Ramandeep is an active 23-year-old. She works as a part-time nurse during the day and is studying for a postgraduate certificate in the evening
Ramandeep started to wear a bite plate at night after she began to experience jaw pain and headaches. Sometimes the pain radiated to her ear, and she would apply a hot water bottle to it to ease the discomfort. It was not until her husband mentioned to her that he heard her grinding her teeth at night while she was sleeping. She knew then that her headaches might be from temporomandibular joint syndrome, and she went to her dentist to confirm her thoughts. In addition to the bite plate, the dentist also recommended she should continue with the application of heat, use NSAIDs when needed, and incorporate regular relaxation exercises throughout her stressful days.
What effect does heat have on nociceptors so that it makes a good nonpharmacologic treatment for pain?
Heat and cold treatment are both hypothesized to have an effect on the release of endogenous opioids. What are these chemicals, and why are they hypothesized to be beneficial in the body?
Using your knowledge of physiology, how do NSAID analgesics function in the management of pain?
The application of heat causes local vasodilation and therefore reduces tissue ischemia. By improving circulation, heat also speeds the removal of inflammatory mediators and metabolites. Finally, heat reduces local swelling. Collectively, the reduction of ischemia, chemical irritants, and local swelling all decrease nociceptive stimulation and therefore the sensation of pain.
Endogenous opioids appear to act as neurotransmitters. Their exact function is not known, but there is speculation they block the calcium channels found in primary afferent neurons and the neurons of the dorsal root and trigeminal ganglia. The transmission of pain impulses is inhibited by their action because the blocking of calcium channels halt neurotransmitter release at the synaptic bulbs. Current research is addressing the possible effect opioids also have on sodium and potassium channels in the modulation of pain signals.
NSAIDs inhibit cyclooxygenase (COX) enzymes, which act to mediate the production of prostaglandins in the body. Prostaglandins (in particular, E2) sensitize nociceptors to chemical mediators and therefore catalyze pain sensations. NSAIDs decrease the sensitivity of blood vessels to chemical mediators and reverse the vasodilatation seen as part of the inflammatory process. They also inhibit the release of inflammatory mediators from granulocytes. NSAIDs therefore have a powerful affect on limiting inflammatory processes and decreasing the sensation of pain.
You might also like to view...
A nurse is working with a client who has been under a great deal of stress recently. Which nursing recommendations would be most helpful when assisting the client in coping with stress? Select all that apply
A) Enjoying a pet B) Spending time with a loved one C) Listening to music D) Focusing on the stressors
On assessing a young adult client who is admitted after a suicide attempt and also has a habitual drug-abuse problem, you note that this client is agitated, restless, and sweating, and has obviously begun withdrawal
You note that the client refused medication when the staff tried to administer it in the emergency department. Under the circumstances, what is the next thing you will do? a. Explain to the client that he or she must take the medication because the provider ordered it. b. Make sure the room is quiet with subdued lighting and that there are blankets if needed. c. Talk with the client about the impending discomfort and potential hazards of withdrawal. d. Get an order for restraints so the client will be protected and you can administer the medication.
What does the nurse recognize as the most dangerous adverse effect of inhalation anesthesia?
1. Hypertension 2. Ventricular tachycardia 3. Malignant hyperthermia 4. Increased intracranial pressure
The physician ordered amiodarone 75 mg IV stat. What is the amount to administer?
A. 1.5 mL B. 2 mL C. 2.5 mL D. 1 mL