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SCCCNursing-Pain
SCCCNursing-Pain
40
Nursing
Undergraduate 2
10/19/2012

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Cards

Term
The Pain Experience
Definition
  • Pain is a physical and emotional experience, not all in the body or all in the mind
  • It is a response to actual or potential tissue damage
  • Severe or persistant pain affects all body systems, causing potentially seious health problems while increasing the risk of coplications, delays in healing, and an accelerated progression of fatal illnesses
  • Severe pain is viewed as anemergency situation deserving attention and prompt professional treatment
Term
The Pain Experience (con't)
Definition
  • Persisteant pain contributes to insomnia, weight gain, constipation, hypertension, deconditioning, hronic tress, depression, and immobility
  • These effects interfere with work, rcreation, domestic activities, and personal care activities to the point that leads many sufferers to question if life is worth living
  • Even if the original cause of the pain heals, the changes in ther nervous sytem resulting from suboptimal pain management can result in the development of incurable chronic pain
Term
Nociception
Definition
  • The physiologic process by which information aout tissue damage is communicated to the Central Nervous System
  • Involves four processes:
    -Transduction
    -Transmission
    -Perception
    -Modulation
Term
Transduction
Definition
  • Nociceptors are receptors throughout the body that become activated by noxious stimuli (mechanical, chemical [external or internal], or thermal)
  • Tissue injury triggers the release of biochemical mediators such as Bradykinin, Histamine, and Postaglandin...
  • ...causing and inflammatory response
  • Anti-inflammatories and Local Anesthetics inhibit transduction (Lidocaine, Ibuprofen, Cold)
Term
Transmission
Definition
  • From site of transduction to the spinal cord and on to the brain
  • A-delta fibers - fast and large (sharp localized pain/pleasurable skin receptors)
  • C fibers - smaller, slow (dull, diffuse, achy)
Term
Perception
Definition
  • The pain is recognized, defined, and responded to by the individual experiencing the pain
  • Pain Threshold - the number and intensity of stimuli necessary to produce pain (repeated experiences to pain can lower threshold)
  • Pain Tolerance - duration or intensity of pain that a person is willing to tolerate (situational)
Term
Pain Modulation
Definition
  • Modulation changes the perception of pain by either facilitating or inhibiting the pain signal
  • Endogenous (endorphins)/Exogenous (medications) Opioids block the transmission or reception of pain signals
  • Gate Control Theory - stimulate A-delta fibers to block C fibers (TENS)
  • Selective Seratonin Reuptate Inhibitors (SSRIs)
  • Analgesia (lack of pain) vs. Anesthesia (lack of feeling)
Term
Definitions of Pain: Origin
Definition
  • Cutaneous or Superficial Pain
  • Visceral Pain (organs)
  • Deep Somatic Pain (ligaments, tendons, bones)
  • Radiating Pain (starts at one site and spreads out)
  • Referred Pain (tissue damage is at one spot but pain is felt in a different spot)
  • Phantom Pain (pain perceived in an area surgically removed)
  • Psychogenic Pain (believed to arise from the mind)
Term
Definitions of Pain: Cause
Definition
  • Nociceptive - arises from damage to the tissues
  • Neuropathic - abnormal or damaged nerves
Term
Definitions of Pain: Duration
Definition

Acute: short in duration, rapid in onset, will get better as tissues heal, more easily treated

Chronic: lasts 6 months or more, may be related to progressive disorder, periods of remission and exacerbation, may be difficult to relieve

Intractable: chronic and highly resistant to relief

Term
Definitions of Pain: Quality/Severity
Definition

How patients describe pain:

  • sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling.
  • Periodicity (how often): episodic, intermittent, or constant.
  • Intensity: mild, distracting, moderate, severe, or intolerable.
Term
Acute Pain
Definition
  • Surgery, Trauma, Childbirth, Infection, Angina (chest pain)
  • Functions as signal, warning the person of potential or actual tissue damage
  • Diminishes over time as healing occurs
  • Treatment includes analgesia for symptom control and treatment of the underlying cause
Term
Chronic Pain
Definition
  • Does not appear to have an adaptive role
  • Progressive disease or neuropathic pain
  • Viewed as meaningless and may lead to depression, anger, anxiety, frustration, and dependance
  • Definitions vary as to duration
Term
Factors Affecting the Pain Experience
Definition
  • Emotions (fear, anxiety, anger, depression)
  • Social Support
  • Environment
  • Past Pain Experience
  • Meaning of Pain
  • Mental Status
Term
Pain and the Elderly
Definition
  • Prevalence of chronic pain in elderly ranges from 45% to 80%
  • May falsely believe that pain and suffering come with age
  • May have multiple conditions presenting with vague symptoms
  • May withhold complaints because of fear of the treatment, of a lifestyle change, or of becoming dependent
Term
Pain and the Elderly (con't)
Definition
  • Fear of being a burden or "bad patient" if they express pain or that nothing can be done about the pain
  • High prevalence of cognitive, sensory-perceptual, and motor problems that interfere with a person's ability to process info and communicate
  • More likely to use words "aching," "soreness," or "discomfort"
  • Treatment complicated by increased sensitivity and polypharmacy
Term
Culture
Definition
  • Asian and Pacific Islander patients are often reluctant to express their pain because they believe that the pain is God's will or punishment for past sins
  • Native Americans use massage, heat/cols and herbal remedies for pain relief
  • In Arab cultures, patients are expected to openly express their pain and anticipate immediate relief, preferably through injections or IV
  • Non-Hispanic white adults reported pain more often than adults of other races
Term
Pain and the Nursing Process
Definition
  • Pain is more than a symptom of a problem, it is a high-priority problem in itself
  • Effective pain management is an important aspect of nursing care to promote healing, prevent complications, reduce suffering and prevent the development of incurable pain states
  • Non-verbal patients can have pain that demands a nursing assessment
Term
Responses to Pain: Physiologic
Definition
  • Acute pain leads to sympathetic response (General Adaptation Syndrome) ^HR, ^BP, ^RR, peripheral constriction
  • Deep or Prolonged Pain: parasympathetic response - decreased BP, HR, withdrawal, constricted pupils, slow and monotonous speech, shallow breathing
Term
Behavioral and Psychological Responses to Pain
Definition
  • Facial expressions: often the first indication of pain; clenched teeth, tightly shut eyes, open somber eyes, biting of lower lip
  • Vocalizations: moaning, groaning, crying, screaming
  • Body Positions: immobilization of body part, assuming the fetal position, restlessness, guarding, splinting or rubbing area
  • Behavioral: confusion, hostility, aggression, fear, decreased attention span
  • Chronic Pain usually manifests as depression, withdrawal, exhaustion, hopelessness
Term
Assess Pain
Definition
  • On admission
  • At rest and during activity
  • When patient complains of pain
  • Before implementing pain management and 30 to 45 minutes later
  • Before and after each potentially painful treament or procedure
  • As 5th Vital Sign
Term
Assess
Definition
  • Location
  • Quality
  • Intensity, Strength, and Severity
  • Timing: Onset, Duration, Frequency
  • Aggravating/Relieving Factors
Term
Assess for
Definition
  • Associated symptoms such as anxiety, fatigue and depression
  • Effect on ADLs
  • Meaning of Pain
  • Past pain experiences
  • Treatments that have been effective
  • Pain relief goals
  • Coping resources
  • Assess for knowledge deficits, fear of addiction
Term
Pain as etiology
Definition
  • Ineffective Breathing Pattern
  • Hopelessness
  • Anxiety
  • Ineffective Coping
  • Impaired Physical Mobility
  • Self-Care Deficit
  • Distrubed Sleep Pattern
Term
Pain Medication as Etiology
Definition
  • Risk for Injury r/t ecreased sensorium or level of consciousness (LOC), over dosage, side effects secondary to opioid use
  • Impaired gas exchange r/t respiratory depression secondary to increasing doses of IV Dilaudid
  • Constipation r/t use of post-operative pain medication (Percoset)
Term
Planning Interventions
Definition
  • Follow the principles of pain assessment
  • Base the treatment plan on the patient's goals
  • Use both drug and non-drug therapies
  • Address pain using a multi-disciplinary approach
  • Prevent and/or manage side effects
  • Offer pain therapies before procedures and/or ambulation
  • Incorporate patient and family teaching throughout assessment and treatment
Term
Pain Management
Definition
  • Non-pharmacological Methods
