Nc3 Comfort And Pain

Front 1

impervious to therapuetic interventions

Back 1

intractable pain

Front 2

related to tissue injury ans will abate with healing

Back 2

acute pain

Front 3

lasts longer than 6 months

Back 3

chronic pain

Front 4

shooting or stabbing resulting from disorder of the peripheral or central nervous system

Back 4

neuropathic pain

Front 5

received at the source and extends to nearby tissues

Back 5

radiating pain

Front 6

process of transmitting a pain signal from site of tissue damage to areas of the brian

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noiception

Front 7

pain transmission of a pain signal from the site of injury to the higher brain centers via a nervous system that has been temporarily or permenantly damaged in some way.

Back 7

neuropathic pain

Front 8

Dorsal horn cells act as a gate, closing to prevent nociceptive impulses from reaching the brain or opening to allow impluses to transmit to the brain. Opening the gate is influenced by the A-delta and C- fibers and closing the gate is innfluenced by the activity of the large A-alpha and A-beta fibers, the reticular formation in the brain stem other brain sites and cerebral cortex.

Back 8

gate control theory

Front 9

Amount of pain stimulation a person requires before feeling it

Back 9

pain threshold

Front 10

Highest intensity of pain that a person is willing to tolerate

Back 10

pain tolerance

Front 11

Characteristic of pain-Superficial or cuteneous (pain emanates from the skin or from tissues close to the surface)

Back 11

location

Front 12

characterisitc of pain- the magnitude or amount of pain perceived by the person; Scale 1-10

Back 12

intensity

Front 13

characteristic of pain- how pain feels to the client

Back 13

quality

Front 14

when pain starts

Back 14

onset

Front 15

how long pain lasts

Back 15

duration

Front 16

increase at night and may cause depression

Back 16

chronic pain

Front 17

perceived in body part that is missing e.g. amputated limb or spinal cord injury. Incidence
can be reduced when analgesics are admin. Via epidural prior to amputation

Back 17

phantom pain

Front 18

Mild to Severe
Sympathetic nervous system responses:
Increased pulse & respiratory rates
Elevated blood pressure
Diaphoresis
Dilated pupils
Related to tissue injury, resolves with healing
Client appears restless & anxious –reports pain

Back 18

acute pain

Front 19

Mild to Severe
Parasympathetic nervous system responses:
Vital Signs normal
Dry, warm skin
Pupils, normal or dilated
Continues beyond healing
Client appears depressed/withdrawn
Often does not report pain unless asked
Pain behavior often absent

Back 19

chronic pain

Front 20

TYPE OF PAIN? originates in the skin or subcutaneous tissue

Back 20

cutaneous pain

Front 21

arises from ligaments, bones, blood vessels, nerves – ex. Sprain.

Back 21

deep somatic pain

Front 22

diffuse & often feels like deep somatic pain that is burning aching or a feeling of pressure –
cause by stretching of the tissues, ischemia or muscle spasm. – ex. Obstructed bowel.

Back 22

visceral pain

Front 23

Trigeminal Neuralgia – intense stab like pain distributed by 1 or more
branches of the 5th cranial nerve – experiences on parts of the face & head

Back 23

central pain syndromes

Front 24

considered the same as pain threshold; pain reaction includes the autonomic nervous system

Back 24

pain sensation

Front 25

causes direct activation of the nociceptors, the release of histamine & vasodilation &
increased capillary permeability – also stimulates the release of prostaglandins

Back 25

bradykinen

Front 26

acts on blood vessels in the damaged area to release chemicals that contribute
to the conduction of nociception – serves as a neurotransmitter across the nerve synapse from
primary afferent neuron to neuron in the dorsal horn.

Back 26

substance P

Front 27

–can occur with stimulation of large fibers through massage, heart & cold application
or use of TENS unit opiod analgesics will also inhibit pain impulses by binding to receptor sites.

Back 27

ascending modulation

Front 28

Release of endorphins & enkephalins provides biochemical descending inhibition
of pain impulses use of relaxation/ guided imagery, distraction can modulate & inhibit the pain perception.

