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293 Cards in this Set

  • Front
  • Back
The fifth vital sign is ______.
pain
Pain is a response to both _____ and _____ stressors.
physical and psychologic
Pain is a _____, _____ and _____ experience.
universal, complex and subjective
Pain plays a _____ role.
protective
The nurse's role in pain management is to be the ______ and promote healing, prevent complications, reduce ____ and prevent development of ______ pain states.
client advocate
suffering
incurable
____ pain can suppress your immune system and affect healing.
Chronic
During the first 24 hours post op the nurse should assess for pain _____. Otherwise, assess for pain ______.
q4h
q12h
A pain report of 1-3 is considered as _____ pain.
mild
A pain report of 4-6 is considered as _____ pain.
moderate
A pain report of 7-10 is considered as ______ pain.
severe
Pain is an unpleasant subjective ____ and _____ experience associated with actual or potential tissue damage.
sensory and emotional
Pain is influenced by ____, ____, _____, _____ and _____ factors.
physical, emotional, cognitive, sociocultural, and spiritual
_____ pain is temporary and has a sudden onset. It is often localized.
Acute
As healing occurs, _____ pain resolves.
acute
_____ pain is prolonged, recurring, intermittent, and/or constant.
Chronic
Acute pain lasts less than ____ months. Chronic pain lasts more.
3
The sympathetic nervous system is activated by _____ pain.
acute
The parasympathetic nervous system responses take over when there is _____ pain.
chronic
_____ pain is not easily localized and the cause is often unknown making it very difficult to manage. It can affect a person's ADL's/
Chronic
When a person has _____ pain there may not be a change in their BP, P or R.
chronic
_____ pain can generally be managed easily with meds or nonpharmacological methods.
Acute
____, _____, and _____ are linked with chronic pain.
Withdrawal, irritability, and depression
_____ pain is associated with cancer progression and toxicities of treatment.
Chronic cancer
_____ pain results from activation of nociceptors.
Nociceptive
Nociceptors are _____ that transmit pain.
nerve receptors
There are two types of nociceptive pain:
somatic and visceral
_____ pain involves injury to the skin, subcutaneous tissue, muscle, bone, joints,and connective tissue.
Somatic
2 types of somatic pain are:
cutaneous and deep somatic
_____ is a type of somatic pain that comes from an injury involving the skin and cutaneous tissue.
Cutaneous
An example an injury that would cause cutaneous pain is a _____.
paper cut
_____ is a type of somatic pain that involves the musculoskeletal system (bones, muscles, joints).
Deep somatic
A type of nocicepetive pain that radiates or is referred is called _____ pain.
visceral
Visceral pain results from an injury to the _____ and supporting tissue.
viscera
Visceral pain is dull and more poorly localized than somatic pain because...
there are fewer nociceptors in the viscera.
When real pain is felt in a missing limb it is called ______.
phantom pain
Phantom pain is an example of injury to nerves in the _____.
peripheral nervous system
____ pain is often associated with NV and hypotension.
Visceral
_____ pain is associated with damaged/malfunctioning nerves.
Non-nociceptive
CNS neuropathic pain can be due to...
spinal cord injuries or conditions like multiple sclerosis.
_____ Neuropathic pain refers to injury to nerves in the PNS or CNS and phantom pain.
Chronic
Chronic neuropathic pain is often the result of ineffective _____ particularly during the perioperative period.
treatment of pain
_____ pain is a hypersensitivity in an area surrounding an injury. It involves sympathetically controlled functions.
Sympathetic
Complex Regional Pain Syndrome is an example of ____ pain syndrome.
sympathetic
With ____ pain there is a disconnect between nerves that transmit pain and the CNS.
sympathetic
When pain receptors become sensitized to pain and the pain continues to persist beyond healing it is known as ______.
