chapter 20 study guide

1. What are the side effects of opioid narcotics?

• Opioids cause sedation, nausea, constipation, and respiratory depression

3. Types of pain:

• Acute - discomfort that has a short duration (anywhere from a few seconds to 6 months), it is associated with tissue trauma, including surgery, although it is severe initially, acute pain eases with healing and eventually disappears

• Chronic-- discomfort that lasts longer than 6 months, the longer the pain exists, the more far-reaching its effects on the sufferer

• Neuropathic- often described as a shooting or burning pain, it may go away on its own but is often chronic, it is frequently the result of nerve damage or a malfunctioning nervous system, it may affect both the site of the injury and the area around it also known as phantom limb pain

• Visceral- discomfort arising from internal organs,associated with disease or injury, sometimes referred or poorly localized

• Cutaneous-Discomfort that originates at the skin level, is a commonly experienced sensation resulting from some form of trauma, damage confined to the epidermis produces a burning sensation, at the dermis level, pain is localized, and superficial, subcutaneous tissue injuries produce an aching, throbbing pain.

• Somatic- discomfort generated from deeper connective tissue, develops from injury to structures such as the muscles, tendons, and joints

• Referred- discomfort perceived in a general area of the body, usually away from the site of stimulation, it is not experienced in the exact site where an organ is located ex heart attack

4. Pain is subjective

• pain is what the pt says it is

5. What is PCA:

• Patient-Controlled analgesia is an intervention that allows clients to self admin opioid pain medication through the use of an infusion device.

6. Advantages of PCA

o Pain relief is rapid

o Pain is kept within contestant tolerable level

o Less of the drug is being used

o Clients are spared discomfort of repeated injections

o Anxiety is reduced due to not having to wait for injections

o Side effects are reduced due to smaller doses.

o Clients tend to move more reducing complications for immobility

o Take active role in their pain management

o Nurse is free to carry out daily responsibilities

7. Components of brief or basic pain assessment:

• onset: time the pain started (after eating)

• quality: degree of suffering (throbbing, sharp, annoying)

• intensity: magnitude of pain (none, slight, mild, moderate, severe, numeric scale 0-10)

• location: anatomical site (jaw, abdomen, chest)

• duration: time span of pain (hours, weeks, months, continuous, intermittent)

9. Pain thresholds:

• The point at which sufficient pain-transmitting stimuli reach the brain, in other words when you can feel pain

10. Pain Tolerance

• The amount of pain an individual can endure.

11. Pain perception:

• The perception that they're in pain- occurs when the threshold is reached.

12. What is the endogenous opioid theory?

• A theory based on the fact that nociceptors contain receptors that can bind with neurotransmitters.

13. Endogenous opioids:

•  Endorphins- Natural pain killers

• Dynorphins-Neuropeptides that modulate pain perception and stress response. 

• Enkephalins- Neurotransmitters related to opium that block pain signals  

15. Opioid use:

• morphine sulfate

• codeine sulfate

• meperidine (Demerol)

• Fentanyl

• When pain is no longer controlled with non-opioids, the non-opioid is combined with an opioid. They are controlled substances because of their potential for being misused.

16. Pain is the fifth vital sign:

• Always ask to rate the pain.  

• Kids and mentally challenged adults use face scale

• Assess vital signs at least once per shift, before and after painful procedures and before and after all interventions.

17. All Pain scales and when/who to use them on:

• numeric scale- Most used on adults

• word scale- mild, moderate, severe, very severe, worst pain ever

• linear scale- a line from no pain to worst pain and the point where they're on at the line

• visual analog scale- Wong-Baker FACES pain rating scale, best for children or clients who have language barriers or are cognitively impaired, children as young as 3 years old can use the FACES scale

20. Know Rhizotomy:

• surgical sectioning of a nerve root close to the spinal cord

• this prevents sensory impulses from entering the spinal cord and traveling to the brain

21. Know Cordotomy:

• refers to the surgical interruption of pain pathways in the spinal cord.

• The surgical procedure in which bundles of nerves are severed has all but been replaced by a percutaneous approach around the spinal cord.l

24. Complementary and Alternative Medical Interventions

• Transcutaneous electrical nerve stimulation (TENS)- Medically prescribed pain management technique that delivers bursts of electricity to the skin and underlying nerves.

• Acupuncture- pain management technique which long, thin needles are inserted into the skin at precise points.

• Acupressure- Technique that involves tissue compression rather than needles to reduce pain.

• Heat and cold- Thermal therapy or applications of heat or cold to relieve pain.

• Biofeedback-A client learns to control or later physiologic phenomenon (pain, blood pressure, headache, heart rate and rhythm) as an adjunct to traditional pain management. Ex white coat syndrome

• Relaxation- releasing muscle tension and quieting the mind

• Hypnosis- Therapeutic technique where a person enters a trance-like state resulting in an alteration of perception and memory.

• Percutaneous Electrical Nerve Stimulation (PENS)- PainManagement technique involving a combination of acupuncture and TENS.

• Imagery- Intentional daydreaming

• Distraction- Diversion of attention to shift focus

• Meditation- Promotes tranquility

27. When do you assess pain?

• When the client is admitted

• Whenever the nurse takes vital signs

• At least once per shift when pain is problem focused or a risk

• When the client is at rest and when involved in a nursing activity

• After each potentially painful procedure or treatment

• Before implementing a pain management intervention, such as administering an analgesic again 30 min later.

• What in the autonomic nervous system is affected by pain

28. Know what “care giver role strain” is.

• The most important factor that causes caregiver role strain is the high demand of time and energy required for caregiving, often leading to physical, emotional, and mental exhaustion. This is especially true when the caregiver has to balance caregiving duties with other responsibilities such as work, family, and personal needs.

31. Nursing guidelines- managing pain

• Don't doubt client's pain or need of relief

• Follow orders for pain administration

• Administer pain-relieving drugs ASAP

• Consult physician if current drug is not controlling client's pain

• Collaborate with physician to develop options for pain management, routes, and schedules

• Support the formation of an interdisciplinary pain management team.

• Administer meds before activity that might cause pain

• If pt pain is continuous administer meds on schedule rather than irregularly

• Monitor for drug side effects

• Change client's position if necessary

• Implement independent and prescribed nondrug interventions

• Allow rest periods btw activities.

32. Nocieptor- specialized neurons that detect and transmit pain to the brain.

    
    

33. Addiction: Chronic, relapsing, treatable disease- Characterized by:

    • Craving

    • Dysfunctional behaviors

    • Inability to control impulses regarding consumption of a substance

    • Compulsive use despite harmful consequences

**if they complain of pain, ALWAYS do an assessment**