Back 28

descending modulation

Front 29

what are these?.... Ethnic & Cultural Values.
 Developmental Stage
 Environment & Support People
 Past Pain Experiences
 Meaning of Pain
 Anxiety & Stress

Back 29

factors affecting pain

Front 30

pure opioids, bind tightly to mu receptors: Morphine, codeine, hesperidins
(Demerol), propoxyphene (Darvon) & hydromorphine (Dilaudid). – There is no maximum daily dose
limit to these drugs.

Back 30

full agonists analgesics

Front 31

antagonist analgesic – can act like opioids & relieve pain when given to Pt who
has not taken any pure opioids - Can block or inactivate other opioids. Includes dezocine (Dalgan),
pentazocine HCl (Talwin), butorphanol tartrate (Stadol, & nalbuphine HCl (Nubain). Blocks mu
receptor site/activate kappa receptor site. No maximum daily dose, not recommended for terminally ill

Back 31

Mixed agonists – antagonist analgesic

Front 32

block mu receptors or are neutral at receptor but bind at kappa receptor site.
√daily dosage limit. – buprenophrine (Buprenex

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partially agonists

Front 33

it is sometimes beneficial to adjust the dose & time interval of the doses as well
as the route & exact medication. A chart can be used to help provide doses approx. equal ability to relieve pain

Back 33

Equianalgesic Dosing

Front 34

These have anti-inflammatory, analgesic & antipyretic effects. Acetaminophen only
has analgesic & antipyretic effects; it is not an anti-inflammatory & will not help to relieve inflammation. Relieve of
pain by acting on peripheral nerve endings at the injury site & decreasing the level of inflammatory mediators
generated. May also decrease prostaglandin release at the injury site. Most common side effect is indigestions –
stomach ulcers & gastric bleeding have also been reported.

Back 34

nonopoid/ nsaids

Front 35

Analgesic medications developed for uses other then analgesia but have been found
to reduce certain type of chronic pain in addition to their primary action, ex. Valium may help reduce painful
muscle spasm as well as reduce anxiety, stress & tension

Back 35

adjunctant analgesics

Front 36

(1) Non-opioid analgesics +/- an adjuvant. If pain persists go to medication in step (2)
(2) weak Opioid +/- non-opioid +/- adjuvant – if dosage reaches maximum & becomes ineffective go
to (3)
(3) Opioid for moderate to severe pain +/- non-opioid +/- adjuvant

Back 36

approach to mange cancer pain

Front 37

relieves acute or chronic pain through techniques such as acupressure,
massage, contra-lateal stimulation, vibration, heat, cold & plain & menthol ointments.

Back 37

cutaneous stimulation

Front 38

what treatment produces analgesia by stimulating A beta
fibers to block A delta & unmyelinated C fibers to block noxious stimuli from the periphery by
stimulating endorphins in the dorsal horn. The client initially feels a tingling, buzzing or vibration
sensation. It increases blood flow & allows the client to decrease or eliminate pain meds. Not used
with pacemakers nor should electrodes be place over eyes, carotid sinus or anterior neck or mouth

Back 38

TENS

Front 39

Heat should not be used within 24 hours because of increased blood flow, edema,
bleeding. After 24 h it is effective for joint & muscle pain. Cold decreases the inflammatory response,
blood flow & edema & is useful for relief from migraines & back pain.

Back 39

heat and cold

Front 40

some inappropiate meds for elderly

Back 40

demerol, asa and valium

Front 41

what age group? May be slow to acknowledge pain
 Recognizing pain or giving in may be considered weakness
 Wants to appear brave in front of peers & not report pain

Back 41

adolescent

Front 42

what age group? Tries to be brave when facing pain
 Rationalized in an attempt to explain the pain
 Responsive to explanations
 Can usually identify the location & describe the pain
 With persistent pain, may regress to an earlier state of development

Back 42

school age

Front 43

what age group? develops the ability to describe pain & its intensity & location
 Often responds with crying & anger because child perceives pain as a threat to security
 Reasoning with child at this stage is not always successful
 May consider pain a punishment
 Feels sad
 May Learn there are gender differences in pain express
tends to hold someone accountable

Back 43

toddler

Front 44

what age group? perceives pain
 Responds to pain with increased sensitivity
 Older infant tries to avoid pain; for ex. Turns away & physically resists.