Complex Regional Pain Syndrome
Vasoconstriction, edema, and color changes are associated with ______ pain.
sympathetic
Pain that is confined to the site of origin or injury is described as ______ pain.
localized
Pain that is perceived initially at the source and then radiates and is less localized is described as ______ pain.
radiating
Pain that is felt at a part of the body distal from the source of painful stimuli is called ______.
referred
_____ pain is highly resistant to relief.
Intractable
Pain that travels along a nerve or nerve root, such as sciatic pain, is called _____ pain.
projected/radicular
_____ are pain receptors that are stimulated by direct injury to the cell itself or biochemical mediators.
Nociceptors
Nociceptors are especially numerous in the _____ and ____ and less numerous in the _____.
skin and muscle
viscera
The process by which an individual becomes consciously aware of pain is called ______.
nociception
_____ is a biochemical mediator that is the most abundant and potent pain producing chemical.
Bradykinin
Bradykinin is released from _____ that leaks around the site of injury, binds to ____ and excites nociceptors.
plasma
peripheral nerves
Bradykinin is a biochemical mediator that is involved in ______ response, causes vaso_____ and ____ capillary permeability.
inflammatory
dilation
increased
_____ is a biochemical mediator that excites nociceptors and produces redness, swelling, pain and inflammation.
Histamine
_____ are biochemical mediators that enhance the pain provoking effect of the bradykinin.
Prostaglandins
Prostaglandins are hormone like substances that like bradykinin, cause vaso_____ and _____ capillary permeability.
dilation
increased
The exchange of _____ and ______ across the cell membrane helps to move pain impulses toward the brain.
hydrogen and potassium
_____ is a neurotransmitter that enhances the movement of nerve impulses across the nerve synapse.
Substance P
There are 4 main processes involved in nociception:
transduction
transmission
perception
modulation
_____ is the activation of pain receptors and the release of neurotransmitters. It occurs at the source of the pain when the injury occurs.
Transduction
After the pain receptors are activated, nerve impulses are going to move from the site of injury to the brain. This is called _______.
Transmission
Transmission is carried out by 2 types of fibers. they are...
A-delta fibers and C fibers
_____ fibers are associated with "first pain" they are larger and myelinated (fast moving).
A-delta
_____ fibers are associated with 2nd pain and chronic pain. They are slower in transmission because they are smaller and not myelinated.
C
3 things occur during transmission . First the NI must move from the ____ to the ____ thru the dorsal horn of the spinal cord. Next it goes up the _____ to the brain and thalamus. From the thalamus the Ni is sent to _____.
PNS --> CNS
ascending pathway
other parts of the brain
4 parts of the brain that NI are transmitted to are:
sensory cortex
limbic system
reticular system
associational cortex
The part of the brain that is involved with perception and interpretation of pain is the ______.
sensory cortex
The part of the brain that is responsible for emotional and behavioral response to pain is the ______ system.
limbic
The part of the brain that is responsible for motor and autonomic responses to pain (warning) is the _____ system.
reticular
The part of the brain that holds memories and experiences of past cognitive activities is the ______.
Associational cortex
Once the NI reaches the brain ____ occurs.
perception
Our pain threshold is part of the _____ portion of nociception.
perception
The last step of nociception is ______.
modulation
Modulation is the response of the _____ to the _____.
brain
pain impulse
During modulation ____ (endogenous substances/opiates) are released along a descending pathway to help inhibit the movement of pain impulses to the brain.
neurotransmitters
The 4 neurotransmitters released during modulation are:
endorphins
enkephalins
serotonin
norepinephrine
The effects from the release of neurotransmitters during modulation is ______. Therefore we still need pain meds for long term relief.
temporary pain relief
_____ are neurotransmitters released during modulation that bind to opiate receptors and affect or inhibit the release of substance P and the movement of impulses to the brain.
Enkephalins
Many nonpharmacological methods for managing pain are based on the _____.
