Prof: Exam 3

modulation

- inhibition or modification of pain - regulated by neuromodulators (neurotransmitters)

Aspirin

- inhibits prostaglandin release - salicylate family - avoid in pts with bleeding disorders or on blood thinners

Assessing Pain

- location - duration - quality/intensity - quality - aggravating and alleviating factors

parasympathetic responses to pain

- nausea and vomiting - fainting - decreased heart rate - decreased BP - irregular breathing

Pharmacologic Relief Measures

- non-opioids - opioids - adjuvant

mu receptors

- opioid receptors - respond to enkephalins and beta-endorphins - morphine and methadone are agonist

phantom limb pain

- pain in a limb that has been amputated - varies and may be severe, burning, fiery sensation, crushing, cramping - triggered by touching stump or occurrence of another illness, fatigue, atmospheric changes, and emotional stress

postherpetic neuralgia

- pain that lasts longer than a month after a shingles infection and is caused by damage to the nerve - the pain may last for months or years.

gate theory of pain

- proposes that there is a special "gating" mechanism that can turn pain signals on or off, affecting whether or not we perceive pain - spinal cord can preferentially forward signals from other modalities (pressure, temp) - stimulation of small nerve fibers ➝ large nerve fibers ➝ signals sent to the brain (open gate) - or- signals blocked (closed gate)

most common side effects of opioids?

- pruritus (itching) - sedation - constipation - nausea and vomiting - urinary retention

behavioral responses to pain

- restlessness - grimacing - crying - guarding

physiologic effects of post-operative pain

- tachycardia - hypertension - hypercoagulation - urinary retention - ileus - part of bowel not working - delayed recovery - delayed rehabilitation - poor sleep

pain process

- transduction - transmission * thalamus (message center) - perception - modulation

what organs does acute post-operative pain affect?

- tissue injury - release of inflammatory markers - release of histamine - activation of the nociceptive signals

Ibuprofen

Advil

trimethoprim/sulfamethoxazole

Bactrim

psychological responses to pain

- exaggeration of behavioral responses - DEPRESSION - withdrawal - anger

levothyroxine

Synthroid

sympathetic responses to pain

- increased heart rate - increased resp rate - increased BP - paleness (palor) - increased blood glucose

warfarin

Coumadin

heparin

Heparin Sodium Injection

When is Oxycodone given with Tylenol?

sometimes

A new mother asks the nurse in a pediatric office for information about safety, diet, and immunizations for the baby. What is the best response by the nurse to address the mother's readiness for enhanced coping?

"I have several pamphlets and online parenting videos that are helpful."

examples of opioids

- Codeine - Tramadol - Hydrocodone (always w/Tylenol) - Oxycodone (IR) (only given w/ Tylenol sometimes) - Oxycontin (ER) - Methadone - Morphine - Fentanyl - Dilaudid

diabetic neuropathy

- Complication of diabetes - damage to peripheral and autonomic nerves - sensory loss can lead to injury progressing to infection and gangrene - symptoms include sensations of numbness, prickling, or tingling

factors that affect pain

- PREVIOUS EXPERIENCES - cultural background - age - sex - religion - environment - fatigue - anxiety

WHO 3 step analgesic ladder

- Step 1: nonopioids (with or without adjuvant medications) after the pain has been identified and assessed. If pain persists or increases, treatment moves to: - Step 2: opioids with or without nonopioids and with or without adjuvants. If pain persists or increases, management then rises to: - Step 3: opioids indicated for moderate to severe pain, administered with or without nonopioids or adjuvant medications. Free from cancer pain

CRIES pain scale

- an acronym of 5 physiological and behavioral variables previously shown to be associated with neonatal pain - neonatal postoperative pain measurement C = Crying R = Requires O2 for Sat >95 I = Increased Vital Signs E = Expression S = Sleepless

Wong-Baker FACES pain scale

- asks children to compare their pain to a series of faces ranging from a broad smile to a tearful grimace (0 - 10)

non-opioid relief measures

- aspirin - Tylenol - NSAIDs

pharmacology of opioids

- attach to opioid receptors on sensory nerves to produce analgesia - 3 opioid receptors: delta, kappa, mu

NSAIDs

- avoid in pt w/ kidney disease, bleeding disorders, or pt on blood thinners - Ibuprofen - Aleve (Naproxen)

