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pain assessment
test 2
Question | Answer |
---|---|
Pain | unpleasant and emotional experience associated with actual or potential tissue damage. |
Pain described by location | Radiating, referred and visceral |
Pain described by duration | Acute (short-term) and Chronic |
Pain described by Intensity | Mild (1-3 on pain scale), moderate (4-6), and severe (7-10) |
pain described by etiology | physiological(properly functioning nervous system sends signals of damage), somatic (originates in skin, muscle, bone or connective tissue), visceral (pain in organs), neoropathic(people with damaged nerves) |
nursing management of pain PQRST | Precipitation (what makes pain worse), Quality (description of pain), Region and radiation(where is the pain), Severity (scale), Timing(onset/duration) |
Nursing diagnosis of pain | Acute pain and Chronic pain |
Planning | must be based on individualized pain managment--goals must be based on pain scale or if they don't speak based on facial response by a certain time/date |
Interventions | interventions should reduce or eliminate factors causing pain |
agonist/antagonist opoiods | Stado, nubain, talwin--have ceiling effect, used to provide analgesic effect without abuse potential; may cause withdrawl when given to a previous agonist user. |
agonist opioids | morphine, dilaudid, oxycodone, codene, demerol, hydrocodone, duragesic patches--no ceiling effect; can continue to increase until pain is relieved |
opioid side effects | respiratory depression, sedation, constipation, nausea/vomiting, pruritis(itching), urinary retention and hypotension |
PCA Pump | Patient Controlled Anelgesia- most significant adverse effect is respiratory depression; patient administers self doses, but is programmed to not allow overdose |
nursing responsibility during patient opioid delivery | assess pain prior to and after, assess resp. rate and alertness before and after, assess bowel function reg., keep track of total amount of tylenol or aspirin recieving through combination drugs, avoid alcohol and other depressants, |
Duragesic patches note | remove old one before replacing and fold in half before disposing in the sharps container. |