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Pain Management Chapter 44
Terms in this set (73)
Is pain subjective or objective?
an unpleasant, subjective sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage
pain is whatever.....
the person says it is existing whenever he says it does
converts energy produced by these stimuli into electrical energy. can be chemical, thermal, mechanical
exp:( exposure to pressure or a hot surface sends impulse across a sensory peripheral nerve fiber)
pain nerve fiber
cellular damage caused by thermal, mechanical, chemical stimuli results in the release of excitatory neurotransmitters such as prostaglandins, bradykinin, substance p, histamine
made from breakdown of phospholipids in the cell membranes, increases sensitivity to pain
released from plasma that leaks from surrounding bloods vessels at the site of tissue injury, bind to receptors, increases pain stimuli, binds to cells that cause the chain reaction producing prostaglandins
- in pain neurons of dorsal horn
-needed to transmit pain impulses from periphery to higher brain centers
- causes vasodilation and edema
-producing mass cells causing capillary dilation and increased capillary permeability
-released from a brain stem and the dorsal horn to inhibit pain transmission
- are the natural supply of morphine like substances in the body
-activated by stress and pain
-located with in the brain, spinal cord, and gastrointestinal tract
- cause analgesia when they attach to opiate receptors in the brain
-present in higher levels in people who have less pain than others with the similar injury
what does the neurotransmitters do?
these pain sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing and inflammatory response
two types of peripheral nerves fibers conduct painful stimuli?
(myelinated) A-delta fibers, very fast, (unmyelinated) C fibers very slow and small
A fibers send what type of stimuli?
sharp localized and distinct sensations that specify the source of the pain and its intensity
C fibers send what type of stimuli?
relay impulses that are poorly localized, visceral and persistent
Central nervous system extracts information such as location and duration and quality
is the point at which a person is aware of the pain, the sensorimotor cortex identifies the location and intensity of pain, association cortex and the limbic system , determines how they fill about it
protective reflex response and releases neurotransmitters such as endorphins , serotonin, norepinephrine, gamma-aminobutyric acid, which hinder the transmission of pain and help produce a analgesic effect.
what is the gate control theory?
Melzack and Walls gate control theory ( 1965) was the first to suggest that pain has emotional and cognitive components in addition to physical sensations.
gating mechanisms located long the central nervous system regulate or block pain. Pain impulses pass through when its open and are blocked when it's closed
conceptual framework of pain management
physiological, emotional, and cognitive influences
the point at which a person feels pain
pain with low to moderate intensity and superficial pain cause what type of response?
Sympathetic response( fight or flight) (General adaption syndrome)
-dilation of bronchial tubes
- increased heart rate
-vasoconstriction ( increase in blood pressure)
-high glucose levels
- increased muscle tension
-dilation of pupils
-decreased gastrointestinal motility
continuous sever or deep pain typically involve the visceral organs
Parasympathetic nervous system
(myocardial infraction or colic from gallbladder or renal stones)
-pallor( un healthy or pale appearance)
-nausea or vomiting
-decreased heart rate and blood pressure
-rapid or irregular breathing
sever or traumatic pain causes your body to do what?
go into shock
behavioral responses of acute pain
clenching the teeth facial grimacing, holding or guarding the painful part, bent posture
behavioral responses of chronic pain
effects patients activity's ( eating, sleeping, socialization) thinking( confusion, forgetfulness), or emotions( anger, depression irritability) and quality of life
the level of pain a person is willing to accept
is protective, usually has a identifiable cause, it is short of duration, and has limited tissue damage and emotional damage, predictable healing
exp(a broken leg will hurt during recovery, but "as time goes on, it gets better and better, surgical incisions)
Chronic Pain/ non cancer
is not protective and serves no purpose, but has a huge effect on the persons quality of life, varies in intensity and usually lasts longer than 6 months, no identifiable cause.
exp( arthritis, lower back pain, headaches, fibromyalgia, peripheral neuropathy)
symptoms of chronic
fatigue, insomnia, anorexia, weight loss, apathy, depression, anger
Chronic Episodic Pain
pain that occurs sporadically over an extended amount of time .
cancer that causes pain , it can be acute or chronic, usually caused by tumor progression, surgery , toxicities of chemotherapy, infection, and physical limitations
senses pain at the actual site of the tumor
is chronic pain in the absence of a identifiable cause
factors influencing pain for aging
-muscle mass decreases
- body fat increases
- bad nutrition
- decline of liver and renal function
- age related changes in the skin such as thinning or loss of elasticity
what does fatigue do to pain
it heightens the perception of pain and decreases and coping abilities
relaxation, guided imagery, massage
what does anxiety often do to pain?
increases the perception of pain, and pain causes feelings of anxiety
what is internal loci?
when people perceive themselves as having control over events in their life, and outcomes such as pain.
cultural factors of pain
age, education, race , and family
Nursing assessment of pain questions?
