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From Flashcardlet > MED SURG - Chapter 07 Pain Mgmt > Flashcards

MED SURG - Chapter 07 Pain Mgmt Flashcards

0
Q

A neurologic response to unpleasant stimuli

A

Pain

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1
Q

The proposal that synapses in the dorsal horn of the spinal cord act as gates and that pain signals compete with signals of other kinds of stimuli for passage through the gate and transmission to the brain.

A

gate control theory

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2
Q

True/False:

Receptors for pain become dulled with repeated stimulation

A

False

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3
Q

Repeated stimulation results in an __ in the acuteness of the pain sensation.

A

increase

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4
Q

Pain results from the release of various (1)__ from damaged (2)__.

A
  1. chemicals

2. cells

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5
Q

Aspects of the Gate Control Theory:
Two types of __ __ carry pain stimuli.
1. __
2. __

A

nerve fibers

  1. small diameter
  2. large diameter
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6
Q

Aspects of the Gate Control Theory:

Activity of the __ __ nerve fibers open the gate.

A

small diameter

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7
Q

Aspects of the Gate Control Theory:

Activity in the __ __ nerve fibers close the gate.

A

large diameter

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8
Q

Aspects of the Gate Control Theory:

Massage and Vibration produce activity in the __ __ nerve fibers.

A

large diameter

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9
Q

Aspects of the Gate Control Theory:

High levels of sensory input create __ __ that seem to close the gate.

A

brainstem impulses

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10
Q

Aspects of the Gate Control Theory:

Distraction in the form of (1) or (2) produces brainstem impulses.

A
  1. activity

2. social interaction

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11
Q

Aspects of the Gate Control Theory:

An increase in anxiety seems to (1)__ the gate; and decrease seems to (2)__ the gate

A
  1. open

2. close

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12
Q

Any group of opiate-like peptides naturally produced by the body

A

Endorphins

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13
Q

The human body produces __ that attach to pain receptors and BLOCK PAIN SENSATION.

A

endorphins

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14
Q

The properties of Endorphins seem to:

  1. modify and inhibit __ __
  2. reduce __
  3. relieve __
  4. produce feelings of __
A
  1. unpleasant stimuli
  2. anxiety
  3. pain
  4. euphoria (and well-being)
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15
Q

Two classifications of pain

A
  1. Nociceptive Pain

2. Neuropathic Pain

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16
Q

Pain associated with pain stimuli form either Somatic or Visceral structures

A

Nociceptive Pain

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17
Q

Somatic Nociceptive Pain arises from ___

A

injury to tissue

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18
Q

Nociceptors are found in

A 
skin
connective tissue
bones
joints
muscles
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19
Q

Four Phases associated with Nociceptive Pain:

A
  1. Transduction
  2. Transmission
  3. Perception
  4. Modulation
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20
Q

__ begins when damage causes the release of substances that STIMULATE the nociceptors and INITIATE the sensation of pain

A

Transduction

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21
Q

__ involves movement of the pain sensation to the spinal cord.

A

Trasmission

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22
Q

__ occurs when impulses reach the brain and the PAIN IS RECOGNIZED.

A

Perception

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23
Q

__ occurs when neurons in the brain send signals back down the spinal cord by release of neurotransmitters.

A

Modulation

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24
Q

___ work by BLOCKING the production of the substances that TRIGGER the nociceptors in the Transduction phase

A

NSAIDs

nonsteroidal anti-inflammatory drugs

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25
Q

Opioids interfere with the __ phase.

A

Transmission

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26
Q

Non-pharmacologic treatments (ie. distraction and guided imagery) may be effective during the __ phase.

A

Perception

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27
Q

Drugs that BLOCK NEUROTRANSMITTER UPTAKE work in the __ stage.

A

Modulation

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28
Q

Pain associated with a dysfunction of the nervous system; an abnormality in the processing of sensation

A

Neuropathic Pain

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29
Q

Neuropathic Pain is often associated with (1)__ __ rather than with tissue damage; may occur in the (2)__ or __ __ system.

A
  1. medical conditions

2. peripheral or central nervous

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30
Q

A sensation of discomfort occurring where an extremity has been amputated.

A

Phantom Pain

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31
Q

True/False:

Analgesics and Opioids usually do not relieve neuropathic pain.

