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ATI > ATI SKILLS-PAIN MANAGEMENT > Flashcards

ATI SKILLS-PAIN MANAGEMENT Flashcards

1
Q

Medication Tolerance

Definition

A

Reduced reaction to a medication when it has been taken over a period of time.

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2
Q

There are objective and universally applicable ways to confirm the existence of pain

True or False

A

False

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3
Q

Pain occurs on a regular schedule when analgesics are due to be administered.

TRUE OR FALSE

A

False

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4
Q

Pain

definition

A

an unpleasant experience associated with tissue injury and with emotional and sensory perceptual components

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5
Q

What blurs the lines as to the definition of pain?

A

Factors at play such as individual perception, communication, and endurance.

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6
Q

Analgesics

definition

A

Medications that reduce or relieve pain, including OTC and Rx Medications

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7
Q

What factors affect a client’s pain response and how they communicate the pain?

A

physical, emotional, cognitive, developmental, and cultural aspects

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8
Q

pain threshold

definition

A

the point at which a person perceives pain

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9
Q

pain tolerance

definition

A

the level of pain a person is willing to endure

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10
Q

What is the most reliable indicator of the presence and intensity of pain

A

the client’s self report

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11
Q

nociception

definition

A

incorporation of the physiologic processes associated with pain perception

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12
Q

What are the physiologic processes associated with pain perception

A

transduction
transmission
perception
modulation

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13
Q

transduction

definition

A

sensory neurons detect tissue damage through neurotransmitter sensitization of nociceptors

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14
Q

NSAIDs

definition

A

pain medications that work in the transduction process by blocking the production of substances at the site of injury, such as prostaglandin

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15
Q

Transmission

definition

A

a pain impulse is transmitted from the peripheral nerves to the spinal cord, brainstem, thalamus, and finally to the somatic sensory cortex where the impulse is perceived as pain

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16
Q

what medications are used to inhibit the pain transmission process

A

opioids

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17
Q

opioid

definition

A

naturally occurring or synthetic compounds that bind to opioids receptors of the central nervous system, usually used as analgesic agents

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18
Q

perception

definition

A

a person’s conscious awareness of the pain perception

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19
Q

what nonpharmacological interventions can be used to reduce the perception of pain

A

distraction
guided imagery
music therapy

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20
Q

modulation

definition

A

pain is modulated as descending regulatory mechanisms help prevent continuous transmission of pain signals

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21
Q

what medications are used to modulate pain and how do they do this

A

adjuvant medications such as tricyclic antidepressants by promoting reuptake of endorphins

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22
Q

What is the gate control theory

A

suggestion that pain varies with the balance between the non-nociceptive information traveling to the spinal cord through large nerve fibers and the nociceptive info traveling to the spinal cord through small nerve fibers.

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23
Q

in the gate control theory, what should happen if the large nerve fibers are more active than the small nerve fibers

A

the person should have little to no pain

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24
Q

how is the gate opened in the gate control theory

A

when there is more activity in the small nerve fibers, those nerve fibers activate projector neurons and block the inhibitory neurons

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25
Q

pain by duration is what

A

acute or chronic

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26
Q

acute pain

A
  • is of a protective nature
  • identifiable cause
  • recent onset
  • tissue injury
  • short duration
  • resolves as damaged tissue heals
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27
Q

what does acute pain trigger

A

a sympathetic nervous response with increases in hr, rr, and bp. also see diaphoresis, pallor, dry mouth, restlessness, nausea, anxiety, and interuption of normal physiologic processes.

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28
Q

chronic pain

A
  • constant or intermittent
  • 3+ months in duration
  • sometimes no cause/explanation
  • sometimes the cause is chronic (cancer)
  • interferes with functioning
  • stabilized vs during early stages
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29
Q

psychologic results of chronic pain

A

client becomes discouraged, depressed, and withdrawn. some become suicidal.

