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QUIZ! QUIZ! QUIZ!
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1. It is considered as the fifth vital
sign
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2 .The type of Pain that lasts fromseconds to 6 months
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3 5 Give 3 Objective Cues of your answer inNumber 2
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6. These are also called pain receptors
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7. These are chemicals released thatexert inhibitory or excitatory activity at
postsynaptic nerve cell membranes
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8. Differentiate A delta fibers from Cfibers (2 Points)
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10 15. NociceptorsStimuli:
Mechanical
Thermal
____10_____
Mast cells
11
PNS
A delta fibers C fibers
Neospinothalamic tract
12
Paleospinothalamic tract
1315
14
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Factors Influencing Pain
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Past Experience
Anxiety and Depression
Culture
Gerontologic Consideration
Gender
Genetics
Placebo Effect
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Nursing Assessment of Pain
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Characteristics of Pain
Intensity none-mild discomfort-
excruciating
Pain threshold the smallest stimulusfor which a person reports pain
Pain tolerance the maximum amount
of pain a person can tolerate
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Timing
Onset
DurationRelationship between time and intensity
Changes in rhythmic patterns
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Location
Quality
Personal measuring
Aggravating and Alleviating Factors
Pain Behaviors
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Instruments For Assessing the
Perception of Pain
Visual Analogue Scale (VAS)
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Faces Pain Scale
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PAIN MANAGEMENT
STRATEGIES
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PHARMACOLOGIC
INTERVENTIONS
Premedication AssessmentAllergies
History
OTC drugsPain status
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APPROACHES FOR USING
ANALGESIC AGENTS
BALANCED ANALGESIA
refers to the use of more than one form ofanalgesia concurrently to obtain more pain
relief with fewer side effects
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APPROACHES FOR USING
ANALGESIC AGENTS
Pro Re Nata (PRN)
using this method, the only way to
ensure significant periods of analgesiais to give doses larger enough to
produce periodic sedation
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APPROACHES FOR USING
ANALGESIC AGENTS
Preventive Approach
Considered the most effective strategy
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APPROACHES FOR USING
ANALGESIC AGENTS
Patient-Controlled Analgesia (PCA)
Allows patient to control the administration
of their own medication withinpredetermined safety limits
GOAL: achieve a minimum therapeutic level
of analgesia and to allow the patient to
maintain that level by using the PCA pump
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Patient-Controlled Analgesia
(PCA)
Advantages:Allows client to receive a predetermined IV
bolus of an opioid by hitting a syringe pump
mechanism
Gives client a sense of control, less anxiety
Provides quick and consistent pain relief
Maintains a constant level of pain relief
Eliminates the need for repeated injections
Saves time
Especially recommended for acute pain
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Patient-Controlled Analgesia
(PCA)
DisadvantagesRequires use of pump
Requires reinforced client teaching for
maximum effectivenessRequires two nurses to program to prevent
errors
Requires designated person to hit button if
client cannot
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Instruct patient:
Not to wait until the pain is severe before
pushing the button to obtain a bolus dose Do not become so distracted by an activity
or visitors that he/she forges to self
administer
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AGENTS USED TO TREAT PAIN
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OPIOIDS
GOAL: relieve pain
and improve quality
of life Work centrally by
blocking the release
of neurotransmitters
in the spinal cord
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Adverse Effects
ConstipationAssess previous bowel habits
Use measures to prevent this problem
Keep a record of bowel movementAdminister stool softeners and stimulant
laxatives
Suppository of fleets enema
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Adverse Effects
Nausea and VomitingAssess actual cause of nausea
Recognize that it can only be initial
Antiemetic prophylactic beforeadministration as prescribed
Prochlorperazine (Compazine) every 4 hrs
as prescribed
Metoclopramied 10 mg before meals and atbedtime as prescribed
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Adverse Effects
Sedation and ConfusionAsses the actual cause of sedation
Recall that tolerance to this side effect
generally occurs after 2 3 daysBe aware that stimulants such as caffeine
may counteract opiod-induced sedation
Consider opioid rotation using an
equianalgesic chart
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Adverse Effects
Respiratory DepressionBe aware that clinically significant
respiratory depression is rarely seen in
clients with severe pain due to cancer, even
when large doses of opioids are given
Recognize that pain and stress seem to
counteract the respiratory depression effects
of opioidsRecall that respiratory depression is usually
preceded by sedation
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Monitor sedation level and respiratory statusfrequently for the first 24 to 48 hours,
especially in opioid-naive clients
If increased sedation occurs, decrease
opioid dose and attempt to stimulate client
Be aware that respiratory rate alone is not
indicative of respiratory status
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NSAIDS
Thought to decrease pain by inhibiting COX
LOCAL ANESTHETIC
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LOCAL ANESTHETIC
