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94 Cards in this Set
- Front
- Back
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what is the 5th vital sign
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pain
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what is pain
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personal experience,
unpleasant sensation caused by stimuli on nerve endings, warning sign of actual or potential tissue damage, presents physical & psycholigal dangers to health and recovery |
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what is the only valid measure of pain
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self report
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pain is more than just a change in the nervous system, it also reflects what?
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pt. past experiences with pain and their personal meaning.
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give an example of pain without actual tissue damage
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the pain of grief
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what are: nociceptors
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sensory pain receptors
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where are nociceptors found
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skin, BV's, sub-q tissue, muscles, viscera, joints and other structures.
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nociceptors respond to what?
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tissue injury stimuli or noxious stimuli
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noxious stimuli can present as what?
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pressure, temp. change, chemical exposure
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mechanical excitation
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pressure
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thermal excitation
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temp. change
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chemoreceptor excitation
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chemical exposure
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biomediators
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chemical substances released when cells are injured from stimuli
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examples of biomediators?
What are their purpose? |
serotonin prostaglandins, histamine, and bradykinin
purpose: help inhibit noxious process. |
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endorphins
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opiod receptors that play a role in inhibition of pain perception.
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where does pain modulation (the release of endorphins) occur
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dorsal horn of spinal cord
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types of pain
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cutaneous, deep somatic, visceral, radiating/referred, neuropathic, phantom pain, phantom sensation, intractible
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a paper cut would be what kind of pain
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cutaneous pain
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pain of ligaments, tendons, bone, bv's, and nerves
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deep somatic pain
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visceral pain
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results from pain in organs, cranium, thorax
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give an example of pain seen with a bowel obsruction
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visceral pain
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pain that extends to tissues
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radiating pain
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pain that is felt in the body , but is removed from the site of the stimuli causing the pain.
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referred pain
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neuropathic pain
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shooting, stabbing pain, often severe in nature
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neuropathatic pain is often due to:
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damage to CNS, PNS due to infection or disease.
*may not be associated with actual tissue damage. |
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phantom pain
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painful sensation percieved in a body part that is missing (amputated limb)
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intractable pain
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pain that is resistant to relief
ex: malignant pain as seen in cancer |
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pain threshold
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amt. of pain stimulation a person requires in order to feel pain.
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pain sensation
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the asam as pain threshold
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this concept describes what? When conditions are normal, the feeling of pain is uniform until there is an event involving tissue damage. Now, the same stimulus that once caused little pain can now produce intense pain
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pain threshold/pain sensation
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Pain reaction involves which system?
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autonomic nervous system
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pain tolerance
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highest amt. of pianand duration that a person can tolerate. each persons tolerance is different
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pain tolerance increases or decreases with age?
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increases
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factors affecting pain experience
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ethnic and cultural values, developmental stage, environment, past experience, anxiety and stress
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gate control theory of pain transmission
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pain, sensations of skin and muscles travel along the same nerve pathway, the brain can't interpret pain while interpreting another impulse.
massage, ice, heat, thoughts, tens unit may block |
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tens unit
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delivers low-voltage electrical impulses to a localized area.
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conscious control behavior of pain transmission
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biofeedback, visual imagery, medication, endorphins, acupuncture, placebo, TENS
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nurses role in pain control
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be an advocate, listen to verbal/non-verbal cues, assess and reassess
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assessing pain
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take a pain history, OPQRST of pain
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acute pain
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temporary, short duration, less than 6 months, results from tissue damage due to surgery, trauma, inflammation
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chronic pain
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prolonged, cause not definite, lass more than 6 months, r/t depression, affect ADL's, may increase at night
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physiologic signs of pain
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increased pulse, resp., B/P, diaphoresis, pallor, dialated pupils N/V, muscle tension
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Behavioral signs of pain
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guarding, narrow focus, withdrawal, impaired thought proocess, distracting behavior.
**remember: everyone is different. |
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Nursing diagnosis R/T pain
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pain: acute or chronic, altered comfort, knowledge deficit, impaired physical moility, sleep pattern disturbance, depression
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Nursing Implementation r/t pain
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pain management that is individualized, combination pain control therapy, treatment before it becomes severe
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additive effect
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effect of combining pain control therapies
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some non-pharmacologic interventions to help maintain comfort
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clean and reposition, maintain and change dressings, hot/cold compresses,massage, imagery, biofeedback relaxation techniques, diversional activity
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ceiling effect
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level at which a high dose of pain med. results in no further increase in analgesic
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full agonists
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pure opiods, provide max pain inhibition.
