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transduction
converts energy produced by stimuli into electrical energy
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transmission
- site of injury to spinal cord
- spinal cord to brain stem and thalamus
- thalamus to cortex for processing
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chemicals that activate nociceptors that perceive pain
- protglandin
- bradykin
- substance p
- histamine
- serotonin
- neuromodulators
-
perception
conscious experience of pain
-
modulation
neurons in the brain stem are decend into the spinal cord and release endogenous opioids that hinder pain and help produce analgesic effect
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nociceptive pain
stimulation of pain nerve endings
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neuropathic pain
damage to pain nerve endings
-
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pain assessment steps 1-5
- 1) pt self report
- 2) patho conditions
- 3) behavioral cues
- 4) family/sig other report
- 5) physiological signs( V/s)
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WILDA
- words
- intensity
- location
- duration
- aggrevating/alleviating
-
acute pain
- anxiety
- agitation
- confusion
-
acute pain goals
- relief at the expense of temp side effects
- pain control w elimination
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chronic pain
- flat
- decresed activity
- fatigue
- withdrawl
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chronic pain goals
- set functional goal
- improve quality of life
- routine dosing
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non opioids are charecturized by
- 1) have an analgesic celling
- 2) no tolerance or dependence
- 3) available w/o prescription
-
non opioids are effective for
mild to moderate pain
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non opiod examples
asprin, NSAIDS, tylenol
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NASAID work on
transduction
-
daily limit for acetometa
4g
-
unlike opioids, NSAIDS____
- - do not depress the cns
- - do not interfer with bm
- -
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how opioids work
- -act on higher centers of the brain and spinal cord
- - bind with opiate receptors to modify perception of pain
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opioids are for
moderate to sever pain
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opiod example
dilaudid, oxy, hydro, fentanyl, morphine
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the results of opiod use
- - inhibition of transmission of nociceptive input from the periphery to the spinal cord
- - altered limbic system activity
- - activaation of the descending inhibitory pathways that modulate transmission to the spinal cord
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opioids are charecturized by
- - physiologic action (agonist, antag)
- - binding at apecific opiod receptors
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adjuvant/co analgesic used for
- -to be used alone or in conjunction w opiod and non opiod analgesics
- - found to be effective for other purposes( seizure, antidep) and found effective for pain releif
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adjuvant/co analgesic example
corticosteriod, anti dep, antiseizure, GABA, local anesthetics, cannabinoid
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nurses must asses every__ hrs for__,__,___
- 4
- pain score
- sedation level
- respiration rate
-
POSS stands for
pasero opiod induced sedation scale
-
POSS is
- - how quickly does the pt arouse with any stimulation
- - pt ability to stay awake once aroused
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if pt requires freq dosing
use ATC dosing or a PCA
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before giving IV opiod, you MUST
check the respiration rate
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nerve blocks involve
a one time or continuous infusion of local anesthetics
-
what do nerve blocks do
they inturupt all afferent and efferent transmission to the area and are not specific to nociceptive pathways
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neuroblative technique
for severe pain that is unresponsive to all other therapies
-
neuroblative technique works by
- -destroy nerves and interuption pain transmission
- -surgical resection
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neuroaugmentation
- electrical stimulation of the brain and spinal cord
- SCS( spinal cord stimulation)
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SCS uses
chronic back pain secondary to nerve damage that is unresponsive to other therapies
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