Lewis Chapter 10 Pain
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| show | PAIN
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| What are the components of the nursing role in regards to pain (4)? | show 🗑
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| show | unnecessary suffering, physical and psychosocial dysfunction, impaired recovery from acute illness and surgery, immunosuppression , and sleep disturbances
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| show | “Whatever the person experiencing the pain says it is, existing whenever the person says it does.”
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| What is the definition of pain according to the International Association for the Study of Pain? | show 🗑
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| Who is the expert, most valid means of pain assessment? | show 🗑
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| show | incorporate nonverbal information such as behaviors into their pain assessment
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| What are affective responses to pain? | show 🗑
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| Studies have consistently demonstrated a link between __________ and __________. | show 🗑
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| show | the state of severe distress associated with events that threaten the intactness of the person
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| show | grimacing, social withdrawal, less physical activity
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| show | Nociception
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| What the four processes of nociception? | show 🗑
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| show | Transduction
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| Where does transduction take place? | show 🗑
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| Give some examples of the chemicals that excite nociceptors to excitation? | show 🗑
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| show | Via small, rapidly conducting, myelinated A-delta fibers and unmyelinated, slowly conducting C fibers
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| show | Pain caused by the activation of peripheral nociceptors
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| What would a pain therapy need to do in order to prevent transduction and initiation of an action potential? | show 🗑
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| show | NSAIDS
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| show | Advil, Motrin, Naprosyn, Aleve
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| What drugs block the action of phospholipase thereby blocking the production of prostaglandins and leukotrienes? | show 🗑
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| show | Local anesthetics like Lidocaine, bupivacaine (Sensorcaine) and antiseizure drugs like carbamazepine (Tegretol), oxcarbazepine (Trileptol), and lamotrigine (Lamictal)
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| show | the movement of pain impulses from the site of transduction to the brain
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| show | 1. Peripheral nerves to spinal cord 2. Dorsal horn processing 3. Transmission to the thalamus and cortex
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| show | Areas on the skin that are innervated primarily by a single spinal cord segment
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| show | the dorsal horn of the spinal cord
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| show | Activation
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| What kind of signal do these neurotransmitters produce? Y-aminobutyric acid (GABA), serotonin, norepinephrine | show 🗑
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| show | They block the release of neurotransmitters, particularly substance P.
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| What are two kinds of opioids? | show 🗑
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| Morphine is an example of what kind of opioid? | show 🗑
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| Enkephalin and Beta Endorphin are examples of what kind of opioid? | show 🗑
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| show | a state in which neurons activated by noxious mechanical and chemical stimuli are sensitized by such stimuli and become hyper-responsive to all subsequent stimuli delivered to the neurons' receptive fields (thefreedictionary.com).
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| show | Central Sensitization
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| show | continued nociceptive input from the periphery
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| show | ongoing stimulation of c-fiber (slow) nociceptors
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| show | gradually increased firing of specialized dorsal horn neurons in response to ongoing stimulation of c-fiber nociceptors
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| show | because windup is dependent on the activation of NMDA
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| show | glial cells
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| What are 4 clinical results of central sensitization? | show 🗑
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| show | Increased response to noxious stimuli- what used to hurt, now really hurts.
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| show | painful response to normally innocuous stimuli – what used not hurt, now hurts!
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| show | prolonged pain after the original noxious stimulus is gone – It shouldn’t hurt, but it does.
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| What is referred pain? | show 🗑
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| What is a first order neuron? | show 🗑
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| What is a second order neuron? | show 🗑
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| show | conduct impulses from the thalamus to the cortex
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| show | to third order neurons primarily in the thalamus and to several other areas of the brain
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| What is it called when pain is recognized, defined and responded to by the individual experiencing the pain? | show 🗑
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| show | There is no single area in the brain for pain perception
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| show | the reticular activating system (RAS)
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| What area of the brain is believed to be responsible for localization and characterization of pain? | show 🗑
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| What area of the brain is believed to be responsible for the emotional and behavioral responses to pain? | show 🗑
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| show | cortical structures
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| show | Modulation involves the activation of descending pathways that exert inhibitory or facilitatory effects on the transmission of pain.
