Pain

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Author:
madelynlee
ID:
68949
Filename:
Pain
Updated:
2011-02-25 21:05:14
Tags:
pain management nursing pain
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Description:
Pain management
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  1. drug tolerance
    more med needed in order for it to work
  2. name 8 cognitive pain interventions
    • relaxation
    • deep breathing
    • music
    • guided imagery
    • meditation
    • TT
    • distraction
    • laughter
  3. physical dependence on a drug
    w/drawal occurs
  4. addiction
    need med for purposes other than therapeutic one
  5. difference between PENS and TENS
    • TENS = electrodes applied to skin
    • PENS = electrical impulses sent through needle
  6. acupuncture is used for
    • musculoskeletal condts
    • chronic strains
    • myofascial pain syndrome
    • post-op pain
    • neuralgia
    • neuropathic pain
    • headaches
  7. PENS/TENS stands for
    pecutaneous/transcutaneous electrical nerve stimulation
  8. most serious side effect of opioids and how to treat it
    • respiratory depression
    • treated with NARCAN
  9. 4 non-opioid pain meds
    • tylenol
    • salycilates (aspirin)
    • NSAIDs (ibuprofen)
    • COX-2 (celebrex)
  10. 2 good things about opioids, aside from their strength
    • no ceiling effect
    • can be given via many routes
  11. 2 good things about non-opioids
    • no ceiling effect
    • no risk for dependence or tolerance
  12. what two pain meds risk GI complications
    • salycilates (aspirin)
    • NSAIDs (ibuprofen)
  13. what pain med causes heart failure and stroke
    COX-2 (celebrex)
  14. neuroablations
    • destroy nerves in the area of pain to end pain response
    • last option
  15. cutaneous therapy
    • use of hot/cold interchangeably
    • research shows cold to be more effective
  16. 5 things relaxation does
    • decrease stress
    • decrease anxiety
    • decrease muscle tension
    • decrease fatigue
    • increase effect of other pain measures
  17. deep breathing does what 3 things
    • interrupts stress response
    • uses diaphragm
    • promotes O2 delivery
  18. guided imagery: remember to...
    use all the senses
  19. how many grams acetaminophen will give GI bleeding and irritation
    3 grams
  20. 5 things music does
    • diverts pain cycle
    • decrease anxiety
    • decrease pain
    • better mood
    • muscles relax
  21. 2 things meditation does
    increase state of awareness
  22. remember what re: distraction
    individualized, so work with patient to determine what distracts well
  23. adolescents and pain
    • less motor activity
    • more verbal expressions, muscle tension and body control
  24. RNs must know what re: cognitively impaired pts in order to assess their pain accurately
    know their normal behavior
  25. how to know if infant in pain
    • changes in position
    • crying
    • facial expression
  26. school aged kids and pain
    • intense response
    • clench fist, grit teeth
    • close eyes, muscles rigid
    • don't complain b/c afraid of shots, sprays, etc.
    • poorly ctrled pain results in exhaustion
  27. If pt doesn't want to bother RN, RN do what
    • ask pt periodically if want prn med
    • tell them the time you will return
  28. RN assesses what re: pain
    • wording used to desc pain
    • pattern -- when, duration, radiate, what relieves it
    • loc -- start, radiate to
    • quality -- ache, throb, stab
    • intensity per scale
  29. QUEST scale
    • for pediatrics - pain scale
    • s = secure the involvement of the parent
  30. how to measure chronic pain
    previous activities - can they do them? i.e. play golf
  31. examples of recurrent chronic acute pain
    • migraines
    • chronic abd pain d/t peptic ulcer
    • PID
    • IBS
    • hep.
    • chronic pancreatitis
    • sickle cell crisis
  32. recurrent chronic acute pain
    episodic acute pain w/ pain free periods in between
  33. characteristics of chronic pain
    • pain continues after injury heals
    • weeks to years
    • may originate with injury
    • serves no purpose
    • anxiety and depression accompany it
  34. chronic pain examples
    • cancer pain
    • low back pain
    • migraines
    • psychogenic pain
  35. acute pain examples
    • infection
    • angina
  36. characteristics of acute pain
    • begins suddenly
    • sharp, stabbing
    • warns body of sth.
    • mild to severe
    • lasts seconds to months
    • physiological s/s - BP up, RR up, etc.
  37. neuropathic pain
    nerve pain - hard to treat because it doesn't always respond to pain meds (i.e. DM, stroke, etc.)
