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NURS366
Clinical Pain Management
42
Nursing
Undergraduate 3
02/03/2012

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Term
4 phases of pain transmission
Definition
Transduction - pain starts with noxious stimuli causes release of chemicals causing inflammation (prostaglandin, histamine, glutamate) create a stimuli that is transmitted.
Transmission - noxious stimuli transmitted up spinal cord to thalamus which acts as relay station and transmits stimuli to high brain levels where it is perceived cognitively and emotionally.
Perception - Cognitive perception is result of painful stimuli, emotional perception is influenced by patient history, experience of pain, experience with similar injuries.
Perception
Modulation
Term
alloynia
Definition
pain caused by a stimuli which does not ordinarily cause pain . Often associated with neuropathic pain
Term
Hyperalgesia
Definition
increased response to a stimulus that is normally painful (can be caused by a patient that is in withdrawal)
Term
Wind Up
Definition
when a neuron that mediates nociception in the dorsal horm is repeatedly stimulated, its rate of discharge dramatically increases with time as does the perception of pain that the patient cognitively perceives is increased the barrage of pain signals can actually cause altered morphology within the spinal cord (neuroplasticity) with a resultant continued discharge persisting when the painful stimuli stops.
Term
Addiction
Definition
When a person is taking drugs purely for psychological effects not because they are taking them for pain
Term
Tolerance
Definition
state of adaption exposure to a drug resulting in decrease of drugs effect over time. Usually occurs within ten days. WHen it occurs, it may increase requirement of opioid to give them the same effect
Term
Dependence
Definition
adaptation to a drug creating withdrawal with abrupt cessation can occur in as little as ten days
Term
Pseudo addiction
Definition
drug seeking behavior doesn't always mean that they don't have pain.
Term
5 typical under treated populations
Definition
elderly (people are fearful of giving htem opioids because of side effects)
pediatric ( have a hard time communicating pain)
confused
non english speaking
patients with a history of alcohol or drug abuse.
Term
5 signs of acute pain
Definition
tachycardia
elevated bp
sweating
dilated pupils
anxiety
Term
5 signs of chronic pain
Definition
heart rate WNL
BP WNL
absent
Pupils WNL
Depression
Term
physiologic component of pain
Definition
depends on intensity of stimulus, duration of stimulus and quality of stimulus, this is combined with psychological component which is what the patient believes about the apin.
Term
Psychological Component of pain
Definition
Meaning of pain, coping of pain, fatigue, resources, anxiety and depression
Term
PQRST
Definition
Palliative Factors - what makes pain better vs. worse
Quality of Pain - descriptors of the pain
Radiation of pain
Severity of Pain - record intensity of pain on scale 0-10 gives you the idea of patients baseline to determine if interventions were sucessfull
Temporal Factors - what is making pain wrose.
Term
Hierarchy of Pain Rating
Definition
#1 Patients Self Report
#2 assume pain is present when pathological cause is present
#3 nursing observations of pain behaviors, does not reflect pain intensity,
#4 surrogate reporting
#5 attempt an analgesic trial
Term
Somatic Pain
Definition
musculoskeletal pain
arises from tissues such as skin, muscle, joins bones
described as sharp localized, intermittent and increased by movement.
Term
Visceral Pain
Definition
deriving from internal organs of the body, poorly localized feels like an ache or cramp and is continuous pain.
Term
Nerve Pain
Definition
pain from peripheral nervous system 9between periphery and spinal cord or from the central nervous system between the spinal cord and brain. can be caused y nerve degeneration, pressure, inflammation or infection.
Term
Two kinds of drugs used to treat somatic pain
Definition
NSAIDS
Opioids
Term
Three kinds of drugs used to treat visceral pain
Definition
NSAIDS
opioids
antispasmodics
Term
5 kinds of neuropathic pain drugs
Definition
alpha adrenergic agents
SSRI's
Tricyclic
membrane stabilizer
NMDA inhibitors
Term
6 examples of nursing interventions for pain
Definition
positioning
relaxation
ice and heat
unresolved psychosocial issues
distraction
increase patient control of pain
Term
2 symptoms of opioid withdrawl
Definition
Irritability
autonomic hyer-activiy (GI, urinary, sweating)
Term
Range frequency orders of opioids
Definition
2 tabs every 3 hours PRN pain
Term
Range dose opioid
Definition
2-6 mg every three hours prn
Term
Side effects of Opioids
Definition
Respiratory Depression
Sedation
Urinary Retention
Constipaton
Pruritis (morphine creates histamine response)
Emetic Effects
Delirium
Term
Where do NSAID's work
Definition
peripheral nervous system
Term
What do NSAIDS do
Definition
mediate postaglandin production, decreases inflammatory process,
Term
Two groups of opioids
Definition
full mu agonists
Mixed agonist - antagonists
Term
Alpha Adrenergic Blocker Action
Definition
Decrease sympathetic outflow from CNS
Useful for sympathetically mediated pain
may be used to assist patients in opioid withdrawal
may be used for neuropathic pain
Term
Antidepressants
Definition
used for neuropathic pain
Term
SSRI action
Definition
block reuptake of serotonin
Term
tricyclic antidepressants action
Definition
block reuptake of serotonin, dopamine, and norepinepherine at the CNS
Term
Membran stabilizers (anticonvulsants) action
Definition
stabilize the nerve membrane
prevent an action potential from occurring
Term
NMDA inhibitor action
Definition
nmda receptor in the dorsal horn of the spinal cord mediates neurogenic hyperalgesia and may block neuropathic pain
Term
What do corticosteroids do?
Definition
inhibit prostaglandins
Decrease edema
Term
What are corticosteroids indicated for...
Definition
acute nerve compression, visceral distention, increased intracrainial pressure.
Term
Action of antispasmodics
Definition
decrease visceral spasm and inhibit GI secretions
Term
indications for antispasmodics
Definition
indicated for GI and Bladder spasm
Term
Muscle Relaxants
Definition
decrease muscle tension adn contractions
Term
Indication of muscle relaxants
Definition
muscle spasm,
Term
universal safe dose of opioids
Definition
no universal safe dose, must evaluate each patient individually.
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