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60 Cards in this Set
- Front
- Back
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Define Pain:
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An unpleasant sensory and emotional experience related to actual or potential tissue damage.
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Why is inadequate pain relief bad?
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Results in longer length of stay, re-hospitalization, visits to outpatient clinics and the ER.
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Pain management is difficult related to:
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1. Inadequate knowledge/skills
2. Unwillingness to believe patient's report of pain 3. Lack of time or dedication 4. Fear of addiction/tolerance to opioids |
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Define Nocireceptors and how they are stimulated.
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Definition: Pre-nerve endings that are found widespread. They must be stimulated to perceive pain and are non-adapting; they keep us constantly informed of painful stimulus.
Stimulation: Tissue injury releases chemicals (histamine, prostaglandin, seratonin) that stimulate the nocireceptors. |
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Give an example of:
Mechanical Pain Thermal Pain Chemical Pain |
Mechanical: Puncture, pressure, squeezing, prick
Thermal: Burn, frostbite Chemical (internal/external): Acid |
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What are the phases of Nocireceptive Pain?
*We went over 5 in lecture but only 4 are in the book* |
1. Transduction: When nocireceptors become stimulated by potentially damaging mechanical, thermal or chemical stimuli.
2. Conduction 3. Transmission: When peripheral nerves carry the pain message to the dorsal horn of the spinal cord. 4. Perception: The recognition and definition of pain in the frontal cortex. 5. Modulation: Changes the perception of pain by facilitating or inhibiting pain signals. The Gate-Control and Endogenous Analgesia System allow this. |
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Give an example of:
Mechanical Pain Thermal Pain Chemical Pain |
1. Transduction: When nocireceptors become stimulated by potentially damaging mechanical, thermal or chemical stimuli.
2. Conduction 3. Transmission: When peripheral nerves carry the pain message to the dorsal horn of the spinal cord. 4. Perception: The recognition and definition of pain in the frontal cortex. 5. Modulation: Changes the perception of pain by facilitating or inhibiting pain signals. The Gate-Control and Endogenous Analgesia System allow this. |
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Define Neuropathic Pain:
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Caused by damage to the Nervous System structures (CNS or PNS) by trauma, inflammation, metabolic/neurological diseases or tumors.
It is described as burning, itching, pins/needles, prickling, sudden, intense, short lived shooting pain. |
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Pain is categorized according to its:
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1. Origin
2. Onset 3. Severity 4. Cause/Etiology |
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Origin of pain:
Cutaneous Deep somatic Visceral Radiating Referred Phantom Psychogenic |
1. Cutaneous: Originates on the skin - Cut/lasceration
2. Deep somatic: Originates internally - Fx, sprain, 3. Visceral: Pertaining to internal organs in the thoracic, abdominal and pelvic cavities. 4. Radiating: Starts at origin but extends to other locations. 5. Referred: Occurs in an area that is distant from the original site. 6. Phantom: Pain that is perceived to originate from an area that has been surgically removed. 7. Psychogenic: Pain that is believed to arise from the mind. |
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Onset of pain:
Acute Chronic malignant Chronic non-malignant |
Acute:
1. Sudden/slow onset 2. Lasts < 6 months 3. Subsides as healing takes place 4. Described as fast or sharp 5. Usually localized, travel through type A fibers (bigger, myelnated, faster, initial) Chronic malignant/non-malignant: 1. Lasts > 6 months 2. Described as dull, slow or delayed 3. Not easily localized, tavel through type C fibers (smaller, non-myelnated, slower, lingering pain) |
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Define:
Hyperalgesia Pain threshold Pain tolerance Pain perception |
Hyperalgesia: Excessive sensitivity to pain
Pain threshold: Amount of pain stimulation a person requires to feel pain Pain tolerance: The maximum amount of pain a patient can handle Pain perception: The point at which the patient perceives pain |
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Define:
Cutaneous pain Deep Somatic pain Visceral pain Radiating pain Referred pain Phantom pain Psychogenic pain |
1. Cutaneous: Originates on the skin - Cut/lasceration
2. Deep somatic: Originates internally - Fx, sprain, 3. Visceral: Pertaining to internal organs in the thoracic, abdominal and pelvic cavities. 4. Radiating: Starts at origin but extends to other locations. 5. Referred: Occurs in an area that is distant from the original site. 6. Phantom: Pain that is perceived to originate from an area that has been surgically removed. 7. Psychogenic: Pain that is believed to arise from the mind. |
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What factors influence pain?