Gate Control theory
The Gate Control theory states that the interaction of two systems determines ____ and its _____.
pain
perception
The 2 systems involved in Gate Control theory are _____ and _____.
peripheral nervous system and higher centers in the brain
In the PNS, there are non-nociceptive nerve fibers that are faster than A-delta and C fibers and therefore block them from entering the dorsal horn. These fibers are called _____.
A-beta fibers
The A-beta fibers of the PNS block pain in the gate theory because they respond primarily to _____ such as...
tactile stimulation
ice, heat, massage, etc...
The second part of the Gate theory is the effect of _____.
higher centers in the brain
Higher centers in the brain help control pain because they activate the _____. Our thoughts, beliefs, emotions, and previous experiences effect how we perceive pain.
descending pathway
The effects of uncontrolled pain include decreased quality of ____, impaired _____, and ______ and _____ sensitization
life
immune function
CNS and PNS
Uncontrolled pain suppresses immune function therefore the person is
susceptible to infection
When the CNS and PNS are sensitized there is a change in structure and function of the ____ due to _____.
nervous system
persistent pain
Sensitization causes increased sensitivity of a _____ after repeated activation by noxious stimuli.
nociceptor
Sensitization results in a _____ pain threshold. Non-painful stimuli may become painful.
lowered
Sensitization affects the ____.
PNS
_____ is increased excitability and sensitivity of spinal cord neurons in the CNS.
Windup
Windup is a result of repeated stimulation of _____ which are associated with chronic pain.
C fibers
Factors that influence a person's response to pain are:
pain threshold
pain tolerance
age
sociocultural
emotional status
past experiences
placebo effect
______ is the amount of pain stimulation a person requires to feel pain.
Pain threshold
Excessive sensitivity to pain is called _____.
hyperalgesia
When non-painful stimuli produces pain it is called _____.
allodynia
The amount of pain we can endure before responding in some was is called _____.
pain tolerance
The _____ is when a response to pain is actually based on the expectation that a medication will work.
placebo effect
Elderly people may have a _____ pain tolerance because of decreased perception of sensory stimuli.
decreased
Pain assessment must be initiated by the _____.
nurse
A client's perceptions of pain can be assessed with one of two models:
PQRST or COLDERR
PQRST stands for
Precipitating factors
Quality
Region, radiation, relief
Severity (intensity)
Timing (onset, rapid, duration)
The FLACC pain assessment tool involves the ____ observations.
nurse's
COLDERR stands for
Character
Onset
Location
Duration
Exacerbation
Relief
Radiation
The _____ pain assessment tool can be used with children 2 months to 7 years of age and with anyone who is nonverbal.
FLACC
FLACC stands for
Face
Legs
Activity
Crying
Consolability
Muscle tension, anxiety, restlessness, ↑HR, ↑BP, tachypnea, dilated pupils, sweating and pallor are all _____ responses to pain.
physiologic
Bracing, guarding, crying, moaning, grimacing, sad facial expression, restlessness, purposeless body movements and immobilization are all _____ responses to pain.
behavioral
Physiologic responses to pain that you may not see with chronic pain include:
↑HR
↑BP
tachypnea (↑Respirations)
dilated pupils
When assessing a patients self management of pain and the effectiveness of their strategies, the nurse should look at...
-alleviating factors
-associated symptoms
-affect on ADL's
-past pain experiences
-affective responses
-coping resources
-daily pain diary
A daily pain diary is used for people with ______ pain.
chronic
A daily pain diary is useful for identifying _____ and factors ____ or _____ the pain experience.
pain patterns
exacerbating or mediating
____ is when a person becomes less sensitive to the analgesic properties and side effects of a drug.
Tolerance
____ is an adaptation manifested by withdrawal symptoms upon cessation, rapid reduction, decreased blood levels and/or administration of an antagonist
Dependence
_____ is a chronic neurobiologic disease influenced by genetic, psychosocial and environmental factors.
Addiction
Addiction is characterized by one of the following:
-impaired control over drug use
-compulsive use
-cravings
-continued use despite harm
_____ is an iatrogenic syndrome created by the undertreatment of pain.
Psuedoaddiction
_____ is an adaptation to a drug in which exposure induces changes that result in a decrease in one or more of the drugs effects over time.
