Pain Assessment And Basic Comfort Measures - Ch 15

Front 1

What is pain?

Back 1

Pain is whaterver the experiencing person says it is, existing when he says it does.

Front 2

Describe three types of pain.

Back 2

Acute or transiet pain - has an identifiable cause, rapid onset, varies in intensity, short in duration, generally disappears with healing.
Chronic or persistent pain - extends beyond the period of healing, often lacks identified pathology, rarely has autonomic sigsm does not provide a protective function, disrupts sleep and activities of daily living (ADLs), degrates health and function of individual.
Cancer pain - may be acute, chronic or intermittent, usually related to tumor recurrence or treatment.

Front 3

What is the most effective way to manage pain?

Back 3

Involves a combined approach of nonpharmacological strategies with the adminnistration pf pharmacological agents: nonopioids and opioids.
Timely administration is crucial for optimal relief.

Front 4

What is the preferable way to administer pain medications?

Back 4

In most situations, administering "around-the-clock" rather than "as-needed".

Front 5

What is pseudoaddiction?

Back 5

When patients exhibit drug-seeking behaviors when they are seeking pain relief.

Front 6

What is physical dependence?

Back 6

State of adaption that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug and /or administration of an antagonist.

Front 7

What is addiction?

Back 7

Primary, chronic, neurobiologic disease, with genetic psychosocial and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Front 8

What is pseudoaddiction?

Back 8

Patient's behavior that may occur when pain is undertreated. Patients with unrelieved pain may focus on obtaining medications, may "clock watch", may otherwise seem inappropriately "drug seeking". Even such behaviors as illicit drug use and deception can occur in the patient's efforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that behaviors resolve when pain is effectively treated.

Front 9

What is drug tolerance?

Back 9

A state of adaption in which exposure to a drug induces changes that result in a diminuation of one or more of the drug's effects over time.

Front 10

Name some most popular NSAIDs?

Back 10

Tylenol, Aspirin, Ibuprofen, Ketorolac, Bextra, Celebrex, Vioxx, Lidocaine.

Front 11

Name some most popular opioids?

Back 11

Codeine, Fentanyl, Hydrocodone, Methadone, Morphine, Oxycodone, Darvon, Ultram, Nubain, Talwin.

Front 12

What is the preferred pain rating scale?

Back 12

It depends on the patient's cognitive and physical ability, culture, developmental level and availability.

Front 13

The Joint Commission Pain Standards.

Back 13

Patient's appropriate assessment and management of pain.
Assess pain in all patients.

Front 14

What should you report to the health care provider?

Back 14

Significant changes in a patient's comfort level and need for changes in the pain management regimen.

Front 15

What actions help effectively manage pain?

Back 15

Effectively managing a patient's pain does not necessarily mean eliminating pain. Pain management requires you to work with the patient and family, to identify an acceptable intensity of pain that allows maximum patient function. And collaboration with other health care providers is essential for the best possible pain relief.

Front 16

Behavioral, emotional signs and symptoms of pain.

Back 16

Increased blood glucose level - the stress of unrelieved pain causes the endocrine system to release excessive amounts of hormones and decreased insulin levels.
Change in mental status (confusion) - confusion is often a sign of unrelieved pain and not opioids.
Decreased GI motility, nausea and vomiting.
Muscle tension, restlessness, exhaustion - continued stimulation of sympathetic vervous system depletes energy stores.
Headache, constipation.

Front 17

PQRSWTU?

Back 17

Procavative/Pallative factors - What makes your pain better or worse - helps determine best intervention.
Quality - tell me what your pain feels like - assists in identifying the underlying pain mechanism, necessary for determining appropriate treatment.
Region/Radiation - show me where your pain is
Severity - ask the patient to rate the pain, alse assess patient's pain when they are moving, not just lying in bed or sitting in a chair.
Timing - ask patient if pain is constant, intermittent, conctinuous, or a combination. Is pain increases during specific times of the day, with particular activities or in specific locations.
Ask patient, "How is the pain affecting YOU (U) in regard to ADLs, work, relationships and enjoyment of life?" - a critical assessment factor, even mild to moderate pain may significantly interfere with function.