Back 44

infant

Front 45

what age group? Pain tolerance appears to increase with age. Nearly 90% of adults by age of 50 have degenerative
abnormalities of the lower spine.
 Pain threshold does not appear to change although effect f analgesics may increase due to physiologic
changes related to metabolism.
 May perceive pain as part of the aging process
 May have decreased sensations or perceptions of the pain
 Lethargy, anorexia, & fatigue may be indicators of pain
 May withhold complaints of pain because of fear of the treatment, or any lifestyle changes that may be
involved, or of becoming dependent
 May describe pain differently, that is, as” ache”, hurt” or “discomfort”
 May consider it unacceptable to admit or show pain.
 Older clients are particularly sensitive to the analgesic properties of opioids & often require less medication
than younger clients d/t reduced excretion of the drug

Back 45

elderly

Front 46

Amitriptyline (Elavil)
 Chlorpromazine (Thorazine)
 Diazepam (Valium)
 Hydroxyzine (Vistaril)

Back 46

adjunctive analgesics

Front 47

Acetaminophen (Tylenol, Datril)
 Acetylsalicylic acid (Aspirin, ASA)
 Choline magnesium trisalicylate (Trilisate)
 Diclofenac sodium (Voltaren)
 Ibuprofen (Motrin, Advil)
 Indomethacin sodium trihydrate (Indocin)
 Naproxen (Naprosyn)
 Naproxen sodium (Anaprox, Aleve)
 Piroxicam (Feldene)
 Tolmetin sodium (Tolectin)

Back 47

non narcotic analgesics

Front 48

Butorphanol (Stadol)
 Fentanyl citrate (Sublimaze)
 Hydromorphine hydrochloride (Dilaudid)
 Meperidine hydrochloride (Demerol)
 Methylmorphine phosphate (Codeine, Tylenol 3, Empirin 3)
 Morphine Sulfate (morphine, MS)
 Proposyphene napsylate (Darvon –N, Darvocet-N)

Back 48

narcotic analgesics

Front 49

pain transmission of a pain signal from the site of injury to the higher brain centers via a nervous system that has been temporarily or permenantly damaged in some way

Back 49

neuropathic

Front 50

is pain that is experienced due to an operative procedurer/t tissue damage

Back 50

procedural pain

Front 51

is pain that is experienced due to an operative procedurer/t tissue damage

Back 51

postoperative pain

Front 52

is the insertion of small needles into the skin at selected sites

Back 52

acupuncture

Front 53

has been shown to provide pain relief

Back 53

humor

Front 54

have been found to decrease pain by blocking the pain transmission through nerve stimulation

Back 54

massage

Front 55

may decrease pain for certain diseases

Back 55

hydrotherapy

Front 56

may decrease pain through theraputic use of concentrated essences or essential oils

Back 56

aromotherapy

Front 57

the opposite area is stimulated with pressure, massage, cold, heat or menthol to relieve pain.

Back 57

contralateral stimulation

Front 58

relieves acute or chronic pain through techniques such as pressure, massage, vibration, heat, cold and plain and menthol ointments.

Back 58

cutaneous stimulation

Front 59

is a drug delivery approach that uses an exertnal infusion pump to delive an opioi dose on client demand

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PCA

Front 60

used for their local effect for pain involving skin or mucus membranes. ointment, cream, drops or aerosol

Back 60

TOPICAL DRUGS

Front 61

penazocine, nalbuphhine, butorphanol and dezocine, are drugs that bind to opioid receptors but exert effects only at certain receptors. used in people dependent on an opioid agonist and can percipitate acute withdrawl syndrome

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OPIOID AGONIST- ANTAGONISTS

Front 62

Naloxone, block the opioid receptors or displace the agonists from these sites. reverse depressant effects

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OPIOID ANTAGONISTS

Front 63

morphine, codeine, hydromorphone, oxycodone, demerol, fentanyl- bind to opioid receptors to produce analgesia

Back 63

OPIOID AGONISTS

Front 64

asprin, nonsteroidal anti inflammatory (NSAIDÕs: motrin, naproxen, tolmetin, indomethacin), and acetaminophen
-have antiprostaglandin effects in both the peripheral and centeral nervous system.
-can be combined with opioid to improve pain control for mild, moderate and severe pain s a perscription

Back 64

nonopioid analgesics

Front 65

using honest explanation of what the client will feel.

