Pain, pharmacology, PACU, Administrarion of medication

sharp, dull, aching, squeezing, deep, pressing, gnawing

mild, moderate, severe

can you point to it?

suddent, slowly, gradual, build-up

it takes a larger dose to provide the same level of pain relief

a physiological phenomenom that some people experience after taking the medication for a few weeks. They exhibit symptoms such as sweating, tearing, runny nose, restlessness, irritability, tremors, dilated pupils, nausea, vomiting and diarrhea.

addiction, compulsive drug use with craving for opoid for the effects other than pain relief

Pain viewed as being controlled by a gate mechanism in the CNS. Opening the gate allows transmission of pain. Closing the gate blocks the transmission of pain. The gate may be opened by activity in small diameter nerves, such as tissue damage. Large diameter nerve activity seems to close the gate (massage, vibration). Lack of input allows the gate to open.

Endogenous, naturally occuring opiate-like peptides that modify the perception of pain. They attach to opoid receptors and block pain (they degrade quickly and are not effective analgesics). Physiologic and psychological stressors can cause the release of endorphins.

Types of pain, severity of pain based on pain scale, quality of pain, location of pain, duration of pain, degree of pain.

short term, associated with injury. Short duration lasting a few hours to a few days, expected to be over soon, described as aching or throbbing, pt may be restless or aggitated, controlled by analgesics. Moaning, crying, irritable, grimacing, guarding/splinting.

long term, may continue for months or years. may be dull, constant, shooting, tingling or burning. May be treated with both pharmacologi interventions. Flat affect, fatigue, withdrawal from others, decreased physical movements.

Body's normal reaction to noxious stimuli, such as tissue injury. Involves injury to tissue in which receptors called nociceptors are located. Found in skin, joints, or organ viscera. 4 phases: transduction tissue damage, pain sensation; transmission-transmitted to spinal cord, conscious of it; perception-brain recognition recognizes impulse as pain; modulation-brain sends signals back. NSAIDs, Opoids, distraction and guided imagery block perception.

sensitivity to stimuli (injury affects the peripheral or CNS). Associated with dysfunction/damage of the nervous system. Pain receptors become more sensitive to stimuli. Associated with Guillan Barre Syndrome, cancer, DM, shingles and HIV. Treated with NSAIDs, tricyclic antidepressants, anticonvulsants or corticosteroids.

after loss of body part. Not controlled bny conventional methods.Treated with TENs implanted in the thalamus.

Most people with chronic pain have some degree of psychological disturbance. Causes a psychologic problem and contributes to the pain.

Tried first, acute and chronic pain, has ceiling effect, no tolerance or physical dependence, NSAIDs (block prostaglandins), anti-pyretic effect

Block COX2 enzyme, present with pain like arthritis

For moderate to severe pain, no ceiling effect, morphine-drug of choice, need to monitor level of sedation and respiratory status, Naloxone opiod antagonist.

May potentiate effect of opiod or nonopiod, have analgesic activity, ex: steroids, antidepressants, anticonvulsants.

onset, location, duration, characteristics, alleviating/aggravating, radiation, timing.

Where is it, how does it feel, aggravating/alleviating factors, timing, severity, usefule data (other sx), perception (what do they think).

rapid eye movement, time in which you dream, a period of a high level of activity, heart rate, bp, and respirations are similar to that when awake, spend 25% of sleep here, Normal: leg kicks, arms, swinging, moaning, nose scratching, laughing.

non-rapid eye movement. believed to be the time when the body receives the most rest. heart rate, blood pressure and respirations decline, 4 stages: light sleep to very deep sleep/difficult to arouse. In one night, go thru 2 states (REM, NREM) in 90 minutes cycles, 5-6 times/night

Drugs with no accepted medical use and a high potential for abuse. (ex. heroin, LSD, crack cocaine}

Drugs with a medical use and high potential for abuse and/or dependence (certain narcotics-morphine, stimulants, Ritalin, depressants)

Drugs that are medically useful but with less potential for abuse (Tylenol #3, Vicodan, Valium)

Drugs that are medically useful but with less potential for abuse than schedule III drugs.

Drugs with medical use and low potential for abuse and that produce less physical dependence than do schedule IV drugs.

how drugs enter the body, are metabolized, reach their site of action, and are excreted.

distribution to tissues and site of action depends on chemical and physical properties of drug and physical status of patient.

chemical transformation

rate determine by weight, age, sex, disease conditions, genetic factors and immune mechanisms.

elimnation from body.

slow absorption

quick absorption

quick absorption

slow absorption

Depends on the form of the drug

slow absorption

Most rapid absorption

Begins with the drug reaches a minimum effective concentration level.

Occurs when the highest blood or plasma concentration of the drug is achieved.

Length of time the drug exerts a pharmacologic effect.

Drugs that produce a response.

Drugs that block a response.

carried out until it it canceled by physician or prescribed number of doses has been given.

an order written for when the pt requires it.

Written for a drug to be just given the one time.

a single dose of a medication to be given without delay.

• 1. The right drug
• 2. The right dose
• 3. The right route
• 4. The right time
• 5. The right Pt

• 1. Teach the pt about the drugs
• 2. Take a complete drug hx
• 3. Assess the pt for drug allergies.
• 4 . Be aware of potential drug interactions from other drugs or foods.
• 5. Document each drug you administer after giving it.

48-72 hour limit

5 or 7 day limit

30 day limit on all medications.

Every 15 minutes for first hour. Every 30 minutes for next 2 hours. Every hour for 4 hours or until pt is totally recovered and VS have returned to normal.