Pain Management for Exam 6

What is consisted of the pain experience?

transduction, transmission, perception and modulation

Describe pain transduction-

converts energy produced by these noxious stimuli into electrical impulses

Describe pain transmission-

occurs when an impulse is sent from the nerve endings near the site of pain and relayed to the brain to alert that there is a pain occurring

Describe pain perception-

the point when a person is aware and perceives the pain

Describe pain modulation-

the process by which the brain alters or modifies the perception of pain signals

Discuss acute pain

usually has an identifiable cause, is short time, and has limited tissue damaged emotional response

Treatments for acute pain-

consider a multimodal approach that includes medications, nerve blocks, physical therapy and other non pharmacological modalities

Discuss chronic pain

prolonged, varies in intensity, and usually lasts longer than 3-6 months and beyond expected or predicted healing time

Treatments for chronic pain-

medications, restorative therapies (PT and exercise), interventional approaches (minimally invasive procedures), behavioral approaches, complementary and integrative health (acupuncture, pilates or yoga)

Discuss the reasons why clients may react to pain:

age, fatigue, genes, neurological factors, previous experiences, family and social networking, spiritual factors, attention, anxiety and fear, and coping styles

Discuss pain assessment data:

determine what level of pain the patient is comfortable with, monitor the pain on a regular basis, consider cultural factors, recognize nonverbal cues of pain, be aware of concomitant symptoms (dizziness, headaches, depression, restlessness), know the patient’s expectations to their pain relief, document any report of pain

During assessment of pain…

note the timing, location, severity, quality, factors, relief measures, and the effect of pain on the patient

Identify the physiological and psychological nursing interventions to relieve or manage pain:

relaxation and guided imagery, distractions, music, cutaneous stimulation, and reducing pain reception and perception

Describe the effects of pain for the client:

pain alters a persons lifestyle and psychological well-being

Pain can cause…

behavioral issues, grimacing, restlessness, crying, clenched teeth

Pain can influence activities of daily living by…

interfering with sleep, mobility, sexual relations, ability to work, socialization (this can lead to reconditioning syndrome)

Describe nursing measures for the relief of pain:

explain to the patient what therapies will and won’t work, talk with a provider to make sure the medications that are chosen are appropriate, acupuncture, massage therapies, physical therapies, cold and heat therapies, and using herbal remedies

Describe medical measures for the relief of pain:

analgesics, patient controlled analgesia, topical and transdermal analgesics, local anesthesia by injection, perineurial local anesthetic infusion, and epidural analgesia

What are analgesics?

most common and most effective method of pain relief, they include nonopioids, opioids, and adjuvant analgesics

What is perineural local anesthetic infusion?

IV medication is delivered near the nerves of a site to reduce pain

Describe surgical measures for the relief of pain:

implantable pumps for injections, spinal cord or deep brain stimulation, trigger point injections, intraspinal medications

Describe medications appropriate for mild pain:

nonopioids such as Tylenol, ibuprofen and aspirin

Describe medications appropriate for moderate pain:

opioids with or without nonopioids (Tylenol) and with or without adjuvants (NSAIDs, antidepressants, anticonvulsants)

Describe medications for severe pain:

opioids used in conjunction with nonopioids or adjuvants or without

What are the 3 types of analgesics:

agonists, agonists-antagonists, antagonists

What is the action of agonists?

bind to an opioid pain receptor in the brain which reduces the pain sensation

What is the action of agonists-antagonists?

they bind to a pain receptor and cause a weaker neurological response than a full agonist (middle of the road pain)

What is the action of antagonists?

reverse the effects of these drugs on pain receptors (this is a reversal drug) there is no response to these medications they can only undo what an agonist is already doing

Nursing implications for analgesics:

medicate patient before pain becomes severe, patients should not take any other medications without the consult of a provider, intersect patients to alert physician of any signs of allergies, keep a running total of acetaminophen given in a 24 hour period, report any easy bruising, bleeding, fever, oral forms should be taken with food, withhold dose if a patients condition is worsening or vital signs are abnormal, instruct patients to get adequate fluid and fiber intake as opioids can cause constipation, keep a record of pain experiences and responses, change positions slowly, monitor for adverse effects, keep an eye on respiratory rate (any less than 10 is a sign of respiratory depression), monitor for therapeutic effects

Factors affecting pain perception/expression:

age, fatigue, genes, neurological function, previous experiences, family and social network, spiritual factors, attention, anxiety and fear, and coping styles

What is Gate Control Therapy?

when you get hurt pain signals travel through nerves to the spinal cord and then up to the brain, if the gate is open pain signals can get through, if the gate is closed pain signals can’t get through

What is opening the gate?

(more pain) stress, worry, fear and focusing on the pain

What is closing the gate?

(less pain) rubbing or massaging the area, applying heat or cold, staying calm or thinking about something else

How to care for a client with pain:

implement previously successful pain relieving remedies, try the least invasive therapies first, health promotion (maintain wellness), non-pharmacological pain relief measures (relaxation, distraction, music), pharmacological pin therapy (analgesics, patient controlled analgesia, topical, local anesthesia, perineural local anesthetic infusion, epidural analgesia)

Side effects of opioid use:

constipation, orthostatic hypotension, respiratory depression, dyspnea, diminished breath sounds, shallow breathing

What is PCA?

patient controlled analgesia, a drug delivery system that allows patients to self administer opioids with minimal risk of overdose

Purpose of PCA?

the goal is to maintain a constant plasma level of analgesic to avoid the problems of PRN dosing

Benefits of PCA?

the patient gains control over pain, and pain relief does not depend of nurse availability, this decreases anxiety and leads to decreased medication use

Side effects of pain medications:

respiratory depress (most serious effect), nausea, vomiting, urinary retention, diaphoresis and flushing, pupil constriction (mitosis), constipation, itching 

Patient teaching for pain medications:

encourages patient to take a fiber supplement, teach patient to rise slowly to reduce the change of orthostatic hypotension, be aware of respiratory depression, oral meds should be taken with food

Non-opioid analgesics: Acetaminophen Action:

blocks pain impulses peripherally by inhibiting prostaglandin synthesis

Side effects of Acetaminophen:

hepatotoxicity (MAX dose for adults daily is 4,000 mg/day)

Patient teaching for Acetaminophen:

patients shouldn’t take other over the counter meds without talking to doctor, instruct patient to notify doctor about signs of allergic reaction or adverse effects, report any easy bruising, bleeding, loss of energy, fever and sore throat

What is opioid tolerance:

a common physiological result of chronic opioid treatment, a larger dose will be required to maintain the same level of pain control

Two types of opioid dependence:

physical and psychological

What is physical opioid dependence?

expected with longer term opioid treatment and should not be confused with psychologic dependence (addiction)

What is psychological opioid 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