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40 Cards in this Set

  • Front
  • Back
acute pain
- immediate phase of response to an insult/injury
- resolves with the healing of underlying tissue
- usually nociceptic but can be neuropathic
- related to treatment of an underlying disease process or an injury that is expected to resolve
addiction
-
adjunct analgesics
- used for secondary pain relief in conjunction with other drugs
breakthrough pain
- transitory flare ups of pain over baseline in a patient receiving opioid therapy
- may last a few seconds to a few hours
chronic pain
- may persist beyond actual tissue injury and healing
- disrupts sleep and normal living
- does not have an adaptive and useful purpose as acute pain does
dependence
-
narcotic
-
neuropathic pain
- term used to represent pain in which the underlying pathology is abnormal processing of stimuli in the peripheral or central nervous systems.
nociceptic pain
- caused by the activation of the delta and C nociceptors in response to painful stimuli, such as injury.
opioid/narcotic analgesics
• Required for conditions, disorders, or treatments that are accompanied by moderate-to-severe pain.
• Include opiate agonists, mixed agonist-antagonists, and antagonists based on their activity at opioid receptors.
• Narcotics have an important role in pain management and control.
• Narcotics are typically underprescribed and underused.
- protoype drug: morphine
pain
- what the person says it is
- duration
- quality
- location
- pain scale
rescue
-
tolerance
-
NSAID's
- nonsteroidal anti-inflammatory drugs
- work on peripheral nervous system
- interfere with prostaglandin synthesis and preventing transmission of pain impulses
Components that influence pain
• Pain has sensory-discriminative (physical) components and affective-motivational (emotional) components.
• The sensory dimension of pain encompasses pain’s location, intensity, and quality.
• Stimulation of the limbic system produces an emotional response to the physical stimulus of pain.
• Inhibition of pain and transmission of painful stimuli occur in various regions of the brain.
• Inhibitory substances such as endogenous opioids, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) are released into nerve synapses.
• These substances bind with receptors on primary afferent and dorsal horn neurons to prevent further transmission of painful stimuli.
Physiology of Pain
• Provides a pathway for pain transmission.
• Physiologic mechanisms
• Complex & not completely understood
• Involves multiple cerebral structures
Morphine: Core Drug Knowledge
• Pharmacotherapeutics
- Moderate-to-severe acute or chronic pain.
- Pain associated with MI
• Pharmacokinetics
- Onset: PO UK, SQ=20min, IM=10-30 min
- Peak: PO=60min, SQ=50-90 min, IM=30-60
- Duration: PO, SQ, IM =4-5 hours.
o Contraindications and precautions
- respiratory conditions and hypersensitivity
o Adverse effects
- RESPIRATORY DEPRESSION, apnea, respiratory arrest, cardiac arrest, shock, and coma, confusion, sedation, hypotension, constipation
Morphine: Core Patient Variables
• Health status
o Assess respiratory status.
• Life span and gender
o Assess age
• Lifestyle, diet, and habits
o Assess for tolerance and/or dependence.
• Environment
o Closely monitor patients receiving drug.
• Culture and inherited traits
• Pain is what the patient says it is.
Morphine: Nursing Diagnosis and Outcomes
• Ineffective Breathing Pattern, Hypoventilation, related to respiratory depression caused by the drug
o Desired outcome: the patient maintains effective breathing despite respiratory depression.
• Constipation secondary to activity of the drug
o Desired outcome: the patient remains free of constipation.
• Urinary Retention related to indirect anticholinergic effects of the drug on the urinary sphincters
o Desired outcome: the patient maintains normal urinary output.
• Risk for Injury related to orthostatic hypotension or sedation secondary to drug effects
o Desired outcome: the patient remains free of injury.
Morphine: Planning and Interventions
• Maximizing therapeutic effects
o Assess pain prior to and during therapy.
o Use a pain assessment tool.
• Minimizing adverse effects
o Conduct frequent assessment.
o Reg. administered vs. prn
o Naloxone (Narcan)antidote
o Pain Rating Tools
Morphine: Teaching Assessment and Evaluations
• Patient and family education
o Teach the purpose of the therapy.
o Stress the importance of rating pain accurately.
• Ongoing assessment and evaluation
o Assess patient’s pain level by using a pain scale.
o Monitor for adverse effects.
• The nurse should always assess the level of pain the patient is experiencing prior to administration of morphine. Also morphine can cause significant respiratory depression, so respiratory rate should also be assessed.
Mild Narcotic Agonists
- prototype drug: codeine
- hydrocodone
- propoxyphene.
Codeine: Core Drug Knowledge
• Pharmacotherapeutics
o Treat mild-to-moderate pain.
• Pharmacokinetics
o Absorbed for GI track, peaks in 1-2 hours.
• Pharmacodynamics
o Acts at specific opioid receptors in the CNS to produce analgesia, euphoria, and sedation.
• Contraindications and precautions
o Not given with other narcotics
• Adverse effects
o Drowsiness, sedation, dry mouth, nausea and vomiting, and constipation
• Drug interactions*
o Antihistamines, phenothiazines, barbiturates, tricyclic antidepressants, cimetidine, and alcohol
Codeine: Core Patient Variables
• Health status
o Assess the need for the patient to cough to maintain airway.