AGENTS Work by blocking nerve conduction when applied
directly to the nerve fibers
Topical Application
Intraspinal Administration
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TCA
Antiseizure medications
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ROUTES OF ADMINISTRATION
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INTRAVENOUS
AdvantagesGood for acute pain or procedures
Immediate pain relief
Provides fastest onset but shortest duration
Peak in 5 15 minutes
Eliminates anxiety and prevents pain
Recommended when unable to achieve pain control
through oral or rectal routes with high dosages of
opioids or unable to use oral/rectal routesContinuous IV administration provides steady blood
level
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INTRAVENOUS
Disadvantages Not recommended for constant pain due to
peaks and valleys in bloodstream
Requires use of infusion pump (PCA) withalarm
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SUBCUTANEOUS
AdvantagesAvoids needs for IV and cheaper than IV
Readily managed at home
Recommended for cancer clients who cannot take
PO and IV access is not desirableavoids peaks and valleys in bloodstream; maintains
steady blood level
Provides prolonged parenteral administration of
opioidNo delay in drug administration
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SUBCUTANEOUS
Disadvantages SC boluses have slower onset and low
peak effect
Requires use of ambulatory infusion pump
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ORAL
AdvantagesPreferred route of analgesia
Allows greater mobility and convenience
Drug levels peak in 1 to 2 hours
Greater client satisfaction
If client is NPO or has NGT or GT, medications can
still be given orally
Cost efficient
Relatively steady blood levels produced
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ORAL
Disadvantages Slow onset
Long-acting opioids cannot be crushed,
broken or chewed Some clients are unable to swallow
Requires functional GIT
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RECTAL
AdvantagesGood for clients who are on NPO, nauseated or at
home
Easy for clients to administer, especially for the
elderlyDuration of action 4 6 hours
Any opioid can be compounded by a pharmacist for
rectal route
Clinical practice suggests oral and rectal doses ofanalgesics fairly equal
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RECTAL
Disadvantages May be more expensive than oral route
and difficult to obtain
Contraindicated to thrombocytopenic
clients
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TRANSDERMAL
AdvantagesNoninvasive, easy to use, accepted by clients
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TRANSDERMAL
Disadvantages Due to gradual increase in plasma
concentration, may need to supplement
with short-acting analgesics for first 12
24 hours after initial application
Costly
Difficult to adjust dose
Febrile clients absorb medication quickly Concerns over disposal
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TOPICAL
AdvantagesEasy to use
Little systemic absorption
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TOPICAL
Disadvantages May cause skin reactions
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SPINAL
AdvantagesPreservative free morphine
Useful for post operative pain
May be intermitted bolus or continuous
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SPINAL
Disadvantages Careful client selection is necessary
Many side effects
Complications
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NONPHARMACOLOGIC
INTERVENTIONS
Cutaneous stimulation and
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Cutaneous stimulation and
massage
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Thermal Therapies
Transcutaneous Electrical Nerve
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Transcutaneous Electrical Nerve
Stimulation (TENS)
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Distraction
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Relaxation Techniques
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Guided Imagery
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Hypnosis
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Music Therapy
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Alternative Therapies
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QUIZ!!!!
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True/False
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1. A patients definition of pain ishighly subjective, making nurses
and physicians the best authority of
the existence of pain.
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2. People who have had multipleexperiences with pain will be less
anxious and more tolerant of pain
than those who have had littleexperience with pain.
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3. Pain threshold and pain toleranceare terms that can be used
interchangeably when describing a
patients pain level.
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4. Alternate forms of communicationmust be used for patients with
sensory impairments and other
disabilities, because painassessment is such a vital part of a
patients care.
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5. The prn approach to administeranalgesics is no longer considered
the most effective strategy for pain
management.
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6 7. 8.
9. 10. 11
14.12 13
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What organ is found:
15. 16.
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17-19. Draw an assessment toolused to measure pain and explain
how it is used
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20 22. Give one approach in usinganalgesic agent and give one
advantage and disadvantage.
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23. Give the mechanism of action ofopioids
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24. How many hours doesrespiratory depression peak
after giving epidural opioids?
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25. How does cutaneous stimulationwork in managing pain?
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ASSIGNMENT
PROVIDE A COPY OF THECOMMON INSTRUMENTS USED
IN THE OPERATING ROOM WITH
PICTURES AND THEIR USEINYOUR NOTEBOOK.