Taylor - Fundamentals Of Nursing - Adn 1 Exam #2 Chapter 35 Comfort

Front 1

APS

Back 1

American Pain Society

Front 2

The APS defines pain as:

Back 2

an unpleasant subjective sensory and emotional experience associated with actual or potential tissue damage.

Front 3

National Pain Care Act of 2003

Back 3

A White House initiated national movement that requires the AHRQ(Agency for Healthcare Research and Quality) to collect EBP(evidence based practice) and to develop and disseminate pain protocols regarding pain and palliative care.

Front 4

Pain is defined as applied to nursing is:

Back 4

whatever the patient says it is, existing whenever the patient says it does.

Front 5

Pain may be classified by its:

Back 5

duration,
its location or source,
its mode of transmission,
its etiology(cause).

Front 6

Etiology

Back 6

the study of the cause of a condition.

Front 7

Acute pain is:

Back 7

protective in nature warning of tissue damage or organic disease.
rapid in onset,
varies in intensity from mild to severe,
disappears after underlying cause is resolved,
ends once healing occurs.

Front 8

Chronic pain is:

Back 8

limited, intermittent, or persistent and lasts beyond the normal healing period.

Front 9

Remission

Back 9

when disease persists but symptoms are not experienced.

Front 10

Exacerbation

Back 10

when symptoms reappear.

Front 11

Chronic Malignant Pain

Back 11

pain associated with cancer or other progressive disorders.

Front 12

Chronic Nonmalignant Pain

Back 12

pain associated with tissue injury that is nonprogressive or healed.

Front 13

Patients have difficulty describing chronic pain because:

Back 13

it is poorly localized, often perceived as meaningless.

Front 14

Chronic, persistent pain may lead to:

Back 14

withdrawal,
depression,
anger,
frustration,
dependency.

Front 15

Misconceptions and personal biases of caregivers regarding chronic pain may:

Back 15

adversely affect the management of chronic pain,
label the patient as :
hysterical,
a malingerer,
a hypochondriac.

Front 16

Location or Source:

Cutaneous pain

Back 16

superficial pain usually involving the skin or subcutaneous tissue.
ex: a paper cut.

Front 17

Location or Source:

Somatic pain

Back 17

diffuse or scattered,
originating in:
tendons,
ligaments,
bones,
blood vessels,
nerves.
ex: a strong pressure on a bone or tissue damage resulting from a sprain.

Front 18

Location or Source:

Visceral pain

Back 18

poorly localized,
originates in body organs that stretch abnormally and become distended, ischemic or inflamed in the:
thorax,
cranium,
abdomen.

Front 19

Guarding

Back 19

a reflex contraction or spasm of the abdominal wall that occurs as a protective mechanism to protect additional trauma to underlying structures.
patient automatically tenses his abdomen, preventing tissue organs from being palpated or touched.

Front 20

Referred pain

Back 20

pain that originates in one part of the body but is perceived in another area distant from its point of origin.
referred pain is transmitted to other areas innervated by the affected nerve root.

Front 21

Neuropathic pain

Back 21

pain resulting from an abnormal functioning or injury to peripheral nerves or the CNS.
its cause is unknown.
it can occur in many forms.
it can be of short duration.
it is often described as burning or stabbing.
appropriate treatment is often delayed as a result of misdiagnosis.

Front 22

Allodynia

Back 22

a characteristic feature of neuropathic pain that occurs after a weak or non-painful stimuli such as a light touch or a cold drink.

Front 23

Neuropathic pain syndromes:

Complex Regional Pain Syndrome
(causaglia)

Back 23

pain occurs in the area partially injured peripheral nerve, most commonly the brachial plexus or median or sciatic nerve.
described as burning, severe, diffuse and persistant.
elicited by minimal movement or touch of the affected area.
it increases with repeated stimulation and continues after stimulation ceases.

Front 24

Neuropathic pain syndromes:

Posterpetic Neuralgia

Back 24

this pain syndrome follows an acute CNS infection, such as Herpes Zoster-shingles.
characterized by vesicular eruption and neuralgic pain, which is usually unilateral and encircles the body ib band-like clusters.
the pain may be mild to severe.
intractable pain may persist for months to years.

Front 25

Intractable pain

Back 25

pain that is resistant to therapy.
it persists despite a variety of interventions.

