N212 Lecture 7

Question 1

The IASP defines pain as

Answer 1

an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

Question 2

McCafferys definition of pain

Answer 2

pain is whatever the experiencing person says it is, existing whenever he says it does

Question 3

Effective pain management improves

Answer 3

quality of life, reduce physical discomfort, promotes earlier mobilization

Question 4

The four physiological processes of normal pain are

Answer 4

transduction, transmission, perception, modulation

Question 5

Transduction, 1st pain process

Answer 5

• begins in the periphery when a pain stimuli sends a impulse across a sensory nerve pain fiber (nociceptor), this initiates an action potential

Question 6

neurotransmitters affect the nerve stimuli by

Answer 6

excite during transmission or inhibit during modulation

Question 7

What enhances transmission of the pain impulse

Answer 7

excitatory neurotransmitters send impulses across the synaptic cleft between 2 nerve fibers

Question 8

the cause of the inflammatory response and spreading the pain message is due to

Answer 8

the pain sensitizing substances surrounding the pain fibers in the extracellular fluid

Question 9

When the pain stimulus reaches the cerebral cortex the brain interprets it as

Answer 9

the quality of the pain and process information from past experience, knowledge and cultural associations in perception of pain

Question 10

perception is

Answer 10

the point at which a person is aware of the pain

Question 11

the intensity and location of the pain is identified by

Answer 11

somatosensory cortex

Question 12

what determines how a person feels about pain

Answer 12

the associated cortex, primarily the limbic system

Question 13

the pain center is in one location

Answer 13

false, there is no single pain center

Question 14

as a person becomes aware of pain what occurs

Answer 14

a complex reaction

Question 15

psychological and cognitive factors interact with

Answer 15

neurophysiological ones

Question 16

perception gives

Answer 16

awareness and meaning to pain, resulting in a reaction

Question 17

the reaction to pain includes

Answer 17

physiological and behavioral responses that occur

Question 18

nerve impulses from pain travel along

Answer 18

afferent sensory peripheral nerve fibers

Question 19

the two types of peripheral nerve fibers that conduct painful stimuli

Answer 19

the fast myelinated A delta fibers and the small/slow unmyelinated C fibers

Question 20

the A fibers send

Answer 20

sharp, localized distinct sensations

Question 21

the C fibers relay impulses that

Answer 21

are poorly localized, visceral and persistent

Question 22

modulation is

Answer 22

the release of inhibitory neurotransmitters ( endorphins/endogenous opioids, serotonin, norepinephrine, GABA) which hinder pain to produce analgesic effect

Question 23

A delta fibers send sensory impulses to the spinal cord to

Answer 23

synapse with spinal motor neurons

Question 24

spinal motor neurons travel via reflex arc along efferent nerve fibers to

Answer 24

a peripheral muscle near the site of stimulation, bypassing the brain

Question 25

contraction of the muscle leads to

Answer 25

a protective withdrawal from the source of pain

Question 26

pain processes require

Answer 26

an intact nervous system and spinal cord

Question 27

the factors that disrupt pain process are

Answer 27

trauma, drugs, tumor growth and metabolic disorders

Question 28

stimulation of the sympathetic branch of the ANS results in

Answer 28

physiological response

Question 29

patients in pain always have changes in vital signs, true or false

Answer 29

false, patients in pain do not always have changes in vital signs

Question 30

what are some behavioral responses to pain

Answer 30

clenching teeth, facial grimacing, holding painful part

Question 31

what influences our perception when it comes to pain

Answer 31

patients ability to tolerate pain

Question 32

patients who have low pain tolerance are sometimes

Answer 32

inaccurately perceived as complainers

Question 33

how is pain caterogized

Answer 33

duration(chronic or acute) or pathology (cancer or neuropathic)

Question 34

whats the primary nursing goal when it comes to pain

Answer 34

to provide pain relief that allows patients to participate in their recovery, prevent complications and improve functional status

Question 35

chronic pain lasts longer than normal pain which can be

Answer 35

cancerous or noncancerous

Question 36

examples of chronic noncancerous pain are

Answer 36

arthritis, headache, low back pain, peripheral neuropathy

Question 37

referred pain is

Answer 37

pain at the actual site of the tumor or distant to the site

Question 38

when there is no obvious source of pain healthcare providers stereotype patients as

Answer 38

malingerers, complainers, or difficult patients

Question 39

a nurses personal opinion about a patients report of pain does what?

