Pain and Surgery Flashcards
(104 cards)
1
Q
Pain is an indication that management should be made either:
A
-Pharmacological
-Non-pharmacological
-Surgical
2
Q
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (American Pain Society).
A
PAIN
3
Q
Infants (1-2 days old) are less sensitive to pain. A full behavioral response to pain is apparent at what age?
A
3-12 months of age
4
Q
the level at which someone experiences pain.
A
Pain threshold
5
Q
the maximum intensity or duration of pain that a person is willing to endure once the threshold has been reached.
A
Pain tolerance
6
Q
a decrease in pain tolerance is evident in the?
A
ELDERLY
7
Q
Who appears to be more tolerant to pain?
A
WOMEN
8
Q
Pain Tolerance is DECREASED when?
A
With repeated exposure to pain;
By fatigue, anger, boredom, apprehension; anxiety & fear
Sleep deprivation
9
Q
Pain Tolerance is INCREASED when?
A
By alcohol consumption;
Medication, hypnosis;
Warmth, distracting activities;
Strong beliefs or faith
10
Q
usually of short duration (less than 6 months) and often described in sensory term such as sharp, stabbing and shooting and accompanied by observable physical responses.
A
Acute Pain
11
Q
This type of pain is a major health concern.
A
Chronic Pain
12
Q
This type of Chronic Pain shows low back pain to rheumatoid arthritis
A
Chronic Nonmalignant pain
13
Q
This type of Chronic Pain usually accompanies migraine and headache.
A
Chronic Intermittent pain
14
Q
This type of chronic pain has something to do with cancer.
A
Chronic Malignant pain
15
Q
produces a physiologic response similar to acute pain.
A
Intermittent Pain
16
Q
allows for adaptation (functions of the body are normal but the pain is not relieved)
A
Persistent Pain
17
Q
used to describe discomfort that is perceived in a general area of the body, but not in the exact site where an organ is anatomically located.
A
Referred Pain
18
Q
This type of referred pain trigger points, small hyperirritable areas within a m. in which n. impulses bombard CNS & are expressed at referred pain.
A
Myofascial Pain
19
Q
This is deep pain, may originate from sclerotomic, myotomic, or dermatomic nerve irritation/injury.
A
Sclerotomic & Dermatomic Pain
20
Q
carries pain impulses to and from the CNS
A
PERIPHERAL NERVOUS SYSTEM
21
Q
This regulates involuntary functions
A
AUTONOMIC NERVOUS SYSTEM
22
Q
This part of the CNS transmits painful stimuli to the brain and motor responses and pain perception to the periphery.
A
Spinal Cord
23
Q
This part of the CNS processes and interprets transmitted pain impulses
A
Brain
24
Q
This pain control theory state that pain is the result of excessive stimulation of sensory receptors.
A
Intensity Theory
25
This pain theory describes that painful and non-painful sensations are transmitted by nonspecific receptors through a common pathway to higher centers of the brain.
Pattern Theory
26
This pain theory Describe four types of cutaneous sensation: touch, warmth, cold and pain. It focuses on the direct relationship between the pain stimulus and perception but does not account for adaptation to pain and the psychosocial factors that modulate the stimulus.
SPECIFICITY THEORY
27
This Pharmacological or Drug Interventions are defined as drugs that are on the market for indications other than pain but may be analgesic in selected circumstances. They include a very large number of drugs in numerous drug classes.
Adjuvant Drug Therapy
28
Includes acetaminophen or paracetamol, dipyrone and nonsteroidal anti-inflammatory drugs or NSAIDs). The NSAIDs are nonspecific analgesics and can potentially be used for any type of acute or chronic pain.
Non opioid Analgesics
29
The most effective analgesics (Ellison, 1998). This includes all drugs that interact with opioid receptors in the nervous system. These receptors are the sites of action for the endorphins, compounds that already exist in the body and are chemically related to the opioid drugs that are prescribed for pain.
Opioid Analgesics
30
Provide example of Non drug Interventions
Heat and cold therapy
31
this therapy works by improving circulation and blood flow to a particular area due to increased temperature.
Heat
32
is also known as cryotherapy. It works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.
Cold Therapy
33
is a method of sending a signal to the body via needles or other means, to turn on its own self-healing or regulatory mechanisms.