A

True

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32
Q

Medications that relieve Neuropathic Pain (4):

A
  1. Adjuvant medications (ie. NSAIDs)
  2. Tricyclic Antidepressants
  3. Anticonvulsants
  4. Corticosteroids
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33
Q

Pain is a (subjective/objective) experience.

A

subjective

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34
Q

That which assists, such as a drug added to a prescription that enhances the action of the principal ingredient

A

Adjuvant

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35
Q

The point at which pain is perceived

A

Pain Threshold

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36
Q

The length of time or intensity at which a person will endure pain before outwardly responding to it

A

Pain Tolerance

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37
Q

Pain Tolerance is influenced by (4):

A
  1. culture
  2. pain experience
  3. expectations
  4. role behaviors
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38
Q

Sharp, severe pain (recent onset, lasting less than 6 months)

A

Acute Pain

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39
Q

Pain of long duration showing little change, or slowly progressive pain

A

Chronic Pain

40
Q

People with Chronic Pain may have learned adaptive methods that allow them to _____.

A

have some control over the pain.

41
Q

Physiologic symptoms of Acute Pain

A 
Pulse+
RR+
BP+
diaphoresis
Muscle Tension+
Nausea & Vomiting
42
Q

Symptoms associated with Chronic Pain:

A

irritability
depression
withdrawal
insomnia

43
Q

The presence of physiologic responses may indicate pain. However, their absence does not prove the absence of pain.

A
44
Q

Learning to accept without judgment, the various ways of coping with and expressing pain is a very necessary process for nurses.

A
45
Q

A person’s __ background influences feelings about pain.

A

cultural

46
Q

Acute Pain: Anxiety and fear are often alleviated by first (1)__, and then (2)__.

A
  1. providing analgesia to relieve pain

2. educating about pain & methods used to control pain

47
Q

Observe (5) to help measure pain:

A
  1. Appearance
  2. Behavior
  3. Activity level
  4. Verbalization
  5. Physiologic Clues
48
Q

Factors that can impair a Pt ability to communicate the degree of pain:

A
  • Limited vocabulary
  • Lack of experience in verbalizing abstract concepts
  • Fear of disbelief or disapproval
  • Culture Stoicism
  • Fear of becoming addicted to analgesic
49
Q

Focused Assessment: The Pt with Pain

A 
Location
Characteristics
Quantity
Pattern
Associated Factors
Alleviating Factors
Aggravating Factors
50
Q

Pain Rating Scales:

(2) must be included in patient care plan

A
  1. Type of scale being used

2. Any pertinent info about how Pt uses the scale

51
Q

(5) Pain Rating Scales

A
  1. Numbered Scale
  2. Visual Scale
  3. Color Scale
  4. Pieces of Pain Scale
  5. Behavioral Pain Scale
52
Q

Pain felt in a part away from its point of origin

A

Referred Pain

53
Q

Goals of Care are (2):

A
  1. RELIEF of pain

2. CONTROL of pain

54
Q

Correctly identify the gate control theory of pain as having what characteristic?

A

Large amount of NON-painful stimuli compete for gate, & pain impulses my be blocked (massage, electrical nerve stimulation)

55
Q

Chronic pain may be a result from the “gate” __ __ at all times.

A

remaining open

56
Q

__ status has no effect on pain perception.

A

Socioeconomic

57
Q

Which physiologic sign indicates Pt is experiencing pain?

a) + RR
b) anxiety
c) BP WNL for Pt
d) + Temperature

A

a) Rapid breathing may indicate Pt is sensing discomfort or pain

58
Q

Anxiety may increase the __ of perceived pain.

A

intensity (but, it does not cause pain)

59
Q

BP changes are a(n) common/uncommon response to pain.

A

common

60
Q

True/False:

Body temperature does not correlate with pain sensation

A

True

61
Q

Most accurate way to assess a Pt’s pain level can be obtained by ____.

A

asking Pt to rate his pain (scale of 1-10) / Pt’s description

62
Q

(1)__ __ sensation is a common phenomenon following amputation. It should be evaluated as (2)__ pain.

A
  1. Phantom limb

2. acute

63
Q

__ pain originates in an area automatically distant from the area it is perceived.

A

Referred

64
Q

__ pain spreads out from the source of the pain.

A

Radiating

65
Q

Psychogenic pain is thought to be of psychological origin.

