NUR 362 - PAIN

Question 1

Definition of Pain

Answer 1

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

Question 2

Acute pain

Answer 2

meaningful, linear, reversible, well defined
recent onset identified cause
observable signs (tachycardia, hypertension, pallor)
time limited: subsides when pain is treated and goes away

Question 3

Chronic pain

Answer 3

meaningless, cyclical, irreversible
> 6 mo. duration
won't see observable signs (patient adjusted to chronic cycle of pain) 
increased appetite
difficulty sleeping

Question 4

Somatic pain symptoms

Answer 4

well localized
aching
stabbing
throbbing
can pinpoint where is

Question 5

Visceral pain symptoms

Answer 5

poorly localized
deep aching
pressure referred
cannot pinpoint where pain is

Question 6

Neuropathic pain symptoms

Answer 6

burning
shooting
tingling

Question 7

Causes of somatic pain

Answer 7

cutaneous nociceptors

musculoskeletal

Question 8

Causes of visceral pain

Answer 8

stretching

distension in internal organs

Question 9

Causes of neuropathic pain

Answer 9

primary dysfunction in nervous system

Question 10

Examples of somatic pain

Answer 10

bone
joint
skin
connective tissue injuries

Question 11

Examples of visceral pain

Answer 11

bowel obstruction
MI
pancreatic tumor

Question 12

Examples of neuropathic pain

Answer 12

TMJ
diabetic neuropathy
post stroke pain

Question 13

Pain processes

Answer 13

transduction
transmission
pain perception
modulation

Question 14

Gate control theory

Answer 14

pain impulses controlled by gating mechanism in substantial gelatinous of the dorsal horn of spinal cord to permit or inhibit transmission

Question 15

A-alpha fibers

Answer 15

muscle sensory

Question 16

A-beta fibers

Answer 16

skin sensory

Question 17

A-delta fibers

Answer 17

prickling, sharp, localized

Question 18

C-fibers

Answer 18

dull, aching, diffuse

Question 19

Pain threshold

Answer 19

how much pain a person can experience when they start to feel pain

Question 20

Pain tolerance

Answer 20

how much pain a person can experience without distress

Question 21

Pain assessment is NOT

Answer 21

relying primarily on changes in vital signs
deciding whether person looks in pain
knowing how much a procedure should “hurt”
assuming a sleeping patient does not pain
assuming patients will tell you when they are in pain

Question 22

Pain assessment IS

Answer 22

asking and believing the patient

Question 23

Subjective assessment of pain

Answer 23

eight dimensions
documentation
document pain before giving medication
reassessment of pain within 30-60 minutes after pain med is given, if patient is still in pain then document and notify provider

Question 24

Pain assessment tools

Answer 24

0-10 scale (adults)
wong-baker faces scale (pediatrics)
verbal scale (mild, moderate, severe)

Question 25

Correlation between 0-10 scale and verbal scale

Answer 25

``` 1-4 = mild 5-6 = moderate 7-10 = severe ```

Question 26

Objective data for pain

Answer 26

vital signs observation (facial expression, movement, ability to do ADLs) physical exam

Question 27

Assessment of cognitively impaired

Answer 27

agitation is often sign of pain | observe: facial movement, body movement, behavioral changes, daily activity changes

Question 28

5 steps in ensuring effective pain management

Answer 28

``` 1 = history (prior and current pain) 2 = assessment 3 = pharmacologic interventions 4 = non-pharmacologic interventions 5 = reassessment ```

Question 29

WHO Analgesic Ladder

Answer 29

step 1 - patients with mild pain intensity (1-4) receive NSAIDs step 2 - patients with unrelieved progression (5-6) receive oral opioid analgesics or low-dose opioid meds step 3 - patients with severe pain (7-10) receive higher-dose IV opioids and more frequent dosing

Question 30

Non-opioid analgesic

Answer 30

mild to moderate pain | ex: NSAID

Question 31

opioid analgesic

Answer 31

moderate to severe pain | ex: morphine prototype

Question 32

adjuvant analgesics

Answer 32

drugs with primary indication other than pain | ex: antidepressants, steroids

Question 33

adjuvants

Answer 33

drugs without analgesic properties that can be critical in pain management in certain populations ex: muscle relaxants, sleep medications

Question 34

short acting drugs

Answer 34

``` morphine hydromorphine (dilaudid) codeine hydrocodone (Vicodin, portable) oxycodone (Percocet) demerol fentayl ```

Question 35

long acting drugs

Answer 35

MS contin oxycontin transdermal fentanyl

Question 36

drug routes

Answer 36

``` oral transmucosal nasal rectal transdermal parental (SQ, IM, IV, epidural, intrathecal) ```

Question 37

loading dose

Answer 37

given at beginning of infusion for immediate relief

Question 38

continuous dose

Answer 38

dose continually infused

Question 39

bolus dose

Answer 39

single doses at prescribed times

Question 40

lockout

Answer 40

time between boluses when no drug is delivered

Question 41

demands

Answer 41

times bolus button pushed

Question 42

side effects of medication

Answer 42

``` constipation sedation N/V respiratory depression itching/hives reversal agent - narcan (Naloxone) ```

Question 43

tolerance

Answer 43

patient receives drug continuously over a long period of time, then develops a neuroadaptive response to require a larger dose to produce the same effect

Question 44

dependence

Answer 44

physiologic adaptation that is characterized by the development of withdrawal symptoms such as diaphoresis, anxiety, tachycardia, or nausea when the drug is stopped abruptly

Question 45

addiction

Answer 45

chronic neurobiology disease that has genetic, psychosocial, and environmental influences in which the patient has impaired control over drug use and craving despite harm

Question 46

psuedoaddiction

Answer 46

drug-seeking, produced not by true drug addiction, but by the under-treatment of pain

Question 47

non-pharmacological methods of basic comfort

Answer 47

positioning for body alignment regular turning appropriate lighting, low noise cutaneous stimulation - heat, cold, massage

Question 48

non-pharmacological methods of cognitive/behavioral comfort

Answer 48

``` relaxation meditation distraction biofeedback guided imagery ```