  • Anesthetics/Analgesics
  • Nonopioid analgesics
    -Mild to Moderate Nociceptive Pain
  • Opioid Analgesics
    -Moderate to Severe Pain
  • Adjuvant Analgesics
    -Enhance the effects of opiates and alleviate symptoms that aggravate pain; also alleviates neuropathic pain
Term
Non Drug Therapies for Pain
Definition
  • Cutaneous Stimulation
  • Massage, Back Rub
  • Empathy
  • Therapeutic Touch
  • Alternative Disciplines
  • Immobilization & Splinting
  • Distratction, Progressive Relaxation, Imagery, Deep Breathing
  • Heat/Cold
  • R.I.C.E. (rest, ice, compression, elevation)
  • Herbs
  • Aromatherapy
  • Surgery, TENS
Term
Nonopioid Analgesics
Definition
  • Tylenol (aetaminophen): analgesia and antipyretic effects, toxic to liver in large doses
  • NSAIDs (Non-Steroidal Anti-Inflammatories): broad class of drugs with varying efficacy
    -Interfere with production of prostaglandin (works on transduction phase of pain)
Term
NSAIDs
Definition
  • aspirin (acetylsalicylic acid or ASA): effective for mild pain, but limited use due to side effects, including gastric upset, platelet dysfunction, bleeding, tinnitis, decreased hearing acuity
  • ibuprofen (Motrin, Advil): side effects can be serious and include renal failure, cardiovascular thrombotic events, and GI bleed (take w/food)
  • Cox II inhibitors (Celebrex)
  • naproxen (Aleve)
  • ketorolac (Toradol)
Term
Opioid Analgesics
Definition
  • Bind with opiates receptor sites in CNS to block the pain response (modulate pain perception)
  • Mu, Kappa, Delta, Sigma
  • Most opioids are Mu Agonists: morphine, oxycodone, oxycontin, hydrocodone, codeine, methadone, hydromorphone (Dilaudid), fentanyl, Demerol (meperidine)
  • Opioids are commonly prescribed with a non-opioid analgesic: Tylenol #3 (codeine/acetaminophen), Vicodin (hydrocodone/acetaminophen), Percoset (oxycodone/acetaminophen), Percodan (oxycodone/aspirin)
Term
Opioid Administration Routes
Definition
  • Oral (tab, liquid, lollipop)
  • Nasal
  • Transdermal
  • Rectal
  • Subcutaneous
  • Intramuscular
  • Intravenous
  • Intravenous - Patient Controlled Analgesia (PCA)
  • Intra-articular
  • Intraspinal and Epidural
Term
Side Effects of Opioid Analgesics
Definition
  • Most common include: constipation, pruritis (itching), orthostatic hypotension, urinary retention, nausea/vomiting, seation, and respiratory depression
  • Diminishes with continued use except constipation
    -fluids, dietary roughage and exercise may not be sufficient. Bowel regimen and laxatives or stool softeners are probably necessary
  • Many side effects are treated with other medications
Term
Sedation/Respiratory Depression
Definition
  • Excessive sedation will precede respiratory depression
  • Patients at risk for respiratory depression include those who are opioid naive, elderly, have underlying lung disease, or are receiving other CNS depressants
  • Always assess the patient for level of alertness and respiratory status before and after administering opioid
  • Reduce dose or administer and opioid antagonist such as Naloxone (Narcan)
Term
Agonist/Antagonist
Definition
  • Stimulate soe opioid receptors and block others
  • Mixed agonist/antagonists bind as as agonists on the kappa receptor and as weak antagonists on the mu receptor to produce less respiratory depression than drugs that act at only mu receptors
  • Examples: Stadol, Nubain
  • Causes more dysphoria and agitation
  • Can precipitate withdrawal if used in a patient who is physically dependent on mu agonist drugs
Term
Adjuvants
Definition
  • Developed originally for other purposes and found later to be effective for pain. Used in conjunction with other pain therapies
  • Antidepressants (Celexa)
  • Antianxieties (Xanax)
  • Antiseizures (Lyrica)
  • Corticosteroids (prednisone)
Term
Caregiver Barriers to Effective Pain Management
Definition
  • Most people don't have pain from that particular illness
  • There is no obvious physical cause for the pain
  • There are no physical or behavioral signs of pain
  • The patient is drug seeking
  • Too much of an opiate will cause respiratory depression
  • Pain is a normal component of aging
Term
Patient Barriers to Effective Pain Management
Definition
  • Fear of addiction
  • Fear of tolerance
  • Concern about side effects
  • Fear of injections
  • Desire to be a "good patient"
  • Forgetting to take the analgesic
  • Fear of distracting caregiver from treating disease
  • Concern the pain signifies disease progression
  • Sense of fatalism
  • Ineffective medication
Term
Teaching
Definition
  • Cause of pain, if known
  • Duration/healing process
  • Use of pain scale
  • Dosing, interval, route of pain options (ATC [around the clock] or PRN)
  • Side effects
  • Balance of pain relief and mobility
  • Take before pain is severe (take when pain is about a 4)
Term
Documentation
Definition
  • Assessment of pain including subjective and objective findings
  • Intervention (MAR and non pharmacologic)
  • Evaluation of all treatment modalities (including effectiveness, side effects, and intervention if not effective)
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