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| The degree of __________ determines the amount of nociceptive stimulation that may or may not be perceived as pain. | show 🗑
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| show | Cymbalta, Elavil, Effexor (used for cancer pain)
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| What are the two categories of pain based on the underlying pathology? | show 🗑
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| show | Nociceptive Pain
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| show | Nociceptive pain
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| show | Bone, Muscle, Joint, Skin, Connective tissue
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| What is the usually quality of somatic pain? | show 🗑
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| Where does visceral pain come from? | show 🗑
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| show | Neuropathic pain
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| The fifth vital sign | show 🗑
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| Name 7 pain characteristics that should be assessed. | show 🗑
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| show | neuropathic
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| Patients typically describe _________ pain as sharp, aching, throbbing, and cramping. | show 🗑
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| show | acetaminophen, aspirin and other salicylates, and NSAIDS
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| show | 1) analgesic ceiling 2) No tolerance or dependence 3) usually OTC
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| What kind of pain is caused by damage to peripheral nerves or the CNS? | show 🗑
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| show | gastric upset, platelet dysfunction, and bleeding
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| show | Like: analgesia and antipyretic effects Different: no anti-platelet or anti-inflammatory effects
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| Where is acetaminophen metabolized? | show 🗑
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| show | Patients with liver disease or alcoholism
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| What is the daily maximum dose for acetaminophen especially for older adults? | show 🗑
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| Cox inhibitors | show 🗑
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| show | increased cardiovascular events such as stroke and myocardial infarction
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| show | NSAIDs
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| What does COX 1 do? | show 🗑
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| What does COX 2 do? | show 🗑
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| show | selective cox 2 inhibitor, Vioxx was pulled from the market along with Bextra due to concerns about adverse cardiovascular events (MI).
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| Use of what non opioid should be limited with elderly patients and patients with a history of PUD? | show 🗑
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| What is the same about Morphine, Oxycontin, hydrocodone, codeine, methadone, Dilaudid and Levo-Dromoran? | show 🗑
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| show | moderate to severe because they are potent and have no analgesic ceiling
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| show | Respirations because morphine can cause respiratory depression
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| show | We withhold the medication and alert the physician.
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| show | Acetaminophen or NSAIDs
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| show | Tylenol 3= codeine plus acetaminophen, Vicodin = hydrocodone plus acetaminophen, Vicoprofen = hydrocodone plus acetaminophen
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| show | physiologic, affective, behavioral, cognitive, sociocultural
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| show | the genetic, anatomic, and physical determinants of pain
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| What is the affective dimension of pain? | show 🗑
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| What is the behavioral component of pain? | show 🗑
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| What does the cognitive component of pain refer to? | show 🗑
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| What does the sociocultural dimension of pain encompass? | show 🗑
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| Name some modulating chemicals sent down by the brain to tone down pain signals. (SON GABA) | show 🗑
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| show | Elavil, Effexor, and Cymbalta
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| show | Nocioceptive pain
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| show | Neuropathic pain
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| show | lasting 3 months or past the time when acute pain is expected to should subside
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| show | onset, duration, pattern, location, intensity, quality, associated symptoms, what makes it better or worsens it
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| What are the three categories of pain drug therapy? | show 🗑
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| show | acetaminophen, aspirin, salicylates, and NSAIDs
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| What characteristics are shared by nonopioid analgesics? | show 🗑
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| What level of pain is aspirin for and what are its drawbacks? | show 🗑
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| show | Has analgesic and antipyretic like asa. Does not have anti-inflammatory or anti-platelet
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| show | acetaminophen is metabolized in the liver/hepatotoxicity
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| What kind of analgesic works by inhibiting the enzyme that converts arachidonic acid into prostaglandins? | show 🗑
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| ¬¬¬Inhibition of _________ causes renal function impairment, bleeding tendencies, GI upset and ulceration, the bad side effects of NSAIDs. Inhibition of__________ reduces inflammation in injured tissues. | show 🗑
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| Why were Vioxx and Bextra pulled from the market? | show 🗑
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| What intensity of pain are opioids for? | show 🗑
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| Why is it that opioids can treat moderate to severe pain when nonopioids can not? | show 🗑
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| Name 6 common opiods. | show 🗑
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| show | Morphine
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| show | meperidine (Demoral, Pethidine)
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| What are the common side effects of opioids (5 )? | show 🗑
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| Which opioid side effect is not likely to improve with time? | show 🗑
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| Why are patients who are on an opioid often also taking Reglan-metocloparmide? | show 🗑
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| show | opioid naive, elderly, underlying lung disease, receiving other CNS depressants (sedatives, benzodiazepines, antihistamines)
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| What drug will be carefully employed if you cannot rouse your patient from a opioid induced somnolence? | show 🗑
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| show | Tricyclic antidepressants
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| What side effects should we monitor for if our patient is taking an antidepressant for pain relief? | show 🗑
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| Amitriptyline, doxepin, imipramine, and nortriptyline are all what type of drugs? | show 🗑
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| show | antiseizure
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| What kind of drug is baclofen (Lioresal)? | show 🗑
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| What kind of drugs are clonidine (Duraclon, Catapres) and tizanidine (Zanaflex)? | show 🗑
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| Which group of adjuvant drugs is good for neuropathic pain as well as prophylaxis of migraine headaches? | show 🗑
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| What kind of drugs are dexamethasone (Decadron), prednisone, and methylprednisone (medrol)? | show 🗑
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| Which group of adjuvant drugs is good for neuropathic pain as well as chronic headache? | show 🗑
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| show | sedation, dry mouth, othostatic hypotension
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| Which kind of adjuvant drugs are especially useful when injected epidurally for acute and subacute disk herniation because they can decrease activation of an inflamed neuron? | show 🗑
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| show | corticosteroids
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| show | hyperglycemia, fluid retention, dyspepsia, GI bleeding, impaired healing, muscle wasting, osteoporosis, adrenal suppression, and immunosupression – eeesh!
