Pain Exam 3

Question 1

What is pain?

Answer 1

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Question 2

How is pain defined according to the person experiencing it?

Answer 2

Pain is whatever the person says it is, and it exists whenever the person says it does.

Question 3

Why is pain different from vital signs like pulse or blood pressure?

Answer 3

Pain cannot be measured objectively like pulse or blood pressure.

Question 4

What is one role of pain in the body?

Answer 4

Pain can be a warning of potential injury to the body.

Question 5

How is pain classified?

Answer 5

Pain is classified and assessed by origin, duration, pattern of occurrence, quality, intensity, and time since onset.

Question 6

What is cutaneous/superficial pain?

Answer 6

Cutaneous/Superficial Pain usually occurs due to a skin or subcutaneous injury and is usually short in duration.

Question 7

What characterizes deep somatic pain?

Answer 7

Deep somatic pain originates in ligaments, tendons, nerves, blood vessels, and bones, and can be longer in duration.

Question 8

What is visceral pain?

Answer 8

Visceral pain is caused by stimulation of deep internal pain receptors, often in the abdominal cavity, cranium, or thorax.

Question 9

What is radiating pain?

Answer 9

Radiating pain starts at the origin but extends to other locations.

Question 10

What is referred pain?

Answer 10

Referred pain starts at the origin but extends to more distant locations.

Question 11

What is phantom pain?

Answer 11

Phantom pain is pain perceived to originate from an area that has been surgically removed.

Question 12

What is psychogenic pain?

Answer 12

Psychogenic pain is believed to arise from the mind, with the patient perceiving pain without an identifiable physical cause.

Question 13

Define acute pain.

Answer 13

Acute pain is usually short in duration, has a rapid onset, and may last up to 6 months.

Question 14

Define chronic pain.

Answer 14

Chronic pain lasts 3-6 months or longer and interferes with daily activities.

Question 15

What is transduction in the context of pain?

Answer 15

Transduction is the process when nerve cells (nociceptors) become activated by mechanical, thermal, or chemical stimuli.

Question 16

What is transmission in pain processing?

Answer 16

Transmission is when peripheral nerves carry the pain message to the dorsal horn of the spinal cord and then to the brain.

Question 17

What role do neurotransmitters play in pain perception?

Answer 17

Neurotransmitters are endogenous chemicals that aid in pain transmission, sending messages to the thalamus of the brain.

Question 18

What is pain perception?

Answer 18

Perception involves the recognition and interpretation of pain in the frontal cortex.

Question 19

What is modulation in pain processing?

Answer 19

Modulation changes the perception of pain by facilitating or inhibiting pain signals through the analgesia system.

Question 20

What are some effects of unrelieved pain on the endocrine system?

Answer 20

Unrelieved pain can trigger hormones that decrease insulin release and increase glucose release.

Question 21

How does pain affect the cardiovascular system?

Answer 21

Pain leads to hypercoagulation, increased heart rate, blood pressure, cardiac workload, and oxygen demand.

Question 22

What impact does pain have on the musculoskeletal system?

Answer 22

Unrelieved pain can lead to impaired muscle function, fatigue, and immobility.

Question 23

What is the Fifth Vital Sign in pain assessment?

Answer 23

Pain is assessed every time vital signs are checked, but its classification as the fifth vital sign has been debated.

Question 24

What is the most common method to assess pain?

Answer 24

The numerical rating scale from 0 to 10 is the most common method.

Question 25

What are nonpharmacological pain relief measures?

Answer 25

Nonpharmacological measures include TENS units, massage, spinal cord stimulators, acupuncture, and heat/cold applications.

Question 26

What is TENS?

Answer 26

TENS (transcutaneous electrical nerve stimulation) uses electrode pads to relieve pain.

Question 27

What is the purpose of moisture heat therapy?

Answer 27

Moist heat therapy helps relax muscles and promote healing.

Question 28

What are some cognitive behavioral interventions for pain management?

Answer 28

Cognitive behavioral interventions include distraction, relaxation techniques, guided imagery, and therapy animals.

Question 29

What temperature range should moist heat therapy be applied?

Answer 29

Moist heat should be applied at temperatures between 40°C to 46°C (105°F to 115°F).

Question 30

What is the primary goal of pain treatment strategies?

Answer 30

Pain treatment strategies should be patient-centered, considering risks and benefits.

Question 31

What is the recommended duration for applying heat or cold therapy?

Answer 31

Heat or cold should be applied for no longer than 15 minutes at a time.

Question 32

What is the purpose of cognitive behavioral interventions in pain management?

Answer 32

They aim to alter negative thoughts and encourage more adaptive thoughts and emotions.

Question 33

What are cognitive behavioral interventions that can help alter negative thoughts?

