Pain and Neoplasm

Question 1

ABC’s of Pain Assessment

Answer 1

A- ask about pain regularly
B- believe the patient and family in their reports of pain and what relieves it
C- choose pain control options appropriate for the patient, family, and setting
D- deliver interventions in a timely, logical, and coordinated fashion
E- empower patients and families
E- enable them to control their course to the greatest extent

Question 2

PQRST

Answer 2

Mnemonic that can be used every time pain is being assessed

When everyone uses the same assessment techniques and tools assessments are more consistent and accurate

Question 3

P- Precipitating and Palliative Factors

Answer 3

Aggravating and alleviating factors
What makes the pain better, what makes the pain worse?
Positioning - walking, sitting, standing, turning and repositioning (are they moaning when moved)?
Time of day
What does the pain interfere with?
What are the patient’s expectations?

Question 4

Q- Quality of Pain

Answer 4

Description
What does the pain feel like?
Use the patient’s own words
Don’t rush the patient, they often need a few minutes to determine a description
Aching, stabbing, burning, tingling, dull, heavy, pinching, sharp, pins and needles, shooting, throbbing

Question 5

R- Radiating

Answer 5

Where is the pain?

Does the pain radiate or travel?

Question 6

S - Severity

Answer 6

Quantitive measure of pain
Use an appropriate scale to evaluate pain
Patients rating of pain, not caregivers perception
What is your pain now, what is the worst/ best it gets?
Type of scale used is dependent on patients cognitive status

Question 7

T- Temporal/ Time

Answer 7

Pattern of the pain
Is there a time of day the pain is better or worse
How long have you had pain
Is the pain constant or intermittent
Is pain associated with a specific activity
What does the pain interfere with

Question 8

Treatment

Answer 8

Cool compresses
Comfort measures
Behavioural techniques
Transcutaneous electric nerves stimulation (TENS)
Acupuncture
Analgesics
NSAIDs
Narcotics
Nerve Blocks
Surgery - cordotomy, neurectomy, sympathectomy, rhizotomy
Complementary therapy - acupuncture, biofeedback, hypnotism, relaxation, distraction, cutaneous stimulation

Question 9

Treatment for chronic pain

Answer 9

Focuses on reducing or eliminating patient’s pain while improving or at least stabilizing
Attempt’s to reduce patient’s needs for medications

Question 10

The WHO 3-step Analgesic Ladder

Answer 10

Pain ->
Nonopioid analgesic 
≠ Adjuvant therapy
(Pain persisting or increasing) ->
Opioid for mild to moderate pain
\+ Nonopioid analgesic
≠ Adjuvant therapy
(Pain persisting or increasing) ->
Opioid for moderate to severe pain
Nonopioid analgesic
≠ Adjuvant therapy
(Freedom from pain)

Question 11

Psychological Manifestations Characteristic of Cancer

Answer 11

Stress
Grief
Guilt
Fear and anxiety
Powerlessness
Isolation
Concern for body image
Sexual dysfunction

Question 12

ACS Goals of Medical Treatment

Answer 12

To eliminate the tumour or malignant cells
To prevent metastasis
To reduce cellular growth and tumour burden
To promote functional abilities and provide pain relief to those whose disease does not respond to treatment

Question 13

Cancer Treatment

Answer 13

Surgery
Chemotherapy
Radiation
- Internal radiation
- External radiation
Biotherapy or immunotherapy
Bone marrow transplant
Complementary therapies

Question 14

Cancer Treatment

Answer 14

Multidisciplinary approach: nutritional counselling, physiotherapy, assistance with other problem
It may be curative, palliative, or prophylactic

Question 15

Team

Answer 15

Surgeon
Surgical oncologist
Radiologist
Pathologist
Medical oncologist
Oncology nurse
Registered dietician
Family doctor
Oncology pharmacist
Oncology social worker or psychologist
Plastic surgeon
Palliative care nurse

Question 16

Radiation

Answer 16

Used to kill, reduce size, decrease pain, or relieve obstruction
Adverse Effects
- Cell damage to blood vessels and skin
- GI effects
- Exudate in lungs
- Fistulas or necrosis of adjacent tissue

Question 17

Chemotherapy

Answer 17

Bone marrow depression
Vomiting
Cell damage (hair loss)
Some can cause lung damage, blood vessel, and organ damage

Question 18

Other Drugs

Answer 18

Hormones
Biologic Response Modifiers
Angiogenesis Inhibitor drugs
Analgesics
Nutrition - very important d/t vomiting and anorexia, sore mouth, loss of teeth, pain, fatigue, malabsorption d/t inflammation in GI tract
Prognosis - some have change and some do not

Question 19

Assessment

Answer 19

Collect focused assessment data:
Be alert for:
Adverse effects of cancer treatments
Infection or bleeding
Decreased blood cell counts
Psychosocial or spiritual distress

Question 20

Diagnosis, Planning, and Implementing

Answer 20

Give psychologic support
- Anxiety
- Disturbed body image
- Grieving
Teach areas of knowledge deficit
Monitor for risk for infection, injury, impaired tissue integrity 
Monitor nutrition
Treat pain management

Question 21

Evaluation

Answer 21

Monitor for exacerbation or remission of the disease process
Make changes in nursing care as indicated
Utilize interdisciplinary care and referrals as needed

Question 22

Teaching for Discharge

Answer 22

Teach client to differentiate minor from serious problems

Teach client when to call for help

Question 23

Oncological Emergencies

Answer 23

Pericardial effusion and neoplastic cardiac tamponade
Superior vena cava syndrome
Sepsis and septic shock
Spinal cord compression
Obstructive uropathy
Hypercalcemia
Hyperuricemia
Tumor lysis syndrome

Question 24

What is palliative care?

