Med Surg Test 1 Review (pain)

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FeverRN
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23794
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Med Surg Test 1 Review (pain)
Updated:
2010-06-16 16:14:54
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med surg test one review pain
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Med Surg Test 1 Review (pain)
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  1. Definition of Pain
    • }Whatever the person experiencing pain says it is
    • }Unpleasant sensory and emotional experience associated with actual or potential tissue damage
  2. Pain Mechanisms
    • nociception
    • }physiologic process that communicates tissue damage to CNS
    • ◦Involves 4 processes
    • - Transduction
    • - Transmission
    • - Perception
    • - Modulation
  3. Transduction
    • 1. Noxious stimuli causes cell damage with the release of sensitizing chemicals
    • - prostaglandins
    • - bradykinin
    • - serotonin
    • - substance P
    • - histamine
    • 2. These substances activate nociceptors and lead to generation of action potential
  4. Transmission
    • Action potential continues from
    • - site of injury to spinal cord
    • - spinal cord to brainstem and thalamus
    • - thalamus to cortex for processing
  5. Perception
    Concious experience of pain
  6. Modulation
    Neurons originating in the brain stem descend to the spinal cord and release substances (e.g., endogenous opioids) that inhibit nociceptive impulses
  7. Physiologic effects of pain
    • - increased cholesterol and fatty acids in blood for energy production systems
    • - increased BP
    • - localized inflammation (redness, swelling, heat and pain)
    • - increased production of blood sugar for energy
    • - decreased protein synthesis; intestinal movement (digestion); immune and allergic response systems
    • - increased metabolism; e.g. faster heartbeat, faster respiration
    • - faster blood clotting
    • - increased stomach acids
  8. Pain assessment
    • }Onset
    • }Duration
    • }Associated symptoms
    • }Factors increasing or relieving pain
    • }Pattern
    • }LocationIntensity

    • }Pain quality
    • ◦Nature or characteristics
    • –Sharp, aching, or burning

    • }Associated symptoms
    • ◦Can worsen pain
    • –Anxiety
    • –Fatigue
    • Depression

    • }Goals
    • ◦Describe experience in order to treat
    • ◦Identify goal for therapy and resources for self-management
  9. Nondrug Therapy
    • }Reduce dose of analgesic required and minimize side effects
    • }Possibly alter ascending nociceptive input or stimulate descending pain modulation mechanisms

    • } Massage
    • }Exercise
    • }Acupuncture
    • }Heat or cold therapy
    • }Cognitive therapies
    • ◦Distraction
    • ◦Hypnosis
    • ◦Imagery
    • ◦Relaxation
    • }TENS or PENS
  10. TENS
    • Transcutaneous Electrical Nerve Stimulators (T.E.N.S)
    • - generate electrical impulses sent through electrodes strategically placed over nerve centers.
  11. Interventional Therapies
    • }Neuroaugmentation
    • ◦Electrical stimulation of brain and spinal cord
    • ◦Usually for intractable back pain
    • ◦http://www.drkoop.com/video/93/13000.html

    • }Nerve blocks
    • ◦Interrupt all afferent and efferent transmission, not only nociceptive input ◦Used during and after surgery to manage pain

    • }Neuroablative techniques
    • ◦For severe pain unresponsive to other therapy
    • ◦Destroy nerves to stop transmission
  12. }Three categories of medications
    • ◦Nonopioid
    • –Analgesic ceiling=Increasing dose above upper limit produces no greater analgesia
    • –Do not produce tolerance or addiction
    • –Many OTC

    • ◦Opioid
    • –Bind to receptors in CNS
    • –Inhibition of transmission of nociceptive input
    • –Common side effects
    • –Constipation (most common)
    • –Nausea/vomiting
    • –Sedation
    • –Respiratory depression
    • –Pruritus

    • ◦Co-analgesic or adjuvant
    • –Used in conjunction with opioids & nonopioids
    • –Generally developed for other purposes, but also effective for pain
    • –Antidepressants
    • –Antiseizure drugs
    • –b2-Adrenergic agonists
    • –Corticosteroids
    • –Local anesthetics
  13. }Scheduling
    • ◦Focus on prevention or control
    • ◦Do not wait for severe pain
    • ◦Constant pain requires around-the-clock administration (not PRN)
    • ◦Fast-acting drugs for breakthrough pain
  14. }Titration
    • ◦Dose adjustment based on assessment of analgesic effect versus side effects
    • ◦Use the smallest dose to provide effective pain control with fewest side effects
  15. }Documentation MUST address all areas of nursing process!
    • }Example:
    • ◦1100- c/o severe pain in left foot-rated 8/10- describes as throbbing & constant-onset ½ hr ago- states “it started when I got out of bed this morning and put my foot down”- left foot pink & warm to touch- pedal pulses =88 & equal B-homan’s sign neg- DTRs 2+ B.
    • ◦(goal and nursing diagnosis implied & doesn’t need to be charted)
    • ◦1110- Repositioned foot without relief-massaged foot without relief obtained
    • ◦1120- medicated with Tylenol #3 2 tabs PO
    • ◦1145- stated “I’m comfortable. My pain is much better now”- rated 2/10
  16. ◦Tolerance
    • –Need for increased dose to maintain same degree of pain control
    • –Not as common as once thought
    • –Rotate drug if tolerance develops, as increasing dose could contribute to hyperalgesia (extreme sensitivity to pain)
  17. ◦Physical dependence
    • –Expected response to ongoing exposure to pharmacologic agents manifested by withdrawal syndrome when blood levels drop abruptly
    • –To avoid withdrawal, drug should be tapered
  18. Addiction
    • –Neurobiologic condition with drive to obtain and take substances for other than prescribed therapeutic value
    • –Tolerance and physical dependence not indicators of addiction

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