Tolerance
When a person's behaviors appear to be indicative of addiction but disappear once the pain needs are adequately met, it is called ________.
pseudoaddiction
Factors affecting addiction include
-genetics
-stress
-mental illness
Over time a person's body or cells change and how require a drug in order to function properly. This is known as ______.
dependence
If a patient is _____, he/she will experience withdrawals when the drug is withdrawn.
dependent
If a person has developed tolerance to a drug it means that they require a _____ or _____ frequent dose to get the same amount of pain relief.
higher
more
A patient that is addicted needs a _____ dose.
higher
Medications used to relieve pain are called _____.
analgesics
Factors that are considered when selecting analgesics include:
-effectiveness of the agent
-duration of action of the drug
-duration of therapy
-ability to cause drug interactions
-patient allergies
-route of administration
In regards to duration of action, for minor procedures you may use a ____ acting analgesic.
shorter
Chronic pain is often treated with _____ instead of opioid analgesics because of the potential for dependency.
NSAIDS
The WHO Three-Step Analgesic ladder is an approach to treating _____ pain.
cancer
The WHO Three-Step Analgesic ladder identifies for mild, moderate and severe pain and the types of ______ used to try to manage them.
medications
____ medications can decrease the need for high doses of opioids therefore reducing side effects and toxic effects.
Combination
According to the WHO Three-Step ladder, pain that is mild should be treated with _____ and ______.
NSAIDS and acetaminophen
____ is when a person becomes less sensitive to the analgesic properties and side effects of a drug.
Tolerance
____ is an adaptation manifested by withdrawal symptoms upon cessation, rapid reduction, decreased blood levels and/or administration of an antagonist
Dependence
_____ is a chronic neurobiologic disease influenced by genetic, psychosocial and environmental factors.
Addiction
Addiction is characterized by one of the following:
-impaired control over drug use
-compulsive use
-cravings
-continued use despite harm
_____ is an iatrogenic syndrome created by the undertreatment of pain.
Psuedoaddiction
_____ is an adaptation to a drug in which exposure induces changes that result in a decrease in one or more of the drugs effects over time.
Tolerance
When a person's behaviors appear to be indicative of addiction but disappear once the pain needs are adequately met, it is called ________.
pseudoaddiction
Factors affecting addiction include
-genetics
-stress
-mental illness
Over time a person's body or cells change and how require a drug in order to function properly. This is known as ______.
dependence
If a patient is _____, he/she will experience withdrawals when the drug is withdrawn.
dependent
If a person has developed tolerance to a drug it means that they require a _____ or _____ frequent dose to get the same amount of pain relief.
higher
more
A patient that is addicted needs a _____ dose.
higher
Medications used to relieve pain are called _____.
analgesics
Factors that are considered when selecting analgesics include:
-effectiveness of the agent
-duration of action of the drug
-duration of therapy
-ability to cause drug interactions
-patient allergies
-route of administration
In regards to duration of action, for minor procedures you may use a ____ acting analgesic.
shorter
Chronic pain is often treated with _____ instead of opioid analgesics because of the potential for dependency.
NSAIDS
The WHO Three-Step Analgesic ladder is an approach to treating _____ pain.
cancer
The WHO Three-Step Analgesic ladder identifies for mild, moderate and severe pain and the types of ______ used to try to manage them.
medications
____ medications can decrease the need for high doses of opioids therefore reducing side effects and toxic effects.
Combination
According to the WHO Three-Step ladder, pain that is mild should be treated with _____ and ______.
