Pain

Nursing 345 with Berry/boellard/jansen at University of Wisconsin - Eau Claire

About this deck

By: Alaina Oakland
Textbook: Clinical Nursing Skills

Gerontologic Nursing (Gerontologic Nursing (Lueckenotte))

Medical-Surgical Nursing (Single Volume): Assessment and Management of Clinical Problems (MEDICAL SURGICAL NURSING (LEWIS))

Mosby's Manual of Diagnostic and Laboratory Tests

Pathophysiology: The Biologic Basis for Disease in Adults And Children Fifth Edition

Pharmacology for Nursing Care
Created: 2011-11-29
Size: 52 flashcards
Views: 9

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affective/emotional dimension

suffering

often have concurrent feelings of anger, fear, depression, and anxiety that make pain better or worse

behavioral dimension

activities that express pain

grimacing, guarding, holding/rubbing painful area

what is done to control pain and how pain interferes with normal daily activities

cognitive dimension

beliefs, attitudes, memories, expectations,and goals related to the pain and pain control

sociocultural dimension

age, gender, culture, social, and family roles and support systems influencing one's perceptions, beliefs, and means of coping with and managing pain

spiritual dimension

religious beliefs and existential beliefs/outlook

physiological dimension

includes transmission, perception, and modulation of pain related to physical and neuro-chemical processes

pain

whatever the person says it is, existing whenever the person says it does

nociceptive pain

normal processing of stimuli that damages normal tissues or had the potential to do so if prolonged

usually responsive to nonopioids and/or opioids

somatic pain

pain which arises from bone, joint, muscle, skin, or connective tissue

usually aching or throbbing in quality and is localized

surgical pain, broken bones, arthritic pain

type of nociceptive pain

visceral pain

pain which arises from visceral organs

-tumor involvement of the organ capsule that causes aching and fairly well-localized pain

-obstruction of hollow viscus that causes intermittent cramping and poorly localized pain

type of nociceptive pain

neuropathic pain

pain inferred to be related to disease or dysfunction of the nervous system

usually numbing, burning, shooting, stabbing, or electrical

can be sudden, intense, short lived, or constant

not well controlled by opioids alone - often use adjuvant meds

nociception

physiologic process by which information about tissue damage (or potential damage) is communicated to CNS

nociceptors

pain receptors

A fibers

large, myelinated, rapid conduction, precise localization, sharp pain fibers that carry impulses from nociceptors to spinal cord

C fibers

small, unmyelinated, slow conduction, poor localization, diffuse aching/burning pain fibers that carry impulses from nociceptors to spinal cord

normal pain transmission

transduction

transmission

perception

modulation

transduction

occurs in the periphery when a noxious stimulus causes tissue damage

damaged cells release substances that activate nociceptors

action potential generated

sensitizing substances: prostaglandins, bradykinin, serotonin, substance P, histamine

transmission

action potential moves from site of injury to the spinal cord and ascends to higher centers in the brain

perception

conscious experience of pain

modulation

inhibition of nociceptive impulses

originates in the brain stem and descends to spinal cord

release of endogenous opioids, serotonin, and norepinephrine to inhibit the transmission of nociceptive impulses

acute pain

lasts less than 3 months

sudden onset

generally able to identify a precipitating event or illness

gets better and goes away

unpleasant sensory, perceptual, and emotional experiences

chronic pain

lasts longer than 6 months

gradual onset

divided into two more types - malignant and non-malignant

malignant (cancer) pain

unpredictable length of time, pathophysiology usually present, increased pain, possible disfigurement, fear of dying

non-malignant pain

lasts months-years, often no pathophysiology, unpredictable prognosis

pharmacological management of pain

opioids

non-opioids

adjuvant therapy

opioids

inhibit the release of excitatory neruotransmitters at the opioid receptors

can use many routes - oral is preferred

no ceiling to the pain releif

harmful side effect respiratory depression

tolerance

characterized by the need for an increased opioid dose to maintain the same degree of pain relief

dependence

an expected physiologic response

manifested by a withdrawal syndrom that occurs when blood levels of the drug are abruptly decreased

early withdrawal: anxiety, chills, tremors, diaphoresis

late withdrawal: diarrhea, restlessness, nausea, vomiting, insomnia

addiction

psychological response

narcan (naloxone)

opioid antagonist used to reverse respiratory depression

respiratory depression

most dangerous side effect of opioids

most common in first days of receiving opioids

opioids

meperidine (demerol)

tramadol (ultram) - produces analgesia

propoxyphene (darvon) - weak, can cause sudden death

non-opioids

NSAIDS

aspirin

acetaminophen

have a ceiling

NSAIDS

analgesic, anti-inflammatory, anti-platelet drug

causes dyspepsia to severe GI bleeding

can cause renal insufficiency/injury

do not consume alcohol - may have hepatic effects

Acetaminophen

analgesic but not anti-inflammatory or anti-platelet

does not cause GI ulceration

overdose can cause fatal hepatic necrosis

not known to cause renal problems

ketorolac

only injectable NSAID

usually given IV

on give for 5 days

may cause renal failure if pt is dehydrated

NSAIDS

can cause increased risk of serious CV thrombotic events, myocardial infarction, and stroke

4 grams

maximum daily dose of acetaminophen for healthy adult

acetaminophen

pts with severe liver disease should not take this drug

pts should have periodic liver function tests when taking long-term and consuming alcohol

adjuvant therapy

drugs that provide analgesia but are not traditional analgesics

work differently than pain meds and can be combined with them

more effective for neuropathic pain

anticonfulsants/antiepileptic drugs (AEDs)

frequently used to treat neuropathic pain and migraine headaches

primary action is dampening of neuronal excitability - suppressing spontaneous firing of action potentials that signal pain

antidepressants

block reuptake of serotonin/norepinephrine in CNS which enhances action of inhibitory pain pathways

stabilize the neuron membrane through inhibition of Na channels and NMDA antagonist-like effects

useful in treating symptoms of depression and insomnia

local anesthetics

decrease neuronal excitability at sodium channels

EMLA cream, lidocaine patch

gives dramatic regional post-operative analgesia

epidural administration

capsaicin

molecule found in all hot peppers that can be applied topically to desensitize cutaneous nociceptive nerve endings

corticosteroids

decrease edema and inflammation

create sense of well-being and stimulate appetite

side effects...hyperglycemia, osteoporosis and excessive GI bleeding with NSAIDS

GABA-B agonists

mimic action of inhibitory neurotransmitter GABA

antiposmodic and may produce analgesia in neuropathic pain

benzodiazepines

helpful for acute anxiety or muscle spasms with acute pain

sedative and respiratory depressant effects

caffeine

given at 65mg or more increase analgesia when given with aspirin-like drugs for uterine cramping, headaches, dental pain, and other adult pain syndromes

basal rate

continuous infusion of IV opioid

bolus

demand dose

patient can self-administer and pre-set amount of opioid on demand

lock out time

pump is set to control the minimum interval between doses

around the clock

give pain medication on a schedule basis

more effective than PRN dosing