Wound Pain

Question 1

What is the definition of pain? (International Association for the Study of Pain)

Answer 1

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

Question 2

Are wet-to-dry dressings are the gold standard in clinical practice?

Answer 2

False. They can disrupt tissue healing and cause damage and pain with removal.

Question 3

Is oral pain relief the best option to give a patient before a dressing change?

Answer 3

False.

It is an option but if the patient is having ongoing or significant pain a full pain assessment should be done.

Question 4

Do individuals with diabetic foot ulcers have no sensation in their feet - analgesics are not needed for this population?

Answer 4

False.

While there may be reduced sensation at some sites, there can be heightened or altered sensation (numbness, tingling or burning as compared to traditional pain sensation) at the site of injury.

Question 5

Does ripping off the dressing quickly is the best way to remove a dressing?

Answer 5

False

It can inflict tissue damage and significant pain.

Question 6

Describe the skill «Reading the pain».

Answer 6

Reading the pain means a thorough assessment of the patient and wound, beyond simply the presence or absence of pain.

An expert nurse should recognize the signs and symptoms that can be associated with pain and knowing how to select the appropriate tool to support pain assessment according to the patient.

Question 7

What are the three essential skills required to provide expert pain nursing.

Answer 7

• Reading the pain
• Attending to the pain
• Acknowledging the pain

Question 8

Describe the skill «Attending to the pain»

Answer 8

Nursing interventions should be implemented to control pain with a holistic approach that includes appropriate medications, positioning, distraction and other evidence-based practice.

Question 9

Describe the skill «Acknowledging the pain»

Answer 9

Care should be provided with empathy for the patient’s experience of pain.

Strategies include pacing of interventions, clear communication on the steps of interventions, collaborative conversation on what helps the patient with the pain or aggravates it, and both verbal and non-verbal communication that shows a sensitivity to the patient’s pain experience.

Question 10

What is the gold standard during pain assessment?

Answer 10

Self-report of pain from the patient is the gold standard (or family member if the patient is unable to verbalize).

Question 11

What are the stepwise approach to pain assessment? (American Society of Pain Management Nursing)

Answer 11

1. Attempt to obtain the patient’s self-report of pain: Gold standard. (A simple yes or non = valid self-report)
2. Look for behavioral changes. Use a standardized and valid behavioral pain scale (BPS, CPOT).
3. The family can help to identify pain behaviors.
4. Attempt an intervention for pain relief, reassess pain and document pain scores.

Question 12

Give examples of pharmacological interventions for wound care?

Answer 12

• Premedication prior to dressing change (systemic and topical)
• Certain dressing types

Question 13

What are non-pharmacological interventions for wound care?

Answer 13

• Strategies for debridement
• Frequency of dressing change
• Atraumatic dressing selection to protect peri-wound

Question 14

What are patient-centered concerns for wound care?

Answer 14

• Past pain experience
• Psychological: depression, anxiety, stress
• Patient’s expectation and treatment goals
• Awareness of disease/pain/treatment
• Active patient involvement (coherence)

Question 15

What model is used to conceptualize pain in chronic wounds?

Answer 15

The Chronic Wound Pain Experience

Question 16

Within the Chronic Wound Pain Experience model, what are the three categories?

Answer 16

1. Noncyclic / Incident
2. Cyclic
3. Chronic pain

Question 17

What is noncyclic / incident pain?

Answer 17

A single episode of pain.

Ex: Wound debridement

Question 18

What is cyclic / episodic pain?

Answer 18

Recurrent pain as the results of repeated treatments.

Ex: Regular debridement, dressing changes, turning and repositioning.

Question 19

What is chronic / continuous pain?

Answer 19

Chronic or continuous pain is persistent and occurs without manipulation of the patient or the wound.

Question 20

Interventions for noncyclic wound pain?

Answer 20

• Identify and develop a pain treatment plan for potentially painful procedures.
• Administer topical or local anesthetics
• Consider an operating room procedure under general anesthesia
• Administer opioids and/or nonsteroidal anti-inflammatory drugs before and after procedures.
• Assess and reassess for pain before, during, and after procedures.
• Avoid using wet-to-dry dressings that can cause pain and trauma upon removal.
• Consider alternatives to surgical/sharp debridement, such as transparent dressings.

Question 21

What is the definition of malnutrition?

Answer 21

Malnutrition can be defined as a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue/body form (body shape, size, composition) body function and clinical outcome.

Question 22

What are the categories of etiology malnutrition?

Answer 22

1. Starvation related: Famine, eating disorders
2. Disease related: Chronic state of inflammation
3. Acute disease or injury related

Question 23

Who should screen for nutritional risk?

Answer 23

• ## Any patients with a wound needs to be assessed for nutritional risk.

Question 24

What tools are available for nutritional screening?

Answer 24

• Canadian Nutrition Screening Tool (CNST)
• Mini Nutritional Assessment (MNA)

Question 25

What are the nurse’s role in nutritional interventions?

Answer 25

• Education to support patient’s understanding
• Monitoring patient’s intake and nutritional status over time
• Evaluation of interventions that form part of a holistic care

Question 26

In what order does nutritional support is more adequate for patients?

Answer 26

Optimal when processed by digestive system, preferably taken by mouth.

When not feasible, tube-feeding.

If both are not possible, parenteral nutrition remains an option.

Question 27

What is the role of the amino acid «Arginine»?

Answer 27

Precursor to proline and subsequent collagen formation.

Question 28

What is the role of the amino acid «Glutamine»?

Answer 28

Enhances the function of the immune system.