Answer 33

* Distraction * Relaxation techniques * Guided imagery * Diaphragmatic breathing * Hypnosis * Humor * Expressive writing ## Footnote These interventions encourage more adaptive thoughts and emotions.

Question 34

What is the purpose of therapy animals in a therapeutic setting?

Answer 34

To decrease stress, anxiety, and depression, and provide benefits for those with chronic pain, including cancer patients. ## Footnote Animal assisted therapy has been used for many years.

Question 35

What is therapeutic touch?

Answer 35

A practice developed by nurses to direct positive energy and help patients relax, derived from the ancient practice of 'laying on of hands'. ## Footnote It is often used to promote relaxation.

Question 36

What are analgesics?

Answer 36

Pain relieving medications that should not be confused with anesthetics. ## Footnote Analgesics work best if given before pain becomes too severe.

Question 37

What is the recommended approach for administering analgesics?

Answer 37

Always start with the least amount possible and maintain around-the-clock dosing to control pain better. ## Footnote Keeping ahead of the pain helps patients function optimally.

Question 38

What are non-opioid analgesics?

Answer 38

* A variety of medications that relieve mild to moderate pain * Available over the counter * Reduce inflammation and fever ## Footnote They can be taken in rotation or combined with opioid pain medications.

Question 39

What are the common side effects of nonsteroidal anti-inflammatory drugs (NSAIDs)?

Answer 39

* Gastric bleeding * Irritation * Increased blood pressure * Harmful to kidneys ## Footnote NSAIDs are the largest group of nonopioid analgesics.

Question 40

What unique effect does aspirin have compared to other NSAIDs?

Answer 40

Inhibits platelet aggregation, affecting bleeding. ## Footnote Regular use can prolong clotting time, increasing bruising and bleeding risk.

Question 41

What is acetaminophen (Tylenol)?

Answer 41

A non-NSAID that reduces fever and pain but has very little anti-inflammatory effect. ## Footnote It can cause liver toxicity and should be limited to 4,000 mg per day.

Question 42

What are opioids used for?

Answer 42

Relief of pain by activating opioid receptors in the brain, spinal cord, and central nervous system. ## Footnote They require careful monitoring due to the risk of addiction.

Question 43

What are the possible side effects of opioids?

Answer 43

* Sedation * Respiratory depression * Orthostatic hypotension * Nausea and vomiting * Constipation * Itching, rashes, and flushing ## Footnote Clients must be frequently assessed to avoid oversedation.

Question 44

What are the three classes of opioids?

Answer 44

* Natural * Semisynthetic * Synthetic ## Footnote Natural opioids come from the opium poppy, semisynthetic are derived from natural opiates, and synthetic are manufactured.

Question 45

What are adjuvant analgesics?

Answer 45

Medications that assist with pain relief by addressing underlying pain generators. ## Footnote Examples include corticosteroids, antidepressants, anticonvulsants, cannabis, and botulinum toxin.

Question 46

What is Patient Controlled Analgesia (PCA)?

Answer 46

Self-administered medication for pain relief, frequently used postoperatively. ## Footnote It allows clients to administer small amounts of pain medication as needed.

Question 47

What are nursing considerations when using PCA?

Answer 47

* Only trained nurses should set up the pump * Two nurses should initiate setup * Monitor CO2 and O2 levels * Educate patient and family ## Footnote PCA pumps are programmed with lock-out times.

Question 48

What is the purpose of KASPER?

Answer 48

A controlled substance prescription monitoring system in Kentucky to assist practitioners and law enforcement with controlled substances. ## Footnote KASPER is not intended to prevent patients from receiving needed medications.

Question 49

What is the difference between drug misuse, abuse, and diversion?

Answer 49

* Misuse: Taking for non-medical reasons * Abuse: Repeated non-medical use * Diversion: Acquiring medication not prescribed ## Footnote All terms relate to improper use of controlled substances.

Question 50

What should be documented regarding pain management?

Answer 50

* Expected outcomes * Present pain level * Response to interventions * Adverse reactions * Planned interventions ## Footnote Pain documentation should occur every 4 hours and after interventions.

Question 51

What should patients and families be taught about pain management?

Answer 51

* Cause of pain * Overall pain management plan * Normal duration of pain * Nonpharmacological treatment options * Side effects of medications ## Footnote Teach how to contact the healthcare team and safely dispose of narcotics.

Question 52

What is the significance of swearing in relation to pain?

Answer 52

Swearing raises pain threshold and tolerance but new 'swear' words do not have similar effects. ## Footnote Swearing may affect pain alleviation through emotion arousal.

Question 53

What nursing interventions are important for managing a client's pain?

