Classification of Pain:Sudden onset, Usually subsides once treated, temporary
Acute pain
Persistent or recurring, Lasts 3 to 6 months, Often difficult to treat, Tolerance, Physical dependence, is assosiate w/ cancer, characterized by slow onset, long duration, and dull persistent aching
Chronic pain
A patient with bone cancer tells the nurse that he is in pain. The nurse knows that bone pain is classified as which type of pain?
A.
PCA and PCA by proxy
Patient-controlled analgesia
Patient-controlled analgesia by family
Why does a PT that is taking a long acting Opioid analgesics have breakthrough pain that must be treated w/an immediate release dosage form that is given b/w scheduled doses of long acting Opioid.
This is because the analgesic effects wear off as the drug is metabolized and eliminated from the body.
The main consideration in pain management for pain associated with cancer is patient comfort and not trying to prevent ____ _______ or ____ ____.
drug addiction or psychologic dependence
A normal physiologic condition that results from long-term opioid use, in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms (same as physical dependence).
Opioid tolerance
Pain that occurs between doses of pain medication
Breakthrough pain
Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone. For example, 1 + 1 is greater than 2.
Synergistic effect
A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern?
A.
One of the most serious adverse effects of opioids is _____ _____, the nurse must assess PT _____ ____ before and after administering opioids.
respiratory depression
respiratory rate
GI adverse effects i.e. _____, _____, and _____ are the most common adverse effects associated w/ opioid analgesics.
nausea, vomiting, and constipation
Less common adverse side effects of opioid analgesics are?
there are 4
Diaphoresis (sweating)
itching
pupil constriction
urinary retention
PTs w/_____ ______ require a larger doses of the opioid agent to maintain the same levels of analgesia, and is a common physiologic result of long-term chronic opioid treatment.
opioid tolerance
Physiologic adaptation of the body to the presence of an opioid, and is expected w/long-term treatment
Physical Dependence
Opioid tolerance and physical dependence are expected with long-term opioid treatment and should not be confused with _____ _____ AKA _____.
psychologic dependence
addiction
A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief
Psychologic Dependence
A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming “unbearable.” The nurse is reluctant to give him the ordered pain medication because the nurse does not want the patient to get addicted to the medication. What do the nurse’s actions reflect?
B.
______, an opioid reversal agent, is used to reverse effects of acute opioid overdose, and is the drug of choice for reversal of opioid induced respiratory depression.
Naloxone
opioid reversal agent is AKA?
opioid antagonist
Syndrome that is manifested as:Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, confusion
Opioid withdrawal or opioid abstinence syndrome
The most serious adverse effect of opioid use is ___ _____ which may lead to respiratory depression.
CNS depression
What is a pure opioid antagonist and is the drug of choice for the complete or partial reversal of opioid-induced respiratory depression?
Naloxone Hydrochloride (Narcan)
What drug is indicated in cases of suspected acute opioid overdose and failure of this drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.
Naloxone Hydrochloride (Narcan)
A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be
D.
_____ _____ is a contraindication to the use of acetaminophen.
Liver disease
Acetaminophen should not be taken in the presence of:
there are 3
Drug allergy
Liver dysfunction or failure
G6PD deficiency
Dangerous interactions may occur if _______ is taken with alcohol or other drugs that are hepatotoxic
acetaminophen
_____ _____ is the most serious acute toxic effect of an acute overdose of acetaminophen.
Hepatic necrosis
☆available OTC
☆lethal when overdosed
☆Overdose, whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity.
☆Long-term ingestion of large doses also causes nephropathy.
☆What drug does this describe?
acetaminophen
Recommended antidote for Acetaminophen toxicity and managing Overdose?
acetylcysteine regimen
_____ is commonly used for migraine headaches, menstrual problems, arthritis, and fever because of its anti-inflammatory properties.
Feverfew
Feverfew possible adverse effects include:
there are 4
muscle stiffness
muscle and joint pain
GI distress
altered taste
Feverfew may interact with _____ and other _____, as well as _______.
aspirin
NSAIDs
anticoagulants
1. For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain medication is which of these?
D.
A patient is receiving an opioid via a PCA pump as part of his postoperative pain management program. During rounds, the nurse finds him unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next?
B.
A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The patient asks the nurse what benefits these patches have. The nurse’s best response includes which of these features?
C.
Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.)
a. Diarrhea
b. Constipation
c. Pruritus (itching)
d. Urinary frequency
e. Nausea
b, c, e
Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication?
A.
The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this dose?
0.75 ml
An opioid analgesic is prescribed for a patient. The nurse checks the patient’s medical history knowing this medication is contraindicated in which disorder? (Select all that apply.)
a. Renal insufficiency
b. Severe asthma
c. Sleep apnea
d. Severe head injury
e. Liver disease
b, c, d
A patient with renal cancer needs an opiate for pain control. Which opioid medication would be the safest choice for this patient?