Front 26

Neuropathic pain syndromes:

Phantom Limb Pain

Back 26

pain that is referred to an amputated limb where receptors and nerves are clearly absent.
pain may be a severe, burning, fiery sensation; crushing; cramping;a sense that the limb is edematous; or a sensation that the limb is being twisted or distorted.

Front 27

Neuropathic pain syndromes:

Trigeminal Neuralgia

Back 27

paroxysms(sudden outbursts) of lightning-like stabs of intense pain in the distribution of one or more divisions of the trigeminal nerve(5th. cranial nerve).
pain is usually experienced in the mouth, gums, lips, nose, cheek, chin and surface of the head and may be triggered by activities like talking, eating, shaving, or brushing one's teeth.

Front 28

Neuropathic pain syndromes:

Diabetic Neuropathy.

Back 28

a common complication of long-term diabetes mellitus.
damage to the peripheral and autonomic nerves resulting from metabolic and vascular changes.
involvement of the peripheral nerves can result in sensory loss which can lead to injury progressing to infection and gangrene.
symptoms include sensations of numbness, prickling, or tingling(parasthesias)

Front 29

Psychogenic pain

Back 29

pain for which a physical cause cannot be identified.
pain from a mental event can be just as intense as pain that results from a phsiycal event.

Front 30

The three types of responses to pain are:

Back 30

physiologic,
behavioral,
affective.
the severity of pain and its duration affects responses to pain.

Front 31

Common Responses to Pain:

Behavioral Responses(voluntary)

Back 31

moving away from painful stimuli,
grimacing,
moaning and crying,
restlessness,
protecting the painful area and refusal to move.

Front 32

Common Responses to Pain:
Physiological Responses(involuntary)
SYMPATHETIC RESPONSES
(moderate and superficial pain)

Back 32

Increased blood pressure
increased pulse
increased respiratory rates
increased adrenalin output
increased blood glucose
pupil dilation
muscle tension and rigidity
pallor(peripheral vasoconstriction)

Front 33

Common Responses to Pain:
Physiological Responses(involuntary)
PARASYMPATHETIC RESPONSES
(severe and deep pain)

Back 33

decreased blood pressure
decreased pulse rate
rapid and irregular breathing
prostration(absolute exhaustion)
nausea and vomiting
fainting or unconsciousness

Front 34

An increase in vital signs may

Back 34

occur briefly in acute pain but
may not occur in chronic pain.

Front 35

Common Responses to Pain:
Affective Responses(psychological)

Back 35

exaggerated weeping and restlessness
withdrawal
stoicism
anxiety
depression
fear
anger
anorexia
fatigue
hopelessness
powerlessness.

Front 36

The Process of Pain(mechanism) involves four stages:

Back 36

Transduction,
Transmission,
Perception,
Modulation.

Front 37

The Process of Pain(mechanism)

TRANSDUCTION

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the activation of pain receptors involving the conversion of painful stimuli into electrical impulses that travel from the peripheral nerve fibers(nociceptors) to the spinal cord at the dorsal horn.

Front 38

Nociceptors

Back 38

the peripheral nerve fibers that transmit pain.

Front 39

Pain Threshold

Back 39

the lowest value of a stimulus that, once reached, allows the recognition of pain.
Gender may influence this threshold.
ADAPTATION has been described during the repeated torture of prisoners of war where it was reported that the pain was not as acute as it would have been under different circumstances; also seen when the toleration of pain from the immersion into hot water that is gradually heated is greater than that of being plunged into water of the same temperature.

Front 40

Sensitization

Back 40

the prolonged effect of pain stimuli on the CNS that leads to the lowering of the threshold for activation of pain, this can allow even harmless stimuli to trigger pain.

Front 41

Injured tissues release neurotransmitters that excite nociceptors, they are:

Back 41

Histamine,
Bradykinin,
Prostaglandins,
Serotonin,
Substance P.

Front 42

Neurotransmitter

Back 42

a substance that can either excite or inhibit target nerve cells.

Front 43

Neurotransmitter

Bradykinin

Back 43

powerful vasodilator, increases capillary permeability,
constricts smooth muscle,
triggers the release of Histamine, resulting in the redness, swelling and pain typical of the inflammatory response.

Front 44

Neurotransmitter

Prostaglandins

Back 44

hormone-like substances

Front 45

Neurotransmitter

Substance P

Back 45

sensitizes nociceptors, increasing the rate of firing.