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ex. of full agonists
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demerol, morphine, codeine, darvon, dilaudid, tylenol #3, no ceiling effect- dose can be increased.
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which classification of drugs act like opiods, but not recomended for terminally ill. why?
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mixed agonists such as nubain, stadol talwin. they have a ceiling effect.
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partial agonists
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block some receptors and have ceiling effect. Buprenex
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how do opiods analgesics work?
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CNS - modify pain perception, provides sense of euphoria
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opiod Anglgesics
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work in CNS to modify pain perception and provide sense of euphoria
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Name an opiod antagonist
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Naloxone (Narcan)
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side effects of opiods analgesics
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respriatory depression, N/V, urinary retention, dry mouth, constipation, puritus, addiction, dependancy, decreased alertness
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what is the most serious side effect of opiods analgesics
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respiratory depression
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Level 7 sedation assessment and what are symtoms
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dangerous agitation: pulling at ET tube, catheter, climbing over bedrail
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level 6 sedation assessment and what are symptoms
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very agitated: doesn't respond to frequent verbal reminding of limits
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level 5 sedation assessment and what are symptoms
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agitated: anxious but calms down with verbal instructions
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level 4 sedation assessment and what are symptoms
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calm and cooperative: calm, awakens easily, follows commands
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level 3 sedation assessment and what are symptoms
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sedated: difficult to arouse
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level 2 sedation assessment and what are symptoms
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very sedated: arouses but not communicate
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level 1 sedation assessment and what are symptoms
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unarousable: minimal or no response to stimuli
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NSAIDS
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non-opiods analgesics that act on peripheral nerve endings at the injury site to decrease inflammation
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Ibuprofen, ASA, Acetaminophen, and corticosteroids are examples of what?
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non-opiods analgesics
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what action does asprin have?
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blocks protsaglandin synthesis.
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what non-opiods analgesic increases pain threshold?
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acetaminophen
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corticosteroids
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anti-inflammatory
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side effects of some opiods analgesics
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stomach ulcers, gastric bleeding, impaired blood clotting
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drugs developed for other uses other than analgesia, but have been found to decrease certain types of chronic pain
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adjuvant analgesics
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types of adjuvant analgesics
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valum, elavil, tegretol, klonopin
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valium as a tranquilizer is used to treat what?
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painful spasms
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Elavil is used for what?
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as an antidepressant, it's used to treat neuropathy
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which adjuvant analgesics are anticonvulsants and used to treat painful neuropathies?
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Tegretol and klonopin
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Ladder approach
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3 step approach recommended by WHO.
Step 1: NSAID/Non-opiod/Adjuvant Step 2: introduction of weak opiod until ceiling is reached / non-opiod/adjuvant Step 3: stronger opiod / non-opiod/ Adjuvant |
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IV route of delivery is best for what kind of pain? Why?
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Acute pain. It has the most rapid onset.
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Bolus method of pain med. delivery
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continuous infusion
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which rout of delivery has a slower absorption and slower onset. how often do you repeat administration?
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IM. repeat Q 3-4 HR
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which is the preferred route of delivery for pain meds? Why?
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Oral. it's easiest. slower onset, but longer duration, but pt. must be able to tolerate some fluids.
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how often do oral doses need to be repeated?
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Q4 Hr.
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CSCI
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battery operated pump with 23 g. needle that delivers pain meds.
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what is a good pain med delivery used for chronic pain?
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transdermal patches
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paient controlled analgesia
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good for acute pain r/t surgical incision, L&D, chronic pain
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Intraspinal delivery of pain meds. in which med runs through cath. into epidural space of spinal column.
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epidural.
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MS and Fentanyl (sublimaze)
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used together for epidural
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what are some nursing responsibilities in regards to epidural care?
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check rate of delivery, intactness of cath.
if resp rate <10/min, notify anesthesia assess for itching, sedation level |
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routs of delivery for pain meds
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IV
Bolus PCA IM Oral Sub Q CSCI Transdermal patches Pt. controlled analgesia Intraspinal delivery |
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Non-pharmacologic invasive procedures for pain management
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nerve block
surgery cordotomy rhizotomy |
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what is a nerve block
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chemical interruption of a nerve pathway - local anestetic into a nerve
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interruption of nerve pathways
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surgery
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cordotomy
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pain in legs and neck
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pain in head and neck for cancer
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rhizotomy
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evaluation of pain
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pain scale
flowsheets day, time onset, activity before and after pain relief measure if outcomes not achieved, explore why is adequate analgesic used? did pt. understate pain? |