NSAIDS and acetaminophen
According to the WHO Three-Step ladder, pain that is moderate should be treated with _____, ______, ______ and ______.
codeine
hydrocodone
oxycodone
tramadol
According to the WHO Three-Step ladder, pain that is severe should be treated with ______, ____, ______ and ______.
morphine
hydromorphone
fentanyl
oxycodone
An _____ is any drug natural/synthetic with actions similar to morphine.
opioid
_____ are compounds present in opium. They are derivatives of the opium plant.
Opiates
_____ reduce pain and provide a sense of euphoria.
Opioid analgesics
Opioid analgesics are schedule ____ drugs for moderate to severe pain.
2
Opioid analgesics attach to _____ in the CNS and affect release of neurotransmitters that help to move the pain impulses to the brain.
opiate receptors
There are 3 types of opioid receptors:
mu, kappa, and delta
The ____ receptors are the opiate receptors most commonly associated with pain relief.
mu
The most potent pain relieving drugs available are _______.
opioid analgesics
Opiate receptors are in heavy concentration in the ____ but are also found in other parts of the body.
CNS
Opiates decrease or inhibit the release of _____ and pain impulses the get to the brain.
substance P
The opiate receptors that are associated with physical dependence are _____ receptors.
mu
Opioid analgesics have widespread _____ effects.
pharmacologic
Opioid analgesics are metabolized in the _____ and excreted by the _____.
liver
kidney
Opioid analgesics are effected by the first-pass effect. When taken PO they go straight to liver and are metabolized rapidly therefore, the PO dose is _____ than the IV or IM dose.
higher
Opiate receptors that cause analgesia sedation and constipation are the _____ receptors.
kappa
Opiates that activate mu receptors will produce _____, _____, ______, and ______.
analgesia, respiratory depression, sedation, and euphoria
2 types of opioids are
full agonist and mixed agonist-antagonist.
A _____ is a pure opioid drug that binds tightly to the receptor site and produces maximum pain inhibition.
full agonist
Full agonist opioids activate _____ and _____ receptors.
mu and kappa
Activation of mu and kappa receptors in a full agonist opioid can result in 6 possible side effects:
analgesia
euphoria
sedation
respiratory depression
dependence
decreased GI motility
_____ opioids have no ceiling on level of analgesia but _____ opioids do have ceiling effects.
Full agonist
Mixed agonist-antagonist
_____ generally have no max daily dose limit unless in combination with a nonopioid.
Full agonists
You must always be mindful of the max daily dose of _____.
nonopioids
Morphine, codeine, hydromorphone, oxycodone and fentanyl are examples of _____ (full agonist/mixed-agonist/antagonist) opioids.
Full agonist
_______ opioids act like opioids and relieve pain when given to clients clients who have not taken a pure opioid or agonist for at least a couple of weeks.
Mixed agonist/antagonist
Mixed agonist-antagonist opioids are antagonist at the ____ receptor and agonist at the _____ receptor.
mu
kappa
Side effects from a mixed agonist-antagost opioid include:
analgesia, sedation, and decreased GI motility
3 Examples of mixed agonist-antagonists are
Talwin, Stadol, and Nubain
_____ opioids can block or inactivate other opioid analgesics therefore there is less pain relief, but they can also precipitate withdrawal.
Mixed agonist-antagonist
_____ happens once a certain amount of a drug is given and the maximum pain relief is reached.
Ceiling effect
______ is a type of chart that lists doses of various opioid analgesics that provide approximately the same pain relief as 10mg of morphine.
Equianalgesic dosing
Nasal and rectal analgesics have a _____ action because they are absorbed they the mucosa.
rapid
Continuous subcutaneous infusion is when a needle is inserted into the anterior chest/abdomen and subcutaneously provides a combination of some ____ and ______.
opioid and a local anesthetic
The various routes of administration for opioid analgesics include:
oral
nasal
transdermal
rectal
subcutaneous
intramuscular
intravenous
intraspinal
A route of administration for opioid analgesics that is rapid, effective, and has few side effects is ______.
intravenous
The _____ route of administration for opioid analgesics is the least desirable because absorption is variable and administration is painful.