Front 46

Neurotransmitter

Serotonin

Back 46

hormone that stimulates smooth muscle, vasoconstricts and inhibits gastric secretions.

Front 47

The four stimulant agents that stimulate skin and superficial organs are:

Back 47

MECHANICAL stimulants- such as friction from bed liners or pressure from a cast,
THERMAL stimulants- sunburn or cold water on a tooth carrie,
CHEMICAL stimulant- acid burn,
ELECTRICAL stimulant- the jolt of a static charge.

Front 48

Afferent nerve fibers associated with pain transmission are:

Back 48

A-delta fibers &
C- fibers.
these carry impulses from pain receptors to the CNS.

Front 49

A-delta fibers

Back 49

fast conducting fibers that transmit acute, well localized pain.

Front 50

C-fibers

Back 50

smaller, slower fibers that conduct diffuse, visceral pain.
pain is often described as burning and aching.

Front 51

Pain Reflex.

Back 51

protective, responsible for withdrawal of endangered tissue from a damaging stimuli.
impulse travel via the (afferent) A-delta fibers through the dorsal root ganglia to the dorsal horn of the spinal cord.
synapsing with an (efferent) motor neuron, the impulse carried is back to the site of the stimulus resulting in an immediate muscle contraction.

Front 52

Thalamus and Cortex of the brain

Back 52

The Thalumus is the sensory center of the brain where sensations such as heat, cold, pain and touch first become conscious.
it receives the impulse from the pain stimuli via the spinal cord soon after it is processed through the pain reflex.
The impulse is then directed to the cortex where the PERCEPTION of intensity and location of the pain are determine.
The cortex then sends a signal back via the spinal cord to the dorsal horn where the pain is MODULATED with the release of chemicals such as endorphins.

Front 53

PERCEPTION of pain

Back 53

occurs in the cortex.
the recognition and interpretation of the pain stimuli.

Front 54

MODULATION of pain

Back 54

the process by which the sensation of pain is inhibited or modified by substances called neuromodulators.

Front 55

Neuromodulators

Back 55

Endogenous opioid compounds(naturally present morphine-like chemical regulators) in the spinal cord and brain.
Possess analgesic activity and alter the perception of pain.
They bind to specific opioid receptor sites throughout the CNS, blocking the release or production of pain-transmitting neurotransmitters.
Pain and Stress are capable of activating this endogenous opiate system.
Endorphins and Enkephalins are opioid neuromodulators.

Front 56

The Endorphins

Back 56

produced at neural synapses at various points along the CNS pathway.
powerful pain blockers with prolonged analgesic and euphoric effects.
May be released when pain-relieving drugs are used and during the application of skin stimulation and relaxation techniques.

Front 57

Dynorphin

Back 57

possess the most potent analgesic effect of all the endorphins.

Front 58

The Enkephalins

Back 58

found widespread throughout the brain and dorsal horn of the spinal cord.
less potent than the endorphins.
believed to reduce pain sensation by inhibiting the release of Substance P from the terminals of afferent neurons.

Front 59

The Gate Control Theory of Pain

Back 59

the theory states:
small diameter afferent nerve fibers conduct excitatory pain stimuli toward the brain.
large diameter afferent nerve fibers inhibit the transmission of pain impulses from the spinal cord to the brain.
a gate mechanism exists in the dorsal horn of the spinal cord.
the inhibitory and excitatory signals at the gate determine the impulses that go to and from the brain.
the brain regulates the gate through learned past experiences & behaviors. this explains how similar painful stimuli are interpreted differently by different people.
this theory may explain why mechanical(massage),thermal(hot/cold compresses), and electrical interventions can bring relief to a painful lower back area or a soothing voice can ease pain all by stimulating the large fibers to close the gate.

Front 60

Terms used to describe the Quality of pain:
Sharp

Back 60

intense, sticking

Front 61

Terms used to describe the Quality of pain:
Dull

Back 61

more diffuse and not as intense as sharp pain, possibly more annoying tha painful.

Front 62

Terms used to describe the Quality of pain:
Diffuse

Back 62

pain that covers a large area.
patient is often unable to point to a specific area, usually moves hand over a large area, such as the entire abdomen.

Front 63

Terms used to describe the Quality of pain:
Shifting

Back 63

pain that moves from one area to another, such as the lower abdomen to the area over the stomach.