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30
Q

physiological responses to chronic pain

A

pain reducing substances like endorphins become depleted. pain signals are processed more expediently thus potentiating the painful stimulus. pain experiences stored in the cerebral cortex increasing the clients response to pain

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31
Q

pain by etiology

A

cancer pain
burn pain

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32
Q

cancer pain

A
  • not all clients with cancer experience pain
  • often cannot find relief
  • usually due to tumor progression
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33
Q

burn pain

A
  • one of the most severe acute pains
  • inflammatory response makes pain intense with any manipulation of the injry
  • pain management must be dynamic as the character of the pain shifts over course of recovery.
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34
Q

pain by pathology

A

nociceptive pain
neuropathic pain

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35
Q

nociceptive pain

A

pain that arises from damage to or inflammation of tissues other than that of the peripheral and central nervous system

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36
Q

types of nociceptive pain

A

somatic (musculoskeletal)
visceral (internal organ)

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37
Q

neuropathic pain

A

arises from abnormal or damaged pain nerves. often described as burning, tingling, numbness, or shooting down an arm/leg. Responds poorly to analgesics like opioids or nsaids.

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38
Q

how to treat neuropathic pain

A

anticonvulsants
antidepressants
local anesthetics

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39
Q

idiopathic pain

A

chronic pain that persists in the absence of a detectable cause
ex. phantom pain

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40
Q

referred pain

A

originates in one place but is felt in another location far from the pain’s origin
ex. gall bladder pain being felt under the right shoulder pain

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41
Q

radiating pain

A

perceived at the source and in tissues that are adjacent to the source

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42
Q

intractable pain

A

defies relief like with advanced malignancies

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43
Q

ethnic background and cultural effects on pain

A
  • pain can be viewed as a negative experience (keep to themselves)
  • expressing pain can bring dishonor to the individual/family
  • can be part of ritualistic practices- may be taught that being stoic is a sign of strength
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44
Q

guiding principles in pain management in relation to culture

A
  • use assessment tools appropriate to clients primary language
  • be sensitive to the meaning of pain in their culture
  • avoid stereotyping
  • encourage client to tell their stories about pain
  • don’t allow your beliefs to influence
  • explore fold remedies
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45
Q

pain in infants

A
  • cannot verbalize the specifics
  • respond by crying or withdrawing
  • behavioral observation is recommended way to assess
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46
Q

toddler and pain

A
  • most can describe location and intensity
  • often express by crying or anger
  • view pain as threat to their securities
  • may associate pain with punishment
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47
Q

pain in school aged children and adolescents

A
  • may view expression as a weakness or lack of bravery
  • tendency not to acknowledge right away
  • might try to rationalize pain
  • if in persisten pain, often tend to regress to an earlier stage of development
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48
Q

pain in adults

A
  • influenced by how they learned to express pain as a child
  • often reluctant to express pain because it symbolizes weakness
  • may not express because there is a fear of something wrong with their body, afraid of treatment, afraid of required lifestyle changes
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49
Q

pain in the elderly

A
  • may not express if afraid of losing their independence
  • some believe pain is a part of the aging process
  • impaired perception of pain
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50
Q

gender expectations regarding pain

A
  • males are told to be brave and tough and tolerate pain making them afraid to express
  • females taught that showing pain or crying when hurt is acceptable
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51
Q

why is pain control important

A

improved pain control allows the client to get up sooner, breathe deeper which prevent a variety of complications like pneumonia or thromboembolism

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52
Q

how do you effectively manage pain

A

assess, understand, and treat the pain and then reassess on an ongoing basis. every client has a right to pain assessment and treatment

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53
Q

when do iv medications peak

A

within 30 minutes

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54
Q

when do oral medications peak

A

within 1 hour

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55
Q

if the client has pain, what do we need to find out

A

intensity, quality, location, timing, onset, duration, frequency, symptoms, treatment, effects on ADLs

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56
Q

PQRST

A
  • provoked- cause/better/worse
  • quality- what does it feel like
  • region/radiation- where/local/spreading
  • severity- pain scale
  • timing- start/frequency/ intermittent/continuous
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57
Q

numeric rating scale (NRS)

A

0-10
0-no pain
1-3 mild
4-6 moderate
7-10 severe

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58
Q

Visual Analog Scale
VAS

A

no numbers, but client rates from none to worst possible. suitable with older children and adults. point to a number line with no numbers

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59
Q

image or pictorial scale

A

presents a series of faces
great for young children, those with cognitive difficulties, or those that do not speak the same language

