Pain

Question 1

pain is

Answer 1

unpleasant sensory/emotional experience w actual/potential tissue damage

Question 2

many patients are reluctant to report pain due to

Answer 2

wanting to be a “good” patient and fear of addiction

Question 3

acute pain

Answer 3

activation of SNS that is temporary with a sudden onset

Question 4

signs of acute pain

Answer 4

localized redness, bruising, bleeding, warmth, inflammation, swelling

Question 5

chronic pain

Answer 5

lasting at least 3 mon with gradual onset that changes over time

Question 6

acute pain responses

Answer 6

high HR/BP/RR, dilated pupils, sweating

Question 7

cancer pain

Answer 7

pain in more than one area where chemo/radiation cause more pain

Question 7

chronic noncancer pain

Answer 7

common in neck, shoulder, low back in over 65 yrs old

Question 7

chronic pain can result in

Answer 7

emotional/financial/relationship burdens, depression/hopelessness

Question 8

procedural pain

Answer 8

acute pain from procedures or surgery

Question 9

nociceptive pain is the

Answer 9

normal pain transmission

Question 10

transduction (nocicpetive)

Answer 10

push pain signal forward

Question 10

modulation (nocicpetive)

Answer 10

serotonin, NE, other processes to reduce activity

Question 11

transmission (nocicpetive)

Answer 11

message relayed from injury site to brain

Question 12

somatic pain

Answer 12

bones, skin, muscles

Question 12

perception (nocicpetive)

Answer 12

conscious awareness of pain

Question 13

visceral pain

Answer 13

organs

Question 14

neuropathic pain

Answer 14

peripheral NS or CNS sense and transmit impulses to tell the body you have pain

Question 15

pain transmission

Answer 15

nerve fibers that transmit pain

Question 16

A delta fibers

Answer 16

fast/myelinated that detect sharp and localized thermal/mechanical injury

Question 17

C fibers

Answer 17

slow/unmyelinated that respond to widely distributed mechanical/chem/thermal injury

Question 18

low drug dosing for older adults

Answer 18

increase dosing based on response to previous dose due to slower metabolism/excretion

Question 19

multimodal analgesia

Answer 19

combination of opioids and nonopioids

Question 20

nonopioids

Answer 20

effective as opioids for mild/mod pain

Question 21

NSAIDS

Answer 21

cause GI issues and increased bleeding risk, must monitor heart and renal

Question 21

NSAIDS+aspirin

Answer 21

rarely used due to poor side effects

Question 21

acetaminophen

Answer 21

for pt who have increase GI bleeding risk but can cause liver toxicity

Question 22

opioid analgesics

Answer 22

interact with opioid receptor sites to block release of neurotransmitters in spinal cord

Question 22

monitor opioid analgesics for

Answer 22

sedation and resp despression

Question 23

types of opioid analgesics

Answer 23

codeine, oxycodone, morphine, hydromorphone, fentanyl, methadone, tramadol, meperidine, oxymorphone

Question 24

opioid epidemic

Answer 24

misuse of prescription opioids and illicit drugs

Question 25

physical dependence and tolerance when taking opioids

Answer 25

normal response

Question 26

pseudoaddiction

Answer 26

mistaken diagnosis of addiction due to underprescription of drugs when pain still present

Question 27

opioid addiction

Answer 27

uncontrollable cravings, inability to control use, compulsive use, use despite harm

Question 28

dependence

Answer 28

predictable and manage with meds and a slow taper off

Question 29

opioid naive

Answer 29

person who has not taken enough opioid to become tolerant

Question 30

opioid tolerant

Answer 30

person who has taken opioids at high doses to develop tolerance

Question 31

patient ed for opioids

Answer 31

time frame of usage, disposal, alternatives to reduce risk of misuse

Question 32

Short acting, fast acting, immediate release (IR), normal release opioids

Answer 32

Onset 30 minutes; duration 3-4 hrs

Question 33

Modified-release, extended release (ER), sustained release (SR), controlled release (CR) opioids

Answer 33

over prolonged time, NEVER crush/chew/break

Question 34

why to avoid meperidine

Answer 34

cause resp/circulatory depression, hallucinations, seizures

Question 35

level 1 pain (1-3 rate)

Answer 35

use non-opioids

Question 36

level 2 pain (4-6 rate)

Answer 36

use weak opioids alone or w adjuvant drug

Question 37

level 3 pain (7-10 rate)

Answer 37

use opioids

Question 38

adverse effects of opioid analgesics

Answer 38

resp depression, constipation, N/V, pruritis, sedation

Question 39

pain management in end of life

Answer 39

opioid regimen should be consistent as pain is still felt while unconscious (no concern for addiction)

Question 40

medical marijuana

Answer 40

not regulated by FDA but is good for cancer pain

Question 41

medical marijuana adminstration

Answer 41

doctors cannot prescribe, nurses cannot administer, ONLY caregiver or pt

Question 42

selected opioid analgesics

Answer 42

Codeine, fentanyl, hydromorphone, oxycodone, hydrocodone, methadone

Question 43

nonpharmacologic interventions

Answer 43

heat/cold, massage, PT/OT, imagery, relaxation