Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 205 > Lecture 9: Pain assessment and Management > Flashcards

Lecture 9: Pain assessment and Management Flashcards

1
Q

who has the highest prevalence of persistent pain

A

indigenous people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

consequences of untreated pain

A
  • unnecessary suffering
  • physical dysfunction and psychosocial distress
  • impaired recovery from acute illness and surgery
  • immunosuppression
  • sleep disturbances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is addiction

A

complex neurobiological condition that is a drive to obtain and take substances for other than the prescribed therapeutic value

  • opioid addiction in acute care clients w no history of substance abuse is <1%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why is pain undertreated (among healthcare providers)

A
  • if pt’s pain doesn’t seem as severe as it appears or pt is not reporting pain - can be a result of a bad assessment.
  • or pt has an addiction
  • bad assessment
  • misconception
  • not reporting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

why is pain undertreated (among pt)

A
  • fear of addiction
  • beliefs and attitudes regarding pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

drug tolerance

A

need for an increased dose to maintain same degree of pain control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what can be confused with addiction

A
  • drug tolerance
  • physical dependence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is physical dependence

A

physiological response to ongoing exposure to pharmacological agents that is manifested by a withdrawal syndrome that occurs when drug is abruptly stopped
- drug should be tapered off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some withdrawal sympt, how long can they last w opioids

A

muscle pain, sweating, diarrhea, vomiting, abdominal cramps, chills, anxiety, insomnia, tremor

can last for 3-10 days w immediate release opioids; 10-20 days with controlled-release or slow-release opioids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the relationship btwn tolerance, physical dependence and addiction

A

tolerance and physical dependence are not indicators of addiction, but result from chronic exposure to certain drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the most serious side effect of opioids

A

respiratory depression is the most serious side effect of opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what reverses the resp effect of opioids

A

narcan (naloxone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is a common concern about providing drug to relieve pain

A

will participate the death of a terminally ill person
- rule of double effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the rule of double effect

A

if an unwanted consequence occurs as a result of an action taken to achieve a moral good (i.e. pain relief), the action is justified bc the nurse’s intent is to relieve pain and not hasten death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the dimensions of pain

A
  1. physiological
  2. affective
  3. behaviours
  4. sensory
  5. cognitive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

nociception

A

physiological process that communicates tissue damage to the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the mechanisms by which pain is perceived

A
  • transduction (stim cause cell damage with release of sensitizing chemicals, substances activate nociceptors and lead to generation of action potential)
  • transmission (action potential continues site of injury to spinal cord, etc)
  • perception (conscious experience of pain)
  • modulation (neurons originating in the brainstem descend to the spinal cord and release substances that inhibit nociceptive impulses)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the sensory-pain elements

A

Pattern
Area
Intensity
Nature

19
Q

emotional response to pain experience

A

anger
fear
depression
anxiety

20
Q

3 dimensions of pain

A
  1. Behavioural
  2. Cognitive
  3. Sociocultural
21
Q

Classification of Pain

A

By underlying pathology
- nociceptive pain
- neuropathic pain

By temporal nature
- acute
- persistent/chronic

22
Q

what is nociceptive pain?
+ 2 types

A

caused by damage to tissue

  1. somatic pain: from bone, joint, muscle, skin or connective tissue. usually aching and throbbing, well localized.
  2. visceral pain: arises from internal organs. tumor involvement (aching and well localized). obstruction of hollow organ: intermittent cramping and poorly localized)
23
Q

neuropathic pain

A
  • damage to nerve cells or changes in spinal cord processing
  • described as burning, shooting, stabbing, or electrical in nature
  • can be sudden, intense, short-lived
  • management: opioids, anticonvulsants and antidepressants
24
Q

acute pain

A
  • sudden onset
  • mild to severe
  • within normal time for healing
  • manifestations reflect SNS activation
  • treatment goal: pain control w eventual elimination
25
Q

persistant/chronic pain

A
  • gradual or sudden onset
  • mild to severe
  • can start as an acute injury
26
Q

1st principal of pain assessment

A

screen for pain
“5th vital sign”

27
Q

sensory pain assessment components

A

Pattern: onset, duration
Area: location, radiation
Intensity: severity
Nature: quality or characteristics

28
Q

what is breakthrough pain

A

moderate to severe pain that occurs despite treatment

29
Q

allodynia

A

pain due to a stim that does not normally provoke pain

30
Q

hyperalgesia

A

increased pain from a stim that normally provokes pain

31
Q

what is the treatment of pain for older persons

A
  • “start low and go slow” is applied to analgesic therapy
  • use of NSAIDS in elderly associated w high frequency of GI bleeding
  • dangerous drug interactions on multiple drugs
  • alterations in cardiac output and renal and hepatic clearance may change drug plasma concentration and duration of action
  • cognitive impairment and ataxia may be exacerbated
32
Q

what’s the best approach to addressing all dimensions of pain

A

multidisciplinary approach

33
Q

med therapy: what is the nurse’s role

A
  • selecting from the prescribed analgesic drugs
  • monitoring and managing medication side effects
  • calculating equianalgesic dose
  • scheduling analgesic doses
  • titrating opioids
34
Q

analgesis ladder

A
  • systematic plan for using analgesic drugs
  • one system widely used
  • made by World Health Organization

3 step approach:
1. nonopioid
2. opioid for mild to moderate pain
3. opioid for moderate to severe pain

35
Q

step 1 drugs

A
  • mild pain
  • 1-3 on a scale of 0-10
  • non-opioid analgesics (tylenol, aspirin, NSAIDs)
36
Q

step 2 drugs

A
  • mild to moderate pain
    (4 to 6 on a scale of 0-10)
  • mild but persistent unlike non-opioid therapy
  • morphine like agonists (codeine, oxycodone, tramadol)
  • mixed agonist-antagonist (pentazocine (talwin), butorphanol (NOT recommended)
37
Q

step 3 drugs

A
  • moderate to severe pain
    (4-10 on a scale of 0-10)
  • step 2 drugs do not produce effective pain relief
  • morphine
  • morphinelike agonists
    (hydromorphone, fentanyl, meperidine)
  • potent, no analgesic ceiling, can be delivered via many routes
38
Q

codeine considerations

A
  • requires conversion to active metabolites to have any analgesic effect
  • 3-10% of caucasian population are poor metabolizers and will have no analgesic effects, but all side effects when taking codeine for pain
39
Q

demerol (meperidine) considerations

A
  • repeated administration can lead to CNS stim
  • not recommended for pt w renal failure, chronic pain, elderly
40
Q

methadone

A

long-acting opioid agonist
- good option in neuropathic pain
- opioid of choice in preg
- used in prevention of withdrawal in opioid addiction

  • variable equianalgesic dose to other opioids
  • requires more careful initial titration
  • many drug interactions
41
Q

equianalgesia

A
  • dose of one analgesic that is equivalent in pain-relieving effects compared w another analgesic
  • important when substituting one analgesic for another in the event that a particular drug is ineffective or causes intolerable side effects
  • generally, equianalgesic doses are provided for opioids
42
Q

fentanyl equinalgesic dose

A

0.1-0.2 parenteral

43
Q

adjuvant analgesic therapy

A
  • used in conjunction w opioids and nonopioids
  • enhance pain therapy: counteract side effects, enhance effects, possess analgesic properties of their own
44
Q

TENS/PENS

A

put them on and they stimulate blood flow to area causing pain

NURS 205 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions