-
drug tolerance
more med needed in order for it to work
-
name 8 cognitive pain interventions
- relaxation
- deep breathing
- music
- guided imagery
- meditation
- TT
- distraction
- laughter
-
physical dependence on a drug
w/drawal occurs
-
addiction
need med for purposes other than therapeutic one
-
difference between PENS and TENS
- TENS = electrodes applied to skin
- PENS = electrical impulses sent through needle
-
acupuncture is used for
- musculoskeletal condts
- chronic strains
- myofascial pain syndrome
- post-op pain
- neuralgia
- neuropathic pain
- headaches
-
PENS/TENS stands for
pecutaneous/transcutaneous electrical nerve stimulation
-
most serious side effect of opioids and how to treat it
- respiratory depression
- treated with NARCAN
-
4 non-opioid pain meds
- tylenol
- salycilates (aspirin)
- NSAIDs (ibuprofen)
- COX-2 (celebrex)
-
2 good things about opioids, aside from their strength
- no ceiling effect
- can be given via many routes
-
2 good things about non-opioids
- no ceiling effect
- no risk for dependence or tolerance
-
what two pain meds risk GI complications
- salycilates (aspirin)
- NSAIDs (ibuprofen)
-
what pain med causes heart failure and stroke
COX-2 (celebrex)
-
neuroablations
- destroy nerves in the area of pain to end pain response
- last option
-
cutaneous therapy
- use of hot/cold interchangeably
- research shows cold to be more effective
-
5 things relaxation does
- decrease stress
- decrease anxiety
- decrease muscle tension
- decrease fatigue
- increase effect of other pain measures
-
deep breathing does what 3 things
- interrupts stress response
- uses diaphragm
- promotes O2 delivery
-
guided imagery: remember to...
use all the senses
-
how many grams acetaminophen will give GI bleeding and irritation
3 grams
-
5 things music does
- diverts pain cycle
- decrease anxiety
- decrease pain
- better mood
- muscles relax
-
2 things meditation does
increase state of awareness
-
remember what re: distraction
individualized, so work with patient to determine what distracts well
-
adolescents and pain
- less motor activity
- more verbal expressions, muscle tension and body control
-
RNs must know what re: cognitively impaired pts in order to assess their pain accurately
know their normal behavior
-
how to know if infant in pain
- changes in position
- crying
- facial expression
-
school aged kids and pain
- intense response
- clench fist, grit teeth
- close eyes, muscles rigid
- don't complain b/c afraid of shots, sprays, etc.
- poorly ctrled pain results in exhaustion
-
If pt doesn't want to bother RN, RN do what
- ask pt periodically if want prn med
- tell them the time you will return
-
RN assesses what re: pain
- wording used to desc pain
- pattern -- when, duration, radiate, what relieves it
- loc -- start, radiate to
- quality -- ache, throb, stab
- intensity per scale
-
QUEST scale
- for pediatrics - pain scale
- s = secure the involvement of the parent
-
how to measure chronic pain
previous activities - can they do them? i.e. play golf
-
examples of recurrent chronic acute pain
- migraines
- chronic abd pain d/t peptic ulcer
- PID
- IBS
- hep.
- chronic pancreatitis
- sickle cell crisis
-
recurrent chronic acute pain
episodic acute pain w/ pain free periods in between
-
characteristics of chronic pain
- pain continues after injury heals
- weeks to years
- may originate with injury
- serves no purpose
- anxiety and depression accompany it
-
chronic pain examples
- cancer pain
- low back pain
- migraines
- psychogenic pain
-
-
characteristics of acute pain
- begins suddenly
- sharp, stabbing
- warns body of sth.
- mild to severe
- lasts seconds to months
- physiological s/s - BP up, RR up, etc.
-
neuropathic pain
nerve pain - hard to treat because it doesn't always respond to pain meds (i.e. DM, stroke, etc.)
-
nociceptive pain
- "normal pain"
- i.e. burn d/t fire, pain d/t cut
- responds well to opioids
-
2 cat.s of pain, and their subcat.s
- NOCICEPTIVE PAIN
- -somatic pain
- -visceral pain
- NEUROPATHIC PAIN
-
2 common side effects of opioids
-
exercise does what to decrease pain
- increase circulation
- decrease edema
- increase strength
- increase physical and psychosocial wellbeing
-
laughter releases...
endorphins - natural pain relievers
-
-
intrathecal vs. epidural - med goes where?
- intrathecal - subarachnoid space
- epidural - epidural space
-
5 physical non-drug pain interventions
- massage
- exercise
- TENS/PENS
- acupuncture
- cutaneous therapy
-
therapeutic nerve blocks - impt to remember re: time
- blocks wear off quickly and pain can be intense
- implement other pain routes
-
total hip and total knee use therapeutic nerve blocks b/c...
- mobilize faster
- decrease risk nosocomial inf
- decrease pneumonia incidence
- decrease length of stay
-
therapeutic nerve blocks do what and are intermittent or continuous
- block all efferent/afferent transmission to the area
- both intermittent and coninuous
-
how often refill a surgically implanted pain med port
every 30-90 days
-
intrathecal/epidural pain med route - intermittent or continuous? and what is special about these?
- intermittent OR continuous
- highly potent
-
side effects of intrathecal/epidural pain med route
- dizziness
- ataxia
- nausea
- confusion
- headache
-
2 complications of intrathecal/epidural pain med routes
-
pain med route most often used for end of life pain mgmt
SQ infusions
-
parenteral pain med routes (4)
- SQ
- IM
- IV
- pt-ctrled analgesia pump
-
transdermal pain meds - opioid or nonopioid? side effects?
- both opioid and nonopioid
- fewer side effects
-
how often change transD pain med patch
q72h (q3d)
-
chronic pain mgmt - what type of med?
transD pain meds commonly used
-
SL/buccal route pain meds - name 2
-
PR pain meds - name 3 and when you use them
- dilaudid
- morphine
- tylenol
- when pt can't take oral
-
what 2 biological things play role in experience of pain
-
massage benefits (2)
- increase blood flow
- decrease tension
-
oral route pain meds short or long duration
- short and long acting
- generally preferred
-
4 criteria in deciding route of pain med delivery
- best targets src of pain
- achieve good blood levels rapidly
- avoid side effects
- ability to swallow
-
herbal suppl are used freq for what (2)
-
local anesthetics - for what kind of pain? name one.
- surgery or trauma pain
- lidoderm
-
corticosteroids - for what kind of pain
- cancer pain
- spinal cord injury
- inflammatory joints (prednisone)
-
adrenergic agonists - name 1 drug and for what kind of pain?
- catapres
- chronic and neuropathic pain
-
antiseizure drugs - name one and for what kind of pain?
- neurontin
- neuropathic pain
-
adjuvants - name 5 cat.s of
- antidepressants
- antiseizure drugs
- adrenergic agonists
- corticosteroids
- local anesthetics
- **these are all used with pain meds to enhance treatment
-
look at tables 10-7, 10-8, 10-9 (LEWIS)
-
antidepressants are for what kind of pain and how does it work
- neuropathic pain
- prevents reuptake of serotonin an norepinephrin thereby decreasing transmission of nociceptive signals
-
which nonopioids are greater than, less than, or equal to the strength of aspirin?
- tylenol = aspirin
- ibuprofen is greater than aspirin
- celebrex = aspirin (or they're almost the same)
-
what professionals do PENS vs. TENS
- TENS = physical therapist
- PENS = surgeon
-
acute overdose tylenol does what to liver
acute liver failure
-
chronic tylenol overdose does what to liver
liver toxicity
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