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127 Cards in this Set
- Front
- Back
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Providing _____ is a basic human & legal right
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pain relief
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______ is a subjective sensory & emotional experience associated with actual or potential tissue damage
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pain
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_____ is whatever the experiencing person says it is, existing whenever he/she says it does
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pain
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physiology of pain has what 4 process?
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1- transduction
2- transmission 3- perception 4- modulation |
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this is normal pain
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nociceptive
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this step in the pain process is where the mechanical stimulus occurs
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transduction
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this step in the pain process is where the stimulus is converted to an electrical energy that travels to the brain
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transduction
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this is the 1st step in the process of pain
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transduction
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this is the 2nd step in the pain process
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transmission
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this is the 3rd step in the pain process
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perception
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this is the 4th step in the pain process
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modulation
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during this phase - once the brain has recieved the message that there is pain, neurotransmitters are released
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modulation
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during this phase, chemicals are released that are the body's natural attempt at analgesia
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modulation
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brain releases these as a natural attempt at analgesia
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neurotransmitters
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this excitatory neurotransmitter causes vasodialation & edema
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Substance P
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this excitatory neurotransmitter increases sensitivity to pain
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Prostaglandins
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this excitatory neurotransmitter binds to receptors on peripheral nerves, increasing pain stimuli
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Bradykinin
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these are the 3 excitatory neurotransmitters associated with neuroregulation of pain
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Substance P, Prostaglandins, Bradykinin
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these are the body's natural supply of morphine-like substances
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inhibitory neuromodulators
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this neuromodulator inhibits pain transmission
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serotonin
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the job of this type of neuroregulator is to try & relieve some of the pain
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inhibitory neuromodulatos
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this is a "normal" type of pain
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nociception
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this is the physiologic process by which information a/b tissue damage is communicated to the CNS
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nociception
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The nature of pain is/does:
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complex, highly individualized, exhausting, interferes with relationships, influences the meaning of life
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"pain being a natural outcome of growing old" is a myth b/c...
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older clients are not in pain unless there is a pathological reason behind it
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S&S that an older client with cognitive impairments might be in pain
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* restlessness
* rapid respirations * elevated heart rate * aggitation |
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this nervous system reacts/regulates low intensity pain
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sympathetic
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the sympathetic nervous system reacts to this type of pain
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nociceptive (low intensity)
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examples of physiological reactions to nociceptive pain
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- dialated bronchial tubes
- increased heart rate - peripheral vasoconstriction - increased blood gluc. - diaphoresis - increased muscle tension - dilation of pupils - decreased GI motility |
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this nervous system reacts/regulates severe/deep pain
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parasympathetic nervous system
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examples of the parasympathetic nervous system physiological response to include:
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- pallor
- muscle tension - decreased heart rate - decreased blood pressure - rapid/irregular breathing |
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rapid, irregular breathing is an example of a physiological response to this kind of pain
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deep/severe
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muscle tension is an example of a physiological response to this kind of pain
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deep/severe
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decreased heart rate & BP is an example of a physiological response to this kind of pain
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deep/severe
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pallor is an example of a physiological response to this kind of pain
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deep/severe
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dilation of pupils & bronchial tubes are examples of a physiological reactions to this kind of pain
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nociceptive (normal, low intensity)
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increased heart rate is an example of a physiological reaction to this kind of pain
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nociceptive (normal, low intensity)
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peripheral vasoconstriction is an example of a physiological reaction to this kind of pain
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nociceptive (normal, low intensity)
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diaphoresis & increased muscle tension is an example of a physiological to this kind of pain
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nociceptive (normal, low intensity)
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decreased GI motility is an example of a physiological reaction to this kind of pain
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nociceptive (normal, low intensity)
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nonverbal indicators of pain might include:
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- clenching of the teeth
- holding the painful part - bent posture - grimacing - crying - moaning - restlessness - frequent requests of the nurse |
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Because clients become accustomed to presence of pain - there may or may not be changes in their VS?
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may not
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With traumatic injuries - will there be changes in VS?