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60
Q

FACES pain rating scale

A

AKA Wong Baker scale
6 cartoon like drawings
pictorial scale type

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61
Q

oucher pain scale

A

another pictorial scale
facial expressions from neutral to extremely distressed
available in several ethnic variations

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62
Q

assessment of pain when a client cannot communicate

A
  • see if diagnosis usually causes pain (objective data)
  • assess for possible causes
  • look for behavior that indicates pain (objective data)
  • other behaviors that indicate pain like combativeness or refusing care (objective data)
  • ask opinions of family members (subjective, second party data)
  • check for physiologic responses like elevated hr or rr (objective data) just remember pain can continue in the absence of vs changes
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63
Q

considerations for pain asessment in infants and children

A
  • must assess frequently
  • parents expect pain will be prevented and treated quickly.
  • unrelenting crying can be associated with abuse
  • assessment can be challenging
  • parents know their child best
  • providing care can cause them pain like vaccines and taking blood samples
64
Q

what are the long term consequences of pain in infancy

A

neurological development, pain sensitivity, emotional and behavioral development and learning

65
Q

CRIES pain scale

A

uses score of 0-2 in five categories for infants
* crying
* increase in oxygen requirement from baseline
* increase in vital signs from baseline
* expression on face
* sleeping

66
Q

FLACC pain scale

A
  • ages 2 months to 7 years
  • used when child cannot express pain verbally
  • 0-2 in each category
  • parents can use
  • facial expression
  • leg movement
  • activity
  • crying
  • consolability
67
Q

what is the most important info when assessing a child for pain

A

what the child tells you if they can communicate verbally. if not, use a behavioral or other tool appropriate to development and communication abilities

68
Q

at what age can a child generally rate their pain

A

3 years and older

69
Q

what are behavioral changes that indicate a child is in pain

A
  • activity level, appearance, behavior, and vs
  • remember language, ethnic background and culture can affect how the child expresses pain
70
Q

bias in assessment of pain

A
  • must be free of biac, preconceived notions, and misconceptions about pain and pain relief
71
Q

myths about clients who have a history of substance use disorder

things that are NOT true

A
  • are already self medicated
  • do not require analgesia
  • tend to overreact/exaggerate
  • are drug seekers
  • are not truthful about perception of pain
72
Q

other myths regarding pain

A
  • administering analgesics/opioids will lead to addiction
  • clients with minor issues have less pain than those who have major alterations
  • hospitalized clients should expect to have pain
  • chronic pain is psychological
  • if they don’t complain, they don’t have pain
  • if unconscious/asleep, they do not have pain
73
Q

myths about pain
(continued)

A
  • infants/newborns do not feel pain
  • those with dementia cannot feel pain
  • Tx is not necessary if they have cognitive impairment
  • irreversible/uncontrolled pain is a part of aging
  • exaggerated reports of pain are common among those over 65
  • strong analgesics should not be used for older adults
74
Q

what kind of relationship should we develop with clients and why

as applicable to pain

A

a therapeutic relationship that incorporates teaching and encouraging them to report pain early. you want them to tell you before the pain goes beyond the mild stages so you can offer interventions and avoid progression

75
Q

clients have the right to expect their health care team will

A
  • be committed to preventing/managing their pain
  • share info with them about pain and pain relief
  • respect their reports of pain and respond appropriately
  • consult with pain management experts
76
Q

client responsibilities regarding pain management

A
  • ask for pain relief sooner rather than later
  • work with hc team to develop pain management plan
  • help the hc team evaluate pain and effectiveness of interventions
  • share info/concerns they have about pain meds
77
Q

basic essential for guiding pain management

A
  • always believe the client
  • the client is entitled to adequate pain relief (basic hum and legal right)
  • pain is an urgent situation
  • base interventions on the clients pain relief goals
  • use analgesics as prescribed
  • incorporate alternative therapies when possible
  • work with other hc team members
  • evaluate effectiveness
  • prevent/minimize side/adverse effects of analgesia
  • educcate client and family about pain and pain management
78
Q

titration

definition

A

increasing/decreasing amounts of pharmaceutical agents to determine a therapeutic level or effect