Front 64

Other Terms used to describe the Quality of pain:

Back 64

sore
stinging
pinching
cramping
gnawing
cutting
throbbing
shooting
vise-like pressure.

Front 65

Terms used to describe the Severity of pain:
Severe or Excruciating
Moderate
Slight or Mild.

Back 65

Patient's interpretation of pain is important.
Behavioral and Physiological signs help the nurse assess the severity.
On a scale of 1 to 10:
mild = 1 to 3
moderate = 4 to 7
severe = 8 to 10.

Front 66

Terms used to describe the Periodicity of pain:
Continuous

Back 66

pain that does not stop.

Front 67

Terms used to describe the Periodicity of pain:
Intermittent

Back 67

pain that starts and stops again.

Front 68

Terms used to describe the Periodicity of pain:
Brief or Transient

Back 68

pain that passes quickly.

Front 69

Factors Affecting the Pain Experience:
Culture & Ethnicity.

Back 69

cultural norms dictate patient's behavior, attitudes and values.
Do not stereotype responses to pain.
be knowledgeable about cultural variations and alternative practices used to manage pain.

Front 70

Factors Affecting the Pain Experience:
Family, Gender and Age variables

Back 70

nurses must increase their respect for diversity.
these variables make pain assessment a complex task for nurses.

Front 71

Factors Affecting the Pain Experience:
Environment and Support

Back 71

a healthcare environment may decrease an individual's ability to cope with pain.
some require the presence of a loved one or friend, others prefer to be alone.
intervening and attempting an honest discussion is important

Front 72

Factors Affecting the Pain Experience:
Anxiety and other Stressors

Back 72

anxiety tends to increase the perceived intensity of pain.
pain may be aggravated with anxiety, tension and fatigue.
the threat of the unknown increases anxiety. teaching patients what to expect about what to expect tends to decrease the need for pain medication.

Front 73

Factors Affecting the Pain Experience:
Past Pain Experiences

Back 73

an individual's experience of pain in the past and the qualities of that experience profoundly affect new pain experiences.
those that have received adequate pain relief in the past are generally unafraid.
some memories are virtually unerasable.

Front 74

Pain Assessment:
Pain as the Fifth Vital Sign.

Back 74

pain is a vital sign along with:
body temperature
pulse
respiratory rate
blood pressure.
The TJC has accreditation standards that include emphasis on patient's rights to effective assessment and treatment of pain.

Front 75

Components of a Pain Assessment:
Data Collection

Back 75

patient's verbalization and description.
report from family and caregiver familiar with patient.
duration of pain.
location.
quantity and intensity-pain scale.
quality.
chronology.
aggravating factors.
alleviating factors.
physiological indicators -vitals.
behavioral responses- nonverbal ques included.
effect of the pain on activities and lifestyle.
patient's expectation for pain relief.

Front 76

Questions and Factors Used to Assess Pain's Characteristics
Location

Back 76

where is your pain?
is it internal or external?
in acute pain,ask patients to point to painful area.
in chronic pain patient may have difficulty trying to localize it.

Front 77

Questions and Factors Used to Assess Pain's Characteristics
Duration

Back 77

how long have you been experiencing pain?
how long does the pain last?
how often does it occur?

Front 78

Questions and Factors Used to Assess Pain's Characteristics
Quantity

Back 78

ask patient to rate scale on a 1 to 10 scale( 1 to 5 for older adults).
rate the pain at its least and at its worst.

Front 79

Questions and Factors Used to Assess Pain's Characteristics
Quality

Back 79

what words would you use to describe your pain?

Front 80

Questions and Factors Used to Assess Pain's Characteristics
Chronology

Back 80

how does the pain develop and progress?
has the pain changed since it first began?
if so, how?

Front 81

Questions and Factors Used to Assess Pain's Characteristics
Aggravating Factors

Back 81

what makes the pain occur or increase in intensity?

Front 82

Questions and Factors Used to Assess Pain's Characteristics
Alleviating Factors

Back 82

what makes the pain lessen or go away?
what methods of relief have you tried in the past?
how long were they used?
how effective were they?
verify current orders and their effectiveness.
ask outpatients to record a medication profile-all the medications they are taking.

Front 83

Questions and Factors Used to Assess Pain's Characteristics
Associated Phenomena

Back 83

are there factors that relate consistently to your pain?
are there any other symptoms that occur just before, during or after your pain?