Acupressure
34
is the use of imagined pictures, sounds, or sensations for generalized relaxation or for specific therapeutic goals, such as the reduction of pain. These images can be initiated by the patient or guided by a practitioner. The sessions in which imagery is used can be individual or group.
Imagery
35
systematic relaxation of the large muscle groups.
Relaxation
36
provides biophysiological feedback to patient about some bodily process the patient is unaware of (e.g., forehead muscle tension).
Biofeedback
37
relaxation + suggestion + distraction + altering the meaning of pain.
hypnosis
38
Changes in the concept of health and illness, a broadening view of healing and curing, and interest in other cultural systems of medicine have created a growing openness to the spiritual dimensions of health
Prayer
39
are useful in teaching patients to control pain, to move in safe and structurally correct ways, to improve range of motion, and to increase flexibility, strength and endurance. " Active" and "passive" modalities can both be used, but active modalities, such as therapeutic exercise, are particularly important when the goal is to improve both comfort and function.
Physical Therapy
40
have a variety of benefits that produce better stamina and function. This may reduce the risk of secondary pain problems like muscle strains, and may also lead to improved confidence and sense of well-being.
Exercise
41
This Phase begins with the decision to perform surgery and continues until the client reaches the operating area.
Preoperative phase
42
This phase begins with the placement of patient on the operating table, including the entire surgical procedure and extends until transfer of the client to the recovery room. The implementation component of the nursing process is performed here.
Intraoperative phase
43
This phase begins with admission to the RR (recovery room) / PACU (Post Anesthesia Care Unit) and continues until the client receives a follow – up evaluation at home or is discharged to a rehabilitation unit. Evaluation component of the nursing process is completed in this phase.
Postoperative phase
44
a physician who realistically appreciate his or her own cognitive skills & personal characteristics & can intervene effectively in a patient’s illness or injury.
Surgeon
45
is an MD or DO, certified by the Phil. Board of Anesthesiology, who specializes in administering anesthetics to produce various states of anesthesia.
Anesthesiologist (part of the non sterile team)
46
a RN or ST (surgical technologist) who functions under the supervision of an RN.
Circulation Nurse (non sterile)
47
refers to a qualified RN, anesthesiologist assistant (AA), dentist, or physician who administers anesthetics.
Nurse Anesthetist (non sterile)
48
- nursing staff member of the sterile team;
- RN, LPN (licensed practical nurse) or LVN (licensed vocational nurse), ST (surgical technologist)
Scrub Nurse
49
- this area is isolated by doors from the main hospital corridor or elevators and from other areas of the OR suite.
- serves as an OUTSIDE-to-INSIDE access area, i.e. vestibular/exchange area.
- Street clothes are permitted.
Unrestricted / Unsterile Area
50
- personnel should be wearing OR scrub suit with cap.
- this area includes peripheral support areas and access corridors to the OR like PACU, SICU, offices for anesthesia department & administrative OR nursing personnel, etc.
Semi-restricted / Semi sterile Area
51
- personnel should be wearing complete OR scrub suit including mask.
- this area performs sterile procedures.
- includes OR suite room, scrub sink areas, sub sterile rooms where unwrapped supplies are sterilized.
Restricted / Sterile Area
52
What are the components of pain?
Stimuli
Perception
Response
Intensity
Threshold
Tolerance
53
What are the types of pain according to source?
Nociceptive Pain and Neuropathic Pain
54
most common type of pain.
Cause by potentially harmful stimuli being
detected by nociceptors around the body
Nociceptive Pain
55
Caused by injury to skin, muscles, bone, joint, and connective tissues. often involves inflammation of injured tissue.
Somatic Pain
56
Classification of Somatic Pain:
perceived as sharp or burning discomfort or pricking quality
Ex. Insect bite, paper cut
Superficial somatic pain or Cutaneous pain
57
Classification of Somatic Pain:
produce localized sensations that are sharp, throbbing, and intense; usually described as dull or aching, diffuse discomfort and
localized in one area.
Ex. Arthritis.
Deep somatic pain
58
Refers to pain that originates from ongoing injury to the internal organs or the tissues that support them.