Answer 53

* Assess pain frequently * Support patient and family * Provide analgesics timely * Manage side effects * Educate the patient ## Footnote Evaluation is critical to ensure pain management effectiveness.

Question 54

What are SMART goals related to pain management?

Answer 54

* Report pain less than 3 * Participate in ADLs by shift end * List 3 ways to manage pain ## Footnote Goals should be specific, measurable, achievable, relevant, and time-bound.

Question 55

How does the body react to pain via respiratory?

Answer 55

Patients in pain tend to breathe more shallow limiting thoracic and abdominal movement. This is called splinting. Splinting reduces tidal volume and increases inspiratory and expiratory pressures. These changes can lead to pneumonia, ateclectasis, and underventilation resulting in respiratory acidosis.

Question 56

How does the body react to pain via genitourinary?

Answer 56

Pain can cause release of excessive amounts of catecholamines, aldosterone, ADH, cortisol, and prostaglandins. These hormones hold onto fluid and cause decreased urinary output, hypertension, fluid overload, and increased cardiac output.

Question 57

How does the body react to pain via gastrointestinal?

Answer 57

In response to pain, intestinal muscle tone increases and gastric emptying decreases.

Question 58

Factors influencing pain

Answer 58

- emotions - previous pain experience - life stages - socialcultural factors -communication and cognitive impairments

Question 59

Pain assessment

Answer 59

Pain location, quality, onset, duration, and intensity should be included in the assessment. Pain free is not always an option

Question 60

scales for pain level

Answer 60

faces called wong baker scale , 0-10, non verbal scale

Question 61

Culturally competent assessment

Answer 61

use an interpreter for pain rating and questions

Question 62

non- opioid analgesics

Answer 62

NSAIDS most side effect is gastric bleeding and ittitation. Can cause BP to raise--->harmful to kidneys

Question 63

ASPRIN

Answer 63

nsaid reducing inflammation, fever, and pain, it can inhibit platelet aggregation, the first step of clot formation no children--->Aspirin in children is associated with Reye’s syndrome

Question 64

Tylenol (acetaminophen)

Answer 64

not an NSAID no anti-inflammatory. does do fever and pain liver toxicity max of 4000mcg per day

Question 65

Opioids

Answer 65

Opioids can cause both sedation and depression of the respiratory system - check VS

Question 66

Managing Pain for Older Adults

Question 67

PCA PUMP

Answer 67

PCA pumps are contraindicated in patients who have limited ability to operate or understand use. Family should be taught to NEVER operate the PCA pump. The patient is the ONLY person who should be instructed to depress the button for administration.

Question 68

Nerve block

Answer 68

Nerve blocks or epidural injections are types of regional anesthesia. Nerve blocks may be used for short term pain relief for/after surgical procedures or for long term management of chronic pain.

Question 69

addiction

Answer 69

A chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.

Question 70

Chemical/Physical Dependence

Answer 70

Develops over time due to long term use of a drug. For example, a 20-year tennis player with chronic elbow pain may be prescribed hydrocodone for pain, as needed. After 10 years, he may be dependent on hydrocodone (meaning he could go in withdrawal without it) but he isn’t necessarily addicted.

Question 71

Why should a client be honest with a nurse during assessment regarding their use of drug?

Answer 71

Treat for withdrawal symptoms

Question 72

Intervention for possible drug abuse or addiction

Answer 72

Nursing intervention: Remember to remain nonjudgmental when providing care. It is the duty of the nurse to maintain balance of pain control and protect against inappropriate drug use.

Question 73

KASPER

Answer 73

KASPER is a controlled substance prescription monitoring system

Question 74

When is pain documented?

Answer 74

Pain should be documented q4h and for response to intervention in one hour

Question 75

Client X is a 65 year old, female admitted to a telemetry unit after a left above knee amputation. She has a history of high blood pressure, diabetes, and non healing wounds. Client X rates her pain as a 5 out of 10. She has a patient-controlled analgesia pump (PCA) with 2 mg of morphine available every 30 minutes. She states she pushed the button 5 minutes ago. She states her goal for pain is a 3. Client X has orders for 5mg of oxycodone PO every 12 hours as needed. Her wife is at the bedside. What will the nurse do next?

Answer 75

-anxiety -risk for falls -risk for opiod abuse -not ready to learn -educate -give pain meds -walk pain goals 3/10 lower pain rating report VS, grimmacing Goal met: yes

Question 76

Eval of pain

Answer 76

Evaluation is critical to pain management. Compare your findings with expected outcomes of the patient. Are the patient’s pain scores consistently at or better than the desired level? Are they improving? Is the patient’s behavior, range of motion, and mood consistent with pain relief? Can the patient participate in ADLs, pulmonary toilet, physical therapy, etc.? Is the pain tolerable during procedures, dressing changes, and therapies?