Front 84

Questions and Factors Used to Assess Acute Pain's Characteristics
Physiological Responses

Back 84

increased vital values
skin color
perspiration
pupil size
nausea
signs of sympathetic stimulation may occur with acute pain but need not be present to verify pain.

Front 85

Questions and Factors Used to Assess Chronic Pain's Characteristics
Physiological Responses

Back 85

decreased pulse and BP,
rapid, irregular respirations,
pupil constriction,
nausea and vomiting,
warm,dry skin
signs of parasympathetic stimulation may occur, especially in prolonged, severe,visceral or deep pain.

Front 86

Questions and Factors Used to Assess Pain's Characteristics
Physiological Responses

Back 86

muscle tension
ask patient if he is aware of any tight, tense muscles.

Front 87

Questions and Factors Used to Assess Pain's Characteristics
Physiological Responses

Back 87

anxiety
are signs of anxiety present?
decreased attention span or an inability to follow directions,
frequent asking of questions,
changing the subject,
avoidance of discussion of feelings,
acting out,
somatizing(expressing a mental condition as a bodily function).

Front 88

Questions and Factors Used to Assess Pain's Characteristics
Behavioral Responses:
Posture, gross motor activities-

Back 88

does patient rub or support a particular area or make frequent position changes?
does patient protect an area from stimulation?
lie quietly?

Front 89

Questions and Factors Used to Assess Pain's Characteristics
Behavioral Responses:
Facial features-

Back 89

does patient show facial grimaces, knotted brow, or an overall taut, anxious appearance?

Front 90

Questions and Factors Used to Assess Pain's Characteristics
Behavioral Responses
Verbal

Back 90

does patient moan,sigh, scream, cry,repetitively use the same words?

Front 91

Questions and Factors Used to Assess Pain's Characteristics
Affective Responses:
Anxiety

Back 91

do you feel anxious?
are you afraid?
if so, how bad are these feelings?

Front 92

Questions and Factors Used to Assess Pain's Characteristics
Affective Responses:
Depression

Back 92

do you feel depressed, down or low?
if so, how bad are these feelings?
are your feelings about yourself mostly good or bad?
do you have feelings of failure?
Do you see yourself or your illness as a burden to those that care about you?

Front 93

Questions and Factors Used to Assess Pain's Characteristics
Affective Responses:
Interactions with others

Back 93

how does patient act when he is pain in the presence of others?
how does patient act when not in pain?
how do significant others respond to the patient when he is in pain and when not in pain?

Front 94

Questions and Factors Used to Assess Pain's Characteristics
Affective Responses:
Pain's interference with patient's life

Back 94

does pain interfere with sleep?
if so, to what extent?
is fatigue a major factor in the pain experience?
are your relationships affected by your pain?
is work affected?

Front 95

Questions and Factors Used to Assess Pain's Characteristics
Affective Responses:
Perception and meaning of pain to patient

Back 95

are you worried about your illness?
do you see a relationship between your pain and your illness?
if so, how do you see them related?
do you find any meaning in your pain?
is this helping or hurting you?
are you struggling to find some meaning in your pain?

Front 96

Questions and Factors Used to Assess Pain's Characteristics
Affective Responses:
Adaptive mechanisms used to cope

Back 96

what do you usually do to relieve stress?
how well do these things work?
what techniques do you use at home to help cope with the pain?
how well have they worked?
do you use these in the hospital?
if not, why not?

Front 97

Questions and Factors Used to Assess Pain's Characteristics
Affective Responses:
Outcomes

Back 97

what would you like to be doing right now if the pain were better controlled?
how much would the pain have to decrease(on a 1 to 10 scale) for you to begin to accomplish these goals?

Front 98

Pain Assessment Scales:
NRS - Numerical Rating Scale

Back 98

a 1 to 10 rating scale with 10 being severe pain

Front 99

Pain Assessment Scales:
COMFORT scale

Back 99

infants,children,and adults who are unable to use the NRS or Wong-Baker FACES scale

Front 100

Pain Assessment Scales:
CRIES scale

Back 100

neonates(0 to 6 months)

Front 101

Pain Assessment Scales:
FLACC scale

Back 101

infants and children(2 months to 7 years) who are unable to validate the presence or quantify the severity of pain.
F- faces
L- legs
A- activity
C- cry
C- consolability

Front 102

Pain Assessment Scales:
Wong-Baker Faces Pain Rating scale

Back 102

adults and children(>3 years old) in all patient care settings.

