Chapter 23 and Chapter 2 adult health nursing

Epidural analgesia

Analgesia delivered via insertion of epidural catheter and infusion of opiates into epidural space

Invasive

Anything that enters the body

4000 mg

Maximum recommended 24-hour dosage of acetaminophen

Intravenous

Most effective route of opioid analgesic administration after major surgery

Respiratory depression

Most negative effect of opiates

Acetaminophen and nonsteroidal antiinflammatory drugs

Most widely available and frequently used drugs of the analgesic group

Click to play this sound Patient-controlled analgesia (PCA) by proxy

When someone other than the patient pushes the button on a PCA pump

pain is what you say it is: i will assist you in whatever way i can

a 52 year old patient admitted for deep vein thrombosis of the left internal iliac vein complains of excruciating pain in his left leg. what is the most appropriate response by the nurse?

morphine

a 63 year old patient underwent a lower anterior bowel resection yesterday. what common central nervous system analgesic is often prescribed for control pain?

Patient-controlled analgesia (PCA)

Drug delivery system that allows patients to self-administer analgesics whenever needed

Opioid analgesics

Drugs used for moderate-to-severe pain

Nonopioid analgesics

Drugs used primarily for mild-to-moderate pain

Education

Effective for reduction of all types of pain

Heat or cold application

Heat relieves stiffness and relaxes muscles; cold application reduces acute pain from inflammation

Report pain as soon as it occurs

Important concept to teach patients regarding pain

Unrelieved pain

Increased oxygen demand, respiratory dysfunction, decreased gastrointestinal motility, confusion, and depressed immune system

Anesthesiologist or nurse anesthetist

Insertion and maintenance of epidural catheter

Oral

Optimal route for chronic pain treatment

Visual analogue scale

Patient marks a spot on a horizontal line to indicate pain intensity

Transcutaneous electric nerve stimulation

Pocket-sized, battery-operated electrode device provides continuous, mild electric current to skin

Endorphins

Potent polypeptides composed of many amino acids, found in the pituitary gland and other areas of the central nervous system

Massage

Reduces mild-to-moderate discomfort; involves firm, gentle, or light stroking of body part involved

Biofeedback

Reduces mild-to-moderate pain and operative-site muscle tension

Progressive muscle relaxation

Reduces mild-to-moderate pain and requires 3 to 5 minutes of staff time for instruction

Intramuscular

Route of administration that has wide fluctuations in absorption

Music

Simple relaxation; patient preferred and easy listening are effective for mild-to-moderate pain

Morphine

Standard agent in opioid therapy

Gate control theory

Theory that pain impulses are regulated/blocked by gating mechanisms along central nervous system

Synergistic

Two or more substances or organs achieving an effect impossible for an individual substance or organ

Imagery

Visualization technique that reduces mild-to-moderate pain; requires skilled personnel

subjective

a patient admitted with severe cellulitis of the left breast states, i have a severe burning pain and it feels like my breast is on fire. she rates the pain as 7 on a scale of 0-10 pain assessment scale. how would this collection of data by the nurse in assessing the patients pain be classified?

transcutaneous electric nerve stimulation (TENS)

a patient was admitted tot he orthopedic section for acute back pain. the HCP is planning to use cutaneous stimulation management. which is an example of this pain control method?

NSAIDS

acetaminophen and non-steroidal antiflammatory drugs, aspririn, ibuprofen, advil, nuprin, motrin, naproxen, aleve

patient controlled analgesia (PCA)

allows patients to self administer analgesics whenever needed. is portable, computerized pump with a chamber for a syringe

emotional consequences of unrelieved pain

anxiety, depression, irritability, and inability to enjoy life

essential message about pain assessment

ask patients about their pain, accept and respect what they say, intervene to relieve their pain, and ask again about their pain

three methods of administering epidural analgesia

bolus, continuous infusion, patient controlled

transcutaneous electric nerve stimulation (TENS)

entails the use of a pocket-sized, battery operated device that provides a continuous, mild electric current to the skin via electrodes that are attached to a simulator by flexible wires

professional negligence

failure to treat pain is inhumane and constitutes what

assess respiratory rate

following surgery for a total knee replacement, a patient was given an epidural catheter for fentanyl epidural analgesia. what is the most important nursing intervention?

signs and symptoms of sleep deprivation

hand tremors, decreased reflexes, slowed response time, reduction in word memory, decreased reasoning and judgement, cardiac dysrhythmias. mood swings, disorientation, irritability, decreased motivation, fatigue, sleepiness, and hyperexcitability

physical effects from unrelieved pain

increased oxygen demand, respiratory dysfunction, decreased gastrointestinal motility, confusion, and depressed immune response

sleep deprivation

is a problem many patients experience as a result of hospitilization. involves decreases in the amount, quality and consistency of sleep.

IV Route

is best for administration of opioid analgesics after major surgery. the most appropriate opioids for pain relief for rapidly escalating, severe pain include morphone, hydromorphone and fentanyl

referred pain

is felt at a site other than the injured or diseased organ or part of the body

chronic pain

is generally characterized as pain lasting longer than 6 months. sometimes the pain is continuous and sometimes it is intermittent; at times it may be an intense as acute pain

acute pain

is intense and of short duration, usually lasting less than 6 months

constipation

is the most common side effect of opioids

duration

is the pain always there? does the pain come and go? do you have both types of pain?

opioids

morphine, meperidine (demerol), hydromorphone (DIlaudid), and fentanyl (Actiq, duragesic)

endorphines

potent polypeptides composed of many amino acids, found in the pituitary gland and other areas of the CNS; stress and pain activate these

less than 1%

research indicates that the risk of clinically significant opioid-induced respiratory depression is

gate control theory

suggests that pain impulses are regulated and even blocked by gating mechanisms located along the CNS. positions of the gates is in the dorsal horn of the spinal cord

numerical

the nurse is assessing the patients description of his back pain. he states that it is immobilizing, intense, and on a scale of 0-10 it is an 8. what type of pain assessment scale is the patient using?

the patient experiencing intense pain has lower levels of endorphines

the nurse is caring for two patients with similar injuries. one patient expresses severe pain and the other reports feeling fine with low levels of pain. which statement is most correct

intermittent

the nurse listens attentively while the patient describes her angina pectoris pain as radiating down her left inner arm to the little finger and upward to the jaw and the shoulder. what term is used to classify this type of pain

the gates of the pain pathways ca be opened with therapeutic message and heat treatments, pain has exclusive use of the pathways ahead of other stimuli, according to the theory, pain is a manifestation of an intricate chain of electrochemical events

the nursing student is discussing the gate control theory of pain. which statement by the student indicates the need for further instruction?

guide lines for individualizing pain therapy

use different types of pain relief measures, provide pain relief measures before pain becomes severe, use measures the patient believes are effective, consider patients ability and willingness to participate in pain relief measures, choose pain relief measures appropriate to the severity of the pain as reflected by the patients behavior, if therapy is ineffective at first, encourage the patient to try again before abandoning it, keep an open mind about what has potential relieve pain, keep trying and protect the patient

patient controlled analgesia

what drug delivery system is used to control pain via a portable computerized pump with a chamber for a syringe?

believe what the patient says about pain

what is the priority responsibility of the nurse related to pain?

aggravating and alleviating factors

what makes pain bettwe and worse?

physiologic and psychological complications can result from unrelieved pain

what statement concerning unrelieved pain is most correct?

cardiac pacemaker

when should a patient not use a TENS unit

meperidine

which opioid is no longer a drug of choice for managing pain because of its toxic complications, such as causing seizures

intravenous (IV)

which route is most appropriate for treating rapidly escalating severe pain?