79
Q

what does the joint commission require documentation of in regards to pain

A

regular pain assessment
all pain management interventions
reassessment of the response to interventions

80
Q

how should nonpharmacological interventions be viewed in pain mangement

A

as approches to pain relief that increase the effectiveness of analgesic meds. they should work together

81
Q

examples of nonpharmacological interventions

A

relaxation
distraction
cutaneous stimulation like thermal therapies, massage, accupressure, transcutaneous electrical nerve stimulation (tens)
guided imagery
hypnosis
biofeedback
music therapy
exercise
control the environment

82
Q

progressive muscle relaxation

A

systematic approach to release tension in major muscle groups.
technique to relieve tension by contracting and relaxing particular muscles

83
Q

cutaneous stimulation

A

techniques that refocus clients attention on tactile stimuli rather than painful sensations. skin triggers release of endorphins.

84
Q

equipment for providing a massage

A

lotion/lubricant
towel
ppe

85
Q

sequence for providing a massage

A
  • check emr for contraindications
  • provide analgesia if needed
  • hand hygiene, id client, explain procedure
  • lotion/lubricant in warm water or warm it in hands
  • apply ppe
  • observe for reddened skin or lesions
  • use smooth strokes and various strokes based on client preference
  • dry the skin
  • remove ppe, hand hygiene
  • reposition client
  • document
86
Q

transcutaneous electrical nerve stimulation (TENS)

A

delivers mild electric current over painful region via electrodes applied to the skin to reduce pain perception

87
Q

biofeedback

A

involves collecting data about physiologica responses of the autonomic nervous system to varaious thoughts, feelings and stimuli like temp, muscle tension, and brain waves. helps learn how to adjust and control body responses.

88
Q

nontradition pain therapies

A

herbal remedies, therapeutic touch, chelation, reflexology, magnetic therapy, and homeopathy

89
Q

complementary therapies

A

treatment approaches used to complement conventional medical Tx

90
Q

three categories of meds to manage pain

A

nonopioids
opioids
adjuvents

91
Q

nonopioids

A

do not contain narcotics

92
Q

physical dependence

A

adaptive state characterized by a medication class specific withdrawal syndrome induced with abrupt cessation, rapid dose reduction, or administration of an antagonist

93
Q

WHO’s analgesic ladder for treatment of pain

A
  • step 1: non opioid- +/- adjuvant
  • step 2: opioid for moderate pain +/- non opioid +/- adjuvant
  • step 3: opioid for moderate to severe pain +/- non opioid +/- adjuvant
94
Q

acetaminophen indications

A

minor aches and pains
fever

95
Q

acetaminophen adverse reactions

A

rare
liver injury from overdose

96
Q

ibuprofen indications

A

mild to moderate pain
arthritis
menstrual pain
fever

97
Q

ibuprofen adverse effects

A

gastrointestinal upset
bleeding

98
Q

aspirin indications

A

headache
mild pain
inflammation
fever
in low doses –> supresses platelet aggregation

99
Q

aspirin adverse effects

A

gastrointestinal upset
bleeding
renal impairment with excessive use

100
Q

ketorolac indications

A

moderate to severe pain
short term use only

101
Q

ketorolac adverse effects

A

gi upset
bleeding
renal impairment

102
Q

celecoxib indications

A

arthritis
acute pain
menstrual pain

103
Q

celecoxib adverse effects

A

gi upset
abdominal pain
possible cardiovascular effects

104
Q

nonopioid medications examples

A

acetaminophen
ibuprofen
aspirin
ketorolac
celecoxib

105
Q

adjuvant medication examples

A

anticonvulsants
antidepressants
corticosteroids

106
Q

anticonvulsant examples

A

carbamazepine
clonazepam
gabapentin

107
Q

anticonvulsants considerations

A

used for chronic neuropathic pain. requires monitoring of blood levels and titration. may require trials to determine the best choice with the fewest adverse effects

108
Q

antidepressants examples

A

duloxetine
amitriptyline

109
Q

antidepressants considerations

A

used for chronic neuropathic pain
may require trials to determine best choice with fewest adverse effects

