Download Learning Guide for Pain

Learning Guide for Pain
1. Definition and dimensions of pain.
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Consequences of unrelieved pain
How does McCaffery define pain
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The dimensions of pain: physiological, affective, behavioral,cognitive, and
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sociocultural
Factors influencing perception of pain
o Reasons inadequate pain management may occur
2. Describe the mechanisms of pain: transduction, transmission, perception and modulation.
o Identify chemicals that activate or sensitize nociceptor excitation.
o Dermatomes
o Referred pain
3. Differentiate between nociceptive and neuropathic pain, acute and chronic pain.
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Signs and symptoms of acute and chronic pain
Define hyperalgesia, persistent and referred pain
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Patient’s description of Somatic versus visceral pain;
o How are they treated differently?
4. Describe the elements of assessment of a patient who presents in pain.
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describe the onset, duration, characteristics, pattern, location, intensity, quality,
and associated symptoms such as anxiety
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breakthrough pain
impact of pain
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patient’s beliefs, expectations, and goals
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What is the most common and reliable way to assess pain? How do you
use a pain scale? What kind of patients do we use a pain scale with?
phantom pain and how would you teach a patient about it?
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5. Describe the basic principles of pain treatment.
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Lewis Table 10-4
How do you use a pain scale? What kind of patients do we use a pain scale
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with?
Pain scale, subjective and objective data
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Patients goals for acute and chronic pain
Manage side effects of pain meds table 10-6
6. Describe the role of drug therapy for pain and discuss the major classifications of pain
medications.
o Explain the following medications(actions, use, side effects and nursing
considerations for them):
1. Nonopioids; aspirin, Tylenol, NSAIDS (ibuprofen,ketorolac) ,COX 2
inhibitors (celebrex); what are the risks with the use of these?
2. Examples of Opioids (morphine, dilaudid, Demerol, hydrocodone)
3. most dangerous side effects of narcotics
4. Opiod antagonist Narcan how is it used? What is the worst side effect?
Which “wears off” first pain med or Narcan?
5. Examples of Adjuvant drugs (corticosteroids,antidepressants,
antiseizure, local anesthetics
7. Describe the information a nurse needs to safely administer pain medications.
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Scheduling, titration,equianalgesic,
Routes
 first-pass effect.
 transmucosally.
 Intranasal administration
 rectal suppositories
 Intravenous administration is the best route when immediate analgesia
and rapid titration are necessary.
 Intraspinal (epidural or intrathecal)
 Patient controlled analgesia
o peak of action for common narcotics given intramuscularly?
Intravenously? How does knowing this help you safely administer these
medications.
8. Define interventional therapies: nerve block- specifically neuroablative techniques.
o Regional anesthesia
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Cordotomies, tractotomies
9. relationship of pain, narcotic administration and addiction; What information can
you give a patient or family about pain medication and addiction?
10. Describe the appropriate use of nonpharmacologic therapies for pain.
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Massage,exercise, TENS,
PENS, Acupuncture
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Heat, cold; are there contraindications?
o Distraction, hypnosis, relaxation
11. Describe the related changes with pain management specific to special populations:
geriatric, cognitively impaired, substance abusers.
o barriers to pain assessment in the elderly
o reduce barriers to pain management (Harkreader, Table 37-10 pg. 1028)
12. Describe barriers to effective pain management:
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Pain tolerance
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Physical dependence
Addiction
13. List common myths and misconceptions about pain (Harkreader, Table 37-5 pg. 1019)
14. List at least three nursing diagnoses for a patient in pain.
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Acute Pain
Chronic Pain
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Activity Intolerance
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Ineffective coping
Examples of nursing diagnosis based on data Harkreader, Table 37-4 pg. 1016)
15. Differentiate the goals for acute and chronic pain
16. Describe interventions for a patient in pain.
o Describe the nursing role
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What information can you give a patient or family about pain medication and
addiction?
17. Compare the nursing interventions for acute and chronic pain. (Harkreader Table 37-7
pg. 1022, Table 37-8 pg1024)
18. Describe evaluation data for the care plan of a patient in pain.