Intramuscular
Side effects of opioid analgesics relate directly to the _____.
receptor site
Side effects of opioid analgesics include:
-drowsiness and lethargy
-euphoria
-NV and constipation
-pruritis
-orthostatic hyportension, flushing
-urinary retention
-miosis
-cough suppression
-respiratory depression
_____ is itching.
Pruritis
Opiates affect the smooth muscle resulting in decreased peristalsis therefore leading to _____.
constipation
After taking opioid analgesics for a while a person may develop tolerance to ____, ______, and _____.
drowsiness, vomiting, and respiratory depression
The most significant problem resulting from taking opioid analgesics is ______.
respiratory depression
_____ is constriction of the pupils and affects vision in dim light.
Miosis
When administering opioid analgesics via IV, side effects will usually occur within ____ minutes.
10-20
When administering opioid analgesics via IM, side effects will usually occur within ____ minutes.
30 minutes
When administering opioid analgesics via SQ, side effects will usually occur within ____ minutes.
60-90
When administering opioid analgesics via PO, side effects will usually occur within ____ minutes.
60 minutes
If a client's respirations are less than 12 you should
withhold the opioid and notify the physician
When assessing the effectiveness of opioid analgesics it should be within _____ of administration.
1 hour
Nursing responsibilities for patients taking opioid analgesics include:
-assess effectiveness of med
-assess and manage adverse effects
-record keeping of meds
-client teaching
When assessing levels of sedation, a 1 means _____, a 2 means ______, a 3 means _____, and a 4 means ______.
1-awake/alert
2-slightly drowsy
3-frequently drowsy
4-somnilant- no/minimal response to physical stimulation
Respiratory depression can be treated with _____, a narcotic antagonist, that reverses effects of the opiate.
Narcan
Narcan can be administered ____, _____, or ____. The effects should be seen within ____ minutes and should last 1-2 hours.
IV
IM
SC
2-5 minutes
If respiratory depression occurs as a side effect of an opioid analgesic, the nurse should administer _____ and then monitor and assess the patient q___m for at least 2h.
Narcan
15
Client teaching for patients taking opioid analgesics should include:
-avoid alcohol, OTC meds, driving, operating machinery
-report tolerance/side effects
-increase fluid and fiber intake
-facts about addiction
A ____ allows self administration of doses of analgesics when needed.
PCA pump
The purpose of patient-controlled analgesia (PCA) is to maintain steady _______ of medication to more effectively manage the client's pain.
plasma levels
Things to know about PCA pumps:
-allow self administration of doses of analgesia prn
-minimizes peaks and valleys that occur with traditional prn administration
-has preset dose (bolus)
-has "lockout" interval (10-15min)
A variation of the PCA pump is low continuous infusion. This type of administration is ____ and the patient is getting _____.
preset
continuous infusion
When a PCA pump drug is discontinued, 2 nurses must look at it and assess...
the amount administered and the amount remaining.
Other types of pharmacologic management are:
-topical analgesics
-local anesthetics
-sympathetic nerve blocks
-regional anesthesia/analgesia
_____ can be put on extremities 30-60 minutes prior to beginning and IV or other procedures.
Topical analgesics
_____ are things like perineural local anesthetics. They are called painbusters/OnQ
Local anesthetics
_____ are used in the management of sympathetic maintained pain states (CRPS).
Sympathetic nerve blocks
A SC catheter placed near nerves around a surgical wound with a patient controlled pump that provides continuous local anesthesia is called ____.
OnQ/painbuster
Capsaicin cream, EMLA cream and lidocaine are all examples of _______.
topical analgesics
A ______ is an injection of local anesthetic into sympathetic nerve tissue (nerves around spine). A steroid may also be injected to help prolong the effects.