*Remember Jaimie's story. She wasn't expressing her pain because she's Asian* |
1. Ethnic/Cultural values
2. Developmental Stage 3. Environmental and Support People 4. Past Pain Experiences 5. Meaning of pain 6. Anxiety and stress |
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Nursing Assessment of pain:
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1. Physical Assessment
2. Vitals 3. General Survey: signs of distress 4. Look - Listen - Feel as appropriate |
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Assessment PQRST
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P: Provoke factors
Q: Quality R: Radiation of pain S: Severity T: Time it occurs |
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Tools to help patient describe pain:
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1. Visual analog scale
2. Faces 3. Diagram to show location 4. FLACC (Peds) *Especially for those who cannot speak or speak a different language |
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Aspirin
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Antipyretic, inti-inflamm, NSAID analgesic, antiplatelet
Doses: 81mg, 325mg, 500mg Enteric coated for GI irritation, absorbance is delayed |
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NSAIDS
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Non-steroidal Anti-Inflammatory Drugs: make up the largest group of nonopioid analgesics. Interfere with peripheral tissues. It is not recommended to use 2 NSAIDs together.
ibuprofen, aspirin, naproxen, celecoxib Risk for GI bleeding Linked to high cardiovascular events |
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Acetaminophen
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Non-opioid Analgesic: very little anti-inflammatory
Can be hepatotoxic!! Maximum of 4grams a day Fever reducing |
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Opioids
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Relieves pain and induces euphoria
Mimics endorphins Can cause respiratory depression and constipation Stigma/fears with use Body weight is NOT related to opioid dose |
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Morphine
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Analgesic, sedation
N/V with initial dose -10-30mg PO sustained release Q8-12hours chronic pain -2.5-10mg SQ/IM/IV Q2-6hours PRN -10-20mg rectally Q4hours PRN May affect breathing Can also be given Epidural, intrathecal |
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Hydromorphone (Dilaudid)
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-2-8mg PO Q4hours
-1-2mg SQ/IM Q4-6hours -3mg rectally Q6hours Can be given IV, Epidural, intrathecal Rapid onset, half life is less than 1 hour *Narcan (naloxone): A narcotic antagonist, doesn't work is pt isn't on any narcotics. |
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Fenatyl patch (transdermal)
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-Long duration 48-72hours
-Easy to use, can be administered by pt or family -Able to use opioid as outpatient -Continuous effect, no pump or needle -Side effects not as fast as PO -Difficuly to modify dose rapidly -Slow onset (12-17hours) -Peak 24-72hours -Requires additional short acting med for breakthrough pain |
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Why should you not use Demerol (meperidine) long term?
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Causes seizures
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Pros of rectal meds:
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Easy to use; can be administered by pt or family
Cheaper than SQ/IV |
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Pros of IV opioids:
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Provide rapid relief
Wide range of drugs can be given IV |
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What should you consider when administering opioids?
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1. Give/offer at regular intervals to maintain blood levels
2. Do not break in half, chew or crush 3. Teach pt to increase fiber, adequate fluids and stool softeners to prevent constipation |
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Sympathetic NS responses to pain:
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1. Increased systolic BP
2. Increased HR and force of contraction 3. Increased RR 4. Dilated blood vessels to the brain to increase alertness 5. Dilated pupils 6. Rapid speech |
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Parasympathetic NS responses to pain:
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1. Decreased systolic BP, possible syncope
2. Decreased HR 3. Changeable breathing 4. Withdrawal 5. Constricted Pupils 6. Slow, monotonous speech |
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Voluntary responses to pain:
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1. Withdrawing from painful stimuli
2. Moaning 3. Facial grimacing 4. Crying 5. Agitation 6. Guarding the painful area |
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Psychological responses to pain:
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1. Anxiety
2. Depression 3. Anger 4. Fear 5. Exhaustion 6. Hopelessness 7. Irritability |
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When should you assess for pain?
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1. Admission
2. Before and after each potentially painful procedure/treatment 3. When the pt is at rest 4. Before you implement a pain management intervention 5. With each vitals check 6. When the pt complains of pain |
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What approach should you take when assessing for pain on a child and why?