Front 103

Pain Assessment Scales:
Beyer Oucher Pain scale

Back 103

young children who can point to a face to indicate their level of pain.

Front 104

Pain Assessment Scales:
WILDA scale

Back 104

widely used scale.
use words to describe pain(stabbing, etc.)
Intensity(1 to 10 or 1 to 5 )
location(pointing to area of pain)
duration(how long?)
aggravating or alleviating factors.

Front 105

Pain Assessment Scales:
PAINAD scale

Back 105

behavioral pain scale for use with the critically ill and those with dementia.examines 5 items:
breathing
vocalization
facial expression
body language
consolability

Front 106

Pain Assessment Scales:
Payen Behavioral Pain scale

Back 106

useful with intubated, critically ill patients which measures bodily indicators of pain and tolerance of intubation.

Front 107

Nursing Diagnosis of Acute or Chronic Pain should identify the following:

Back 107

type of pain.
etiological factors, to the extent that they are known and understood.
patient's behavioral, physiologic, and affective responses.
factors affecting pain stimulus, transmission,perception and response.

Front 108

Pain Tolerance

Back 108

the point beyond which a person is no longer willing to endure pain.

Front 109

Nonpharmacologic Relief Measures

Back 109

complementary and alternative
distraction
humor
music
imagery
relaxation
cutaneous stimulation-accupressure and TENS unit
acupuncture
hypnosis
biofeedback
therapeutic touch.

Front 110

Analgesics

Back 110

a pharmaceutical agent that relieves pain.

Front 111

Three general classes of drugs-analgesics- used for pain

Back 111

Nonopoid analgesics:
acetominophen
NSAIDS - nonsteroidal anti-inflammatory drugs - motrin.

Opioid analgesics:
controlled substances e.g.
morphine
meperidene
codeine
hydromorphone
methadone

Adjuvant Drugs:
anticonvulsants
antidepressants
multipurpose drugs.

Front 112

Administering analgesics requires a thorough knowledge of the:

Back 112

mechanism of action,
side effects,
administration guidelines.

Front 113

The prototype opioid is

Back 113

morphine
tolerance to the drug and its respiratory depressant effects occurs.
side effects are:
sedation,
nausea,
constipation.

Front 114

Assessment
Numeric Sedation Scale

Back 114

determines patient's risk for respiratory depression.
1- awake
2- -occasionally drowsy but easily aroused- no action required.
3 - frequently drowsy, drifts off to sleep during conversation-decrease opioid use
4 - somnolent with minimal or no response to stimuli - dicontinue use of opioid and consider naloxone.

Front 115

Naloxone (Narcan)

Back 115

if respiratory depression is suspected,
an opioid antagonist(Narcan) will reverse the respiratory depressant effect of an opioid.

Front 116

Physical Dependance

Back 116

when body becomes physiologically accustomed to the opioid and suffers withdrawal symptoms if the opioid is suddenly removed.

Front 117

Tolerance

Back 117

occurs when the body becomes accustomed to the opioid and needs a larger dose for pain relief.

Front 118

Addiction

Back 118

a pattern of compulsive use for means other than pain control.
4 characteristics for an addiction:
craving
compulsive use
lack of control over the drug
continued use despite harm.

Front 119

Range Orders

Back 119

a medication order in which the dosage or time period or both are specified according to a range.
ex: Morphine 2 to 8 mg IV every 2 hours as needed.

Front 120

Which is the major class of analgesics used to manage moderate to severe pain?

Back 120

opioids, formerly called narcotic analgesics.

Front 121

The drugs of choice for mild to moderate pain are:

Back 121

nonopioid analgesics such as acetaminophen and NSAIDS.

Front 122

Besides their analgesic effect, NSAIDS also have an

Back 122

anti-inflammatory effect.

Front 123

NSAIDS are contraindicated in patients with

Back 123

bleeding disorders(their action may interfere with platelet formation) and probable infections(they can mask the inflammatory signs of an infection).

Front 124

Nonopioid analgesics such as the COX-2 inhibitors, a class of NSAIDS, have a lower risk if GI bleeding but are thought to significantly increase

Back 124

cardiovascular risks.

Front 125

Adjuvents

Back 125

drugs typically used for other purposes but are also used to enhance the effects of opioids.
ex: antidepressants and anticonvulsants.

