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71 Cards in this Set
- Front
- Back
definition of pain: |
an unpleasant sensory and emotional reaction to actual or POTENTIAL tissue damage |
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Physiological impact of unrelieved pain (table 3.1): |
- prolongs stress response - Increases HR, BP, and oxygen demand - decreases GI motility - causes immobility - decreases immune response - delays healing - increases risk for chronic pain |
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QOL impact of unrelieved pain (table 3.1): |
- interferes with ADLs - causes anxiety, depression, hopelessness, fear, anger, and sleeplessness - impairs family, work, and social relationships |
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financial impact of unrelieved pain (table 3.1): |
- costs americans billions of dollars per year - increases hospitals lengths of stays - leads to lost income and productivity |
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characteristics of acute pain (table 3.2): |
- has short duration - usually has well-defined cause - decreases with healing - is reversible - serves a biologic purpose (warning sign) - ranges from mild to severe in intensity - may be accompanied by anxiety and restlessness |
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characteristics of chronic/persistent pain (table 3.2 - 4.2 in version 7 p 40): |
- lasts longer than 3 months - may or may not have well-defined cause - begins gradually and persists - is exhausting and serves no biological purpose - ranges from mild to severe in intensity - may be accompanied by depression and fatigue, as well as decreased functional ability |
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2 big classifications of pain: |
acute chronic |
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2 types of chronic pain: |
- cancer -non-cancer |
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Chronic cancer pain is: |
pain associated with cancer OR ANOTHER PROGRESSIVE DISEASE, SUCH AS AIDS |
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Chronic non-cancer pain is: |
is associated with tissue injury that has healed or is not associated with cancer, such as arthritis or chronic back pain |
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physiological responses to acute pain |
- increased HR - increased BP - increased Resp rate - dilated pupils - sweating |
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population groups who are more likely to have inadequately treated pain: |
- older adults - peds - drug abusers - those who speak a different primary language than hcp |
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Misconceptions associated with peds pain: |
- nb and infants don't feel pain - kids feel less pain than adults - infants can't express pain - parents exaggerate pain - children are not in pain if distracted or asleep - repeated pain allows child to be more toleratnt and cope better - kids recover from painful experiences more quickly than adults - kids will tell you they are in pain - kids w/o obvious physical reasons for pain are not likely to have pain - kids run risk of becoming addicted to pain meds |
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characteristics of acute pain: |
- serves a biological purpose - severe pain activates SNS - response to pain is highly individual - usually temporary, sudden onset, and easily localized |
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characteristics of chronic cancer pain: |
- increases as the disease advances - need round the clock dosing of meds - often inadequately treated - treatment can cause acute pain |
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Gate control theory: |
spinal cord has a gate; when open impulses go to brain and pain is perceived; when closed, impulses are blocked and pain is not perceived |
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preemptive analgesia is designed: |
- technique designed to decrease pain in post-op period - decreases requirements for post-op analgesia - prevent morbidity - decreases hospital stay |
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preemptive analgesia definition: |
giving pain meds during pre-, intra-, or post-op to inhibit changes in the spinal cord, thereby inhibit the pt's post-op perception of pain |
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nociceptive pain: |
arises from damage to or inflammation of tissue other than that of peripheral and central nervous system - the activation of normal processing of painful stimuli |
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nocecptive pain is typically described as: |
- throbbing - aching -localized |
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nocecptive pain typically responds to: |
opioids and nonopioid meds |
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2 types of nociceptive pain: |
visceral and somatic |
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somatic pain: |
in bones, joints, muscles, skin or connective tissue |
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visceral pain: |
- in internal organs such as stomach or intestines. It may also be referred pain in other body locations separete from the stimulus |
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neuropathic pain: |
- arises from abnormal or damaged pain nerves |
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neuropathic pain includes: |
- phantom limb pain - pain below the level of a spinal cord injury - diabetic neuropathy |
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neuropathic pain is often described as: |
- intesnse - shooting 'pins and needles" |
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transduction: |
the conversion of painful stimuli to an electrical impulse through peripheral nerve fibers |
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transmission |
occurs as the electrical impulse travels along the nerve fibers, where neurotransmitters regulate it |
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perception: |
awareness of pain; occurs in various areas of the brain, with influences from thought and emotional responses |
