kozier chap 46 Pain Managment Flashcards

acute pain
Terms Definitions
Equianalgesic dosing
the relative potency of various opioid analgesics compared to a standard dose of parental morphine. A chart provides doses of approx. equal ablity to releave pain
Physical Dependance
a state if adaptation and it includes withdraw if abrupt cessation or rapid dose reduction
a state if adaptation in which exposure to a drug includes changes that result in a diminution of one or more of the drugs effects over time
Narrow theraputic index
There is not much of a margin for safety between the dose that may produce a toxic or lethal effect and the dose that produces the desired effect
Ceiling effect
once the maximun analgestic benifit is achieved, more drug will not produce more analgesic, however toxicity may occure
Preemptive analgesia
the administration of analgesics prior to an invasive or operative procedure. Nurses can also use the approach by providing ATC & supplimenting with PRN doses
3 types of opioid
Agonist analgesic (pure)
agonist-antagonist analgesic
partial agonist
Angonist analgesic
Pure opioid, have no ceiling level; EX: morphine
Agonist-antagonist analgesic
acts like an opioid but can block opioid effects. these have ceiling effect levels that limit doses. Not recommended for use with termally ill clients
Partical Agonist
have ceiling effect but act like agonist EX: buprenex used in methodone therapies
Theraputic serum level
a high enough level of a drug in the serum blood to be effective
Drugs that were put on the market for other reasons than pain. Given at lower doses that the usual dose; given in conjuction with an opioid
A chronic disease that develps
Key strategies to reduce pain
Acknowlege and accept the clients pain; Assist support people; reduce misconceptions; reduce fear and anxiety; prevent pain
Pain managment
alleviating pain or reducing pain to a level of comfort that is acceptable to the client
Character; Onset; Location; Duration; Exacerbation; Relief; Radiation
S 1-2-3-4
S=Sleep 1=awake and alert; 2=Drowsy but easliy aroused; 3= freq. Drowsy 4 = somnolent
subjective data
data that is apparent only to the person affected; can be described or verified by that person
Pain Scales
Objective data for a subjective experience
At what phase of nociceptive pain will a local anesthetic work and why
in the transdcution phase of pain by decreasing ion movement
at what phase of nociception will asprin or NSAID's work and why?
transduction phase by blocking the production of prostaglandin
Threhold of pain
the amount of pain stimuli that is need for a person to label the sensation as pain. changes very little in the individual; Varies from person to person
Tolerance of pain
The amount of pain you can take. The maximum amount of pain stimuli that a person is willing to withstand. Varies within the same person, according to the situation
An increase in sensitivity of a receptor after repeated activation by noxious stimuli
acute pain
Only last through an expected period of recovery. Pulse RR and B/P all go up
Chronic Pain
prolonged, reoccuring, persisting; interferes with functioning
Ceiling effect
once the maximun analgesic benifit is achieved, more drug will not produce any more analgesic; however toxicity may occure
Pseudo -addiction
"clock watching" caused by undertreatment. client becomes focused on obtaining meds by watching time for next dose. can be distinguished from true addiction because it is resolved whtn pain is treated effectively
Wind up phenomenon
caused by persistant pain; New nerve growth occurs which intensifies spreads and prolongs the noxious stimuli
Narrow thrapuetic Index
there is not much of a margin for safety between the dose that causes a toxicity or lethal dose a nd the dose that produces the desired effect
Types of mechanical pain stimuli
tissue trauma; edema, blockage to a duct, tumor, muscle spasm
types of thermal pain stimuli
extreme hot or cold; causes tissue distruction
types of chemical pain stimuli
tissue ischmia (blocked coronary artery) bcause of accumulation of lactic acid.
Refered Pain
appears in different area than the area of the condition
Radiating Pain
spreads or extends to other areas
Visceral Pain
Pain arising form organs or hollow virceral; often is it refered pain - remote from the organ of origin
Pain intensity assessment
Use a pain scale
1-3 on pain scale
mild pain
4-6 on pain scale
moderate pain
7-10 on pain scale
severe pain
a painful response to non painful stimuli EX: contact with linens cause pain
Hyperalgesia or Hyperpathia
a heightened response to painful stimuli EX: severe respons to a paper cut
Tolerance to pain
the maximum amount of painful stimuli that a person is willing to withstand without seeking avoidance
Pain threshold
the amount ofpain stimuli that is needed for a person to label the sensation as pain
an abnormal unpleasant sensation. It mimics Neropathic pain disorder such as pain that follows a stroke or spinal cord injury
Transmission phase of nociception
The 2nd phase. Pain impulses travel form perpheral to spinal to brainstem to thalmus to somatic sensory cortex where perception occures
the 3rd phase of nociception; the decending system; Neurons from thalmus and brainstem send signals down the dorsal horn
Perception phase
the final phase of nociception; when the person becomes aware of the pain. It is the sum of all activites of the CNS and gives character and meaning and intensity to pain
transduction phase
the 1st phase of nociception; Nociceptors are excited by stimuli; that triggers the release of biochemicals
Nociceptive pain
Pain theat is directly related to tissue damage. may te somatic or visceral has 4 phases
what are the 4 phases of Nociceptive pain
Transduction; Transmission; Modulation and perception
the physio process of pain perception.
meds that work in the transduction phase of pain
NSAID's, asprin, tylenol; local anethetic; topical analgesic
Meds that work in the transmission phase of pain
Opioids, Capsaicin
specialized pain receptors
Pain meds that work during the modulation phase of pain perception
Trycyclie Antidepressants; NMDA antagonist (ketamin dextromethophan can diminish pain signals
Ibuprofen, acetaminophen asprin
Side affects of NSAID's
GI bleeding Diminished renal flow; inhibits blood clotting
Does a opioid have a ceiling effect?
Does a NSAID have a ceiling effect
Does a NSAID have a narrow theraputic index
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