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traumatic injuries (deep pain) may cause client to go into shock, causing changes in their VS
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deep/severe pain causes stimulation of this nervous system
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parasympathetic
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nociceptive/normal/low intensity pain causes stimulation of this nervous system
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sympathetic
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this type of pain is protective
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acute pain
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this type of pain has an indentifiable cause
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acute
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this type of pain is of short duration
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acute
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this type of pain has limited tissue damage & emotional response
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acute
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this type of pain is long lasting
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chronic
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this type of pain does not always have an identifiable cause
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chronic
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this type of pain can lead to great personal suffering
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chronic
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an example of this kind of pain is an injured knee
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acute
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this type of pain can be cancerous or noncancerous
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chronic
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this type of pain is usually non life-threatening
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chronic
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this type of pain is a major cause of psychological & physical disability
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chronic
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this type of pain is physically & mentally exhausting
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chronic
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non-cancerous types of chronic pain include:
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- arthritis
- low back pain - myofascial (muscle) - headaches - peripheral myopathy |
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the 5 types of pain include:
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- acute
- chronic - chronic episodic - cancer - idiopathic |
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this type of pain may last for hours/days/weeks
(e.g. migraine headaches) |
chronic episodic
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this type of pain occurs because tumor progression results in pressure on nerves
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cancer
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this type of pain is chronic, and is w/out an identifiable pathology
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idiopathic
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how does the use of imagery & hypnosis help to control pain?
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they reduce the sensory and affective components of pain
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this is the #1 non-narcotic analgesic used
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Aspirin
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NSAIDs have both of these properties, which help with mild pain
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- analgesic
- anti-inflammatory |
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ibuprofen interferes with this phase of the pain process
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transduction: works on swelling (inflammation) and as an analgesic, at site of injury
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these are common side-effects of NSAIDs
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- GI irritation
- prolonged bleeding time |
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S&S of aspirin hypersensitvity
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- tinnitus (ringing in the ears)
- vertigo - bronchospasm - urticaria (rash) |
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Tylenol interfere with this phase of the pain process
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transduction
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this non-narcotic analgesic has no anti-inflammatory properties & is not an NSAID
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Tylenol (acetaminophen)
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this non-narcotic analgesic/antipyretic is safe to use for fevers from vial infections
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Tylenol (acetaminophen)
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this non-narcotic analgesic causes no GI distress or interfers with platelets/blood clotting
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Tylenol (acetaminophen)
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there is no link between Reye syndrome & this non-narcotic analgesic
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Tylenol (acetaminophen)
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this non-narcotic analgesic is toxic to the liver in high doses
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Tylenol (acetaminophen)
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S&S of an ovedose of this non-narcotic analgesic include:
- N/V - diarrhea - abdominal pain |
Tylenol (acetaminophen)
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S&S of a Tylenol overdose include:
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- N/V
- diarrhea - abdominal pain |
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these analgesics act mostly on the CNS
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opiods (MS & codeine)
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MS & codeine are derived from what?
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opium
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side effects of opiods include:
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- suppressed respirations & cough
- N/V - constipation - hypotension |
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this side effect is almost always caused by opiod analgesics
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constipation
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the reason older adults should receive lower doses of opiods is because of what?