Sympathetic nerve block
_____ is when a catheter is placed with tubing attached to an infusion pump. The administration could be bolus, continuous infusion, or patient controlled.
Regional anesthesia/analgesia
Regional anesthesia/analgesia can be either _____ or _____.
intrathecal (spinal) or epidural
Intrathecal administration is when the catheter is placed in the _______.
subarachnoid space of the spine
Epidural administration is when the catheter is entered into the _______.
epidural space of the spine.
Between Intrathecal (spinal) and Epidural administrations, the one seen most often is _______.
epidural
______ is used for surgeries/procedures or to help the patient control or manage chronic cancer or post op pain.
Intraspinal analgesia
The nursing responsibilities that go along with regional anesthesia/analgesia are:
-assess effectiveness of med
-assess for adverse effects
-prevent infection
-maintain placement of catheter
Adverse effects of regional anesthesia/analgesia include:
-sedation
-respiratory depression
-reduced/loss of sensation
-bowel and bladder distention
-constipation
-decreased I&O
When administering regional anesthesia/analgesia, _____ should be available at the bedside at all times!
Narcan
Use _____ technique with catheters placed for regional anesthesia/analgesia.
sterile
2 things an epidural can cause are:
decreased sensation and urinary retention (related to micturation reflex)
_____ are often combined with narcotics for moderate to severe pain because it can reduce the dose of opioid needed and provides better relief when combined.
NSAIDS
NSAIDS serve the functions of _____, ______, and ______.
Anti-inflammatory
Antipyretic
Analgesic
NSAIDS can interfere with _____ synthesis (decreasing # of nociceptors stimulated) and ______ aggregation (impaired clotting/bleeding).
prostaglandin
platelet
3 NSAIDS are:
Aspirin
Ibuprofen
Naproxyn
An adverse effect of NSAIDS is
GI irritation.
NSAIDS interfere with ____ synthesis. This can cause GI irritation because the _____ protect the stomach lining.
prostaglandin
prostaglandin
NSAIDS may also increase the effects of ______ agents.
hypoglycemic
NSAIDS are the treatment of choice for _______.
mild-moderate pain
People who should not take NSAIDS are those with...
GI bleeding, ulcers, and impaired clotting
Things you should teach a client who is taking NSAIDS are:
-take with food or milk
-don't administer with Aspirin or other NSAIDS
-use of antacids
-tinnitis
Using antacids when taking NSAIDS may...
decrease GI distress but also decreases absorption and effectiveness of the medication.
____ is associated with high doses of aspirin which is ototoxic.
Tinnitis
Tinnitis is ______. It is an early sign of _____.
ringing in the ears
ototoxicity
______ are medications that were developed for another use but are found to reduce pain as well.
Adjuvant analgesics
Adjuvant analgesics are also called ______.
coanalgesics
Adjuvant analgesics that help to reduce stress, anxiety, and tension and promote sleep and rest are called ______.
mild sedatives and tranquilizers
Many _____ are SSRI (selective serotonin reuptake inhibitors) and prevent reabsorption of serotonin. More serotonin in the blood blocks pain impulses from getting to the brain where they are perceived.
antidepressants
A common antidepressant is _____.
cymbalta
_____ are adjuvant analgesics that stabilize nerve membranes therefore decreasing excitability and pain.
Anticonvulsants
Neurontin is developed for ______ but actually helps with neuropathic pain.
seizures
_____ is developed for the purpose of managing neuropathy/nerve pain.
Lyrica
2 Non-opioid centrally acting analgesics are:
tramadol and clonidine
_____ is a non-opioid centrally acting analgesic that is a weak agonist at the mu receptor site and acts somewhat like an opiate. It may inhibit reabsorption of norendorphins and serotonin therefore helping prevent pain impulses from getting to the brain.
Tramadol
____ is a non-opioid centrally acting analgesic that for HTN and administered transdermally for pain; sometimes epidurally with anesthetic for epidural analgesic and also for sympathetic pain blocks to prolong the effect of local anesthesia.