Answer 39

affects pain assessment and titration of opioid doses

Question 40

pain is apart of aging, true or false

Answer 40

false its not apart of aging

Question 41

pain perception does decrease with age, true or false

Answer 41

false, pain perception does not decrease with age

Question 42

pain in older adults requires

Answer 42

aggressive assessment, diagnosis and management

Question 43

increased attention is associated with increased pain whereas distraction is associated with

Answer 43

diminished pain response

Question 44

when in pain spirituality stretches beyond what ?

Answer 44

religion

Question 45

what increases the perception of pain

Answer 45

anxiety

Question 46

anxiolytic medications are not a substitute for

Answer 46

analgesia

Question 47

pain is a lonely experience which causes patients to feel loss of control but coping style influences

Answer 47

the ability to deal with pain

Question 48

persons with internal loci of control perceive

Answer 48

having control over events in their life and the outcomes such as pain

Question 49

persons with external loci perceive

Answer 49

other factors in their life such as nurses are responsible for the outcome

Question 50

successful critical thinking for pain requires

Answer 50

knowledge, experience, information gathered from patients, critical thinking attitudes intellectual and professional standards

Question 51

successful pain management means pain elimination, true or false

Answer 51

false, it means attainment of a mutually agreed on pain relief goal that allows patient to control their pain

Question 52

whats the first step in helping patient regain control of pain

Answer 52

asking a patient about his or her tolerable pain level

Question 53

abc's of pain management

Answer 53

ask ( pain regularly), believe(patient and family in their report of pain), choose ( pain control options), deliver ( interventions in a timely fashion) and empower( them to control their course)

Question 54

is pain static or dynamic

Answer 54

dynamic

Question 55

a patients self report of pain is

Answer 55

the most reliable indicator of existence and intensity

Question 56

when assessing patient for pain we ask

Answer 56

onset of pain, duration of pain and time sequence

Question 57

the most subjective and useful characteristic for pain is

Answer 57

severity

Question 58

an accurate nursing clinical problem may be made only after you

Answer 58

perform a complete assessment

Question 59

one strategy for planning care is

Answer 59

concept map

Question 60

whats the outcome of care for patients with pain

Answer 60

helping them learn how to manage their pain

Question 61

relaxation and guided imagery allow patients to

Answer 61

alter affective motivational and cognitive pain perception

Question 62

relaxation is

Answer 62

mental and physical freedom form tension or stress that provides individuals a sense of self control

Question 63

a form of cutaneous stimulation is

Answer 63

transcutaneous electrical nerve stimulation (TENS) -stimulates of the skin with mild electrical current

Question 64

most common and effective method of pain relief is

Answer 64

analgesics

Question 65

3 types of analgesics

Answer 65

nonopioids (acetaminophen and NSAIDS), opioids (traditionally narcotics), co analgesics or adjuvants ( variety of medications that enhance analgesics or have analgesics properties that were originally unknown)

