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Gate control theory assumes that the pain experience reflects
both physical and psychosocial factors
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What anesthetic has analgesic properties?
Ketamine; may prolong analgesia for 12-24 hours after surgery
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Sympathetic nerve responses to pain
Increase in BP, P, R, dilated pupils, perspiration, pallor
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Parasympathetic nerve response to pain
Constipation and urinary retention
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Behavior changes in acute pain
restless, thrashing, rubbing body part, pacing, grimacing, and other facial expressions of pain
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Behavioral changes in chronic pain
Tired looking, minimal facial expression, quiet, sleeps, rests, attention on other things
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Cancer pain may be considered
acute and chronic
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Nursing assessment of pain is essential to identify
characteristics and amount of pain, whether pain is acute or chronic, and whether patient has both acute and chronic at the same time
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6 steps in pain assessment
Accept pt report, determine status of the pain, describe pain, examine site, identify coping methods, record the assessment, interventions and evaluation of interventions
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Possible nursing diagnoses for pain
activity intolerance, anxiety, disturbed sleep pattern, fatigue and self care deficit
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How do physical interventions help pain?
Increase pain threshold, reduce muscle spasm, decrease congestion in injured area
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How does jaw relaxation help pain?
Effective in reducing mild to moderate pain and as an adjunct to drugs for severe pain
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How does simple imagery help pain?
Use when patients express an interest in relaxation; requires 305 minutes of staff instruction
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How does music help pain?
Patient preferred and easy listening music are effective in reducing mild to moderate pain
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How does imagery help pain?
Effective for reduction of mild to moderate pain; requires skilled personnel
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How does educational instruction help pain?
Should include sensory and procedural information and be aimed at reducing activity-related pain; requires 5-10 minutes of staff time
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How should pain meds be given when pain is predictable?
Around the clock rather than prn; ATC maintains therapeutic blood levels of analgesics
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What properties do nonopioids have?
Antipyretic, analgesic, or anti-inflammatory
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Parenteral nonopioid
toradol (ketorolac)
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Nonopioids are not recommend for people with
liver or kidney disorders; use cautiously with CHF or HTN
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Older adults should not use
propoxyphene, meperidine, indomethacin, ketorolac, promethazine
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Adverse effects of nonopioids
stomach irritation, fluid retention, increased bleeding time
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PCA instructions
when pain begins to return, press PCA button; put it down and wait 10-15 minutes; if pain returns, push PCA again and repeat until pain is relieved
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What is an herbal remedy for migraine prevention?
Feverfew
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Preferred treatment of chronic pain
Oral analgesics
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Adjuvant analgesics
antidepressants-neuropathic pain; benzos-muscle spasm and anxiety; antihistamine-nausea/anxiety; corticosteroids-spinal cord or nerve compression, bone pain; anticonvulsants-neuropathic pain; local aneth-diabetic neuropathy; clonidine-spinal cord, phantom limb, peripheral nerve; psychostimulants-analgesic effect-cancer pain
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When analgesic is not working,
Check order; consider alternative script; collaborate with pt, other nurses, pharmacist and family
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Most chronic pain is
neuropathic because of nerve damage
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