Pain

Question 1

Pain is a…

Answer 1

universal, but individual subjective experience that is often misunderstood and inadequately treated

Question 2

Pain definition

Answer 2

unpleasant subjective sensory and emotional experience often associated with actual or potential tissue damage

Question 3

Nurse’s job in pain

Answer 3

assess; improve systems; provide patient-centered care

Question 4

nociception

Answer 4

observable activity in NS in response to adequate stimuli

Question 5

4 steps of NS pain activity

Answer 5

transduction, transmission, perception, modulation

Question 6

acute pain

Answer 6

protective; short duration and limited tissue damage; can threaten recovery if untreated and can progress to chronic

Question 7

Chronic pain

Answer 7

no outward sx; over 3-6 months; cause psych and phys disability (anorexia, depression, suicide, hopelessness); goal is it improve functional status

Question 8

cancer pain

Answer 8

damage from tumors, chemo, infection, all cancer related

Question 9

how does pain change wth time

Answer 9

observable signs decrease; acute pain is more observable (inc BP, pulse, RR, dilated pupils, sweat)

Question 10

acute pain response

Answer 10

tachy, HTN, anxiety, muscle tension, diaphoresis

Question 11

behavioral response

Answer 11

grimace, guarding

Question 12

chronic pain response

Answer 12

physiologic response is uncommon; more fatigue, depression, decreased functioning

Question 13

subjective opinions of pain

Answer 13

believe the patient, acknowledge own prejudice, think safety when deciding what meds to give–eval patient first

Question 14

factors influencing pain

Answer 14

age, fatigue, genes, cog/neuro (problems communicating), previous pain experience, support system/coping, spirituality, anxiety/fear

Question 15

cultural aspects of pain

Answer 15

may not acknowledge pain if threatens lifestyle; some cultures more demonstrative, some more stoic, assess pain in native language bc may translate differently

Question 16

what does pain impact

Answer 16

QoL, self-care, work, social support

Question 17

who is the authority on pain?

Answer 17

the patient

Question 18

Measures of pain

Answer 18

visual analog scale, simple descriptive, visual pain assessment or word bank, subjective and objective, PQRSTU, Baker face scale

Question 19

who establishes acceptable level of pain goal

Answer 19

patient and care team; 0 pain might not be a reasonable goal

Question 20

NC for pain treatment

Answer 20

multidimensional, inc functional status, use multiple methods, include cultural beliefs, be open-minded, pain may not be eliminated; include all patient concerns

Question 21

relaxation and guided imagery

Answer 21

alters cognitive and affective perception; dec physiological response to pain

Question 22

distraction

Answer 22

reticular system inhibits pain stimuli if person gets sufficient sensory input; best for SHORT, INTENSE pain

Question 23

music

Answer 23

ACUTE/CHRONIC pain—Dec SNS response, distract, positive mood and emo

Question 24

cutaneous stim

Answer 24

stim skin with massage, temp, TENS (acute); unknown MOA but may be gate control, watch out for hot temperatures

Question 25

What temperature to use for acute and chronic pain?

Answer 25

heat for chronic, cold for acute

Question 26

adjuvants

Answer 26

enhance or have analgesic properties (ex: sleep meds)

Question 27

pharmacological tx of pain; nurse responsibility

Answer 27

assess, give med, reasses

Question 28

NSAID SE

Answer 28

Gi bleed especially in old

Question 29

non-opioids what they are and function

Answer 29

Acetaminophen and NSAIDs; mild-moderate pain; can have ceiling effect, give up to 800 mg

Question 30

Tylenol limit

Answer 30

4g/24h

Question 31

opioids function and SE

Answer 31

moderate to severe pain; GI SE, memory, thought change, respiratory depression

Question 32

opioids NC

Answer 32

don't do edu immediately after getting; know pt baseline neuro status; start low and try to keep use temporary

Question 33

Respiratory depression/overdose NC; when do you see it

Answer 33

have oxygen and open airway; assess breathing and give Narcan (check after 15 minutes and reassess); common with opioid naive and around the clock dosing; often seen with BDZs

Question 34

around the clock dosing

Answer 34

max pain relief and potentially dec opioids use; give meds at a regular interval to prevent pain from coming back; might end up giving unneeded meds

Question 35

range-order meds

Answer 35

med orders where the dose is flexible (ex: 2-6mg morphine q2h); know your patient and count TYLENOL if given like this

Question 36

Patient controlled analgesia (PCA)

Answer 36

nurses program IV machine and pt pushes button to get bolus when needed; start with a higher loading dose to get pain under control then decrease; programmed frequency and lockout (limit)

Question 37

epidural anesthetic

Answer 37

regional anesthesia; must be preservative free; PCA or continuous

Question 38

SE of epidural

Answer 38

hypotension, N/V, urinary retention, constipation, respiratory depression, pruritis--itchy

Question 39

nursing care for epidural

Answer 39

monitor site placement, monitor infection/bleed, urinary retention/cath need, fall risk depending on location, monitor coagulation

Question 40

tolerance

Answer 40

Caused by repeated drug exposure long-term; associated with chronic opioid use but not a sign of addiction

Question 41

dependence

Answer 41

withdrawal symptoms occur after long-term opioid use; need to withdraw drug gradually; not a sign of addiction

Question 42

addiction

Answer 42

psychological dependence; use of drugs FOR mind-altering effects; "drug-seeking" behaviors

Question 43

Nociceptive pain and what helps it

Answer 43

Arises from pain receptors and usually response to opioids/analgesia; ache/pound/gnaw

Question 44

Neuropathic pain and tx

Answer 44

Injury to nerves or abnormal processes of sensory input; tx with adjuvant analgesics; burning, shooting, electrical, abnormal sensation; phantom limb, neuropathy, spinal cord

Question 45

Somatic pain

Answer 45

Type of nociceptive pain In bones, joints, muscles, skin or connective tissue; well-localized

Question 46

Visceral pain

Answer 46

Type of nociceptive pain in internal organs, often associated with referred pain (non-specific); often poorly localized

Question 47

Cutaneous pain

Answer 47

A type of nociceptive pain in skin or SQ tissue; well localized

Question 48

Idiopathic pain

Answer 48

Chronic pain w/o known cause

Question 49

When to give IV acetaminophen

Answer 49

Post-surgery

Question 50

Big complication of acetaminophen use

Answer 50

Liver failure esp with over 4g/24 hours

Question 51

Goal of non-pharm/alt/complementary

Answer 51

Inc QoL, inc functioning

Question 52

How does a support system/coping affect pain

Answer 52

Presence of these decrease pain sensitivity

Question 53

How does anxiety and fear impact pain?

Answer 53

May increase pain perception which causes more anxiety and fear

Question 54

How do genes impact pain?

Answer 54

May increase or decrease pain sensitivity

Question 55

Should you use non-pharm interventions if your patient is having moderate to severe pain?

Answer 55

You can, but use pharmacological interventions first

Question 56

What drug can cross the blood-brain barrier?

Answer 56

IV tylenol