pain management ATI

pain threshold
is the point at which a person feels pain
pain tolerance
is the amount of pain a person is willing to bear
increased pain (substances)
substance p, prostaglandins, bradykinin and histamine
decreased pain (substances)
serotonin and endorphins
4 types of pain categories
acute, chronic, nociceptive and neuropathic pain
acute pain
is one of the 4 pain categories and is a protective, temporary, self-limiting and resolves with tissue healing. physiological response includes the sympathetic nervous system such as fight or flight, tachycardia, hypertension, anxiety, diaphoresis, muscle tension. interventions include treatment of the underlaying problem.
acute pain (behavior)
grimacing, moaning, flinching and guarding.
chronic pain
is one of the 4 pain categories and is not a protective, it is ongoing or secures frequently, laying longer than 6 months and persisting beyond tissue healing. Clients may have depression, fatigue, and a decreased level of functioning. physiological response do not usually alter vital signs. this type of pain might not have a known cause, and it may not respond to interventions. Chronic pain can be malignant or nonmalignant.
nociceptive pain
is one of the four pain categories and arises from damage to or inflammation of tissue other than that of the peripheral and CNS. it is usually throbbing, aching, and localized. this pain typically responds to opioids and nonopiod medication.
nociceptive pain (3 types)
somatic, viceral and cutaneous
somatic pain
is one of the three nociceptive pain and is associated with bones, joints, muscles, skin or connective tissues.
visceral pain
is one of the three nociceptive pain and is associated with internal organs such as the stomach or intestines. It can referred pain in other body locations separate from the stimulus.
cutaneous
is one of the three nociceptive pain and is associated with in the skin or subcutaneous tissue.
neuropathic pain
is one of the four pain categories and is pain that arises from abnormal or damaged pain nerves. it includes phantom limb pain, pain below the level of a spinal cord injury, and diabetic neuropathy. neuropathic pain is usually intense, shooting burning or described as “pins and needles”. This pain typically responds to adjuvant medications (antidepressants, antispasmodic agents, skeletal muscle relaxants).
pain (risk factors)
cultural, societal attitudes, lack of knowledge, fear of addiction and exaggerated fear of respiratory depression.
pain (risk of under treatment)
infants, children, older adults and clients who have substance use disorder.
pain (acute/chronic)
trauma, surgery, cancer, arthritis, fibromyalgia, neuropathy, diagnostic treatment procedures (injection, intubation, radiation)
heat (pain)
is used to increase blood flow and to reduce stiffness. non pharmacological pain management.
cold (pain)
is used inflammation. non pharmacological pain management.
distraction (pain)
ambulation, deep breathing, visitors, television and music. non pharmacological pain management.
relaxation (pain)
meditation, yoga and progressive muscle relaxation. non pharmacological pain management.
imagery (pain)
focusing on a pleasant though to divert focus. requires an ability to concentrate. non pharmacological pain management.
acupuncture (pain)
vibration or electrical stimulation via tiny needles inserted into the skin and subcutaneous tissue at specific points. non pharmacological pain management.
elevation (pain)
is used for edematous extremities to promote venous return and decrease swelling. non pharmacological pain management.
non pharmacological pain (types)
cutaneous stimulation (skin), distractions, relaxation, imagery, acupuncture, elevation and environmental stimuli.
pharmacological interventions
analgesics are the mainstay for relieving pain. There are three types of analgesics. opioids, nonopioids and adjuvants.
nonopioid analgesics
acetominophen, NSAID’s and salicylates. These are appropriate for treating mild to moderate pain.
acetaminophen
is a nonopiod analgesics and is used for treating mild to moderate pain. be aware of hepatotoxic effects. clients with a healthy liver should only take 4g/day. Some opioid medication have acetaminophen such as vicodin which has 5 mg of hydrocodone bitartrate and 500 mg of acetaminophen.
salicylism
consist of tinnitus, vertigo, decreased hearing acuity. occurs with an increase use of salicylate acids. acute or chronic aspirin poisoning. A nonopiod analgesics.
NSAID’S
is a nonopiod that can lead to bleeding
opioid analgesics
morphine, sulfate, fentanyl (sublimaze), and codeine, are appropriate for treating moderate to severe pain (postoperative pain, myocardial infarction pain, cancer pain)
opioid analgesics (use)
is used for managing acute severe pain with short-term relief of acute pain. the oral route is better for chronic, nonfluctuating pain. consistent timing and dosing of opioid administration provide consistent pain control.
opioid analgesics (adverse effects)
constipation, orthostatic hypotension, urinary retention, nausea/vomiting, sedation and respiratory depression.
constipation (opioid adverse effects)
use a preventative approach (monitoring of bowel movements, fluids, fiber intake, exercise, stool softeners, stimulants laxatives, enemas.
orthostatic hypotension (opioid adverse effects)
advise clients to sit or lie down if symptoms of light-headedness or dizziness occur. instruct client to avoid sudden changes in position by slowly moving from a laying to a sitting or standing position. provide assistance with ambulation.
urinary retention (opioid adverse effects)
monitor I&O, assess for distention, administer bethanechol (urecholine), and catheterize.
nausea/vomiting (opioid adverse effects)
administer antiemetics, advise clients to lie still and move slowly and eliminate odors.
sedations (opioid adverse effects)
monitor levels of consciousness and take safety precautions. sedation usually precedes respiratory depression.
respiratory depression (opioid adverse effects)
monitor respiratory rate prior to and following administration of opioids especially for client who are opioid naive. Initial treatment of respiratory depression and sedation is generally a reduction in opioid dose. if necessary, slowly administer diluted narcan to revers opioid effects.
adjuvant analgesics
enhance the effects of nonopioids, help alleviate other symptoms that aggravate pain (depression, seizures, inflammation) and are useful for treating neuropathic pain.
adjuvant analgesics (drugs)
anticonvulsants (tegretol), antianxiety agents (valium), tricyclic antidepression (elavil), antihistamine (vistaril), glucocorticoids (decadron) and antiemetics (zofran).
patient controlled analgesia (PCA)
is a medication delivery system that allows clients to self-administer safe doses of opioids. frequent dosing ensures consistent plasma levels. there is less lag time between identification need and delivery of medication which increases a sense of control and may decrease the amount of mediation needed. morphine and hydromorphone (deluded) are a type of opioid used for PCA. should let the nurse know if using the pump does not control pain. the client is the only person who should push the PCA button.
below 8/min
stop opioids and give the antagonist naloxone (narcan) if the respiratory rate decrease to this rate. clients who are difficult to arouse and have a shallow breathing.
acute pain (definition)
protective, temporary, usually self-limiting, resolve with tissue healing.
acute pain (physiological response)
tachycardia, hypertension, anxiety, diaphoresis, muscle tension.
acute pain (behavioral response)
grimacing, moaning, flinching and guarding.
chronic pain (definition)
not protective, ongoing, or recurs frequently, last longer than 6 months, persists beyond tissue healing can be malignant or nonmalignant.
chronic pain (physiological response)
no change in vital signs, depression, fatigue, decreased level of functioning, disability.
nociceptive pain (definition)
arises drom damage to or inflammation of tissue other than that of the peripheral and CNS, is usually throbbing; pain typically responds to opioids and nonopioid medications
adjuvant medications (response)
antidepressants, antispamoid agents, skeletal relaxants.