110
Q

corticosteroids examples

A

dexamethasone
prednisone

111
Q

corticosteroids considerations

A

used for anti inflammatory effect. cannot be given simultaneously with NSAIDs

112
Q

opioids for moderate to severe pain

A

morphine
butorphanol
oxycodone

113
Q

opioids for cough and mild to moderate pain

A

codeine

114
Q

opioids for moderate pain

A

hyydrocodone

115
Q

opioids for severe pain

A

hydromorphone
fentanyl

116
Q

mild pain

A
  • 0-3 rating
  • treated with nonopioid meds
  • have analgesic ceiling
117
Q

analgesic ceiling

A

the point at which the medication has reached its peak effect and additional amounts of the same medication will have no additional effect

118
Q

mild to moderate pain

A
  • 4-6 rating
  • combo of nonopioid and opioid meds with adjuvant prn like acetaminophen and hydrocodone
119
Q

difference in nonopioids and opioids on Tx of pain

A

nonopioids act locally to reduce pain and inflammation while opioids act on higher centers of the brain and spinal cord to modify perceptions of pain

120
Q

severe pain

A
  • 7-10 rating
  • treated with opioids plus adjuvants prn
121
Q

opioid monitoring

A
  • given in scheduled doses
  • can cause serious adverse effects like respiratory depression
  • diligent monitoring is crucial
122
Q

route of analgesic administration

A
  • oral is preferred
  • if need for immediate relief or for the dose to be titrated, may be prescribed intravenous
  • intramuscular
123
Q

patient controlled analgesia (pca)

A

medication delivery system that uses a computerized pump with a button that the client can press to deliver a dose through the iv catheter

124
Q

intramuscular route of analgesic administration

A
  • least preferable
  • erratic absorption
  • risk of tissue damage
  • espcially avoided in children
  • for clients who cannot swallow but do not need iv dosing
125
Q

scheduling of analgesic administration

A
  • prn is acceptable for intermittent pain
  • continuous or chonic pain indicates around the clock dosing
  • bolus dosing is preferable to clients who have breakthrough pain
126
Q

breakthrough pain

A

pain that occurs when pain has previously been reduced to a tolerable level. often occurs when previous dose is wearing off

127
Q

adverse effects of analgesics

A
  • better to prevent or treat adverse effects if the client is receiving adequate pain relief
  • constipation- stool softeners
  • nausea- antiemetics
128
Q

opioid induced respiratory depression

A
  • follow facility protocols
  • improve oxygenation
  • stimulate respiration
  • initiate opioid reversal
  • summon the rapid response team for aggressive intervention
129
Q

opioid reversal

A

unless severe, want to administer naloxone in low doses as prescribed to improve respiration without negating the analgesic effect

130
Q

clients who are tolerant or dependent on opioid meds or alcohol might need what

A

higher than usual doses of some meds

131
Q

tolerance

A

develops as physiological response to the med decreases after repeated admin. happens if taking the same med or related substance consistently over a period of time. ex: opioids and barbiturates

132
Q

dependence

A

developing when a client needs a substance to function. different from tolerance. stopping substance abruptly causes withdrawal symptoms like irritability, n&v, abdominal cramping, delirium, muscle twitching, sweating and convulsions. take a long time to develop

133
Q

addiction

A

compulsive, inappropriate use of a substance. tolerance and dependence are physical responses to prolonged med use. chemical changes in brain result in strong cravings compelling the purseon to use despite knowing the negative consequences

134
Q

fear of addiction

A

clients experiencing acute pain are afraid of opioids because they don’t want to become addicted but addiction is unlikely when pain meds are used appropriately

135
Q

effects of unrelieved pain

A
  • stresses many body systems
  • endocrine and cv systems increase activity
  • metabolism speed up
  • respiratory, gi, and gu systems decrease
  • musculoskeletal system becomes erratic
  • mobility and immune system become depressed
136
Q

unrelieved acute pain can lead to what

A

chronic pain. both reduce quality of life. those who cannot sleep, eat, or experience life without pain may experience worsening hopelessness

137
Q

special strategies for pain management in pediatrics

A
  • breastfeeding or admin of sucrose/glucose after injections
  • comfort hold
  • distraction/deep breathing
138
Q

should i be concerned about admin analgesics to clients with Hx of substance use disorder

A

no. it is a common fear and barrier to pain management. Tx as perscribed. assessment should be complete and documented. it is not your responsibility to prevent people seeking health care to obtain meds

139
Q

what if i do not believe a client is hurting

A

you can’t feel what they feel or hold them to your beliefs. everyone expresses pain differently.

