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Chpt 30: Comfort/Pain Management

Acute Pain
– Rapid Onset
– Varied intensity from mild-severe
– warns indv of tissue damage/organic disease
Chronic Pain
Limited, intermittent, or persistent
Lasts beyond the normal healing period
Periods of remission and exacerbation
Pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage
Pain tolerance
Point beyond which a person is no longer willing to endure pain
Neuromodulators
Endogenous opioid compounds naturally present chemical regulators in the spinal cord and brain that alter the perception of pain.
Cutaneous Pain
Superficial, skin or subcutaneous tissue
Visceral Pain
Poorly localized, originates in organs in the thorax, cranium, and abdomen.
Referred Pain
Originates in one place of the body but is perceived in another area.
Phantom Pain
Pain without demonstrated physiologic or pathologic substance
Aromatherapy
The use of essential oils of plants to treat symptoms.
Breakthrough Pain
temporary flare-up of moderate to severe pain that occurs even when the patient is taking around-the-clock medication for persistent pain
Exacerbation
An increase in the severity of a disease or disorder, marked by an increase in signs and symptoms
Opioid
natural or synthetic morphine-like substance that causes analgesia (pain relief), resp. depression, sedation, cough suppression, & decreased GI motility.
Imagery
Creation of mental pictures by pertinent, vivid word choice
Drug Abuse
The deliberate taking of a drug for other than a medical purpose and in a manner that can result in damage to a person’s