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pain threshold |
the point at which a person feels pain |
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pain tolerance |
the amount of pain a person is willing to bear |
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substances that may increase pain transmission and cause an inflammatory response: |
- substance P - prostaglandins - bradykinin - histambrady had a hissy fit & peed his pantsine |
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Substances that may decrease pain transmission and produce analgesia: |
- seratonin - endorphins |
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A Delta fibers |
myleniated fibers that carry rapid, sharp, pricking, or peircing sensations - found primarily in the skin and - usually intermittent |
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Where are A Delta fibers primarily found: |
- skin - muscle |
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C fibers: |
- unmyleniated or poorly myelinated fibers that conduct thermal, chemical, or strong mechanical - slower and more diffuse - often described as dull, burning, or achy - usually persistent |
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Where are C fibers typically found: |
- muscle -periosteum (around bones, but not joints) - viscera (guts, organs) |
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2 types of somatic pain: |
- superficial or cutaneous - deep |
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superficial or cutaneous pain is typically described as: |
- sharp, burning |
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deep somatic pain is often described as: |
dull, aching, cramping |
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deep somatic pain vs visceral pain: |
?? look up |
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Referred pain: |
pain felt somewhere distant from point of injury |
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radiating pain: |
along the nerve or group of nerves (ie radiating pain in left arm with MI) |
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parasethesia: |
itching/tingling/crawling skin |
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dysthesia: |
light touch to skin causes pain |
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allodynia: |
can be tactile or thermal; felt as pain |
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phantom limb pain: |
pain in amputated body part |
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psychogenic pain: |
pain that arises from prolonged emotional state |
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hypalgesia: |
decreased sensitivity to pain |
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hyperalgesia: |
increased/exaggerated sensitivity to pain |
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breakthrough pain: |
pain that occurs despite scheduled meds; treated with PRN meds |
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tolerance: |
a normal phsyiological response after regular admin of opioids, pt becomes "used to" the med and more tolerant of it's s/e - may need to up dosage or change the opioid |
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dependence: |
a normal physiological response where the body is now dependent on having that med to function normally - if d/c abruptly, pt will have withdrawals |
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addiction: |
a pattern of behavior in which a pt seeks a meds and has become emotionally (and physically) dependent on it; will seek out despite negative consequences |
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pseudoaddiction: |
pain is not controlled well enough by med, do pt seeks more of it |
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Factors that influence pain |
- age - gender - culture - anxiety - coping style - family and social support - perception - previous experience - preparation for what to expect - response of health professionals - religious beliefs |
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Subjective data to collect: |
- onset - duration - location - severity/intensity - quality - pattern - relief mesaures - other s/s |
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types of pain scales: |
- pediatric pain - acute pain - chronic pain - end of life pain - non-responsive/comatose pain |
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numeric |
0-10 |
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Wong-Baker: |
faces |
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Faavs: |
-- |
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Flavvs: |
-- |
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PQRST pain assessment mneumonic: |
P- precipitaing or palliative Q- quality or quantity R- region or radiating S- severity scale T- timing; when did it start, how long does it last, how often does it happen |
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Objective data to collect in pain assessment: |
- inspection - VS - Overt signs/related behavior -- vocalization -- facial expression -- body movement/guarding -- social interaction |
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Autonomic s/s data collection in pain assessment: |
.. |
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Influence of ADLs: |
- sleep -hygiene - sexual function - home management/work - social activities |
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Barriers to successful pain management: |
- HCP - client - client and family fears |
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Nursing diagnoses r/t pain: |
- impaired comfort - acute pain - chronic pain -other related diagnoses |
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Principles for admin of analgesics: |
- previous response - selecting proper meds - normal dosages - lifespan considerations - determining right time and intervals - choosing route - acute vs chronic pain - WHO analgesic ladder |
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WHO analgesic ladder |
1. non-opioid 2. weak opioid 3. strong opioid |