Visceral Pain
59
A simple label for all kinds of pain that can be best explained by psychological problems
Sometimes occurs in the absence of any identifiable disease in the body.
PSYCHOGENIC PAIN
60
- Can be a symptom or complication of several diseases and conditions
- referred pain
- Pain that is processed abnormally by the nervous system and usually results from damage to either the pain pathways in peripheral nerves or pain processing centers in the brain
NEUROPATHIC PAIN
61
Used to describe discomfort that is perceived in a general area of the body, but not in the exact site where an organ is anatomically located.
Referred Pain
62
What are the types of pain according to characteristics?
Acute and Chronic Pain
63
Identify the type of pain:
o Sudden onset
o Sumptomatic of primary injury or disease
o Specific and localized
o Severity associated
with the acuity or sensitivity of the injury or disease process
o Responds favorably to drug therapy
o Requires gradually decreased drug therapy
o Diminishes with healing
o Suffering decreases
Acute Pain
64
Identify the type of pain:
o Remote onset
o Uncharacteristic of primary injury or disease
o Nonspecific and generalized
o Severity out of proportion to the stage of the injury or disease
o Responds poorly to drug therapy
o Requires increasing drug therapy
o Persists beyond healing stage
o Suffering intensifies
Chronic Pain
65
TRANSMISSION OF PAIN:
Is the conversion of chemical information in the cellular environment to electrical impulses that move toward the spinal cord.
“It triggers the release of noxious stimuli”
Transduction
66
TRANSMISSION OF PAIN:
The phase during which the peripheral nerve fibers form synapses with neurons in the spinal cord,, the pain impulses move from the spinal cord sequentially levels in the brain, the impulses ascend to the reticular activating system, the limbic system and the thalmus and finally the cerebral cortex.
Transmission
67
TRANSMISSION OF PAIN:
Refers to the phase of impulse transmission during which the brain experiences pain at a conscious level (awareness of pain)
Perception
68
TRANSMISSION OF PAIN:
The last phase of pain impulse transmission during which the brain interacts with the spinal nerves in a downward fashion to alter the pain experience.
Modulation
69
This nerve fibers carry impulses TO the CNS
Afferent Nerve Fibers
70
This nerve fibers carry impulses FROM the CNS
Efferent Nerve Fibers
71
This type of nociceptor has rapid rate, transmit acute sharp pain
A - Delta Fibers
72
This type of nociceptor has slower rate and produce chronic type of pain
C - Fibers
73
Fight or flight response to stress
Sympathetic Nervous System
74
Exhaustion or shock response “pampakalma”
Parasympathetic
75
What theory is this?
- located in the dorsal horn of the spinal cord
- Smaller, slower nerve fibers carry pain impulses
- Larger, faster nerve fibers carry other sensations
Gate control theory
76
This is done to establish the presence of a disease condition
- Enables the surgeon to verify a suspected diagnosis
Diagnostic Surgery
77
This is done to determine the extent of the disease condition and at times to make or confirm a diagnosis
E.g. exploration of abdomen for unexplained pain
Exploratory
78
Type of Curative
Removal of decreased organ (suffixed used is “ectomy”)
E.g. cholycystectomy,
appendectomy
Ablative
79
Type of Curative:
Repair of congenitally defective organs (suffixes used are “plasty”, “orrhapy”, “pexy”)
E.g. total hip replacement, orchiopexy (surgery for undescended testes)
Constructive
80
Type or Curative:
Repair of damaged organs
E.g. plastic surgery after burns
Reconstructive
81
This is done to relieve distressing signs and symptoms, not necessarily to cure the disease
o E.g. resection of tumor to telieve pressure and pain
Palliative Surgery
82
This is Correction of defects, improvement of appearance or change to a physical feature
o E.g. rhinoplasty, cleft lip repair,
mammoplasty
Cosmetic
83
CLASSIFICATION BASED ON URGENCY:
o Without delay
o Condition is life-threatening requiring surgery immediately
o Severe bleeding, bladder or intestinal obstruction, fractured skull, gunshot or stab wounds, extensive burns
Emergent
84
CLASSIFICATION BASED ON URGENCY:
o Within 24-30 hours
o Client requires prompt attention
o Closed fracture, infected wound,
exploration, irrigation
Urgent
85
CLASSIFICATION BASED ON URGENCY:
o Needs surgery
o Planned within a few weeks or month
o Thyroid disorders, prostatic
hyperplasia, cataracts
Required
86
CLASSIFICATION BASED ON URGENCY:
o Should have surgery
o Client will not be harmed if surgery is not performed but will benefit from it
o Repair of scars, simple hernia, vaginal repair
Elective
87
CLASSIFICATION BASED ON URGENCY:
o Personal preference, not required
o Ex. Cosmetic surgery
Optional
88
DIETARY RESTRICTIONS:
How many hours NPO prior to surgery under GENRAL ANESTHESIA?
