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94 Cards in this Set

  • Front
  • Back
what is the 5th vital sign
what is pain
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
what is the only valid measure of pain
self report
pain is more than just a change in the nervous system, it also reflects what?
pt. past experiences with pain and their personal meaning.
give an example of pain without actual tissue damage
the pain of grief
what are: nociceptors
sensory pain receptors
where are nociceptors found
skin, BV's, sub-q tissue, muscles, viscera, joints and other structures.
nociceptors respond to what?
tissue injury stimuli or noxious stimuli
noxious stimuli can present as what?
pressure, temp. change, chemical exposure
mechanical excitation
thermal excitation
temp. change
chemoreceptor excitation
chemical exposure
chemical substances released when cells are injured from stimuli
examples of biomediators?

What are their purpose?
serotonin prostaglandins, histamine, and bradykinin

purpose: help inhibit noxious process.
opiod receptors that play a role in inhibition of pain perception.
where does pain modulation (the release of endorphins) occur
dorsal horn of spinal cord
types of pain
cutaneous, deep somatic, visceral, radiating/referred, neuropathic, phantom pain, phantom sensation, intractible
a paper cut would be what kind of pain
cutaneous pain
pain of ligaments, tendons, bone, bv's, and nerves
deep somatic pain
visceral pain
results from pain in organs, cranium, thorax
give an example of pain seen with a bowel obsruction
visceral pain
pain that extends to tissues
radiating pain
pain that is felt in the body , but is removed from the site of the stimuli causing the pain.
referred pain
neuropathic pain
shooting, stabbing pain, often severe in nature
neuropathatic pain is often due to:
damage to CNS, PNS due to infection or disease.

*may not be associated with actual tissue damage.
phantom pain
painful sensation percieved in a body part that is missing (amputated limb)
intractable pain
pain that is resistant to relief

ex: malignant pain as seen in cancer
pain threshold
amt. of pain stimulation a person requires in order to feel pain.
pain sensation
the asam as pain threshold
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
pain threshold/pain sensation
Pain reaction involves which system?
autonomic nervous system
pain tolerance
highest amt. of pianand duration that a person can tolerate. each persons tolerance is different
pain tolerance increases or decreases with age?
factors affecting pain experience
ethnic and cultural values, developmental stage, environment, past experience, anxiety and stress
gate control theory of pain transmission
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
tens unit
delivers low-voltage electrical impulses to a localized area.
conscious control behavior of pain transmission
biofeedback, visual imagery, medication, endorphins, acupuncture, placebo, TENS
nurses role in pain control
be an advocate, listen to verbal/non-verbal cues, assess and reassess
assessing pain
take a pain history, OPQRST of pain
acute pain
temporary, short duration, less than 6 months, results from tissue damage due to surgery, trauma, inflammation
chronic pain
prolonged, cause not definite, lass more than 6 months, r/t depression, affect ADL's, may increase at night
physiologic signs of pain
increased pulse, resp., B/P, diaphoresis, pallor, dialated pupils N/V, muscle tension
Behavioral signs of pain
guarding, narrow focus, withdrawal, impaired thought proocess, distracting behavior.
**remember: everyone is different.
Nursing diagnosis R/T pain
pain: acute or chronic, altered comfort, knowledge deficit, impaired physical moility, sleep pattern disturbance, depression
Nursing Implementation r/t pain
pain management that is individualized, combination pain control therapy, treatment before it becomes severe
additive effect
effect of combining pain control therapies
some non-pharmacologic interventions to help maintain comfort
clean and reposition, maintain and change dressings, hot/cold compresses,massage, imagery, biofeedback relaxation techniques, diversional activity
ceiling effect
level at which a high dose of pain med. results in no further increase in analgesic
full agonists
pure opiods, provide max pain inhibition.
ex. of full agonists
demerol, morphine, codeine, darvon, dilaudid, tylenol #3, no ceiling effect- dose can be increased.
which classification of drugs act like opiods, but not recomended for terminally ill. why?
mixed agonists such as nubain, stadol talwin. they have a ceiling effect.
partial agonists
block some receptors and have ceiling effect. Buprenex
how do opiods analgesics work?
CNS - modify pain perception, provides sense of euphoria
opiod Anglgesics
work in CNS to modify pain perception and provide sense of euphoria
Name an opiod antagonist
Naloxone (Narcan)
side effects of opiods analgesics
respriatory depression, N/V, urinary retention, dry mouth, constipation, puritus, addiction, dependancy, decreased alertness
what is the most serious side effect of opiods analgesics
respiratory depression
Level 7 sedation assessment and what are symtoms
dangerous agitation: pulling at ET tube, catheter, climbing over bedrail
level 6 sedation assessment and what are symptoms
very agitated: doesn't respond to frequent verbal reminding of limits
level 5 sedation assessment and what are symptoms
agitated: anxious but calms down with verbal instructions
level 4 sedation assessment and what are symptoms
calm and cooperative: calm, awakens easily, follows commands
level 3 sedation assessment and what are symptoms
sedated: difficult to arouse
level 2 sedation assessment and what are symptoms
very sedated: arouses but not communicate
level 1 sedation assessment and what are symptoms
unarousable: minimal or no response to stimuli
non-opiods analgesics that act on peripheral nerve endings at the injury site to decrease inflammation
Ibuprofen, ASA, Acetaminophen, and corticosteroids are examples of what?
non-opiods analgesics
what action does asprin have?
blocks protsaglandin synthesis.
what non-opiods analgesic increases pain threshold?
side effects of some opiods analgesics
stomach ulcers, gastric bleeding, impaired blood clotting
drugs developed for other uses other than analgesia, but have been found to decrease certain types of chronic pain
adjuvant analgesics
types of adjuvant analgesics
valum, elavil, tegretol, klonopin
valium as a tranquilizer is used to treat what?
painful spasms
Elavil is used for what?
as an antidepressant, it's used to treat neuropathy
which adjuvant analgesics are anticonvulsants and used to treat painful neuropathies?
Tegretol and klonopin
Ladder approach
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
IV route of delivery is best for what kind of pain? Why?
Acute pain. It has the most rapid onset.
Bolus method of pain med. delivery
continuous infusion
which rout of delivery has a slower absorption and slower onset. how often do you repeat administration?
IM. repeat Q 3-4 HR
which is the preferred route of delivery for pain meds? Why?
Oral. it's easiest. slower onset, but longer duration, but pt. must be able to tolerate some fluids.
how often do oral doses need to be repeated?
Q4 Hr.
battery operated pump with 23 g. needle that delivers pain meds.
what is a good pain med delivery used for chronic pain?
transdermal patches
paient controlled analgesia
good for acute pain r/t surgical incision, L&D, chronic pain
Intraspinal delivery of pain meds. in which med runs through cath. into epidural space of spinal column.
MS and Fentanyl (sublimaze)
used together for epidural
what are some nursing responsibilities in regards to epidural care?
check rate of delivery, intactness of cath.
if resp rate <10/min, notify anesthesia
assess for itching, sedation level
routs of delivery for pain meds
Sub Q
Transdermal patches
Pt. controlled analgesia
Intraspinal delivery
Non-pharmacologic invasive procedures for pain management
nerve block
what is a nerve block
chemical interruption of a nerve pathway - local anestetic into a nerve
interruption of nerve pathways
pain in legs and neck
pain in head and neck for cancer
evaluation of pain
pain scale
day, time onset, activity before and after pain relief measure
if outcomes not achieved, explore why
is adequate analgesic used?
did pt. understate pain?