Pain and Sleep

Question 1

What is nociception?

Answer 1

Physiologic process that communicates tissue damage to the CNS

Question 2

What are the 4 processes of nociception?

Answer 2

Transduction
Transmission
Perception
Modulation

Question 3

What factors affect the way pain is expressed?

Answer 3

Age
Culture
Ethnicity

Question 4

What does SLIDTA stand for?

Answer 4

Severity/intensity
Location
Influencing factors
Duration
Type
Associated factors

Question 5

How do you assess pain in children under 7?

Answer 5

Use faces pain rating scale

Question 6

What is considered objective data in assessing pain?

Answer 6

Facial expressions
Moaning
Crying
BP
Pulse
RR

Question 7

How does chronic pain affect physiological measures of pain?

Answer 7

Physiological measures eventually normalize

Question 8

What is the FLACC scale?

Answer 8

Objective measurement of pain in patients who aren’t able to verbalize/self-report (infants and children under 3, nonverbal, intubated pt, cognitively impaired, dementia)

Question 9

What does the FLACC score represent?

Answer 9

An indicator that pain may be present, not a level of pain

Question 10

What are physiological responses to acute pain?

Answer 10

Tachycardia
HTN
Anxiety
Diaphoresis
Muscle tension

Question 11

What are physiological responses to chronic pain?

Answer 11

Body eventually adapts to the pain, resulting in no more acute activation of the SNS
Vital signs often normalize

Question 12

What is nociceptive pain?

Answer 12

Normal processing of stimuli that has damaged normal tissue

Question 13

What is somatic nociceptive pain?

Answer 13

Pain coming from bones, joints, muscles, skin, or connective tissues

Question 14

What is visceral nociceptive pain?

Answer 14

Pain coming from internal organs

Question 15

What is cutaneous nociceptive pain?

Answer 15

Pain coming from the skin or subcutaneous tissue

Question 16

What is neuropathic pain?

Answer 16

Abnormal processing of sensory input by the peripheral or CNS

Question 17

How is neuropathic pain usually described?

Answer 17

Pins and needles, shock-like, tingling, numbness, burning, cold, itching

Question 18

What does neuropathic pain respond to?

Answer 18

Adjuvant meds
Antidepressants
Antispasmodics
Muscle relaxants

Question 19

What are gerontological considerations when assessing pain?

Answer 19

The variety of terms that could be used
Their expectation to have pain
Their fear of addiction/stigma of narcotics
Drug therapy being affected

Question 20

In what ways is drug therapy affected in geriatric pts?

Answer 20

Absorption rates may be affected by thinner, less elastic skin
Distribution is affected from a lower serum albumin - more bioavailable drug
Metabolism is affected from age-related decreased liver and kidney function - higher drug levels
Pain is often undertreated

Question 21

What factors affect the perception of pain?

Answer 21

Fatigue, fear, anxiety, lack of knowledge, cognitive function, culture, values, beliefs, age, pain threshold, adaptation

Question 22

How is pain classified?

Answer 22

Acute vs. chronic
Nociceptive vs. neuropathic
Somatic vs. visceral
Persistent vs. episodic

Question 23

What are some nonpharmacologic relief measures of pain?

Answer 23

Pt teaching
Distraction
Humor
Music
Imagery
Relaxation techniques
Cutaneous stimulation (massage, cold/hot application)
Acupressure
Acupuncture

Question 24

What are the three types of analgesics?

Answer 24

Nonopioid analgesics (NSAIDs and Acetaminophen) - mild to moderate pain
Opioids - used for moderate to severe pain
Adjuvant analgesics (anticonvulsants/antidepressants) - enhance analgesics. Good for neuropathic pain

Question 25

What are side effects of opioids?

Answer 25

``` Constipation Drowsiness Dizziness Orthostatic hypotension Nausea/vomiting Sedation Urinary retention ```

Question 26

What are side effects of nonopioids?

Answer 26

NSAIDs can increase CV risk, decrease clotting and cause GI bleeding or ulcers

Question 27

What is tolerance?

Answer 27

Diminished response to a drug as a result of repeated use

Question 28

What is dependence?

Answer 28

Physical condition in which the body adapts to the present of a drug as a result of constant exposure

Question 29

What is addiction?

Answer 29

Chronic, relapsing brain disease characterized by compulsive drug seeking and use

Question 30

What are some general principles of administering pain meds?

Answer 30

Around the clock administration is better for acute pain Don't wait until pain is severe Ongoing assessment of pain/sedation ID changes in pt's condition Maintain steady bloodstream levels of drug

Question 31

What are the Observer's Assessment of Alertness and Sedation and the Pasero Scales?

Answer 31

Sedation scales

Question 32

What is PCA?

Answer 32

Pt controlled analgesia - self-administered via IV

Question 33

What is PCEA?

Answer 33

Pt controlled epidural analgesia - action of delivery close to the site, so smaller amounts can be used

Question 34

What are benefits of PCA?

Answer 34

Avoids delays in administration | Decreases the likelihood of oversedation

Question 35

What are some side effects of PCEA?

Answer 35

``` Hypotension Urinary retention Nausea Vomiting Infection Pruritus ```

Question 36

What are some functions of sleep?

Answer 36

Routine restoration of biological processes Preservation of cardiac function Conversation of body's energy supply Brain tissue restoration and cognitive restoration

Question 37

What is the BEARS approach to sleep assessment?

Answer 37

``` Bedtime Excessive daytime sleepiness Awakenings Regular schedule Snoring ```

Question 38

What are interventions to improve rest and sleep?

Answer 38

Health promotion - Good sleep hygiene - Reduce stimulants before bed - Environmental controls - Bedtime routines

Question 39

What are pharmacological approaches to sleep?

Answer 39

Nonbenzodiazepines Benzodiazepines Melatonin

Question 40

What are examples of nonbenzodiazepines?

Answer 40

Ambien, Lunesta

Question 41

What are examples of benzodiazepines?

Answer 41

Ativan, Restoril

Question 42

What are some sleep disorders?

Answer 42

Insomnia Obstructive sleep apnea Sleep deprivation

Question 43

Why is chronic NSAID use not recommended for older adults?

Answer 43

It causes GI bleeding and renal insufficiency

Question 44

What is the scoring scale for OAAS?

Answer 44

0 - no response to deep stimulus | 6 - agitated

Question 45

What is the scoring scale for the Pasero scale?

Answer 45

S - sleep, easy to arouse | 4 - somnolent, minimal or no response to physical stimulation