Pain Objectives

Question 1

considered the 5th vital sign

Answer 1

Pain

Question 2

Origin:Arises in skin/Sub-q tissue (paper cut/hot stove)

Answer 2

Cutaneous/superficial

Question 3

Origin:Originates in the ligaments, tendons, nerves, blood vessels, and bones (fracture/bone cancer)

Answer 3

Somatic

Question 4

Origin:Deep internal pain; often experienced in the abdominal cavity, cranium, or thorax
Not well localized; tight/pressure/crampy
Menstrual/labor pain; GI infections; bowel disorders; organ cancers

Answer 4

Visceral

Question 5

Origin:Starts at the origin but extends to other locations.

Example - sore throat extends to ears/head

Answer 5

Radiating

Question 6

Origin:Occurs in an area that is distant from the original site.
Example -the pain from a heart attack may be experienced down the left arm, through the back, or into the jaw.

Answer 6

Referred

Question 7

Origin:Perceived to originate from an area that has been surgically removed. Patients with amputated limbs may still perceive that the limb exists and experience burning, itching, and deep pain in that area.

Answer 7

Phantom

Question 8

Origin:Believed to arise from the mind. The patient perceives the pain despite the fact that no physical cause can be identified. Psychogenic pain can be just as severe as pain from a physical cause.

Answer 8

Psychogenic

Question 9

Most common type of pain

Answer 9

Nociceptive pain (acute)

Question 10

Occurs when pain receptors respond to thermal, chemical, or mechanical stimuli

Answer 10

Nociceptive pain

Question 11

Type of pain that may occur as a result of trauma, surgery, or inflammation.
Often described as “achy” pain

Answer 11

Nociceptive pain

Question 12

a complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli.

Answer 12

Neuropathic pain (Often chronic)

Question 13

Short duration/rapid onset (up to 6 months)
Varies in intensity
Protective in nature
Associated with injury/surgery
Generally lessens/disappears with healing
Activates the sympathetic nervous system

Answer 13

acute pain

Question 14

Lasts more than 6 months
Interferes with ADL’s
Periods of remissions/exacerbations
Not protective in nature; may lead to W/D; depression; anger; frustration; dependence

Answer 14

Chronic pain

Question 15

Chronic
Highly resistant to relief
Frustrating to the client
Treat with multiple methods to ensure pain relief

Answer 15

Intractable pain

Question 16

may be described as sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling.

Answer 16

Pain quality

Question 17

may be referred to as episodic, intermittent, or constant.

Answer 17

Pain periodicity

Question 18

is described with a variety of terms, such as mild, distracting, moderate, severe, or intolerable.

Answer 18

Pain intensity

Question 19

In a process called ________, nociceptors become activated by the perception of mechanical, thermal, and chemical stimuli.

Answer 19

transduction

Question 20

Peripheral nerves carry the pain message to the dorsal horn of the spinal cord in a process known as _____

Answer 20

transmission

A-delta and C-delta fibers

Question 21

involves the recognition and interpretation of pain in the frontal cortex

Answer 21

Pain Perception

Question 22

is the duration or intensity of pain that a person can endure. This varies not only from person to person but also for the same person in different situations

Answer 22

Pain tolerance

Question 23

A process called ___________changes the perception of pain by either facilitating or inhibiting pain signals through the endogenous analgesia system and the gate-control mechanism.

Answer 23

modulation

Question 24

It is most important for the nurse to understand the various ways in which pain is classified so that he or she can

Document the client’s pain using accurate terms.
Be clear in communication with the physician.
Develop an effective pain management plan.
Educate the client thoroughly.

Answer 24

Develop an effective pain management plan

Different modalities are used in the treatment/management of pain and are often based on how the pain is classified (e.g., acute versus chronic).

Question 25

These fibers: are large and fast myelinated and transmit pain that is sharp, fast, well localized, “1st pain”

Answer 25

A” delta

Question 26

These fibers: are smaller and unmyelinated and transmit slow, diffuse, aching pain, “2nd pain”

Answer 26

C” fibers

Question 27

lowest intensity of a stimulus that is recognized as pain | Varies from client to client

Answer 27

Pain threshold

Question 28

The onset of acute pain activates the ________ nervous system

Answer 28

sympathetic this fight-or-flight (stress) response is protective. It minimizes blood loss, maintains perfusion to vital organs, prevents and fights infections, and promotes healing.

