Class 8-Comfort

Question 1

pain is…

Answer 1

-an unpleasant sensory and emotional experience associated with actual or potential tissue damage
-pain is what the person says it is, existing whenever they say it does
-pain is accompanied by suffering

Question 2

scope of the problem

Answer 2

-75 million americans suffer chronic pain annually
-25 million suffer acute pain
-pain costs more than $100 billion each year in medical expenses, lost wages and lost productivity
-inadequate pain relief hastens death (by psychological stress)

Question 3

barriers preventing effective pain relief by health care providers

Answer 3

-poor assessment of pain (under assessed)
-inadequate knowledge of pain management
-biases and judgements regarding pain

Question 4

barriers preventing effective pain relief by patients in pain:

Answer 4

-“I might get addicted”
-opioids should be saved for when it is really needed
-unpleasant side effects
-“I want a shot”

treat pain as soon as pt feels pain

Question 5

look at slide 6

Question 6

the pain process

Answer 6

-transduction: activation of pain receptors (touch something hot)
-transmission: pain sensations sent to higher
-perception: awareness of the characteristics of pain
-pain threshold: lowest intensity of a stimulus that causes you to recognize pain
-modulation: inhibition or modification of pain (pain electrical stimuli comes back down spinal cord; natural response for body to help pain)

Question 7

gate control theory of pain

Answer 7

-describes the transmission of painful stimuli and recognizes a relationship between pain and emotions
-small and large diameter nerve fibers conduct and inhibit pain stimuli toward the brain
-gating mechanism determines the impulses (signals) that reach the brain

Question 8

categories of pain

Answer 8

-duration
-acute (sudden cause; usually has a distinct cause_
-chronic (lasts longer/beyond normal healing period (can be difficult for pts to describe))

Question 9

responses to pain

Answer 9

-physiologic
-behavioral
-affective (psychological; my pain has caused fear, anger, etc)

Question 10

factors affecting pain experience

Answer 10

-family, gender, and age variables (boys don’t cry)
-environment and support people (noise; lack of sleep)
-anxiety and other stressors
-past pain experience

people in and out of room; sense of powerlessness

Question 11

pain assessment is…

Answer 11

asking and believing the patient! (the right questions!)

Question 12

nonverbal pain indicators

Answer 12

-moaning
-crying
-grimacing
-guarded position
-increased VS but not always especially with chronic pain
-reduced social interactions (withdrawal)
-irritability
-difficulty concentrating
-changes in eating and sleeping

Question 13

when should pain be assessed

Answer 13

-at regular intervals (at every shift)
-with each new report of pain
-after each pharmacological and non-pharmacological intervention (every 4 hours to see if intervention worked)
-assess pain and sedation! (how awake are they?)

Question 14

intensity

Answer 14

-FLACC in epic
-1-10 in epic
-baker Wong faces (usually for kids)
-checklist of nonverbal indicators
-PAINAD in epic
-payen behavior pain scale

Question 15

location(s)

Answer 15

-indicate area(s) of pain
-different areas may have different types of pain
-referred pain (move some place?)

Question 16

quality of pain based on source

Answer 16

-somatic
-visceral
-neuropathic
-cutaneous

Question 17

somatic

Answer 17

descriptors: aching, deep, dull, gnawing, throbbing, sharp, stabbing

ex: muscle, tendon, bone injuries

Question 18

visceral

Answer 18

descriptors: cramping, squeezing, pressure (referred to different sites)

ex: gallstones, kidney stones, pancreatitis

Question 19

neuropathic

Answer 19

descriptors: burning, numbness, radiating, shooting, tingling, touch sensitive

ex: herpes zoster, peripheral neuropathy

Question 20

cutaneous

Answer 20

descriptors: superficial, skin or subcutaneous tissue. short with a burning sensation

Question 21

phantom limb pain

Answer 21

painful or non painful usually sensations

Question 22

intractable pain

Answer 22

severe; relentless; no cure; can result in early death

Question 23

what are the patient goals?

Answer 23

-objective measure on a scale
-in terms of function
-ability to perform ADL’S
-ambulate
-to be able to deep breath after surgery

ask about goals
1-3=mild
4-6=moderate
7-10=severe

Question 24

pain assessment is NOT

Answer 24

-relying on changes in vital signs
-deciding a patient does not “look like he is in pain”
-assuming a sleeping patient does not have pain
-knowing how much a procedure or disease should hurt
-assuming a pt will tell you when they are in pain

Question 25

non pharmacologic pain relief measures

Answer 25

-distraction (tv)
-humor
-music
-imagery (guided; meditation)
-relaxation
-cutaneous stimulation (“close gate” to prohibit painful stimuli from reaching brain)
-acupuncture
-hypnosis
-biofeedback
-therapeutic touch
-animal-facilitated therapy

don’t need orders to do

Question 26

look at slide 22

Question 27

terms

Answer 27

-opioids controlled substances
-morphine-considered the gold standard COMMON SIDE EFFECT NAUSEA/VOMITTING; itch
-codeine
-hydromorphone
-methadone
-fentanyl transdermal patches take up to 12 hours to reach effectiveness. is 8-10 time more powerful than morphine

-adjuvant drugs
-anticonvulsants, tricyclic-antidepressants, steroids, anti-anxiety

Question 28

PCA patient controlled anesthesia

Answer 28

-must be alert and able to work the pump
-patient is in charge of the pain control
-morphine, fentanyl, hydromorphone
-iv administration
-maximum dose and lock out settings
-can be used for continuous infusion

Question 29

look at slide 26

Question 30

break through pain

Answer 30

flare up of moderate to severe pain that occurs even when the patient is taking around the clock (etc) mediation (in-between doses of pain meds)

Question 31

physical dependence

Answer 31

the body physiologically adapts to the presence of an opioid and suffers withdrawal symptoms if the opioid is suddenly withdrawn

Question 32

psychological dependence (addiction)

Answer 32

a pattern of compulsive drug use characterized by continued craving for an opioid and the need to use the opioid for effects other than pain relief

Question 33

tolerance

Answer 33

a common physiological result of chronic opioid use, a larger dose of opioid is required to maintain the same level of analgesia (don’t have biases chronic pain is real)

Question 34

placebo

Answer 34

-a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect

-a person unaware of the placebo’s properties may find it to be effective for the relief of pain because of the perception that it will provide comfort and because of belief in the person administering it

-considered to be unethical

Question 35

pain experience in the elderly

Answer 35

-myth: pain is a natural component of the aging process
-fact: pain is often unreported leads to a higher risk for patient experiencing pain
-fact: adverse effects of pain medications are more dramatic in the elderly due to decreased liver and renal function (drugs metabolized and excreted slower)