8 hours
89
DIETARY RESTRICTIONS:
How many hours NPO prior to surgery under EPIDURAL ANESTHESIA?
4 Hours
90
DIETARY RESTRICTIONS:
How many hours NPO prior to surgery under LOCAL ANESTHESIA.
No restrictions
91
Identify which stage under general anesthesia.
o Extends from the administration of
anesthesia to the time of loss of
consciousness.
o Drowsy, dizzy, amnesic, exaggerated
hearing, decreased pain.
Stage I: ONSET /INDUCTION
92
Identify which stage under general anesthesia.
Reached by administration of anesthetic vapor or gas and supported by IV agents as necessary. The patient is unconscious and lies quietly on the table.
Stage III: STAGE OF SURGICAL ANESTHESIA (RELAXATION STAGE)
93
Identify which stage under general anesthesia.
o Extends from time of loss of consciousness to the time of loss of lid
reflex.
o Maybe characterized by shouting,
struggling of the patient, excited with irregular breathing & movements of extremities, susceptible to stimuli like noise and touch
o Patients DO NOT BE STIMULATED during this stage and restrain the patient.
Stage II: EXCITEMENT/DELIRIUM
94
Identify which stage under general anesthesia.
o Characterized by respiratory & cardiac depression or arrest. It is due to overdose of anesthesia
o Not breathing, little or no pulse heartbeat
o Resuscitation must be done
Stage IV: DANGER STAGE
95
sometimes called CONDUCTION ANESTHESIA; produces loss of painful sensation in one area or region of the body and does not result in unconsciousness.
Regional Anesthesia
96
TYPE OF REGIONAL ANESTHESIA:
Drug is sprayed or dropped onto an area to be desensitized, block peripheral nerve endings, in the skin, mucus membrane of the vagina, rectum, nasopharynx and mouth.
Topical
97
TYPE OF REGIONAL ANESTHESIA:
Only the peripheral nerves around the area of incision are blocked
Local Block
98
TYPE OF REGIONAL ANESTHESIA:
The area surrounding the incision is injected and infiltrated with local anesthesia
Field Block
99
TYPE OF REGIONAL ANESTHESIA:
Blocks major nerve (brachial,
intercostal, radial, femoral)
Nerve Block
100
This type of anesthesia is achieved by injecting a local anesthetic agent into the epidural space that surrounds the dura mater of the spinal cord
- Injected through catheter
EPIDURAL ANESTHESIA
101
This type of anesthesia is a Extensive conduction nerve block that is produced using local anesthetic agent.
- For the lumbar puncture procedure, the patient usually lies on the side in a knee-chest position.
- Sterile technique is used as a spinal puncture is made and the medication is injected through the needle.
SPINAL ANESTHESIA
102
TYPE OF SKIN SHAVING MATERIAL:
o available in electric type or cordless handle with rechargeable batteries.
o Electric clippers with fine teeth cut hair close to the skin.
o can be done immediately before the surgical procedure or up to 24 hours preoperatively using short strokes against the direction of hair growth
Clippers
103
TYPE OF SKIN SHAVING MATERIAL:
o Skin testing should be done first for possible allergies.
o Should not be used around the eyes and genitalia.
o Should be applied on the skin, wait for 20 minutes before washed off.
Depilatory cream
104
TYPE OF SKIN SHAVING MATERIAL:
o Avoid making nicks and cuts in the skin (nicks done 30 minutes before the surgical procedure are considered clean wounds)
o Always use a sharp and should always be clean. Hold the skin taut and shave by stroking in the direction of hair growth.
Razor
