Exam 3 N323

Subdecks (1)

Cards (166)

  • Transduction
    Noxious stimuli cause cell damage with the release of sensitizing chemical mediators
  • Sensitizing chemical mediators
    • Prostaglandins
    • Bradykinin
    • Serotonin
    • Substance P
    • Histamine
  • These substances
    Activate nociceptors and lead to generation of action potentials
  • Transmission
    1. Action potential continues from site of injury to spinal cord
    2. Spinal cord to brain stem and thalamus
    3. Thalamus to cortex for processing
  • Primary afferent fibers
    A delta and C fibers are pain-sensing nerves
  • Perception
    Conscious experience of pain
  • Modulation
    Neurons originating in brain stem descend to spinal cord and release substances (e.g. endogenous opioids) that inhibit nociceptive impulses
  • Classification of Pain
    • Nociceptive: somatic—super deep
    • Nociceptive: visceral—internal organs, manifests as cramping or soreness
    • Neuropathic: Damage to peripheral nerve or CNS, Numb, hot, shooting, stabbing, or electrical, Sudden, intense, short-lived or lingering
  • By duration
    • Acute: Lasts less than 3 months, Identifiable cause
    • Chronic: Harder to treat
  • Pain Assessment
    • OLD CARTS
    • Faces
    • NRS 0-10
    • MMS Mild/Mod/Severe
  • Tolerance
    Chronic exposure, Increase dose to maintain
  • Physical dependence
    Withdrawal w/ stopping
  • Pseudoaddiction
    s/s of addiction; just ineffective treatment
  • Addiction
    Behaviors; use other than prescribed reason
  • Infants and Young Children
    • Can't voice pain, Look for nonverbal cues
  • Gerontology
    • 50-80% of older adults are estimated to have chronic pain problems, Chronic pain can have many consequences, It's not a normal part of aging
  • Drug Therapy
    • Nonopioid: Tylenol, Advil—>mild
    • Opioids: Morphine, Fentanyl—>mod/severe
    • Adjuvant: Lidocaine, anticonvulsants (gabapentin)
  • Nondrug Therapy
    • Massage
    • Exercise
    • TENS or PENS
    • Acupuncture
    • Hot/Cold therapy
  • Pancreatitis
    Inflammation of the pancreas, Pancreatic enzymes cause auto digestion and severe pain, Varies from mild edema to severe necrosis
  • Etiology of Pancreatitis
    • Gallbladder disease (more common in women)
    • Gallstones
    • Chronic alcohol intake (more common in men)
    • Smoking
    • Hypertriglyceridemia
  • Clinical Manifestations of Pancreatitis
    • Abdominal pain predominant, LUQ or Midepigastrium, Radiates to back, Sudden onset, Deep, piercing, continuous, steady, Aggravated by eating, Jaundice, Increased HR, Abd tenderness and muscle guarding, Decreased or absent bowel sounds, Crackles in lungs (increased volume), Abd skin discoloration (blood seeping from pancreas), Grey Turner's spots, Cullen's sign, Could lead to shock due to bleeding or hypovolemia
  • Complications of Pancreatitis
    • Pseudocyst: fluid, enzyme, debris, and exudate surrounded by wall
    • Pancreatic abscess: infected pseudocyst because of extensive necrosis
  • Diagnostic Studies for Pancreatitis
    • Serum amylase level—elevated
    • Serum lipase level—elevated
    • AST/ALT (liver enzymes)—elevated
    • Triglycerides—elevated
    • Calcium—decreased
    • Chvostek/Trousseau sign
    • Tetany
    • Ultrasound
    • CT scan
  • Treatments for Pancreatitis
    • Pain relief
    • Prevention or alleviation of shock
    • Decrease pancreatic secretions
    • Correction of fluid/electrolyte imbalances
    • Prevention of infections
    • Removal of precipitating factors
  • Medication Therapy for Pancreatitis

    • IV Morphine: pain
    • Antispasmodics
    • Carbonic anhydrase inhibitors (acetazolamide): decrease enzyme secretion
    • Antacids
    • PPI: decrease HCL acid secretion and decrease pancreatic activity
    • Compazine/Zofran: n/v
    • Decreased magnesium levels if alcohol use indicated
  • Nutrition for Pancreatitis
    • Settle pancreas—>NPO
    • Small, frequent feedings when able
    • High carb (least stimulating of pancreatic enzymes)
    • No alcohol
    • Supplemental fat-soluble vitamins (DAKE)
  • Nursing Implementations for Pancreatitis
    • Pain assessment and management
    • Morphine
    • Position of comfort with frequent position changes
    • Flex trunk and draw knees to abdomen
    • Side-lying with head of bed elevated 45 degrees
    • Frequent oral/nasal care
    • Proper antacid administration
  • Tension Headache
    Vary in length and severity, Bilateral location and pressing/tightening quality, band squeezing on head, Common in women, OTC meds and caffeine can exacerbate, Lasts hrs-days
  • Diagnostics for Tension Headache
    • History
    • OLD CARTS pain assessment
    • Increased resistance to passive movement of head
    • EMG (mid-headache—shows prolonged muscle contractions)
  • Medications for Tension Headache
    • Symptomatic: Aspirin, Acetaminophen, NSAID, Caffeine, Sedative, Muscle relaxant
    • Prevention: Tricyclic antidepressants—Amitriptyline, Anti seizure—Tepiramate
  • Migraine

    Common in women 20-30yrs, With aura=classic migraine, Without aura=common migraine, Complex neurovascular event, Hyper excitability in neurons—brain and cerebral cortex, Unilateral throbbing pain, Premonitory symptoms or triggers, Varies in severity and function, 4-72hrs, Dilation of vessels
  • Risk Factors for Migraine
    • Family history
    • Low level of education
    • Low SES
    • Stressful life events
    • Depression
  • Triggers for Migraine
    • Meds, food, periods, stress, fatigue, weather
  • Diagnostics for Migraine
    • History
    • Neuro exam often normal
    • No specific lab or rediologic test
  • Medications for Migraine
    • Symptomatic: Mild-mod: NSAID, Aspirin, Analgesic with caffeine, Mod-severe: Triptans—Sumatrip
    tan or Imatrex with Naproxen
    • Prevention: Anti seizure—Gabapentin, Beta blockers—Propranolol, Botox—q3 months, SSRIs—Prozac, fluoxetine
  • Cluster Headache
    Most severe, Common in males, Up to 8x/day—>cyclical, Mistaken as sinus allergies, Trigeminal autonomic cephalalgia—>runny nose/congestion, Usually occur at same time of day/night, Unilateral pain reported as sharp and stabbing (around eye), Swelling around eye, tearing, facial flushing, pallor, nasal congestion, pupil constriction, agitation, restless, auras
  • Pathophysiology of Cluster Headache

    Dysfunction of circadian rhythm, Involved hypothalamus—melatonin and cortisol wacky levels, Hypothalamic activation at onset, Headaches at night, Wake up with sharp, stabbing pain—>circadian rhythm changed, Pain in eyes: neurons being activated in eyes and trigeminal area
  • Risk Factors for Cluster Headache
    • Alcohol
    • Strong odors
    • Weather changes
  • Diagnostics for Cluster Headache
    • History
    • Headache journal useful—log episodes
    • Scans to rule out other things
  • Medications for Cluster Headache
    • Symptomatic: Triptans, 100% O2 at 6-8L/min for 10min
    • Prevention: High-dose verapamil, Invasive nerve blocks, Deep brain stimulation, Ablative neurosurgical procedures