Front 18

What is splinting?

Back 18

Splinting is the technique to secure the part of the body that is injured to decrease further movement and subsequent pain during activity and further damage or injury to that part of the body, and to make the individual more comfortable until treatment can be initiated.

Front 19

What scale is used to rate children with verbal skills?

Back 19

Pain Rating Scale or the Oucher Pain Scale is used.

Front 20

What is patient-controlled analgesia (PCA)?

Back 20

It is an interactive method of pain management that permits patient to control over pain through self-administration of analgesics. Allows for more even administration of pain medicine, patient gets medicine more quickly. Candidates must be able to understand how, why and when to self-administer. Used by patients with acute (postoperative), and chronic (cancer) use it. Not recommended in situations in which oral analgesics could easily manage pain.

Front 21

Important things to know about PCA?

Back 21

1. Observe for signs of adverse reactions, especially excessive sedation. Monitor level of sadation, vital signs and pulse oximetri every 2 hours for the first 12 hours.
Pain is easier to prevent than to treat - encourage patients to push button on timing unit whenever they feel pain.
Safe and effective for patients as young as 5 years old.

Front 22

Sedation scale.

Back 22

S = sleep, easy to arouse
1 = awake and alert
2= slightly drowsy, easily aroused
3 = frequently drowsy, arousable, drifts off to sleep during converstion
4. somnolent, minimal or no response to physical stimulation

Front 23

What is epidural analgesia?

Back 23

Analgesia, delivered into a space between the vertebral bones and the dura mater, the outermost meninges covering th brain and spinal cord.
MOST EFFECTIVE in managing postoperative pain from thoracic and abdominal surgeries.

Front 24

How do administered drugs spread?

Back 24

1. Diffusion through the dura mater into the CSF, where they act directly on receptors in the dorsal horn of the spinal cord.
2. Via blood vessels in the epidural space
3. Means of absorption by fat in the epidural space, creating a depot where the drug is slowly released into the systemic circulation.

Front 25

What kind of medications are commonly used in epidural analgesi?

Back 25

Opioids and local anesthetics - improves pain control and reduces complications while lowering opioid doses.

Front 26

Where is the epidural catheter placed?

Back 26

It is placed into the epidural space below the second lumbar vertebra, where the spinal cord ends. The only way to ensure proper placement of an epidural catheter is by x-ray.

Front 27

How is epidural medication administered?

Back 27

Intermittently via bolus injection through an epidural catheter or continuously via a controlled delivery system.

Front 28

How should you clean epidural catheter?

Back 28

Clean it with povidoneiodione or substitute antiinfective. DO NOT USE ALCOHOL - causes pain and is toxic to neural tissue.

Front 29

How should you inject opioids into the epidural catheter?

Back 29

Draw up prediluted, preservative-free opioid solution through filter needle.
Change from filter needle to regulat 20-gauge needleless adapter, attach syringe directly to injection cap. Aspirate.
Inject opioid at a rate of 1 mL over 30 seconds.
Assess catheter insertion site every 2 to 4 hours for redness, warmth, tenderness, swelling or drainage. Report any of there immediately to the physician managing the epidural catheter - TREAT AS EMERGENCY!!!

Front 30

What to observe?

Back 30

Observe sedation level and respiratory rate, rhythm and pattern every 2 hours for 12 to 24 hours after an epidural bolus of opioid is given - sedation occurs before respiratory depression and should be closely monitored to prevent respiratory depression.

Front 31

IN CASE OF EMERGENCY ...

Back 31

Be prepared to deliver Narcan, a strong opioid antagonist, 0.4 mg diluted in 9 mL of saline at 1 to 2 mL/min (for adults), if respirations fall below 8 breaths per minute and are shallow. Desired effect is to increase respirations, not reverse analgesia.

Front 32

What are the most common side-effects when opioids are delivered via the intraspinal route?

Back 32

Pruritus (itching), specially on the face, head, neck and torso - not an indication of an allergic response.

