Pain management

Question 1

Nociceptive pain

Answer 1

• Damage to bones, soft tissue, internal organs
• Throbbing, aching
• Localized
• Response opioid and non-opioid medications

Question 2

Neuropathic pain

Answer 2

• Damaged pain nervous
• Pain is intense
• Burning, shooting, pains a needles
• Response to adjuvant medications

Question 3

Somatic pain?

Answer 3

aching, throbbing(arthritis)

bone fractures.
strained muscles
connective tissue diseases, such as osteoporosis
cancer that affects the skin or bones

Question 4

Visceral pain?

Answer 4

Squeezing, cramping
pain related to the internal organs in the midline of the bod= abdominal pain

Question 5

Cutaneous pain

Answer 5

Sharp(surgical wounds)

pain perceived from the skin
Subcutaneous/below the skin=skin pain

Question 6

Acetaminophen

Answer 6

Analogist and antipyretic
Consider maximum daily doses 4g(2-3g if liver disease)
Can cause liver dysfunction

Question 7

NSAIDS

Answer 7

Aspirin, ibuprofen, naproxen
Mild pain alone or adjuvant
Inhibits inflammation
GI toxicity, bleeding
Renal dysfunction

Question 8

What mean by pain is multidimensional?

Answer 8

pain is a bio-psycho-social-spiritual experience

Question 9

Pain

Biological

Answer 9

Fifth vital sign

Cause of pain
Impact on functional status and sleep

Question 10

a) Acute pain?
b) Chronic pain?

Answer 10

a) lasts less than 1-3 month
Protective
Fight and flight
Self-limiting
Direct cause

b) longer than 3 months
Not protective
Not impacted Vital sings

Question 11

Wong-Baker FACES pain rating scale

Answer 11

• PQRST
• Age 3 and above
• Very important to qualify how the scale number means

best question
What pain level could you live with so you can be a function?

Question 12

Pain assessment in advances

PAINAD

Answer 12

DEMENTIA

Pain assessment tool for patients with advanced dementia

1-3=mild pain; 4-6=moderate pain; 7-10=severe pain

Question 13

FLACC pain score

Answer 13

For infant and toddler

1-3 = Mild discomfort. 4-6 = Moderate pain. 7-10 =pain

Question 14

Pain

Psychological

Answer 14

Pain influences mood
Past experiences with pain

Depression or anxiety?
Stress and fear make pain stronger

Question 15

Pain

Social

Answer 15

• *Impact on quality of life**
• If the pt immobility, isolate from the society
• *Cost and access**
• insurance?

Question 16

Pain

Spiritual

Answer 16

• *Cultural considerations**
• pain is punishment
• *Chaplain support**

Question 17

Opioid

Answer 17

• To use moderate to severe(first line therary)
• Block neurotransmitters=reduce pain
• No ceiling effect
• Contraindication is the history of reaction(cause opioid?)
• Nausea and vomiting is not a contraindication

Question 18

Opioids options

Answer 18

• Fentanyl
• Hydrocodone
• Hydromorphone
• Methadone
• Morphine
• Oxycodone

Question 19

What mean by no ceiling effect

Opioid

Answer 19

Keep working and working till respiratory depression and die

Question 20

What is the most concerning side effect?

Opioid

Answer 20

• *Respiratory depression**
• *Opioid naïve patient with the first dose**

Reserve with naloxone(reverses an opioid overdose)
Ongoing assessment
EOL is the different

Question 21

Another side effect of Opioid

Answer 21

Sedation
Urinary retention
Nausea and vomiting
Pruritis
Myoclonus
Orthostatic hypotension

Question 22

Tolerance

medication

Answer 22

Starts not working as desire

It is not a significant problem with clinical setting

Question 23

Physiological dependence

medication

Answer 23

Most happen with opioid medication

A person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses.

Question 24

Substance-use disorder

medication

Answer 24

• A mental disorder
• Affects a person’s brain and behavior
• Inability to control their use of medications
• Starting fail
• Starting to see a problem but still functioning

Substances such as alcohol, marijuana and nicotine also are considered drugs.

Question 25

Addiction medication

Answer 25

- Primary, chronic, neurobiological disease - Genetic, psychosocial factors - Impaired control over drug use, cannot live without it

Question 26

**Chronic pain management** Things to keep in mind

Answer 26

-Body learns to adapt to deal with the pain Vital signs may not be impacted.... **But if pt says that pain is 5/10, means pain is 5/10!!!!**

Question 27

Ethnology and location

Answer 27

Where does it start from? Where does it begin from?

