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?