Front 33

What signs should you monitor?

Back 33

1. Blood pressure and pulse - postural hypotension and heart rate changes may occur.
2. Intake and output, assess for bladder distention - urinary retention may occur as a result of effects of medication on spinal nerves innervating the bladder.
3. Nausea and vomiting - can begin 3 to 6 hours after bolus because of time needed for drug to reach chemoreceptor trigger zone. Nausea from epidural worsens by movement.
4. Temperature - infection can occur from poor sterile technique or systemic bacteremia.
5. Insertion site for clear or bloody drainage, assess for reports of headache - headache and cerebrospinal fluid leakage occur from a dural puncture. Bloody drainage may occur if catheter has migrated into a vessel.
6. Evaluate for motoe weakness or numbness and tingling of lower extremities (pasesthasias) - excessive analgesia, infusion of drugs toxic to CNS, or contact of catheter with neural tissue may cause adverse sensory deficits - NOTIFY PHYSICIAN IMMEDIATELY. Reducing epidural dose helps eliminate unwanted motor and sensory deficits.

Front 34

How fast can the patient expect the pain relief to begin?

Back 34

Within 30 to 60 minutes of initiation of epidural infusion.

Front 35

How fast can the patient expect the pain relief to begin?

Back 35

Within 30 to 60 minutes of initiation of epidural infusion.

Front 36

What is local infusion pump analegesia?

Back 36

Infusion pump to deliver local anesthetic to the surgical site through a one-way catheter. Pain relief is provided directly to the surgical site. The pump has a demand (4 to 6 mL per bolus) and a continuous rate (2 to 4 mL/hr) feature. The device remains in place for about 48 hours.

Front 37

What is local infusion pump analegesia?

Back 37

Infusion pump to deliver local anesthetic to the surgical site through a one-way catheter. Pain relief is provided directly to the surgical site. The pump has a demand (4 to 6 mL per bolus) and a continuous rate (2 to 4 mL/hr) feature. The device remains in place for about 48 hours.

Front 38

Signs of local anesthetic toxicity?

Back 38

Hypotension, dizziness, tremor, severe itching, swelling of the skin or throat, irregular heartbeat, palpitations, confusion, ringing in the ears, muscle twitching, numbness around the mouth, metallic taste, seizures.

Front 39

Signs of local anesthetic toxicity?

Back 39

Hypotension, dizziness, tremor, severe itching, swelling of the skin or throat, irregular heartbeat, palpitations, confusion, ringing in the ears, muscle twitching, numbness around the mouth, metallic taste, seizures.

Front 40

What are nonpharmacological aids to promote comfort?

Back 40

Distraction, relaxation, guided imagery, cuteaneous stimulation such as massage and acupressure. Trigger a relaxation response by stimulating parasympathetic nervous system. You use these pain-relief measures in combination with pharmacological interventions, not in place of medications.
Help diminish the physical effects of pain, alter a patient's perception of pain, provide a patient with a greater sense of control.

Front 41

What are nonpharmacological aids to promote comfort?

Back 41

Distraction, relaxation, guided imagery, cuteaneous stimulation such as massage and acupressure. Trigger a relaxation response by stimulating parasympathetic nervous system. You use these pain-relief measures in combination with pharmacological interventions, not in place of medications.
Help diminish the physical effects of pain, alter a patient's perception of pain, provide a patient with a greater sense of control.

Front 42

Massage stroke techniques?

Back 42

1. Effleurage - circular - increases nutrient absorption, improves lympatic and venous circulation.
2. Petrissage - pinching - promote relaxation, and stimulate local circulation.
3. Friction - strong circular strokes - bring blood to surface of skin, increase local circulation and loosening tight muscle groups.

Front 43

Massage stroke techniques?

Back 43

1. Effleurage - circular - increases nutrient absorption, improves lympatic and venous circulation.
2. Petrissage - pinching - promote relaxation, and stimulate local circulation.
3. Friction - strong circular strokes - bring blood to surface of skin, increase local circulation and loosening tight muscle groups.