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PathoPharm Pain

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by

Mary Bartlett

on 30 October 2017

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Transcript of PathoPharm Pain

Pain
MEB
N365

Neurotransmitters
What is Pain?
Pain is whatever the experiencing person says it is, existing whenever he/she says it does.
(McCaffery, 1996)

Physical
Emotional
Assessing Pain
Location
Intensity
Quality
Pattern
Time of Onset
Duration
Constancy
Chronology
Assessing Pain
Precipitating factors
Alleviating factors
Associated symptoms
ADLs
Meaning of the pain
Coping
Affective measures
Look for:
Facial expressions
Immobilization
Purposeless body movements
Behavior changes
Rhythmic body movements
Pain Scales
Pain Scales
Visual Analogue Scale (VAS)

Numeric Rating Scale (NRS)

Simple Descriptor
Nonverbal Clients especially children or confused
Ask, you may get an answer!

Consider what is being done or has been done

LOOK, LISTEN, FEEL....

Evaluate other physiological indicators like...

Conduct a trial of analgesia and reassess
Pain Management
Non-pharmacological



Pharmacological
Pain Management
Definition Check
Transduction: activation of nociceptors by a stimulus

Transmission: conduction of pain message to spinal cord

Pain perception: recognizing pain in cortex

Pain modulation: changing pain perception
NCLEX
The nurse is assessing an intubated patient who returned from coronary artery bypass surgery 3 hours ago. Which assessment finding might indicate that this patient is experiencing pain?

a. Blood pressure 160/82 mm Hg
b. Temperature 100.6°F
c. Heart rate 80 beats/min
d. Oxygen saturation 95%

NCLEX
After receiving ibuprofen (Motrin) 800 mg orally for right hip pain, the patient states that his pain is 8 out of 10 on the numerical pain scale. Which action should the nurse take?

a. Use nonpharmacological therapy while waiting 3 more hours before next dose.
b. Administer an additional 800 mg oral dose of ibuprofen right away.
c. Do nothing because the patient’s facial expression indicates he is comfortable.
d. Notify the prescriber that the current pain management plan is ineffective.

NCLEX
The nurse uses his hands to direct energy fields surrounding the patient’s body. After this intervention, the patient states that his pain has lessened. How should the nurse document the intervention?

a. Tactile distraction was performed and appeared effective in reducing pain.
b. Guided imagery was effective to relax the patient and reduce the pain.
c. Therapeutic touch was performed; patient verbalized lessening of pain after treatment.
d. Sequential muscle relaxation was performed; patient states pain is less.

NCLEX
A patient prescribed an NSAID, naproxen (Aleve, Naprosyn), for treatment of arthritis reports stomach upset. What should the nurse instruct the patient to do?

a. Notify the prescriber immediately.
b. Take the medication with food.
c. Take the medication with 8 ounces of water.
d. Take the medication before bedtime.

NCLEX
A patient is prescribed morphine sulfate 4.0 mg intravenously for postoperative pain. Which action should the nurse take before administering the medication?

a. Monitor the patient’s respiratory status.
b. Auscultate the patient’s heart sounds.
c. Check blood pressure in supine and sitting positions.
d. Monitor the patient for psychological drug dependence.

NCLEX
A client reports taking acetaminophen (Tylenol) to control osteoarthritis. Which instruction should the nurse give the patient requiring long-term acetaminophen use?

a. Explain that physical dependence may occur with long-term oral use.
b. Explain that acetaminophen increases the risk for bleeding.
c. Advise taking acetaminophen with meals to prevent gastric irritation.
d. Caution the patient against combining acetaminophen with alcohol.

NCLEX
Which expected outcome is best for the patient with a nursing diagnosis of Acute Pain related to movement and secondary to surgical resection of a ruptured spleen and possible inadequate analgesia?

a. The patient will verbalize a reduction in pain after receiving pain medication and repositioning.
b. The patient will rest quietly when undisturbed.
c. On a scale of 0 to 10, the patient will rate pain as a 3 while in bed or as a 4 during ambulation.
d. The patient will receive pain medication every 2 hours as prescribed.

A
D
C
B
A
D
C
C
B
B
It's not what you look at that matters.
It is what you see.

Henry David Thoreau
These are some of the mechanisms, but it is SO much more
Nursing Dx:
Is pain the problem?
Does pain cause or contribute to the problem?
How does pain differ between people?
Perception
Response
Tolerance
Meaning
Duration
Acute
Chronic
Acute on Chronic
Intractable

What is pain?
Sensory/discriminative
Motivational/affective
Cognitive/evaluative
Types of Pain
Nociceptive
Neuropathic
Psychogenic
Phantom
How do we perceive
people who are in pain?
Remember the 10 ??? from IEL 1
Nociceptive Pain
Somatic
Well localized
Sharp
Dull
Aching
Throbbing
Gnawing
QUICK: A-delta fibers
Visceral
Poorly localized
Deep
Aching
Crampy
Pressure
C-fibers: slow & diffuse
Nociceptive
Injury to tissues
Transduction
Transmission
Ascending nerves-->spinal cord-->brain
Perception
Modulation
Neuropathic Pain
Central
Phantom
Neuroplasticity
Body image in R superior parietal
Peripheral
Diabetic neuropathy
Post-herpetic neuropathy
Neuropathic
Trauma or disease to nerves
Ectopic discharge
Tingling
Shooting
Burning
Shocking
Vise-like
Hypersensitivity
Allodynia
Hyperalgesia
Psychogenic
Neurotransmitters
Excitatory: Fast
Glutamate, aspartate
Inflammatory: PGs, histamine, NO, bradykinins, NE
Inhibitory: slower
GABA, glycine
Dopamine, serotonin
Endorphins
More pain words:
Threshold: lowest intensity recognized
Tolerance: greatest endured
Perceptual dominance: multiple sites
The nurse teaches the patient relaxation techniques and guided imagery as an adjunct to medication for pain. What is the main rational for these techniques?
A. They are less costly
B. They may allow lower doses of drugs with fewer adverse effects
C. They can be used at home
D. They do not require a prescription

Gate Control Theory of Pain
Pediatrics, elders and Fibromyalgia
MODULATION
But rare...
, buccal
Lollipop for children
Chemoreceptor trigger zone
This is different than DEPENDENCE or ADDICTION
IF on antibx?
What is important to your nursing care about these risk factors? What will it change?
Available as RX
What are we trying to do?
Opiate withdrawal sx
Not used as much
Intrinsic activity
Non-selective
selective
selective
)
Why?
topical analgesia
MODULATES PAIN PERCEPTION
Case Study
BH is a 44 year old female with chronic pain
HIV+, excellent med adherence
Former IVDU, on Methadone
Chronic back pain
Osteonecrosis b/l knees
Depression, PTSD
Hep C positive
What else do you need to know?
What facts may affect how she is treated?
Would you prescribe pain meds for her?
Why or why not?
Doh...what makes us human
NE & ACH
GABA, Serotonin, Dopamine
Full transcript