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prostaglandins
chemical substances that are believed to increase sensitivity of pain receptors
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factors influencing pain response
- anxiety
- culture
- age
- gender
- genetics
- exectations reg. pain relief
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factor to consider in a complete pain assessment
- intensity
- time location
- quality
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assessment of pain
- intensity
- time
- location
- quality
- personal meaning
- pain behaviors
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Premedication assessment
- ask + check for any allergies
- check for current/recent other meds and herbs
- check for health disorders (e.g. renal functioning)
- current pain status, level after previous administration and side-effects
- religious/ raciel/ ethnic background
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agents used to treat pain
- opioids
- NSAIDs
- local anesthetics
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Opioid analgesic agents
side-effects
- 1. respiratory sedation and depression
- constipation
- pruritus (itching)
- epidurally: urine retention
- nausea, vomiting
- hypothyroidism: lower dose
decreased responsive with: monoamine oxidase inhibitors, tricyclic antidepressants,...
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NSAID's
- Nonsteroidal Anti-inflammatory drugs
- aspirin, ibuprofen
- arthritic diseases,
- cancer bone pain
- impaired kidney function: monitor and lower dose
- easy bruising-> anticoagulant
- might displace other meds like Coumadin-> increase their effects
- high doses can irritate stomach
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routes of administration of analgesia
pros and cons
- parenteral (IM,IV, subq)
- shorter duration, faster,
- IV: comfortable, peak level more rapid, more reliable dose smaller: IV push, slow push or continuous
- SUBQ: limited IV access, cannot take oral, managing pain at home, effective and convenient but small amount
- oral
- easy and noninvasive, higher doses
rectal: cannot take meds with any other route, onset delayed, duration long
- transdermal
- consisten level, home r hospice (cancer) Duragesic (fentayl) and Buprenex (buprenorphine), absorption increased in febrile patients, never use heating pad where patch is applied
- intraspinal + epidural:
- fewer side-effects incl. sedation than systemic analgesia,
- side-effect: headache (loss of spinal fluid) monitor patient for 24 h after first injection, antagonist such as naloxone (Narcan) avail if resp. depression occurs,
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placebo
- endogenous production of endorphines
- may increase effectiveness
- no placebo-meds to be used in pain management (without active ingredient
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gerontologic considerations reg. opioids
- history check before administration (which other meds, renal health...)
- might not be metabolized that quickly
- avoid meperidine (Demerol)
- listen what patient says-> may be smaller doses, less frequent
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NON PHARMACEUTICAL WAYS FOR PAIN RELIEF
- massage,
- thermal therapies (no longer than 15-20 min., not to be used for patients with circulatory problems)
- TENS Transcutaneous electrical nerve simulation
- relaxation techniques (breathing "in, two, three" "out, two, three)
- guided imagery (breath out pain, muscle tension and discomfort, breath in relaxation, energy and comfort)
- hypnosis
- music therapy
- changing position
- distraction
- cool wash cloth to face
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neurologic + neurosurgical pain management
- 1. stimulation procedurs (electrical)
- 2. administration of intraspinal opioids
- 3. interruption of nerve tract (non-reversible and last resort)
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ABC
- 1. Airway
- 2. Breathing
- 3. Circulation
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On Q pump
- subcutaneous catheter inserted at site of affected area
- pump releases local anesthesia as prescribed continuously
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physical responses to acute pain
- increased bloodpressure, pulse, respiration
- diaphoresis (sweating)
- tremors
- redness and swelling around painful area
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glaucoma: Beta Adrenergic Blockers
- first line drug
- decrease production of aqueous humor
- drug -olol (bteaxolol HCI (Betoptic S), carteolol HCI, levobunolol...)
- -eye discomfort
- can slow heart rat
- worsen bradycardia
- prevent adequate bronchodilation in patients with asthma
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glaucoma: prostaglandin analogues
- latanoprost (Xalatan)
- improving trabecular outflow
- change color of iris
- change color of eyelids
- eyelash hypertrichosis
- blurred vision
- redness of conjunctiva
- itching and stinging
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glaucoma: cholinergic agents
- cause miosis -> constriction of pupil
- cholinergic agonist and cholinergic inhibitors
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aspirin
- prostaglandin inhibitor
- anti-inflammatory
- anticoagulant (antiplatelet drug)
- antipyretic (lower temperature)
- decrease pain
- ASA = acetylsalicylic acid
- can cause gastric distress (bleeding and ulcer), take with food or enteric coated tabs
- allergic: tinnitus, vertigo (dizziness), bronchospasm
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ibuprofen
- also Motrin, Advil
- OTC over the counter drug
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