Answer 24

Support and comfort for individuals and families living with chronic or life-threatening illnesses
Focuses on:
- Relieving pain and other uncomfortable symptoms
- Helping families and friends involved in care giving
- Planning for chronic care and facing the end of life

Question 25

Radiation Therapy (Palliative)

Answer 25

Radiation therapy is the medical use of ionizing radiation as part of cancer treatment to control malignant cells Can be used for curative or adjuvant cancer treatment Also used as palliative treatment such as pain management Radiation therapy is commonly applied to the tumour, lymph nodes, or surrounding tissue

Question 26

Chemotherapy (Palliative)

Answer 26

``` Chemotherapy is the use of chemical substances to treat disease - it refers primarily to cytotoxic drugs used to treat cancer - the chemo meds destroy cancer cells Side Effects: Nausea Anemia Immunosuppression Hair loss Weight loss ```

Question 27

Complementary Therapies (Palliative)

Answer 27

``` Provide a positive and complementary role or enhancement of the various therapies when used in conjunction with traditional approaches Examples: Dietary Massage Therapeutic touch Relaxation ```

Question 28

Key Elements of Palliative Nursing

Answer 28

``` Pain Management Symptom Management Cultural Considerations Spiritual Care Communication Grief, Loss, and Bereavement Preparation and Care at the time of death Achieving QOL at end of life ```

Question 29

Pain Management

Answer 29

``` Mild to moderate pain - Acetaminophen; Codeine Severe pain - Morphine; Hydromorphone, Oxycodone; Transdermal Fentanyl; Methadone Adjuvant Analgesics - NSAIDs; Tricyclic antidepressants, anticonvulsants, steroids, oral local anesthetics Alternate routes - Oral; SC; rectal; transdermal; IV ```

Question 30

Symptom Management: N/V

Answer 30

``` Causes: - Constipation/ bowel obstruction - Chemo - Radiation - Other meds Treatment: - Antiemetic (haloperidol, stemetil) - Odour control ```

Question 31

Symptom Management: Constipation

Answer 31

``` Causes: - Opioids - Chemo - Radiation - Inactivity - Dehydration Treatment: - Laxatives used whenever opioids are prescribed - stimulant such as senna (Glysennid, Senokot), plus a softener such as decussate (Surfak, Colace) - Diet: fluids and fruits (prunes, figs, dates, etc.) - Mobility ```

Question 32

Symptom Management: Anorexia/ Cachexia

Answer 32

Loss of appetite, poor food intake, weight loss Causes: - Medication (can cause nausea, bad taste in mouth) - Pain - Loss of appetite Treatment: - Improve nausea and appetite - Dietitian to be involved to advise and optimize nutritional intake

Question 33

Symptom Management: Dsypnea

Answer 33

``` Causes: - Pneumonia - Anemia - Pulmonary embolus - COPD, CHF - Positioning Treatment: - Oxygen - Opioids - Bronchodilators - Repositioning ```

Question 34

Cultural Considerations

Answer 34

Culture - the learned, shared, and life way practices of a particular group that guides thinking, decisions, and actions in a patterned way Focus on meeting the needs of each individual person and family, knowing they will experience their culture in their own unique way Cultural Assessment - Ascertain from the patient - Perceptions (health, illness, death) - Use of or belief in traditional remedies - Role of family

Question 35

Spiritual Care

Answer 35

Palliative Care aims to meet the psychological, social, spiritual, and practical needs of the individual and family Spirituality has many facets - get to know the preferences r/t rituals, symbols, practices, gestures and meditation - make an attempt to meet these needs

Question 36

Communication

Answer 36

``` What makes it difficult to talk about death and dying? Factors that make it difficult - Fear of own mortality - Denial - Language barriers - Lack of experience - Conflict within the family Factors making it easier - Being honest, genuine being "yourself" - Acceptance of the reality - Notion of "living until one dies" - Willingness to listen ```

Question 37

Grief, Loss, and Bereavement

Answer 37

Grief - Psychological, behavioural, social, and physical reactions to the loss of someone or something Mourning - The process by which people adapt to loss Bereavement - The period after a loss during which grief is experienced Kubler - Ross Stages of grief

Question 38

Preparation and Care at the Time of Death

Answer 38

``` Final hours of caring - Keep the dying person comfortable - Not dying alone Signs of dying process - Decreased LOC - Changes in body function ```