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health or ability to function.
Physical Dependence
Appearance of signs and symptoms such as sweating, dilated pupils, tachycardia, vomiting, hypertension, fever, irritability, and anxiety when the drug is withdrawn or the dose is rapidly decreased
Addiction
Addiction is psychological and /or physiological dependence on an opiod
PRN
“pro re nata” = as needed/ as the occasion arises
Patient Controlled Analgesia (PCA)
Drug-delivery approach that uses an external infusion pump to deliver an opioid dose on a “patient demand” basis intravenously or via epidural route, morphine, fentanyl, hydromorphone
Pain tolerance
State of adaptation that occurs as the body becomes accustomed to the drug and dose; once it develops, the patient requires progressively higher doses to obtain the same effect
Sympathetic involuntary response to pain
Increased BP
Muscle tension
Increased pulse/respirations
Increased blood glucose
Pupil dilation, increased adrenal ouput
Parasympathetic Severe/Deep Response to pain
n/v, prostration, fainting or unconsciousness, decreased BP, rapid/irregular heart beat
Pain Threshold
lowest inensity of a stimulus that causes the subject to recognize pain
Bradykinin
powerful vasodilator, increases capillary permeability & constricts smooth muscle
Histamine
released by damaged cells, excites the nerve endings
Endorphins
Powerful pain blocking chemicals that have a prolonged analgesic effects and produce euphoria, dynorphin = most potent
Factors affecting the pain experience
Culture, environment/support people, anxiety/stressors, past pain experiences
Acute Pain Assessmeent
– increased VS
– dilated pupils
– pallor w/diaphoresis
– muscle tension
Chronic Pain Assessment
– Normal VS
– Skin warm and dry
– few visible signs
– fatigue
– poor hygeine
Assessment in older adults
– may have reduced peripheral nerve fibers & diminished pain perception
– may not report pain
– focus on slow/decreased movement
– confusion, lethargy, anorexia, depression
Assess cognitively impaired
– nonverbal cues
– physiologic signs : increased BP, rapid pulse
Nonpharmacologic Pain Relief
– distraction. humor, music, imagery, relaxation, accupuncture, hypnosis
When does heat produce max vasodilation in regards to heat application?
In 20-30mins
When does rebound phenomenon of heat application occur?
Vasoconstriction occurs if heat application is left on greater than 30-45 minutes
When does cold produce max vasoconstriction in regards to cold application?
when skin reaches temp. 60 degrees (10-15 min)
When does rebound phenomenon of cold application occur?
Below 60 degrees vasodilatation begins, prolonged exposure leads to impaired circulation, cell deprivation & subsequent damage to tissues
Analgesics
Pharmacologic agents that relieve pain, reduce person’s perception of pain and alters the persons responses to discomfort.
Nonopioid Analgesics
Acetaminophen and NSAIDs, Prescribed for mild to moderate pain, generally well tolerated
NSAIDs
Aspirin, acetaminophen, Toradol, ibuprofen, Aleve,SE:Heartburn, nausea, occult blood loss:Contraindicated in patients with impaired blood clotting, GI bleed, ulcers, renal disease, possible infection Give w/milk/food to minimize side effects
Opioid Analgesics
Controlled substances: Morphine,codeine,meperidine, hydromorphone,methadone, Prescribed for acute pain and cancer pain that is moderate to severe
Side Effects of Opioids
Sedation, GI: Nausea & Constipation
Respiratory depression, Assess level of alertness, respiratory rate, depth, rhythm & pupil size for baseline.Respirations < 8/min & miosis = signs of toxicity, Withhold drug, notify physician Naloxone (Narcan), an opioid antagonist, can be administered slowly IV
Adjuvant Drugs
Anticonvulsants, antidepressants, antiemetics, corticosteroids, sedatives
Pain relief measures for cancer/chronic pain patients
Gived meds orally if possible
admin meds ATC rather than PRN
adjust dose, manage BTP, allow control over regimen
When treating older adults:
avoid IM injections due to diminished muscle, fat stores, and circulation
NSAIDS should be used cautiously d/t renal and gastric complications
Epidural Analgesia
Pain relieved by smaller doses with less severe side effects, Narcotic acts directly on opiate receptors in spinal cord, SE:resp depress, hypotension, urinary retention, n/v
Local Anesthesia
Agents may be applied topically to the skin or mucous membranes or injected into the body ( nerve blocks ), Used in dental work, minor surgical procedures, newborn delivery
Barriers to effective pain management
consider a sign of weakness, dont want to be difficult, fear of loss of control & fear of being labeled a drug seeker
A nurse is about to use the Wong-Baker FACES pain scale to assist a patient in assessing his pain level. Which of the following should the nurse know in order to use this pain scale?
This scale is useful for adult patients who have cognitive impairments
A patient who has been experiencing frequent, severe migraine headaches tells the nurse she has heard that biofeedback is effective in treating migraines. The patient asks the nurse to describe how this pain-relief method works. The nurse should reply that biofeedback involves?
Measuring skin tension and using learned techniques to relieve pain
During a pain assessment, a nurse asks questions about the quality of an adult patient’s pain. Which of the following statements by the patient refers to pain quality?
My pain feels like I’m being stabbed by a knife
A nurse is caring for a patient admitted to the emergency department with severe pain following a fall from a ladder. The initial assessment reveals long-term use of opioids for chronic pain. Which of the following provider prescriptions for initial pain relief should the nurse question?
Pentazocin (Talwin)
A nurse is caring for two patients of different cultural backgrounds. Both patients returned from the same type of surgery 2 hr. ago. Which of the following should the nurse expect to be the same for both patients?
Class of medication used to treat acute postoperative pain
A nurse is planning to administer a dose of intravenous morphine sulfate for a postoperative patient. Which of the following is a pain management protocol that should be used by the nurse in this situation?
Have an opioid antagonist available during the administration
Agonist
A drug that produces and promotes the desired result
Allopathic Medicine
traditional medicine; science based on modern medicine
Antagonist
A drug that prevents the agonist from acting
Balanced Analgesia
using more than one form of analgesia concurrently to obtain more pain relief with fewer side effects
Chiropractic medicine
A system of therapy based on the theory that disease is caused by pressure on the nerves.
Complementary therapies
Alternative treatments used with traditional medical interventions
Healing touch
energy therapy using the hands to clear, energize, and balance the energy field
Holistic Nursing
nursing practice that has as its goal the healing of the whole person
Homeopathy
A method of treating diseases with remedies that produce effects similar effects like the disease itself
Psychological Dependence
A psychological need to use a drug, such as to relieve negative emotions
Remission
Partial or complete disappearance of symptoms of disease.
Sensitization
An increased effect of a drug after repeated exposures

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