• Life span and gender
o Consider age before administration.
• Lifestyle, diet, and habits
o Can cause physical dependency.
• Environment
o Assess environment where drug will be given.
Codeine: Nursing Diagnosis and Outcomes
• Disturbed Sensory Perception r/t drowsiness and sedation
o Desired outcome: the patient will be protected from injury related to sedation and drowsiness.
• Risk for Ineffective Airway Clearance r/t suppression of cough reflex
o Desired outcome: the patient will maintain baseline respiratory function.
• Constipation secondary to activity of the drug
o Desired outcome: the patient remains free of constipation.
Codeine: Planning and Interventions
• Maximizing therapeutic effects
o Actions are similar to those for morphine.
• Minimizing adverse effects
o Provide for patient safety.
o Assess respiratory function prior to administration.
o Do not administer to patients who need to cough to clear airway.
Narcotic Agonists/Antagonist
Prototype drug: pentazocine (Talwin)
- Some narcotic analgesics have mixed opioid effects, being an agonist at some receptors and an antagonist at others.
Pentazocine: Core Drug Knowledge
• Pharmacotherapeutics
o Agonist to control pain.
• Pharmacokinetics
o Well absorbed orally and from SQ and IM sites. Hepatic metabolism.
o Peak: 1-1 1/2 hours.
o Duration: 3 hours.
• Pharmacodynamics
o Mixed agonist-antagonist. It stimulates kappa receptors much as morphine does but also exhibits weak antagonist effects at the mu receptors.
• Contraindications and precautions
o Hypersensitivity.
o Use caution with respiratory conditions.
• Adverse effects
o Nausea, vomiting, dizziness or lightheadedness, respiratory depression, and euphoria.
• Drug interactions
o Alcohol and CNS depressants.
Pentazocine: Core Patient Variables
• Health status
o Assess for contraindications and hepatic disease.
• Life span and gender
o Pregnancy category C.
• Lifestyle, diet, and habits
o Assess for abuse potential.
• Environment
o Assess environment where drug will be given—oral forms can be given at home.
Pentazocine: Nsg Diagnoses & Outcomes
• Disturbed Sensory Perception related to dizziness and lightheadedness
o Desired outcome: the patient will not be injured from falls while taking pentazocine.
• Imbalanced Nutrition secondary to nausea and vomiting
o Desired outcome: the patient’s nutrition will not be compromised while on pentazocine.
• Ineffective Health Maintenance related to abuse of pentazocine
o Desired outcome: the patient will use drug therapy appropriately.
Pentazocine: Planning & Interventions
• Maximizing therapeutic effects
o Provide environmental controls to reduce sensory stimuli and to aid relaxation.
• Minimizing adverse effects
o Ensure that safety precautions are used.
o In cases of overdosage, naloxone is indicated.
Pentazocine: Teaching, Assessment & Evaluations
• Patient and family education
o Teach adverse effects.
o Teach how to take medication properly.

• Ongoing assessment and evaluation
o Monitor the effect of pentazocine on motor control, sedation, and pain.
o Adequate pain control should be achieved without adverse effects.
Harrison Narcotic Law of 1914
- Provided regulation regarding the manufacture and distribution of certain drugs
The 1970 Comprehensive Drug Abuse Prevention and Control Act
o Established the Drug Enforcement Agency (DEA)
o Five categories, known as schedules, were established
CONTROLLED SUBSTANCES ACT:1970
Classified Scheduled Drugs
• Schedule I
• Schedule II
• Schedule III
• Schedule IV
• Schedule V
Nursing Implications and Drug Legislation
• The “Count”
• Inventory must match
• The Record (Narcotic sheet)
• Co-signing all discarded and wasted meds.
• All controlled substances locked.
• Narcotics double locked
• Authorized persons only allowed access
Nursing Management of Controlled Substances
• The prescribing, dispensing, and storing of controlled substances is subject to governmental control.
• Procedures are precisely defined by law for every step, from manufacture to administration to wasting or discarding.
• Many hospitals use an automated system to electronically track the use of stock drugs.
Patient Education as a Safeguard in Drug Therapy
• Educating patients is a key safeguard in drug therapy
• Patient learning needs
• Teaching focus and content
• Evaluating and documenting educational outcomes
• Consumer drug information on the internet
Importance of Nursing Management of Drug Therapy
• Nurses are legally responsible for the drugs they administer.
• Safe drug administration requires a thorough understanding of therapeutic drug actions and adverse drug reactions.
• In some clinical settings, nurses are allowed to modify drug regimens.
Importance of Nursing Management of Drug Therapy
• Application of the nursing process to the pharmacologic aspects of patient care is especially important because long-term use of drug therapy is frequently necessary to control chronic disease processes.
• Nursing management of drug therapy may be considered an applied science
Effect of Legal and Institutional Controls on Nursing Management of Drug Therapy
• Drug laws and nurse practice acts vary from state to state.
• Nurses must be familiar with the current regulations in their states and in their practice settings.
• In professional practice, nurses must adhere to and obey established drug control laws and protocols.
• Nurses cannot provide drug therapy without proper authorization.
• Nurses are responsible for drug security and safe administration.