  38. nociceptive pain
    • "normal pain"
    • i.e. burn d/t fire, pain d/t cut
    • responds well to opioids
  39. 2 cat.s of pain, and their subcat.s
    • NOCICEPTIVE PAIN
    • -somatic pain
    • -visceral pain
    • NEUROPATHIC PAIN
  40. 2 common side effects of opioids
    • constipation
    • pruritis
  41. exercise does what to decrease pain
    • increase circulation
    • decrease edema
    • increase strength
    • increase physical and psychosocial wellbeing
  42. laughter releases...
    endorphins - natural pain relievers
  43. common sites for massage
    • foot
    • hand
    • back
    • neck
  44. intrathecal vs. epidural - med goes where?
    • intrathecal - subarachnoid space
    • epidural - epidural space
  45. 5 physical non-drug pain interventions
    • massage
    • exercise
    • TENS/PENS
    • acupuncture
    • cutaneous therapy
  46. therapeutic nerve blocks - impt to remember re: time
    • blocks wear off quickly and pain can be intense
    • implement other pain routes
  47. total hip and total knee use therapeutic nerve blocks b/c...
    • mobilize faster
    • decrease risk nosocomial inf
    • decrease pneumonia incidence
    • decrease length of stay
  48. therapeutic nerve blocks do what and are intermittent or continuous
    • block all efferent/afferent transmission to the area
    • both intermittent and coninuous
  49. how often refill a surgically implanted pain med port
    every 30-90 days
  50. intrathecal/epidural pain med route - intermittent or continuous? and what is special about these?
    • intermittent OR continuous
    • highly potent
  51. side effects of intrathecal/epidural pain med route
    • dizziness
    • ataxia
    • nausea
    • confusion
    • headache
  52. 2 complications of intrathecal/epidural pain med routes
    • inf
    • catheter migration
  53. pain med route most often used for end of life pain mgmt
    SQ infusions
  54. parenteral pain med routes (4)
    • SQ
    • IM
    • IV
    • pt-ctrled analgesia pump
  55. transdermal pain meds - opioid or nonopioid? side effects?
    • both opioid and nonopioid
    • fewer side effects
  56. how often change transD pain med patch
    q72h (q3d)
  57. chronic pain mgmt - what type of med?
    transD pain meds commonly used
  58. SL/buccal route pain meds - name 2
    • fentanyl
    • morphine
  59. PR pain meds - name 3 and when you use them
    • dilaudid
    • morphine
    • tylenol
    • when pt can't take oral
  60. what 2 biological things play role in experience of pain
    • gender
    • genetics
  61. massage benefits (2)
    • increase blood flow
    • decrease tension
  62. oral route pain meds short or long duration
    • short and long acting
    • generally preferred
  63. 4 criteria in deciding route of pain med delivery
    • best targets src of pain
    • achieve good blood levels rapidly
    • avoid side effects
    • ability to swallow
  64. herbal suppl are used freq for what (2)
    • headaches
    • anxiety
  65. local anesthetics - for what kind of pain? name one.
    • surgery or trauma pain
    • lidoderm
  66. corticosteroids - for what kind of pain
    • cancer pain
    • spinal cord injury
    • inflammatory joints (prednisone)
  67. adrenergic agonists - name 1 drug and for what kind of pain?
    • catapres
    • chronic and neuropathic pain
  68. antiseizure drugs - name one and for what kind of pain?
    • neurontin
    • neuropathic pain
  69. adjuvants - name 5 cat.s of
    • antidepressants
    • antiseizure drugs
    • adrenergic agonists
    • corticosteroids
    • local anesthetics
    • **these are all used with pain meds to enhance treatment
  70. look at tables 10-7, 10-8, 10-9 (LEWIS)
  71. antidepressants are for what kind of pain and how does it work
    • neuropathic pain
    • prevents reuptake of serotonin an norepinephrin thereby decreasing transmission of nociceptive signals
  72. which nonopioids are greater than, less than, or equal to the strength of aspirin?
    • tylenol = aspirin
    • ibuprofen is greater than aspirin
    • celebrex = aspirin (or they're almost the same)
  73. what professionals do PENS vs. TENS
    • TENS = physical therapist
    • PENS = surgeon
  74. acute overdose tylenol does what to liver
    acute liver failure
  75. chronic tylenol overdose does what to liver
    liver toxicity

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