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Use techniques such as art and play to assess for pain. Children often associate pain with injections and will deny pain if they fear treatment. The indirect method is often more effective than the direct to determine pain.
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Recommended ABCDEE assessment:
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Assess pain systematically
Believe pt/family in their reports and what they say relieves it Choose pain control options as appropriate Deliver interventions timely, logically and in a coordinated fashion Empower pt/family Enable pt to control their course as much as possible |
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What specific nursing activities can you perform for pain management?
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1. Actively listen to pt's report of pain
2. Support pt in maintaining active role in treatment 3. Provide ordered pain meds 4. Assess for responses to meds 5. Evaluate effectiveness of treatment 6. Provide interventions to manage side effects of meds 7. Reduce anxiety/fear by offering explanations about care/meds 8. Consult with healthcare team 9. Delegate pain management strategies as appropriate |
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What tasks may be delegated for pain management?
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1. Repositioning
2. Massaging 3. Providing darkness/quiet for sleeping 4. Straightening sheets 5. Mouth care 6. Using distraction |
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TENS Unit to relieve pain:
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Transcutaneous Electrical Nerve Stimulator: Worn externally to relieve pain. Pads are attached to painful area.
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PENS Unit to relieve pain:
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Percutaneous Electrical Nerve Stimulator: Probes are placed through the skin to stimulate nerves. Used for short term management of acute/chronic pain. Promotes physical activity, improves sleeping.
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SCS to relieve pain:
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Spinal Cord Stimulator: Surgically implanted, produces tingly sensation that interferes with perception of pain.
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Acupunture to relieve pain:
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Extremely fine needles, believed to stimulate the endogenous analgesia system.
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Acupressure to relieve pain:
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Stimulates certain sites in the body. Fingertips provide firm, gentle pressure over pressure points.
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Massage to relieve pain:
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Cutaneous stimulation helps to reduce pain.
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Contralateral stimulation to relieve pain:
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Stimulating the skin in an area opposite to the painful site. Often used with phantom pain.
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Immobilization to relieve pain:
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The use of casts/splints can offer some relief. It is important to remove the cast/splint to allow movement and exercise to the body part to prevent further injury.
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Cognitive Behavior Interventions to relieve pain:
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Attempt to alter patterns of negative thoughts and to encourage more adaptive thoughts, emotions and actions. Used to decrease depression and anxiety. Helps the pt by fostering a sense of control. Be sure to obtain the pt's permission for this technique.
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Distraction to relieve pain:
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Drawing the pt's attention away from the pain and focusing on something else. Based on the belief that the brain can only process so much information at once.
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Sequential Muscle Relaxation (SMR) or Progressive Relaxation:
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The pt tenses up a group of muscles for 15 seconds and then relaxes them, usually working from the facial muscles on down.
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Describe Guided Imagery:
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Auditory and imaginary processes to affect emotions, calm and relax pt. Usually used for chronic pain but works for lesser pain as well.
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Describe Hypnosis:
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Inducing a deeply relaxed state. Once in the state the hypnotist offers therapeutic suggestion to provide relief of symptoms.
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Describe Therapeutic Touch (TT):
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Does not require physical contact but focuses on the use of the hands to direct energy fields surrounding the body. Studies do not show consistent effectiveness.
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Describe humor:
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Positive effects on a pt's physical and emotional health.
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Describe Expressive Writing:
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Often used for chronic pain. Pt described stressful events for a specified time period over consecutive days. Best when done with a practitioner to direct and support them.
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What are the 3 classes of Analgesics?
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1. Non-Opioids
2. Opioids 3. Adjuvants |
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Nonopiod Analgesics:
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OTC meds, onset within 1 hour. These are often given with opioids to allow for a lower dose of that opioid.
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How are prostaglandins related to pain?
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They sensitize receptors and are related to inflammation.
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Mu agonists:
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Acute/Chronic/Cancer pain
Good for breakthrough pain No daily max Codeine Hydromorphone Fentanyl mehtadone Oxycodone |
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Agonist Antagonists
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Opioids
Moderate to severe acute pain Should not be given with Mu agonist |
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How to treat pruritus from an opioid:
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1. Reduce dose by combining with nonopioid or adjuvant drug.
2. Use cool packs, local, topical anesthetics. 3. Antihistamines 4. Distraction |
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Opioid Side Effects:
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1. Nausea
2. Vomiting 3. Constipation 4. Drowsiness |