Clonidine
Many nonpharmacologic managements are based on the ______.
gate control theory
Examples of nonpharmacologic management through cutaneous stimulation are:
-massage
-heat and cold
-contralateral stimulation
-Transcutaneous Electrical Nerve Stimulation (TENS)
Examples of nonpharmacologic management through cognitive or behavioral measures are:
-distraction
-relaxation
-guided imagery
Invasive therapies that are types of nonpharmacologic pain management are:
-neuroablative procedures
-trigger point injections
-spinal cord stimulation
Stimulation to the skin and subcutaneous tissue which prompts closure of the "gate" is known as _____.
Cutaneous stimulation
Cutaneous stimulation increases the release of _____.
endorphins
_____ is the stimulation of skin in an area opposite to the painful area.
Contralateral stimulation
_____ is low voltage electrical stimulation applied to skin and subcutaneous tissue.
TENS
TENS works by stimulating _____ in the same area as the fibers transmitting pain therefore the large nonpain nerve fiber reaches the dorsal horn and prevents pain impulses from entering the spinal cord and going to the brain.
non pain receptors
_____ is focusing attention on something other than pain.
Distraction
____ is using one's imagination to achieve a specific effect.
Guided Imagery
_____ relaxes tense muscles and reduces anxiety and tension.
Relaxation
_____ produces a deeply relaxed state by helping muscles relax and increasing the release of endorphins.
Meditation
_____ is a cognitive/behavioral measure that must be done by someone who is certified.
Hypnosis
Cognitive/Behavioral measures that are nonpharmacologic methods of pain management are:
-distraction
-guided imagery
-relaxation
-meditation
-hypnosis
-diaphragmatic breathing
A _____ is a chemical interruption of a nerve pathway.
nerve block
3 types of surgical interruptions of nerve pathways are:
-neurectomy
-cordotomy
-rhizotomy
The purpose of neuroablative procedures is to stop transmission of the ____ to the _____.
nerve impulse to the brain
______ interruption of a nerve pathway is used for more severe or chronic types of pain. The nerve is actually cut to prevent the NI from reaching the brain.
Surgical
______ is a permanent invasive therapy that delivers a low voltage electrical current continuously to the spinal cord nerves to block sensation of pain.
Spinal Cord stimulation (SCS)/ neuromodulation
A _____ is done to remove a nerve.
neurectomy
Client teaching about pain management should include:
-Medication (frequency, side effects, drug/food interactions, special precautions, take prior to SEVERE pain)
-risk of addiction
-scheduled periods of sleep and rest
-non-pharmacologic measures
Some ____ believe pain and suffering is a part of life and is to be endured. Some may deny dealing with it until it is unbearable and some believe prayer and laying on of hands will free a person of suffering and pain.
African Americans
____ may view pain as part of life and seriousness of illness. For some enduring pain is a sign of strength.
Mexican americans
Some ______ may tend to be loud and outspoken in their expressions of pain. This is a socially learned way to cope with pain.
Puerto Ricans
____ cultures value silence therefore some clients may be quiet when in pain so as not to dishonor their families or themselves.
Chinese
_____ may have a stoic response to pain. They may refuse pain meds. Bearing pain is considered a virtue and a matter of family honor.
Japanese
______ patients may believe that pain is God's will. Some elderly may refuse pain meds.
Filipino
If the client is a _____, remaining calm when in pain is viewed as bringing oneself to a higher state or being.
Buddhist
_____ in general are quiet, less expressive verbally and nonverbally, and may tolerate a high level of pain. They tend to not request pain medication and may tolerate pain until they are physically disabled.
Native Americans
Pain responses in ____ may be considered private and reserved for immediate family. As a result this may lead to conflicting perceptions among the family and the nurse regarding effectiveness of the client's pain relief.
Arab Americans
_____ are an age group that often receives inadequate pain medication.
Children