fon ch. 16 - pain management c

8/12/2019 FON Ch. 16 - Pain Management C

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38. Opioids - Morphine, meperidine (Demerol), hydromorphone (Dilaudid), and fentanyl (Actiq, Duragesic)

- It act on higher centers of the brain to modify perception and reaction to pain. It decrease the perceptiion of pain b

binding to pain receptor sites in the CNS.

- Manage moderate to severe acute pain

- Often delay gastric emptying, slow bowel motility, and decrease peristalsis. They also tend to reduce secretions fro

the colonic mucosa. Gastrointestinal dysfunction can result in ilus, fecal impaction, and obstruction

- Constipation is the most common side effect

39. Oral route for

opioid

analgesics

Optimal route, especially for chronic pain. It is convenient, flexible, and relatively steady blood levels. It use is

appropriate as soon as the patient can tolerate oral intake and is the mainstay of pain management for ambulatory

surgical patients.

40. Patient-

controlled

analgesia (PCA)

Allow patients to self-administer analgesics whenever needed. Each dose may be as small as 1 mL or 1 mg of

morphine every 6 to 12 minutes. Assess the patient for signs of oversedation and respiratory depression

41. PCA by proxy If someone other than the patient pushes the button on a PCA pump

42. PCA is delivered

by one of two

modes

- PCA bolus doses with a continuous infection (also called a basal rate) or PCA bolus doses alone

43. Preparation for

Patient-Controlled

Analgesia

Teach the use of PCA before surgery so that patients will know how to use it after awakening from anesthesia.

(Confused and unresponsive patients, patients with neurologic disease, patients with impaired renal, hepatic orpulmonary function, and those unable to press the delivery button are not candidates for PCA)

44. Prostaglandin Inflammatory mediator, released when cells are damaged, that sensitizes nerves that carry information about pain

45. Rapid eye

movement

(REM)

One of the two highly individualized sleeping states that follows NREM state. May last from a few minutes to a half

an hour and alternate with NREM periods; dreaming occurs during this time

46. Referred pain Pain that is felt at a site other than in the injured or diseased organ or part of the body. An example is the pain of

coronary artery insufficiency that will in some cases be felt in the left shoulder or arm, or the jaw.

47. REM Sleep - Stage of vivid, full-color dreaming (less vivid dreaming sometimes occurs in other stages)

- First occurs approximately 90 minutes after sleep has begun, thereafter occurs at end of each NREM cycle

- Typified by autonomic response of rapidly moving eyes, fluctuating heart and respiratory rates, and increased orfluctuating blood pressure

- Loss of skeletal muscle tone

- Responsible for mental restoration

- Stage in which sleeper is most difficult to arouse

- Duration increasing with each cycle and averaging 20 minutes

48. Respiratory

depression on

opioids

Clinically significant respiratory depression occurs less often when administering opioids by the epidural route

(0.07% - 0.4%) or by IV patient-controlled analgesia (0.1% - 0.23%) than when the intramuscular (IM) route is use

(0.9%)

49. Side effects of

epidural

opioids

Urinary retention, postural lyotension, pruritus, nausea, vomiting, and respiratory depression

50. Sleep Cycle As adults fall as leep, they progress through the four stages of NREM sleep. At the end of the fourth stage, they come

out of a sleep, go back to stage 2, and then enter a period of REM. A person reaches REM sleep in about 90 minutes

(average).


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51. Sleep Deprivation Possible physiologic signs and symptoms include:

- Head tremors

- Decreased reflexes

- Slowed response time

- Reduction in word memory

- Decreased reasoning and judgement

- Cardiac dysrhythmias

Possible psychological signs and symptoms include:

- mood swings- Disorientation

- Irritability

- Decreased motivation

- Fatigue

- Sleepiness

- Hyperexcitability

52. Spinal Cord The proposed location of the gates is in the dorsal horn of the

53. Stress and Pain What activate endorphins

54. Substitutes if the patient has

an unusual reaction or allergy

to morphine

- hydromorphone HCI

- levorphanol

- oxycodone-fentanyl

55. Synergistic Action of two or more substances or organs to achieve an effect of which each is capable

56. The purpose of noninvasive

pain relief techniques

Decrease the patient's perception of pain as well as improve the patient's sense of control

57. Thoughts, feelings, and

memories

Gating mechanisms are also subject to alteration by

58. Three methods of

administering epidural

analgesia

- Bolus doses

- Continuous infusion

- Patient-controlled epidural analgesia

59. TJC Requirement for Paincontrol

- Patient have the right to appropriate assessment.- Patient is to be assessed and regularly reassessed.

- Patients will be taught the importance of effective pain management.

- Patients will be taught that pain management is part of treatment.

- Patients will be involved in making care decisions.

- Routine and prn analgesics are to be administered as ordered.

- Discharge planning and teaching will include continuing care based on the patient's needs at the

time of discharge, including the need for pain management.

60. Transcutaneous electric nerve

stimulation (TENS)

A type of pain control that is managed with a pocket-sized, battery-operated device that provides a

continuous, mild electrical current to the skin via electrodes. It is typically used for patients sufferin

post-operative or chronic pain.

61. Types of pain - Mild or severe

- Chronic or acute- Intermittent or intractable

- Burning, dull, or sharp

- Precisely or poorly localized

- Referred

62. Under the new TJC standards Health care providers are expected to be knowledgeable about pain assessment and management,

and facilities are expected to develop policies and procedures supporting the appropriate use of

analgesic and other pain control therapies.

63. Useful noninvasive

approaches include

Cutaneous stimulation (heat, cold, massage, and TENS), the removal of painful stimuli, distraction

relaxation, guided imagery, meditation, hypnosis, and biofeedback


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64.Visual analog

scale

An objective means of assessing pain severity; it consists of a straight line, representing a continuum of intensity, and

has visual descriptors at each end.

fon ch. 16 - pain management c

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