Question 28

Patient controlled analgesia PCA

Answer 28

- **Only controlled by the patient** - Small dose - Another RN to verify the pump settings

Question 29

Which of the following signs or symptoms in a patient who is opioid-naïve is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? 1. Oxygen saturation of 95% 2. Difficulty arousing the patient 3. Respiratory rate of 12 breaths/min 4. Pain intensity rating of 5 on a scale of 0 to 10

Answer 29

２ arousing/awaken (someone) from sleep.

Question 30

A patient is being discharged home on an around-the-clock (ATC) opioid for postoperative pain. Because of this order, the nurse anticipates an additional order for which class of medication? 1. Opioid antagonists 2. Antiemetics 3. Stool softeners 4. Muscle relaxants

Answer 30

3

Question 31

A new medical resident writes an order for oxycodone CR 10 mg PO q2h prn. Which part of the order does the nurse question? 1. The drug 2. The time interval 3. The dose 4. The route

Answer 31

2 Adults—10 to 30 milligrams (mg) **every 4 hours as needed**

Question 32

The nurse reviews a patient's medical administration record (MAR) and finds that the patient has received oxycodone/acetaminophen (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? 1. The patient's level of pain 2. The potential for addiction 3. The amount of daily acetaminophen 4. The risk for gastrointestinal bleeding

Answer 32

3

Question 33

1. An oriented patient has recently had surgery. Which action is best for the nurse to take to assess this patient's pain? a. Assess the patient's body language. b. Ask the patient to rate the level of pain. c. Observe the cardiac monitor for increased heart rate. d. Have the patient describe the effect of pain on the ability to cope.

Answer 33

B One of the most subjective and therefore most useful characteristics for reporting pain is its severity.

Question 34

When using ice massage for pain relief, which of the following is correct? SATA 1: Apply ice using firm pressure over the skin 2: Apply ice for 5 minutes or until numbness occurs. 3: Apply ice no more than 3 times a day 4: Limit application of ice to no longer than 10 minutes 5: Use slow, circular steady massage

Answer 34

1,2,5 Firm

Question 35

Idiopathic pain

Answer 35

- Chronic pain - Not know the reason

Question 36

Adjuvant Medications

Answer 36

- To enhance the effects of pain medications, - Treat concurrent symptoms, and provide analgesia for other types of pain

Question 37

Pain pathway Transduction

Answer 37

Noxious stimuli cause cell damage Damaging to tissue and liable to cause pain(detected by sensory receptor)

Question 38

Pain pathway Transmission

Answer 38

Action potential continue to form Site of injury to spinal cord

Question 39

Pain pathway Perception

Answer 39

Experience of pain

Question 40

Pain pathway Modulation

Answer 40

Where can pain be modulated in the body, and what causes its modulation? Answer: Pain is modulated at many places. It can be modulated **at the level of pain receptors by simultaneous activity in low-threshold mechanoreceptors**

Question 41

The nurse understands that the shortest acting relief method is 1: Patient controlled analgesia 2: Intramuscular sedatives 3: Intravenous narcotics

Answer 41

3 Quick response, but duration is short

Question 42

The nurse is caring for a pt who is experiencing pain. The nurse understands that a common psychological pt response to pain is 1: Experiencing fear related to loss of independence 2: Developing an increased tolerance to the drug 3: Asking for pain meds relieve pain

Answer 42

1 2-physiological response 3-Behavioral response

Question 43

A pt complains of pain. When caring for this pt, the most important things that nurse must recall is that 1: The extent of pain is directly related to the amount of tissue damage 2: Administering opioids for pain will eventually lead to addiction 3: The person experiencing the pain is the authority about the pain 4: Behavioral adaptions are congruent with statements about pain

Answer 43

3 authority=right

Question 44

A pt requests pain medication. What should the nurse do first when responding to this pt request for pain meds? 1: Use distraction to minimize the pt's perception of pain. 2: Place the pt in the most comfortable position possible 3: Administer pain meds to the pa quickly 4: Asses the various aspects of the pt's pain

Answer 44

4 ADPIE!!!!

Question 45

Which statement by the pt to a nurse indicates a precipitating factor associated with pain? 1: " I usually feel a little dizzy and think I 'm going to vomit I have pain" 2: "I usually have pain after I get dressed in the morning" 3: "My pain usually comes and goes throughout the night" 4: "My pain feels like a knife cutting right through me"

Answer 45

2 precipitating=induce

Question 46

A pt has a history of severe chronic pain. One of the most important guidelines associated with providing nursing care to this pt is 1: Determining the level of function that can be performed without pain 2: Focusing on pain management intervention before pain is excessive 3: Providing interventions that do not precipitate pain 4: Asking what is an acceptable level of pain

Answer 46

2