Question 66

nsaids work on

Answer 66

peripheral nerve receptors to reduce transmission of pain stimuli

Question 67

Provides mild to moderate pain relief

Answer 67

nsaids

Question 68

has no anti inflammatory or antiplatelet effects

Answer 68

acetaminophen

Question 69

long term use of nonopiods is associated with

Answer 69

GI bleeding and renal insufficiency

Question 70

prescribed for moderate to severe pain

Answer 70

opioids

Question 71

one adverse effect of opioids is

Answer 71

sedation that precedes respiratory depression

Question 72

to maximize pain relief with opioid use is

Answer 72

administer analgesics around the clock rather than prn

Question 73

when switching from IV to oral form of opioid its much higher because

Answer 73

the first pass effect of medication metabolized in the liver

Question 74

opioids are usually necessary and effective for

Answer 74

acute pain and cancer pain of moderate or severe intensity

Question 75

patients at higher risk for opioid related adverse drug events, true or false

Answer 75

true

Question 76

why should you avoid partial doses at more frequent intervals for opioids

Answer 76

to not under dose patients with small, frequent ineffective doses

Question 77

adjuvants and co analgesics are

Answer 77

used to treat other conditions but have analgesics qualities

Question 78

what is PCA

Answer 78

patient controlled analgesia involving IV or subq drug administration

Question 79

range for PCA to deliver a dose at specific time intervals

Answer 79

range of 8-15 minutes

Question 80

commonly used topical agents include

Answer 80

nsaid products (ketoprofen patch) and capsaicin

Question 81

Eutectic mixture of local anesthetics (EMLA) are not used around the eyes, tympanic membrane or over large surfaces, true or false

Answer 81

true

Question 82

lidoderm patch is used for cutaneous neuropathic pain, postherpetic neuralgia, true or false

Answer 82

true

Question 83

lidoderm patch use a 12 hour on and 12 hour off schedule, true or false

Answer 83

true

Question 84

local anesthesia is during brief surgical procedures such as skin lesion, suturing a wound, true or false

Answer 84

true

Question 85

regional anesthesia is

Answer 85

injection or infusion of local anesthetics to block a group of sensory nerve fibers

Question 86

a perinerural local anesthetic infusion is when the surgeon

Answer 86

places the tip of an unsutured catheter near a nerve or group of nerves and catheter exits from the surgical wound

Question 87

common side effects of topical applications of local anesthetics are

Answer 87

pruritus or burning of the skin or localizes rash

Question 88

applying local anesthetics to a vascular mucous membrane will

Answer 88

increase chance of systemic effects such as increased heart rate

Question 89

the use of local anesthetics in peripheral nerve and epidural infusions may block motor nerves as well as sensory nerves, true or false

Answer 89

true

Question 90

epidural analgesia effectively treats

Answer 90

acute postoperative pain, rib fracture pain, labor and delivery, chronic cancer pain

Question 91

epidural analgesia is short or long term depending on patients condition, true or false

Answer 91

true

Question 92

cancer pain is either chronic or acute, true or false

Answer 92

true

Question 93

the american pain society primary goal in treating chronic noncancer pain with opioids is

Answer 93

increase patients level of function

Question 94

patients on chronic opioid therapy require

Answer 94

monitoring and follow ups

Question 95

when patients are unable to swallow, have nausea or vomiting, or near death we administer analgesics by

Answer 95

rectally

Question 96

patient barriers for effective pain management

Answer 96

fear of addiction, side effects, fear of tolerance

Question 97

health care barriers for effective pain management

Answer 97

inadequate pain assessment, no pain management protocols, concern with addiction or accidental overdose

Question 98

healthcare system barriers for effective pain management

Answer 98

concern with creating addicts, difficulty filling Rx, limitation on reimbursement for Rx

Question 99

experiencing a physical dependency does not imply addiction, true or false

Answer 99

true

Question 100

what does a comprehensive pain center do

Answer 100

treat persons on an inpatient or outpatient basis

Question 101

the goal for palliative care is

Answer 101

to learn to live life fully with an incurable condition

Question 102

what does hospice do

Answer 102

helps terminally ill patient continue to live at home or in a health care setting in comfort

Question 103

main priority for hospices

Answer 103

pain control

Question 104

a patients behavioral responses to pain relief interventions are not always obvious, true or false

Answer 104

true