Are you numb
Used to cause loss of pain sensation and feeling in a designated area of the body, but does not produce the systemic effects associated with severe CNS depression
What is the local anesthetics?
Medications: Amide type- lidocaine
Ester type - tetracine, procaine, chloroprocaine
Trigeminal nerve stimulated → painful neurogenic inflammation → neurogenic vasodilation → inflammation
What is the pathophysiology of migraine headaches?
Tension Headache clinical manifestation is Bilateral, non throbbing head pain, mild to moderate in intensity, pressure, fullness, or band-like
Migraine headache clinical manifestation is unilateral, pulsating pain, moderate to severe in intensity, with 3-4 phases
Which medication is commonly used as an adjuvant for neuropathic pain management due to it ability to stabilize abnormal electrical activity in the brain
What is Gabapentin?
Need to monitor CBC, s/s bone marrow suppression, N/V/D
Binds to receptors in brain spinal cord → blocks pain transmission (and alters perception of and response to pain)
What is the mechanism of action for opioid agonists (e.g. morphine or fentanyl)?
Client states
"Pain is a lot worse when I roll over, but if I lie perfectly still, it's not too bad."
What precipitates or worsens the pain part of the pain assessment?
Vital signs, with close attention to respiratory status (respiratory rate, depth, quality, and SpO2), level of consciousness, level of sensory block and pain level.
What does nursing assessment for anesthetics include?
Nonanalgesic class of adjuvant drugs used to treat nausea and vomiting wit associated with migraine headaches.
What are antiemetic drugs?
Corticosteroid dosage must be tapered when discontinuing therapy and are used to control arthritic flare-ups in severe cases.
What are nursing health teaching plan for patients taking corticosteroids?
CNS depression, respiratory depression, constipation.
What are the adverse effects of opioid agonists?
Non-opioid Analgesics + Weak opioids + Strong opioids
What is the pain analgesic ladder?
Topical Administration, Infiltration, Field Block, Nerve Block, Intravenous Regional Anesthesia
What are methods of administering for local anesthesia?
Topical Cream (EMLA) apply to intact skin 1 hour before routine procedure and 2 hours before intensive procedures - remove dressing prior to procedure and clean skin/site
Allergic Reactions - most likely ester-type agents (procaine/tetracaine) and amide-type less likely tx antihistamines/emergency
L&D-prolong labor d/t decrease in uterine contractility, cross placenta can cause fetal heart rate to drop
Spinal block- HA remain flat for 12 hours post procedure urinary retention monitor urinary output and notify provider if not voided with 8 hours
NSAIDs, serotonin receptor agonists, beta blockers, anticonvulsants, tricyclic antidepressants and estrogens
What are medications used to prevent inflammation and dilation of the intracranial blood vessels relieving migraine pain?
Medications that stop migraine after it starts: NSAIDs and combination anti-inflammatory medications, triptans, and ergot alkaloids.
Prophylactic medication used to prevent migraines beta blockers, anticonvulsants, amitriptyline, and estrogens.
The term used for a med that is not a narcotic but helps with pain, such as muscle relaxers.
What is adjuvants?
The first thing the nurse watches for in a patient on narcotics.
What is sedation?
Might be an objective indicator of pain.
What is vital signs (Increased HR, BP, Resp rate), oxygen saturation may decrease, increased muscle tension and agitaion?
Evidence by bradycardia (HR<60), reduce contractile force/cardio suppression, hypotension and cardiac arrest
What are common complications in spinal anesthesia due to sympathetic block?
Nursing Actions: need to monitor vital signs/ECG, seizures, respiratory depression, maintain IV access for emergency medication administration or IV fluids, and protect the area of numbness from injury
*Antihypertensive medications can have hypotensive
What are complications of medications used to treat migraine?
NSAIDs-bone marrow suppression, GI distress, MI/CVA
Serotonin receptor agonists (triptans) - chest pressure, CAD, dizziness or vertigo
Ergot alkaloids (ergotamine/dihydroergotamine) - N/V, toxicity (muscle pain, tingling, peripheral ischemia), physical dependence (don't take daily), monitor of withdrawal
Beta Blockers (propranolol)- extreme fatigue, depression, asthma exacerbation
Anticonvulsants: divalproex - GI distress N/V/D, indigestion, pancreatitis
Tricyclic antidepressants (amitriptyline) - anticholinergic effects dry mouth, constipation, urinary retention, tachycardia, hypotension, blurred vision
Route of pain med admin which should be avoided in the elderly.
What is intramuscular?
Respiratory depression, constipation, fall/injury prevention, tolerance, and ER vs IR (crush-chew/no-crush no-chew)
What are the nursing implications for opioid agonists?
Delivery system that allows patients to self-administer opioids with minimal risk of overdose.
What is patient-controlled analgesia (PCA)?
Very effective means of IV pain managment. Used for acute pain many times post op. Safety guidelines must be followed carefully. Monitor patient for S & S of sedation and respiratory depression. Continuous pulse ox. Instruct the patient and family that the patient should be the only one pushing the button!
Epinephrine can be added to local anesthetic contraindications
What is contraindicated for use in fingers, nose, other body parts with end arteries?
Epinephrine causes vasoconstriction that leads to decreased perfusion or gangrene
This medication has drug interactions with diltiazem causes additive cardiosuppression effects, diuretics causes additive hypotensive effects and can mask the hypoglycemic effect of insulin and prevent the breakdown of fat in response to hypoglycemia.
What is propranolol, beta blocker?
NSAIDs/ASA/Tylenol - NSAIDs can reduce effectiveness antihypertensives, lasix, thiazide diuretics and oral antidiabetic. Corticosteroids, alcohol and tobacco can increase GI effects. NSAIDs can increase levels of oral anticoagulants and lithium.
Serotonin receptor agonists (triptans)- concurrent use of MAOI (tx depression) can lead to MAOI toxicity and SSRIs + triptans can cause serotonin syndrome (confusion, agitation, hyperthermia, diaphoresis, possible death)
Pain assessment and management needs to be systematic and is best done by using
What is pain scales for assessment and ongoing reassessment?
[Medication] [exact dose] [exact dosing interval] [pain rating indication][p.r.n.]*
Ex: Morphine sulfate 1 mg IV every 6hours for pain level 4-7
What are the requirements for an opioid medication order? (p.r.n. may be as needed or breakthrough order in addition to continuous order)
A state of adaptation that is manifested by a drug class specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
What is physical dependence?