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anticipatory guidance

Front 66

used best during brief periods of intense pain ie during dressing changes, debridement, biopsy etc., visual, audile or tactle

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distraction

Front 67

helping patient focus on a pleasant, relaxed mental image

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guided imagery

Front 68

blocks patients’ awareness of pain through suggestions

Back 68

hypnosis

Front 69

comfortable position, passive attitude, quiet environment and concentration. It complements other pain-relief techniques.

Back 69

relaxation

Front 70

learn voluntary control over autonomic functions, such as heart rate, hand temperature, and muscle tension. Motivation of the client is important because it requires extensive training.

Back 70

biofeedback

Front 71

Marked rhythmic waxing and waning of respirations from very deep to very shallow breathing and temporary apnea. Pattern is not unusual during sleep in the elderly and should not be exclusive reason to restrict opioid pain relief

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cheyne stokes

Front 72

conducts research to provide guidelines for pain management.
1. Better pain management
2. Increased client comfort
3. Shortened length of hospital stay

Back 72

agency for health care policy and research (AHCPR)

Front 73

Respiratory rate is moderately affected (8-10 breaths/minute...do what?

Back 73

withhold the opioid and reduce subsequent doses.

Front 74

Respiratory rate is significantly affected (fewer than 8 breaths/minute) ...do what?

Back 74

administer Narcan until adequate respiratory rate returns by pain relief remains intact.

Front 75

serotonin, histamine, potassium, bradykinin and substance P.

Back 75

Biochemical mediators of pain

Front 76

location in the spinal cord that prevents or permits pain impulses to reach the brain

Back 76

dorsal horn

Front 77

(abdominal cavity, cranium and thorax), slowly transmitted

Back 77

visceral pain

Front 78

ligaments, , tendons, bones, blood vessels, and nerves

Back 78

somatic pain

Front 79

[ are opiate like] provide biochemical descending inhibition.

Back 79

Endorphins and enkephalins

Front 80

Newborns do feel pain.
2. Sleep or lack of complaint does not indicate pain relief.
3. Pain is not a normal part of aging.
4. People with chronic pain do not have hypochondriasis [hysterical personality] nor do they have hysterical personalities.

Back 80

myths about pain

Front 81

use smaller opioid dosages, decreased delay in receiving pain med, decreases potential for overdosing, decreases dependency on nursing personnel, decreases client anxiety and promotes earlier activity with improved pulmonary status. Best used for moderate-to-severe pain and with patients who can understand and follow instructions.

Back 81

PCA benefits

Front 82

room temperature, noise reduction, improving ventilation and use of assistive devices can increase comfort or decrease pain.

Back 82

environemental interventions

Front 83

decreased sensation to pain associated with peripheral nerve disease.

Back 83

diabetic neuropathy

Front 84

is primarily pharmacologic but the basis of chronic pain management is nonpharmacologic. Medications may be adjunctive components of the treatment plan. Interventions should be implemented when pain is mild or when it is anticipated.

Back 84

management of acute pain

Front 85

(ibuprofen, naproxen, tolmetin and indomethacin), Aspirin, and Acetaminophen are all single agent therapies used for mild pain relief.

Back 85

NSAIDS

Front 86

response are the most dependable indicators of pain if the patient is able to communicate verbally.

Back 86

VERBAL RESPONSE

Front 87

rubbing painful areas, frowns and grimaces and increased muscle tension occuring with guarding and immobilization

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NON VERBAL REPONSE

Front 88

rating scale is effective with children

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WONG BAKER FACE