14152372
Description
Flashcards by Elizabeth Then, updated more than 1 year ago
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Created by Elizabeth Then
over 6 years ago
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| Question | Answer |
| pain definition | unpleasant sensory and emotional experience associated with actual or potential tissue damage, described in terms of such damage |
| type of pain | acute, chronic, nociceptive, neuropathic |
| acute pain | recent onset, limited duraton identifiable cause, indicayes injury and illness, predicatable course |
| chronic or persistent pain | persistent, cause is often obscure, sensitisation of noiceptors or nerves, poorly responsive to therapy, including opioids, unpredictable |
| Nociceptive pain | most common in acute settings stimulation of nociceptors as result of tissue damge pain characteristics - somatic = sharp, ot, stinging visceral = dull, crampy |
| neuropathic pain | dysfunction in nervous systen - nerve pain e.g. amputation of limb, burning, pulsing, shooting, tingling, hyperalgesia (increased pain with painful stimuli) , allodynia (pain with non-painful stimuli) |
| prolonged injury response | hyperglycaemia - increased risk of infection, length of stay increase in fatty acids - myocardial o2 consumption increase in coagulation - increase DVT/PE increase muscle protein breakdown - decrease wound healing decrease immune function - increase infection |
| prolonged sympathetic reponse | increase heart rate, BP, myocardial oxygen, ischaemia, decreased GI motility - ileus |
| major complications of bed rest | Increase pulmonary complications, decrease lung volumes, hypoxaemia, increase thromboembolism goal: mobilise and cough comfortably |
| Measuring pain | subjective - only patient knows |
| assessing pain at | rest and movement - reassess after analgesic administration |
| FAS | assessment of function, the ability to deep breathe/cough, participate in physio a - no limitation due to pain b - mild limitation c - unable to complete activity |
| non-pharmacological management | rest, position, elevation, compression, reaasurance, explanation, expectation |
| Pharmacological management | opioids- IV, PCA, oral, SC non- opioids - paracetamol, NSAIDS, ketamine, anticonvulsant, antidepressants neuraxial - epidural, intrathecal regional |
| morphine | least lipid soluble - slower onset of action, longer duration active metabolites - M3G M6G renal excretion - caution with elderly SR - kapanol, MS contin |
| Fentanyl | highly lipid soluble - fast onset, shorter action no active metabolites - safer for renal impairment and elderly SR - transdermal - durogesic patch |
| Oxycodone | first line opioid semi - synthetic opioid derivative of thebaine not codiene no harmful metabolites - suitable for elderly SR - oxycontin, targin |
| Tramadol | synthetic - opioid like analgesic combined effect SSRI reduces pain transmission and perception active metabolite - caution elderly lower risk of sedation and resp depression lower risk of constipation |
| Adverse effect of opioids | nausea and vomiting -- antiemetics Pruritis - naloxone, antihistamines urinary retention constipation sedation and resp depression |
| opioid effect on resp system | decreased rate, rhythem irregular, decrease tidal volume, increase co2, sedation, depression of upper airway tone and obstruction resp rate is a late and unreliable sign increasing sedation is a better sign |
| sedation scores | o- wide awake 1- easy to rouse, remains awake 2- easy to rouse but cannot stay awake 3 - difficult to rouse (severe resp depression) |
| Naloxone | opioid antagonist half life 30-60 minutes |
| Adjunvants | paracetamol, NSAIDS, ketamine, anticonvulsants, antidepressant are all opioid sparring lead to reductoin of opioid required, fewer side effects |
| Ketamine | blocks NMDA receptors in the spinal cord side effects : vivid dreams, hallucinations |
| dermatome | area of skin that is mainly supplied by a single nerve which originates in the epidural space |
| epidural complications | systemic toxicity tingling, umbenss, metallic taste, light headed, coma, convulsions treatment: stop infusoin, resp and cario support |
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