Palliative or provocative : what makes your pain worse or better?
Quality: how do you describe your pain?
Relief measures: what do you take at home to gain pain relief?
Region; who me where you are hurting?
Severity: on a scale of 0-10 what is your pain right now?
Timing: is you pain constant, intermittent
U; the effect of pain: what are you not able to do because of your pain?
location, severity, and quality
cognitive, behavioral, spiritual, and social dimensions
superficial or cutaneous pain location
pain resulting from stimulation of the skin, short in duration , and localized, sharp sensations
exp( needle stick or small laceration)
deep and visceral pain locations
pain resulting from stimulation of internal organs, diffuses and radiates, sharp or dull depending in the organ involved
exp;(burning sensation(gastric ulcer)
referred pain locations
pain is apart of the body but separate from the source of pain
exp(myocardial infraction which causes referred pain to the jaw, left arm and left shoulder)
radiating pain locations
sensation that is extending from initial site to another body part, travels to another part of the body
exp(ruptured intervertebral disk accompanied by radiating leg pain from sciatic nerve irritation
behaviors of people in pain
facial movements( grimacing, teeth clenching), body movements( pacing, restlessness), social interactions ( does the patient avoid conversation), rigid body, limping, frowning crying
headache, dizziness, urge to urinate, constipation, depression, and restlessness occur with pain and usually increases the pains severity
nursing diagnosis for pain management
-bathing self care deficit
-impaired physical mobility
consults for pain
advanced practice nurses, doctors of pharmacology, physical therapists, occupational therapists, physicians social worker, psychologists and clergy
transcutaneous electrical nerve stimulation (TENS)
sends shocks or impulses around the site of pain to try and defer the pain.
long term opioid use
may cause constipation
short term opioid use
may cause shortness of respiratory rate
what are the three types of analgesics
non-opioids , opioids , adjuvants
are the most common effective method
NSAIDS(non-steroidal anti-inflammatory drugs like ibuprofen, acetaminophen(Tylenol considered to be the safest analgesics, aspirin)
•Hydrocodone (Zohydro ER)
•Oxycodone (OxyContin, Roxicodone)
•Hydromorphone (Dilaudid, Exalgo)
•Morphine (Avinza, Kadian, MSIR, MS Contin)
•Fentanyl (Actiq, Duragesic)
or co-analgesics, a variety of medications that enhance analgesics properties, or have properties that they weren't intended for antidepressants, anti-seizure medications, muscle relaxants, sedatives or anti-anxiety medications, and botulinum toxin
what is the max dose for acetaminophen (Tylenol)
4g is the max dose for acetaminophen and the same with aspirin
reduce transmission of pain stimuli and inflammation, mild to moderate acute intermittent pain such as from headache or muscle pain
PCA pump (patient controlled analgesia)
allows the patient to self- administer opioids, with minimal risk of over dose, maintain drug at a constant plasma level
acute pain,only for 5minutes till burning or aching sensations and numbness, you can apply ice 2-5 times a day
chronic pain, heat application is more effective for some patients a
Opioid or opioid analgesics
Prescribed for moderate to severe pain
Administering naloxone (narcan)
0.4 mg diluted with 9 ml of saline IV push at a rate 0.5 every 2 minutes
Combines drugs with atleast with two mechanisms of action so pain control can be optimized
Local infiltration of an anesthetic medication to induce loss of sensation for a body part
(Exp when removing a skin lesion or suturing a wound by applying local anesthesia)
Injection or infusion of local anesthetic so to block a group of sensory nerve fibers
Preservative opioids are often administered as single agents or in combination with local an esthetics into a patients epidural space with a blunt needle.
Severe pain that erupts while a patient is already medicated with a long acting pain killer
WHO analgesic ladder
Syndrome, is not a diagnosis- resembles drug addiction, but in reality its caused by under prescription of drugs to treat pain causing them to seek more
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