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| show | NSAIDS
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| Which type of adjuvant drug works by interfering with nociceptive impulses, and is mainly used for muscle spasms? | show 🗑
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| show | dose adjustment based on assessment of pain relief vs. side effects
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| show | to use the smallest dose of analgesic that provides effective pain relief and with the fewest side effects
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| show | everybody deserves pain relief, treatment based on patient goals, combine drug and nondrug therapy, manage side effects, collaborate, Evaluate, educate
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| Name two opioids that we don’t use often because of limited efficacy or toxicities. When we do use them, it is definitely not for long term. | show 🗑
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| show | transduction
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| Give some examples of drugs that prevent transduction. | show 🗑
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| What kind of opioid is administered transmucosally and approved for before surgery and procedures and cancer break through pain? | show 🗑
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| show | Kadian, Avinza, MSContin
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| Name some sustained release formulations of oxycodone. | show 🗑
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| show | Butorphanol (Stadol)
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| show | rectal
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| Name the analgesics that are available in rectal formulations (4 PHs). | show 🗑
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| show | prepare the skin one hour before placement with a corticosteroid cream.
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| What kind of patch can be used to help with postherpatic pain (if the skin is unbroken)? | show 🗑
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| show | joint and muscle pain
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| show | GI upset
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| Name a topical pain relief drug derived from red chilli peppers. | show 🗑
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| What kind of topical pain relief is covered with plastic for 30 to 60 minutes before a painful procedure? | show 🗑
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| show | IV
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| show | IM
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| Why does it only take a little bit of drug if it delivered intraspinally? | show 🗑
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| 1mg of intrathecal morphine is equal to ____mg of epidural morphine is equal to _____mg of IV morphine is equal to _____mg of oral morphine. | show 🗑
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| Name 6 drugs that are administered intraspinally. | show 🗑
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| What are the common side effects with intraspinal anesthesia? | show 🗑
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| show | Oops, we missed and a little CSF leaked out. Results in severe headache that only hurts when the patient is sitting or standing
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| How do we check if a intrathecal catheter is correctly placed (hasn’t migrated)? | show 🗑
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| Give three types of areas that should not be treated with cold therapy. | show 🗑
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| show | areas being treated with radiation therapy, bleeding areas, recently injured (within the past 24 hours), or areas with decreased sensation
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| show | Negative consequences if unrelieved, maintain a record of level and relief, don’t wait till pain gets bad to ask for pain relief, dosage can be adjusted if loses effectiveness, side effects, report when not relieved
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| What is the formula for tapering a patient off an opioid to which they have developed dependence. | show 🗑
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| show | Anxiety, tears, runny nose, sweating, yawning, piloerection, shaking chills, dilated pupils, anorexia, tremor
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| Give 9 late (48-72 hrs) manifestations of opioid withdrawal. | show 🗑
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| What is the rule of double effect teach us? | show 🗑
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| show | for older patients because they metabolize drugs more slowly so are at greater risk for high blood levels and side effects
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| show | because NSAIDs are associated with a high frequency of serious GI bleeding
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| show | assess and comminicate, ameliorate, evaluate, advocate
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