NUR1230 Pain

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NUR1230 Pain
2014-09-19 02:00:33

NUR1230 Pain
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  1. algogenic
  2. prostaglandins
    chemical substances that are believed to increase sensitivity of pain receptors
  3. factors influencing pain response
    • anxiety
    • culture
    • age
    • gender
    • genetics
    • exectations reg. pain relief
  4. factor to consider in a complete pain assessment
    • intensity
    • time location
    • quality
  5. assessment of pain
    • intensity
    • time
    • location
    • quality
    • personal meaning
    • pain behaviors
  6. 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
  7. agents used to treat pain
    • opioids
    • NSAIDs
    • local anesthetics
  8. Opioid analgesic agents
    • 1. respiratory sedation and depression
    • constipation
    • pruritus (itching)
    • epidurally: urine retention
    • nausea, vomiting
    • hypothyroidism: lower dose

    decreased responsive with: monoamine oxidase inhibitors, tricyclic antidepressants,...
  9. 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
  10. 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,
  11. placebo
    • endogenous production of endorphines
    • may increase effectiveness
    • no placebo-meds to be used in pain management (without active ingredient
  12. 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
    • 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
  14. neurologic + neurosurgical pain management
    • 1. stimulation procedurs (electrical)
    • 2. administration of intraspinal opioids
    • 3. interruption of nerve tract (non-reversible and last resort)
  15. ABC
    • 1. Airway
    • 2. Breathing
    • 3. Circulation
  16. On Q pump
    • subcutaneous catheter inserted at site of affected area
    • pump releases local anesthesia as prescribed continuously
  17. physical responses to acute pain
    • increased bloodpressure, pulse, respiration
    • diaphoresis (sweating)
    • tremors
    • redness and swelling around painful area
  18. 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
  19. 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
  20. glaucoma: cholinergic agents
    • cause miosis -> constriction of pupil
    • cholinergic agonist and cholinergic inhibitors
  21. 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
  22. ibuprofen
    • also Motrin, Advil
    • OTC over the counter drug