Front 126

Timing is an important consideration when administering analgesics. To time analgesics properly, you need to know:

Back 126

average duration for the drug and time administration so that the peak analgesic effect occurs when the pain is expected to be most intense.
ex: before ambulating a patient postoperatively.

Front 127

P.R.N.

Back 127

as needed

Front 128

ATC

Back 128

around the clock.

Front 129

Breakthrough Pain

Back 129

BTP
a temporary flare-up of moderate to severe pain that occurs even when the patient is taking ATC medication for persistent pain.

Front 130

Breakthrough Pain can be classified as:

Back 130

Incident pain- e.g., pain caused by movement.
Idiopathic pain- spontaneous pain due to an unknown cause.
End-of-Dose pain- where the pain occurs before the next dose of analgesic is due.

Front 131

Effective management of BTP requires:

Back 131

a medication with rapid onset and short duration.

Front 132

APP

Back 132

assume pain present.

Front 133

The major principles that guide treatment for cancer or chronic pain include:

Back 133

give medication orally, if possible.
administer medication ATC rather than on a p.r.n. basis.
adjust dosage to achieve maximum benefits with minimal side effects.
allow patients as much control as possible over their medication regimen.

Front 134

The WHO 3 Step Analgesic Ladder.

Back 134

devised by the World Health Organization.
the 3 step ladder is a progression of drugs that manages chronic pain.
this provides relief to 70-90% of patients with cancer pain.

Front 135

PCA

Back 135

Patient Controlled Analgesia
computerized infusion pump containing a chamber prefilled with the prescribed opioid analgesic.
the patient presses a button to self-administer a preset bolus dose.
can be programmed to deliver only a specified amount within a given time interval.
allows patient control over his pain.
decreases dependency on the nurse.
allows stabilization of blood serum levels-determined by patient's pain level.
must include client education and an alert & intact mental status.

Front 136

Loading Dose

Back 136

an initial dose administered to raise blood levels to a therapeutic level.

Front 137

The most frequently prescribed drugs for a PCA are:

Back 137

morphine
fentanyl
hydromorphone.

Front 138

The most common human error associated with PCA therapy is:

Back 138

improper programming of the pump.
another nurse needs to check:
patient's ID
drug dose and concentrations
PCA pump settings
infusion tubing
infusion site.

Front 139

Epidural Catheter

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used to provide pain relief during the immediate postoperative phase, particularly after thoracic, abdominal, orthopedic and vascular surgery.
anesthesiologist inserts the catheter in the midlumbar region into the epidural space between the walls of the vertebral canal and the dura mater.(outermost connective tissue membrane surrounding the spinal cord).
Monitoring for respiratory rate and pattern is very important.

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Drug of choice for an Epidural Catheter is

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preservative-free morphine or fentanyl.
Fentanyl is lipid soluble so it is readily dissolved and has a rapid onset of action(5 minutes) but short duration( 2 hours).
morphine is a hydrophilic opioid with a high affinity for water with a slow onset but a long duration(24 hours) so it remains longer in the CFS and spinal tissue.

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Local Anesthetics

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aka Nerve Blocks.
may be applied topically to the skin or mucous membranes or injected into the body to produce a temporary loss of sensation and motor and autonomic function in a localized area.they chemically block the nerve pathways involved in pain sensation and response.

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Placebo

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any medication or procedure that may produce an effect because of its implicit or explicit intent and not because of its specific or chemical properties.

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Pure Opioids
Therapeutic Goal

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relief of moderate to severe pain while causing minimal respiratory depression, constipation, urinary retention and other adverse effects

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Pure Opioids
Contraindications

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premature infants-both during and after delivery.
morphine-following biliary surgery.
meperidene- for patients taking MAO inhibitors.

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Pure Opioids
Use With Caution

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head injury-ICP
profound CNS depression
coma
respiratory depression
pulmonary disease
cardiovascular disease
hypotension
reduced blood volume
prostatic hyperthrophy
urethral stricture
liver impairment
treating infants,elderly,debilitated patients
patients receiving MAO inhibitors, CNS depressants, anticholinergics and hypotensive drugs.

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Pure Opioids
Adverse Effects

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respiratory depression-12 breaths per minute or less.
sedation
orthostatic hypotension
constipation
urinary retention
emesis
cough suppression
miosis
neurotoxicity.
dependence in the neonate.