Question 29

If the pain continues, the body adapts, and the________ nervous system takes over

Answer 29

parasympathetic

Question 30

Unrelieved pain - Effects on endocrine system - triggers_____ Insulin and testosterone _____ Carbohydrates, proteins, and fat breakdown leading to _______ All which can result in :

Answer 30

excessive release of hormones decrease hyperglycemia Weight loss, tachycardia, fever, increased respiratory rate

Question 31

Cardiovascular System Unrelieved pain leads to __________ clotting, also called____________ ___________ heart rate, blood pressure, cardiac workload and O2 demand All of which can lead to: _____

Answer 31

increased , hyper coagulation increased Chest pain, intracoronary thrombosis, Myocardial Infarction

Question 32

Musculoskeletal system - unrelieved pain effects

Answer 32

Fatigue, impaired muscle function, immobility | alters ability to perform ADL’s

Question 33

Respiratory system - unrelieved pain effects: Breaths become ________ Tidal volume ______ Resulting in:_______

Answer 33

shallow reduced Pneumonia, retained carbon dioxide (Hypercarbia), respiratory acidosis

Question 34

Unrelieved pain - Genitourinary system : ___________amounts of catecholamines, aldosterone, ADH, cortisol, angiotensin II, and prostaglandins _________ urinary output, urinary retention, fluid _______, ____kalemia, ______tension, increased cardiac output

Answer 34

excessive decreased overload hypo hyper

Question 35

unrelieved pain - Gastrointestinal system: Intestinal secretions and smooth muscle tone ______ Gastric emptying, and motility __________

Answer 35

increase | decrease

Question 36

The first step in the treatment of pain is an appropriate and thorough

Answer 36

pain assessment.

Question 37

The nurse is caring for a client who was involved in a motor vehicle accident. As a result of the accident, the client required multiple surgeries and is currently intubated. ``` What are the common responses to acute pain - Select all that apply A Constricted pupils B Increased heart rate C Decreased respiratory rate D Increased respiratory rate E Tearful ```

Answer 37

B, D, E constricted pupils are a sign of deep or prolonged pain not acute. A change in breathing pattern can be seen with prolonged pain, but it is not a typical sign of acute pain. In acute pain, the client is likely to be tearful with tachycardia and tachypnea.

Question 38

When we use pain scales, we are measuring | the_________ of the client’s pain

Answer 38

INTENSITY

Question 39

_______vital signs do not mean that the patient is free of pain.

Answer 39

normal

Question 40

What is PQRST in pain assessment

Answer 40

Precipitating factor: What provokes or causes the pain, makes it worse, or better? Quality: What it like - sharp? dull? burning? Stabbing? Crushing? Changing? Radiate: Does pain travel from one area to another? Severity: Does the patient think the pain is mild, moderate, or severe? (On a scale of 1-10) does it vary – what does the variation depend on? Timing: Constant or intermittent? Occurred before? Started? Change in severity- get better, then worse? When did it start? How long has it been going on?

Question 41

Non pharmacological pain relief: _______consists of electrode pads, connecting wire, and the stimulator. The pads are applied directly to the painful area, which is most often muscle and soft tissue. Once activated, the unit stimulates A-delta sensory fibers.

Answer 41

transcutaneous electrical nerve stimulator (TENS)

Question 42

Non pharmacological pain relief: _______combines a TENS unit with needle probes percutaneously placed (through the skin) to stimulate peripheral sensory nerves.

Answer 42

Percutaneous electrical stimulation (PENS)

Question 43

Analgesics are classified into three groups:

Answer 43

nonopioids, adjuvants, and opioids.

Question 44

Which analgesic act on peripheral nerve ending at the injury site

Answer 44

Nonopioid analgesics include a variety of medications that relieve mild to moderate pain, and chronic and acute pain. Many are available over the counter (e.g., acetaminophen, aspirin, ibuprofen, and naproxen). Most also reduce inflammation and fever.

Question 45

Unlike most nonopioid analgesics, _________ has very little anti-inflammatory effect.

Answer 45

acetaminophen

Question 46

this analgesic reduces the amount of opioid the patient requires. They include

Answer 46

Adjuvants/Co-analgesics anticonvulsants, antidepressants, local anesthetics, topical agents, psychostimulants, muscle relaxants, neuroleptics, corticosteroids, and others. It is used: As a primary therapy for mild pain In conjunction with opioids, for moderate to severe pain Especially by patients experiencing significant side effects from increased doses of opioids To manage neuropathic pain

Question 47

These analgesic are natural and synthetic compounds that relieve pain, although they vary in potency. They act on

Answer 47

Opioids – Act on the CNS

Question 48

Name some opioids

Answer 48

Morphine, Codeine, Demerol; also synthetic opioids like Dilaudid)

Question 49

Analgesics work best if given

Answer 49

before pain becomes too severe. “Keeping ahead of the pain” helps to maintain pain at an acceptable level allow patients to function optimally.

Question 50

Most common side effects of opioids

Answer 50

drowsiness, nausea, vomiting, and constipation. Some, such as drowsiness and nausea, improve after a few doses.

Question 51

Opioid antagonist

Answer 51

Narcan also called naloxone

Question 52

What is a PCA

Answer 52

Patient Controlled Analgesia

Question 53

Application of extremely fine needles to specific sites in the body to relieve pain is called

Answer 53

Acupuncture

Question 54

This type of non pharm pain relief is documented to provide relief from joint pain and dental discomfort. It is also used after surgery and chemotherapy to treat nausea

Answer 54

Acupuncture

Question 55

the use of slow, long, guiding strokes, is used for obstetrical patients during labor and as back rubs for postsurgical patients.

Answer 55

Effleurage

Question 56

Similar to acupuncture, from which it evolved,_________ stimulates specific sites in the body. However, instead of needles, fingertips provide firm, gentle pressure over the various pressure points.

Answer 56

acupressure