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45 Cards in this Set
- Front
- Back
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Pain according to APS
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"whatever the person says it is"
1. physical/emotional experience 2. actual/potential tissue damage 3. describe as damage |
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Types of pain:
LIED |
Location
Intensity Etiology Duration |
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Location
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Where it is locate on/in body
referred pain: appear to arise in different areas visceral pain: arise from organs |
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Referred sites
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Heart: mid posterior back, L breast/arm, cheeks
Lungs: L neck Liver: R neck, R ant/pot breast/back Gallbladder: R shoulder Kidneys: B pos lower back, R mid thigh Bladder: B upper thigh Appendix: R inguinal |
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Intensity
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Mild 1-3
Moderate 4-6 Severe 7-10 |
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Etiology
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APhysiological:
1aSomatic 2bNeuropathic: 3bPeripheral Neuropathic 4bCentral Neuropathic 5bSympathetically Maintained |
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Physiological:
Somatic Neuropathic |
Neuro sends signals to damaged tissue and pain subsides
ie broken bone |
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Somatic
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skin, muscles, bones or connective tissue
ie sharp pain from paper cut |
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Neuropathic:
Peripheral Central Sympathetically |
damaged/malfunctioning nerves due to illness
ie phantom leg pain |
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Peripheral Neuropathic
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damage to peripheral nerve
ie phantom limb |
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Central Neuropathic
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Malfunctioning nerve in CNS
ie s/p stroke |
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Sympathetically Maintained
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abnormal connections between pain fibers and SNS
ie edema, temp regulation |
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Pain threshold
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least amount of stimulus to cause pain
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Pain tolerance
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maximum amount of stimulus to cause pain
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Hyperalegsia/Hyperpathia
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heightened response to painful stimuli r/t abnormal processing of neuropathic nerves
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allodynia
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non painful stimuli cause pain
ie sheets, wind |
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dysesthesia
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unpleasant abnormal sensation
ie mimics central neuropathic disorders: stroke |
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Physiology of Pain
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Nociception
Gate Control Theory Response to Pain Factors Affecting Pain Strategies in Pain Managemnt |
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Nociception:
Transduction Transmission Modulation Perception |
physiologic process related to pain perception
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Transduction
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Specialized pain receptors
ie meds can block production of prostaglandin or decrease ion movement ie ibuprofen |
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Transmission:
3 segments |
a. pain impulse: Peripheral Nerve fibers to spinal cord
1.dull/ ache 2.sharp/localized modified pain from dorsal horn b. Spinal cord to brain stem/thalamus c. thalamus to somatic sensory cortex |
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Modulation
"descending system" |
Thalamus/Brain stem-> dorsal horn of spinal cord
release substances to dampen |
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Perception
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Pain becomes conscience
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Gate Control Theory
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Peripheral nerve fibers carry signal to dorsal horn-> signal modified->ion channels open allowing +ions to rush in-> electrical impulse= pain
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Responses to pain
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initial: sympathetic system
fight or flight: increase in BP, HR, RR |
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Uncontrolled Pain
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results: loss of sleep, appetite, lower quality of life, reduced mobility, CO, susceptibility of infection, changes nervous sys, pain threshold lowered
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Factors Affecting Pain
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Ethnic/Cultural Values
Developmental Stages Environment/Support People Past Pain Experiences Meaning of Pain |
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RN Management of Pain
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Assess:
"Are you experiencing discomfort right now?" 1. Location: proximal, distal, medial, lateral, diffuse 2. Intensity: 0-10 3. Quality: Adjectives- intense, throbbing, tender 4. Pattern: interval(w/w/o activity) 5. Observe: physiological/behavioral responses: LOC, suicidal |
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RN Management of Pain
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Dx:
Acute or Chronic |
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RN Management of Pain
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Planning:
Establish goal ie pain free for 24hr. Give meds on a schedule |
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RN Management of Pain
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Implementing:
Alleviate pain: meds or noninvasive or both |
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Barriers to Pain Management
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Do not know pain will/can be relieved
Think it will be addictive |
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Key Strategies to Manage Pain
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Acknowledge: listen
Teach: reduce misconceptions Prevent: stay on schedule |
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Pain Management
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1. Nonopioid/NSAID
2. Opioid 3. Weak/Mixed 4. Strong 5. Side effects |
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Nonopioid/NSAID
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ie ibuprofen or aspirin
NSAIDs-antiinflammatory/analgesic/antipyretic Acetaminophen: analgesic/antiphyretic |
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Opioid
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Full agonist- binds tightly to receptor to reduce pain
ie oxy, hydromorphone Mixed agonist/antaongist- can act like opioid to relieve pain when pt has not had pure opioid ie dalgan, nubain Partial agonist: good potency ie buprenex |
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Weak/Mixed
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Max daily dose
2-4x stronger than nonopioids ie weak: codeine mixed: narcan |
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Strong
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Pure agonist- bind to receptors in peripheral and CNS
ie morphine changes pain and mood |
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Side Effects
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depression, decreased HR, RR, BP, nausea/vomiting, urinary retention, blurred vision
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Addiction
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primary, chronic: impaired control over drug use, compulsive use, craving
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Physical Dependence
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physical dependence that is manifested by a drug class
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Tolerance
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state of adaptation in which exposure induces change of drug effect
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coanalgesic
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med not classified as pain med but can reduce pain
ie antidepressant |
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Route of opiate delivery
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Oral
Nasal Transdermal Rectal Subcu IM IV Intraspinal PCA |
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Non Med Pain Management
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physical intervention
ie mobility, pillows cutaneous stimulation ie massage |
