Management of Pain
Terms
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- considered to be the 5th vital sign
- pain
- sever discomfort or uncomfortable sensation with a sudden onset, usually subsides with treatment
- Acute Pain
- Persistent or recurring pain that contiumes for more then six months.
- Chronic Pain (nonmalignant or benign)
- Pain that persists beyond normal heling period. Non life threatening
- chronic
- Stimuli damage tissues or has potential to do so if prolonged
- Nociceptive Pain
- arises from bone, joint, muscle, skin or connnective tissue. Aching throbbing, well localized
- Somatic
- arises from panceas, or gi tract.
- visceral
- tumor aching is
- well localized
- cramping poorly localized
- obstruction
- Abnormal processing of sesory input by nervous system
- Neuropathic pain
- Injury to either peripheral or Cns (phantom)
- Deafferentation
- dysregularion of autonomic nerfus system
- sympathetically maintained
- centrally generated
-
deafferentation
sympathetically maintained - peripherally generated
- polyneuropathies
- pain along a peripheral nerve (diabetic)
- polyneuropathies
- nerve root compression, entrapment
- mononeuropathies
- send pain signal along peripheral nerve fibers iwth neurotransmitters.
- nociceptors
- cells release prostaglandins (increase pain) potassium bradykinin.
- nociceptors
- sharp well localized pain after injury
- A delta
- dull, poorly localized persistent pain after injury
- C fiber
- Substance P allows impulse to travel to spinothalamic tract
- Dorsal horn of spinal cord
- motor impulses travel along ? to cause a contraction of muscle near site of stimulation and withdrawl
- efferent nerve fibers
- when released from the brain, cord, gi tracte this causes analgesia
- endorphines and dynophins
- WHat released from the brain and dorsal horn, inhibits pain transmission
- serotonin
- pain impulses ascend to spinal cord to somatosensory and ? cortex
- association
- dorsal horn of spinal cord, thalamus, limbric system as as what
- gate that can be opened to pass pain impulse along or closed to block transmission
- if imput dominates from A-beta fibers, gate will
- close
- what can be done to stimulate mechanoreceptors a beta fiber
- nurse ccan massage
- release endorphins to close gate by inhibiting substance P release
- descending neural pathways
- what elicts flight or fight reaction.
- Mild to moderate pain
- physiological responses to pain are
- increased rr hr pallor diaphoresis glucose increase muslce tension pulpil dilation.
- sever continuous or deep pain stimulates what
- PNS
- sever pain results in what to the hr, bp
- decreased. irreg breathing nausea and vomiting pallor and weakness
- factors influencing pain
-
age
gender
attention - system that processes emotional reaction to pain, aggravating or relieving it.
- Anxiety -limbric
- fatigue does what to pain?
- intensifies pain and decreases coping
- stoicism and self control moaning and crying accepted. communicating it is not.
- Mexicans
- disgraceful to express pain verbally and may refuse anagesic
- japanese
- may not complain of pain except to family, or eldest male
- chinese
- germans and scandinavians handle pain by being
- stoic
- punishment from god for sinful thinking or behavior, suffering is part of ones fate, sacrament of sixk mandatory
- catholic
- disease pain and suffering is gods will, and are part of expiating sin. some may not adhere to therapy because of fatalistic views
- muslim
- believe illness is result of actions in this or previous lifes
- budhists
- nonpharmacologial pain relief include
- acupressure, relaxation , guided imagery, distration, biofeedback, cutaneous stimulation to close gate, massage ice
- a child with reyes syndrome do not use
- ASA
- side effects of opioids
- constipation, sedation, nausea and vomiting
- vertigo, faintness when standing, decreased bp and increased sweating are side effects of
- Opiod
- cancer pain relief, acute pulm adema sever pain
- morphine
- this type of pain relief can cause hepatic toxicity rash pruritis respiratory depression
- morphine
- opiods should not be used if Rr is less then
- 12
- pain med perferred for biliary colic, pancreatitis.less apt to release histamine
- demerol
- do not use this pain med with head injury and increased intracranial pressure because neuro stats masked
- demerol (copd)
- Do not use this med older adutls impaired renal or liver function
- Demerol
- dermal patch for cancer pain
- transdermal fentanyl
- onset is 12-18 hourse will continure giving short term analgesia until onset
- transdermal fentanyl
- sustained release for chronic pain relief
- oxycodones
- to be administered atc, not prn
- oxycontin
- use what? for pruritis
- antihistamines
- use this for nausea, vomiting
- antiementics