140
Q

what if a client stops breathing because i administered pain meds

A

sedation occurs before respiratory depression so respiratory compromise is preventable. monitor carefully. start low and go slow.

141
Q

naloxone

A

antidote or opioid antagonist that can quickly reverse the effects of opioids

142
Q

can massage help clients pain

A

yes. it relaxes and trigger release of endorphins.

143
Q

is a pain goal of 5 acceptable

A

no. pain ratings greater than 3 indicate moderate to sever pain. pain increases stress and reduces immune system function

144
Q

if a client needs more opioids to manage pain, should i be concerned about addiction

A

no. tolerance to opioids develops over time. the client might need higher doses. tolerance is not addiction

145
Q

if a clients pain does not seem to be relieved with various interventions, would it be okay to ask for a placebo

A

no. experts discourage this. it is deceptive and unethical

146
Q

placebo

A

substances or treatments that produce an effect in some people that is unrelated to the Tx specific properties

147
Q

how can i provide pain relief when im already to busy

A

helping manage pain will help you manage client care more effectively reducing nursing care needs

148
Q

if the client is breathing 10x/min, should i stop pain meds and give naloxone

A

wake the client
count rr again
if they arouse easily and talks clearly, continue monitoring
if difficult to stimulate give naloxone as prescribed with caution

149
Q

what is the initial recommended dose of naloxone

A

0.4 iv push undiluted over 2 minutes. repeat 2-3 minutes prn. naloxone may be given iv infusion. it wears off more quickly than opioid so must continue to monitor

150
Q

a nurse is caring for 2 clients who are 2 hr postoperative following the same procedure. which factor should the nurse expect to be similar for both clients
a. perception of intensity of pain
b. prescriptions containing guidelines for pain med admin
c. goal of pain management for each client
d. level of pain indicated by each client on a numeric pain scale

A

b

151
Q

a nurse is preparing to asses the pain level of a 4 yr old child. which of the following pain assessment tools should the nurse use
a. cries instrument
b. comfort behavior scale
c. faces
d. painad scale

A

c

152
Q

a nurse is speaking with a client who reports experiencing frequent, severe migraines and asks if you can tell them about biofeedback. which is the correct response?
a. it measures skin tension and uses learned techniques to relieve pain
b. provides soothing visual images id by the client to promote relaxation
c. it includes listening to an increasing volume of music until the pain subsides
d. stimulates the skin with a mild electric current when pain occurs

A

a

153
Q

a nurse is planning to admin a dose of morphine sulfate iv for a client who is postoperative. which protocol should the nurse use?
a. withold the med for a rr of 14/min
b. perform iv injection over 1 minute
c. avoid admin of opioid agonists on a fixed schedule
d. have opioid antagonist available during admin

A

d

154
Q

a nurse is caring for a client prescribe iv morphine via pca with a demand of 1 mg/15 min and a 4 mg/hr lockout. client reports unbearable pain after attempting 6 demand doses within 1 hr. after assessing pain, which action should the nurse take
a. check iv site and pca pump for proper functioning
b. teach the client proper use of pca system
c. ask provider to increase the morphine dose and shorten the interval between doses
d. encourage family to admin a dose of morphine via pca when the client is in too much pain to do it themselves

A

a

155
Q

during a pain assessment, a nurse asks questions about the quality of an adult clients pain. which statement by the client refers to pain quality
a. the pain began last night and has gotten worse
b. pain is at a 9 on a 0-10 scale
c. pain feels like being stabbed by a knife
d. pain is worse when bending over at waist

A

c

156
Q

a nurse is caring for a client admitted to the ed for severe pain following fall from a ladder. client reports taking opioid Rx for chronic pain. Which of the provider Rx for inital pain relief should the nurse question
a. morphine sulfate
b. naloxone
c. fentanyl
d. hydromorphone

A

b

it is not appropriate because it can cause severe opioid withdrawal in a client who is physically dependent on opioids

157
Q
A

ATI (10 decks)

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