Lecture 5

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Lecture 5
2012-10-26 13:40:07
Pain Management

Pain Management
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  1. What is skin to skin holding of an infant
    Kangaroo care
  2. What is Eutectic mixture of local anesthetics
  3. What is pain not relieved with the usual programmed dose
    Breakthrough pain
  4. When using PCA with kids the drug of choice is
  5. The anesthetic cream EMLA is applied
    before invasive procedures
  6. The most common side effect from opioid therapy is
  7. What is the primary reason people seek health care
    For pain
  8. What is pain caused by the ongoing activation of the pain receptors in either the surface or deep tissues of the body
    Nociceptive pain
  9. What is pain that is the damage to nerve cells or changes in the processing of pain information through the spinal cord
    Neuropathic pain
  10. What are the types of pain
    • Cutaneous
    • Somatic
    • Visceral
    • Neuropathic
    • Psychogenic
  11. What is cutaneous pain
    • Easily localized
    • superficial
    • cut or bruise, can point to the pain
  12. What is somatic pain
    • Originates from ligaments, tendons, bones, blood vessels, and nerves
    • poorly localized
    • can cause N/V, sweating, b/p changes
    • accompanied by inflammation
    • deeper pain, harder to find where it hurts
    • ex = pain of a sprained ankle is felt in the entire ankle even through the injury might only be on one side
  13. What is visceral pain
    • Originates from viscera or organs
    • Difficult to localize
    • may cause "referred pain" (pain felt in an area distant from the source)
    • ex = angina can cause shoulder or back pain
    • manifested as N/V, restlessness, sweating
    • Deeper pain
  14. What is neuropathic pain
    • Peripheral or CNS nerve pain
    • can include phantom limb pain, neuropathies
    • Felt as numbness, burning, stabbing, needles
    • Diabetics, carpal tunnel syndrome
  15. What is psychogenic pain
    • mental or emotional problems that can cause, increase, or prolong pain
    • can include headaches, back pain, stomach pain and muscle pain
    • dx when other causes are ruled out
    • Treated with psychotherapy, antidepressants, and non-narcotic analgesics
  16. What is pain threshold
    • Lowest intensity of a painful stimulus that is perceived by a person as pain
    • Where they can start to feel the pain
  17. What is pain tolerance
    • Duration or intensity of pain that the person is willing to endure
    • How much a person can take
  18. What temporarily blocks nerve impulses between peripheral structures and higher centers and may be applied topically or infused locally
    Local anesthetics
  19. What local anesthetic acts within 5-10 minutes and lasts about 2 hours and is usually used locally for things such as stitching
    lidocaine (most commonly used)
  20. What local anesthetic has a slow onset, lasts 4-8 hours, is 4 times more potent than lidocaine, and blocks sensory nerves in preference to motor nerves
    • Bupivacaine (can be injected into incisions post-op for pain control)
    • used at end of surgery so incision will be numb for awhile
  21. What are nerve blocks
    • may be used to produce a complete reversible or irreversible interruption of nerve pathways
    • knee surgery is an example
  22. Why is epinephrine often added to local anesthetics
    it is a vasoconstrictor so it makes it so that the anesthetic won't be absorbed as quickly, and will prolong anesthetic effect
  23. What does EMLA cream consist of
    Mixture of lidocaine and prilocaine
  24. What is the first tier/step of WHO pain ladder
    non-opioid analgesics
  25. What are non-opioid analgesics
    • They have a ceiling effect but don't cause physical dependence or tolerance. (Can only get relief from certain dosage. If you give more the pt won't get more of an effect)
    • May have anti-inflammatory effects and prevent the production of prostaglandins
  26. What are some examples of non-opioid analgesics
    • aspirin
    • salicylate salts
    • Acetaminophen
    • NSAIDS (Ibuprofen and Toradol)
  27. A 28-year-old quadriplegic complains of burning pain in his lower legs. What type of pain should the nurse suspect?
    Neuropathic pain
  28. When caring for a patient with a suspected viral infection, which medication order would the nurse question?
    Aspirin 650 mg q4h prn PO (Aspirin may pose a risk for people of any age when administered to those with viral infections. Adults have experienced Reye's syndrome–like manifestations. Acetaminophen, Percocet, and Toradol all have anti-inflammatory properties that can be used for treatment of viral infections.)
  29. A patient with cancer is experiencing increased pain issues. A plan is developed for adding ibuprofen 600 mg twice daily to the medication regimen of narcotics. The patient asks the nurse why he is now expected to take ibuprofen since he does not have arthritis. What is the most appropriate reply by the nurse?
    "Ibuprofen increases the effects of your narcotic, providing better pain relief."
  30. The most consistent indicator of pain in infants is:
    Facial expression of discomfort.
  31. What should you know about aspirin
    • most effective non-opioid med
    • can cause GI irritation and anti-clotting effects
    • do not give to people with viral infections
    • available in tablets, capsules, rectal suppositories and topical creams
  32. what should you know about salicylate salts
    • Similar to aspirin but with fewer GI effects
    • Examples are Choline magnesium trisalicylate (trilisate) and Diflunisal (Dolobid)
    • Contain mag and sodium, avoid use in clients with high sodium or Mg levels and clients with heart failure
  33. What should you know about Tylenol (acetaminophen)
    • No GI effects or anti-clotting effects.
    • Minimal to no anti-inflammatory effects
    • Max dose for adults must not exceed 4 grams (4,000mg) in 24 hours
  34. What should you know about NSAIDS
    • Decrease inflammation and block prostaglandin synthesis
    • include Ibuprofen (motrin) and ketorolac (toradol)
    • can cause GI upset and bleeding effects
  35. What is the second tier on the WHO ladder
    Opioid analgesics that treat mild to moderate pain
  36. What is the third step on the WHO ladder
    opioids to treat moderate to severe pain
  37. What are the adverse effects of analgesics
    • Constipation - #1 problem, high-fiber diet, adequate hydration, stool softeners
    • N/V - include anti-emetics if problem
    • Respiratory Depression - rare, usually in clients who have never had opioids before
    • circulatory depression - may cause decreased b/p or orthostatic hypotension
    • Cutaneous effects - itching, flushing, sweating, include antihistamines
    • urinary retention - may require cath
  38. What are adjuvant medications
    Meds developed for other problems that may have pain-reducing properties
  39. What is relative potency
    ratio of the doses of 2 meds required to have the same effect (how "strong" the med is)
  40. what is duration of action
    how long it takes to work and how long the effect lasts
  41. What is another name for dilaudid
    hydromorphone HCL
  42. What is another name for Oxycodone
  43. what is another name for oxycodone with acetaminophen
  44. what is another name for oxycodone aspirin
  45. what is another name for hydrocodone with acetaminophen
  46. What is another name for fentanyl
  47. What does the FLACC pain assessment tool consist of
    • Face
    • Legs
    • Activity
    • Cry
    • Consolability
  48. What is one of the most important tools to measure pain in kids
    Parent's report/perception of child's pain
  49. How do infants show pain
  50. how do toddlers/preschoolers show pain?
    cry, verbal expressions, physical resistance, start to anticipate pain
  51. How do school age kids show pain
    vocal protest, stalling, muscle rigidity
  52. How do adolescents show pain
    less vocal protest, increased muscle tension
  53. What is another name for methadone