NSAIDS ibuprofen (advil, motrin) or aspirin. Ceiling effect - more drug does not procuce more benefit. Thin line btwn therapeutic dose and toxic dose

Front 24

Tylenol

Back 24

Kidney damage w/high dose or prolonged use. <4g/day.

Front 25

Opioids

Back 25

Full agonists-pure opioids that bind tightly to mu receptor sites, = max pain inhibition. Morphine/oxycodone No ceiling, can incrs dose to relieve pain. No daily dose limit

Front 26

Mixed Agonist/antagonist

Back 26

Will relieve pain if no pure opioids have been taken; but can block effects when taken in combo. ceiling effect

Front 27

Partial Agonists

Back 27

Ceiling effect.

Front 28

Strong Opioid analgesics

Back 28

Opioids scheduled as controlled substance due to potential for misuse. mood swings. severe pain when other meds have failed. Demerol.

Front 29

Opioid Side Effects

Back 29

Respiratory depression. Assess alertness and resp. baseline b4 administering.

Front 30

Opioid Side Effects

Back 30

Constipation, Nausea, resp. depression, pruritus (itching), urinary retention

Front 31

Nonpharm Pain Mgmt

Back 31

Physical, cognitive, behavioral and lifestyle pain mgmt strategies that target body, mind, spirit, & social

Front 32

Physical Modalities

Back 32

Cutaneous stimulation, ice, heat, immob or therapeutic exercises

Front 33

Mind Body

Back 33

Distracting, relaxation, imagery, meditation, biofeed back hypnosis, counseling.

Front 34

Lifestyle Mgmt

Back 34

Monitor stress, exercise, nutrition, symptom monitor

Front 35

Physical Intervention

Back 35

The goal of physical interv. is to provide comfort, alter physi ologic response to reduce pain perception and optimize functioning.

Front 36

Cutaneous Stim

Back 36

Distracts the client as they focus on tactile stimuli, instead of the pain. Interferes with the transmission and perception of pain. Contra indicated in areas of skin brk dwn or impaired neurological abilites.

Front 37

Diagnosing

Back 37

Location, related factors both physical and psycho. R/T can include deficient knowledge of pain mgmt techniques or fear of drug addition

Front 38

Diagnosing

Back 38

Pain can affect many areas of a person's functioning, pain may be the etiology of other rn diagnoses:

Front 39

Planning

Back 39

Interventions selected to meet individual needs of client. Consider clients ability and willingness to participate. Use variety of pain relief measures. Act before pain becomes too severe. Align measures w/severity of pain. Don't give up and educate client and caregivers

Front 40

Client Teaching

Back 40

Keep pain diary, educate, discuss actions, side effects, dosages, freq, etc. Demonstrate and have client or caregiver demonstrate proper skills to administer analgesics.