A
66
Q

Cancer Pt always refuses the offer for pain medication. What might be the cause of his refusal?

A

High pain tolerance

67
Q

Indicates the level of pain that must be present before an individual IS SIGNIFICANTLY AFFECTED BY IT

A

Pain tolerance

68
Q

The level of pain that must be present before an individual PERCEIVES ITS PRESENCE

A

Pain threshold

69
Q

The best pain management is to PREVENT its occurance

A
70
Q

Pt with right total knee replacement returned from PACU. Best time to administer pain medication?

A

on a regularly scheduled basis

71
Q

Narcotic analgesia produces __ __ as an additional effect, especially in larger doses.

A

respiratory depression

72
Q

Which assessment it mor critical prior to administering a narcotic pain medication?

A

Respiratory rate

73
Q

Less than __ __/minute is the general standard for decreasing the dosage or increasing time between doses of narcotic pain medication.

A

8 respirations

74
Q

The fear of uncontrollable pain may _____.

A

increase the intensity of pain.

75
Q

Based on the gate control theory of pain, (1)__ seems to open the gate, which causes (2)__ pain.

A
  1. anxiety

2. increased

76
Q

__ attach to pain receptors and block pain.

A

Endorphins (endogenous morphine)

77
Q

Endorphins aid by reducing (1)__ and (2)__ pain.

A
  1. anxiety

2. reducing

78
Q

True/False:

Debilitated Pts are usually more tolerant and can withstand pain

A

False

79
Q

COPING with a chronic illness/pain expends a great deal of energy. Debilitated Pts tend to be __ able to withstand the pain.

A

LESS ABLE TO WITHSTAND THE PAIN.

80
Q

Fatigue also increases the __ of pain.

A

PERCEPTION

81
Q

Physiologic Symptoms of a Pt experiencing acute pain (5)

A
    • Pulse
    • Respiratory rate
    • Blood pressure
  4. Diaphoresis
    • Muscle tension
82
Q

Managing Pain:

Indication of need for further teaching…

A

“At this time, I should try to maintain my usual aversion to using analgesics”

83
Q

Avoiding the use of analgesics will hamper the Pt’s ability to __ from surgery in a timely manner.

A

RECOVER

84
Q

When a Pt experiences pain felt in a different part of the body from where it actually originates, it is considered __ __.

A

referred pain

85
Q

Referred Pain: The Pt has a neurologic condition that causes __ __ __ __.

A

improper interpretation of pain.

86
Q

Intense pain over an extended period of time is very exhausting, and may lead to a patient falling asleep.

A

Do not assume Pt was seeking attention or drugs, or is no longer in pain.

87
Q

Nurse just administered pain meds to Pt. To prevent complications, which actions should LPN take?

A
  • Document reactions to meds after admin.
  • Record Pt’s use of adjunctive measures
  • Ask Pt to rate pain on pain scale before/after med. given
88
Q

A Pt should only ambulate with assistance after receiving pain medication.

A
89
Q

The person who has pain is the ONE TO DECIDE if he/she is willing to tolerate it.

A

There does not have to be an obvious reason for the Pt to experience pain.

90
Q

Analgesia for neonates is appropriate/inappropriate during procedures or situations that would be known to cause pain in more mature Pts.

A

appropriate (Neonates perceive pain)

91
Q

When administering analgesics to elderly Pts, nurse must carefully monitor __ __ __.

A

for side effects.

92
Q

Elderly Patients: May have __ __ to analgesics.

A 
reduced tolerance
(they often require lower dose of pain medication)
93
Q

PCA Administration:

Indicates need for further teaching

A

“I will have set times at which I can give certain quantities of medications.”

94
Q

Pt receiving epidural analgesia should be monitored for which side effect?

A

Urinary retention

95
Q

Possible side effects from Epidural Analgesia (6):

A
  1. delayed respiratory suppression or apnea
  2. bradycardia
  3. hypotension
  4. urinary retention
  5. nausea and vomiting
  6. allergic reactions
96
Q

Narcotics (such as codeine) *slow peristalsis, causing *water to be absorbed from stool in colon. This leads to __.

A

constipation

97
Q

Narcotic Antagonist medication that can be given IM or IV

A

Naloxone (Narcan)

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