Tylenol

- avoid/limit in patients with liver disease - max dose of 4 grams a day

efferent pain transmission

- back to the site of the painful stimulus in a reflex arc. - results in an immediate muscle contraction intended to withdraw/remove the injured body part from the source of the pain

neuropathic pain

- caused by a lesion or disease of the peripheral or central nerves - typically chronic - ex: phantom limb pain, postherpetic neuralgia, diabetic neuropathy

chronic pain

- chronic conditions such as osteoarthritis, degenerative disc disease - exacerbations and remission are possible - fibromyalgia - neuropathies and neuralgias - previous injury

pain inhibiting neuromodulators

- endorphins! - enkephalins! - serotonin - acetylcholine

nursing interventions for pain

- establishing a trusting nurse-pt relationship - initiating non-pharmacologic pain relief measures - delivering pharmacologic pain interventions - teaching the pt about pain and communication

0-10 pain scale

0 = no pain 10 = worst pain imaginable pt verbally selects a value that matches the pain they are feeling

what is the max dose of Tylenol?

4 grams per day

bisacodyl

Alophen

aspirin

Asaphen; Bayer Aspirin

diphenhydramine

Benadryl

diltiazem

Cardizem

citalopram

Celexa

docusate sodium

Colace

diazepam

Valium

A nurse manager has directed a registered nurse who is out of school for one year to become a member of the institution's policy and procedure committee. A goal in the nurse manager's delegation is to assist the nurse to what?

grow in her profession

Which strategy might a nurse use to increase compliance with education?

include the client and family as partners

nociceptive pain

initiated by nociceptors, or free nerve endings, that are activated by actual or threatened damage to the peripheral tissue

pain threshold

minimum intensity of a stimulus that is perceived as painful

what are opioids used for?

moderate to severe pain

Glutamate

most common/numerous excitatory neurotransmitter

Substance P

neurotransmitter that increases the rate of firing to feel pain

referred pain

perceived at site different from the source

what do opioids derive from?

poppy plant

meperidine

Demerol

Hydromorphone

Dilaudid

morphine

Doloral ??

potassium bicarbonate/potassium citrate

Effer-K ???

insulin regular

Humulin R

digoxin

Lanoxin

insulin glargine

Lantus

furosemide

Lasix

metoprolol

Lopressor

enoxaparin

Lovenox

amoxicillin

Moxatag

guaifenesin

Mucinex

gabapentin

Neurontin

nitroglycerin

Nitrostat

insulin NPH

Novolin

insulin aspart

Novolog

A client 36 years of age is able to understand the health education when she is given the opportunity to put the education into practice. The nurse helps the client to self-administer the medication dosage before the client is discharged from the health care facility. Which domain correctly identifies the client's learning style?

psychomotor domain

acute pain

recent injury such as a burn, fracture, or sprain

lisinopril

Prinivil

albuterol

ProAir HFA

prednisone

Rayos

fentanyl

Sublimaze

acetaminophen

Tylenol

simvastatin

Zocor

hydrocodone

Zohydro ER/ Vicodin??

transduction

activation of pain receptors

categories of pain

acute and chronic

When is Hydrocodone given with Tylenol?

always

define pain

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Which of the following nursing care tasks is acceptable for a graduate nurse to delegate to unlicensed assistive personnel (UAP)?

assisting a client with ambulation

perception of pain

awareness of the characteristics of pain at cortex - pain threshold

transmission

conduction along pathways - afferent & efferent

pain initiating neuroodulators

considered endogenous - glutamate (NMDA) - Substance P - Bradykinin - Prostaglandins

somatic pain

deep, diffuse and originates in tendons, ligaments, bone, and blood vessels

visceral pain

deep, poorly localized from organs

Adjuvant Relief Measures

examples include anti-depressents, meds for neuropathy (Lyrica), muscle relaxers

A senior student nurse has been elected class president. What type of power will the student have in this position?

explicit power

A nurse refers a client with a new colostomy to a support group. This nurse is practicing which aim of nursing?

facilitating coping

Developing an education plan is comparable to what other nursing activity?

formulating a nursing care plan

afferent pain transmission

from the pain source to the brain via A-delta (fast) and C-fibers (slow)

Nurses with varying levels of experience possess leadership skills. A graduate nurse walks out of the nurse manager's office after a meeting. The graduate nurse reflects on the positive and negative feedback that she received from the manager regarding her three months working on the unit. What nursing leadership skill is best illustrated by the graduate nurse in this scenario?

self-evaluation skills

The nurse has been hired to manage a nursing unit that has had a variety of problems. The nurse manager has assessed possible reasons for the problems and has set a vision for the unit. The nurse manager has engaged the staff individually and in group settings to accept this vision. The nurse manager has established committees to set a practice of staff members leading themselves. What type of leadership style has the nurse manager demonstrated?

servant

a patient who has bone cancer is most likely experiencing which type of pain?

somatic

cutaneous pain

superficial pain usually involving the skin or subcutaneous tissue