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decreased liver & kidney functioning
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reduced liver & kindney functioning causes what to happen in older adults
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possible drug accumulation
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things to consider with administration of opiods with older adults include:
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- over 65 y/o
- polypharmacy - increased risk of durg interactions & side effects - narcotic side effects are more pronounced - possible drug accumulation |
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MS (morphine) is contraindicated in clients with:
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- increased intercranial pressure
- respiratory disorders - severe renal disease |
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MS is contraindicated in clients with increased intercranial pressure because:
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increased IP often causes changes in resp. status - if administer MS - cannot tell if changes in respiratory status to due to increased IP or MS
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MS administration can cause these side effects:
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- dizziness
- urinary retention - constipation - respiratory depression |
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this analgesic is an example of a synthetic narcotic
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Demerol
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this analgesic is contraindicated for chronic pain
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Demeral
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this analgesic is good for Client's in labor
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Demeral
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Demerol is good for client's in labor because:
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- it does not diminish uterine contractions
- it does not suppress neonatal respirations |
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this analgesic is primarilay effective in GI procedures
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Demerol
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this analgesic is not given for cancer pain due to risk of CNS toxicity from high doses required
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Opiod agonist-antagonist
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this analgesic is a medication that mixes a drug that relieves pain with a drug that reverses the 1st drug
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opiod agonist-antagonist
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examples of opiod agonist-antagonists include:
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- Talwin
- Pentazocine - Stadol - Buprenex - Nubain |
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one of the reasons to use an opiod agonist-antagonist analgesic is to:
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reduce risk of addiction
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this analgesic is used for moderate to severe pain, and can be administered PO, IM, SQ, & IV
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Nubain (opiod agonist-antagonist)
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this analgesic can cause respiratory depression if mixed with alcohol
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Nubain (opiod agonist-antagonist)
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narcotic antagonist that reverses respiratory and CNS depression
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Narcan
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this is the antidote for narcotic analgesia
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narcan
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Narcon can be administered via what 2 routes?
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IM or IV
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what letter's of the alphabet represent a clinical approach to pain assessmt. & mgmt.?
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A-B-C-D-E
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What does the "A" in re: "ABCDE" pain mgmt. represent?
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ASK - about pain regularly, ASSESS - systematically
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What does the "B" in re: "ABCDE" pain mgmt. represent?
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BELIEVE - the client and family in the report of pain
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What does the "C" in re: "ABCDE" pain mgmt. represent?
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CHOOSE - appropriate pain control mechanisms
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What does the "D" in re: "ABCDE" pain mgmt. represent?
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DELIVER - timely interventions
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What does the "E" in re: "ABCDE" pain mgmt. represent?
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EMPOWER - clients and families to control their course as much as possible
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Examples of assessment questions in pain control include:
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- onset
- location - intensity - quality - pattern of pain - relief measures - contributing symptoms - effects of pain - behavioral - influence |
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examples of non-pharmacological pain interventions that use cutaneous stimulation are:
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- back rub
- massages |
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non-pharmacolocial pain interventions include:
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- relaxation
- music - distraction - herbals - cutaneous stimulation |
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this type of analgesia is similar to a PCA pump, however is used for a shorter amt of time.
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perineural local anesthetic infusions
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this a patient controled analgesic
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PCA pump
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examples of adjuvants or coanalgesics might include:
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- Tylenol w/ codeine
- phergan c/ Demerol |
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this type of analgesia combines 2 drugs together, that have a synergistic effect (work better together)
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adjuvants/coanalgesics
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complications of opioid epidural analgesia include:
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- N/V
- urinary retention - constipation - respiratory depression - pruritus |
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#1 thing for nrsg. consideration when taking care of an epidural analgesia Client
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make sure epidural catheter does not become displaced
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#1 thing to watch for in Client's with epidurals
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respiratory depression due to possiblity of analgesia going up spinal column - causing an inability to breath
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what position should you keep a client receivng an epidural in?
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semi-fowlers
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what technique should RNs use when caring for an epidural catheter?
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sterile - to prevent infection in the spinal column
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what are the 2 types of Fentanyl?
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- transdermal
- transmucosal |
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Transdermal Fentanyl is how many times more potent than morphine?
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100 Xs
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Transmucosal Fentanyl is used for what type of pain?
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breakthrough
(e.g. chronic cancer pain) |
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why would you use transmucosal Fentanyl for CA patients w/ breakthrough pain?
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b/c client's become tolerant of MS or codeine
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this type of breakthrough pain is predictable (e.g. working with PT or having a dressing change)
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incident pain
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this type of breakthrough pain occurs when it is almost time for the next dose
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"end-of-dose" pain
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this type of breakthrough pain is not associated with anything
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spontaneous pain
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this type of breakthrough pain is unpredictable
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spontaneous pain
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what are 3 barriers to effective pain management?
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- the client
- the health care provider - the health care system |
