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
