Sensory/Perception: Pain Flashcards Preview

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Flashcards in Sensory/Perception: Pain Deck (53):
1

What is part of external stimuli?

Visual
Auditory
Olfactory
Tactile
Gustatory

2

What is part of internal stimuli?

Gustatory
Visceral
Kinesthetic

3

What are the components of pain?

Reception (receiving of stimuli or data)
Perception (translation of the stimuli/data into meaningful information)
Reaction (response of the stimuli)

4

S/S of sensory deprivation

Yawning
Drowsy, sleepy
Decreased attention span
Disorientation
Nocturnal confusion (sun downing)
Apathy
Hallucinations, delusions

5

What is sensory deprivation?

Decrease or lack of meaningful stimuli

6

What happens with patients with sensory deprivation?

Become more aware of remaining stimuli
Alters perception, cognition, and emotion

7

What is sensory overload?

Inability to process or manage the amount or intensity of sensory stimuli

8

What are the three factors of sensory overload?

Internal
External
Inability to disregard stimuli selectively

9

S/S of sensory overload

Irritability
Disorientation
Fatigue, sleeplessness
Reduced problem solving ability
Scattered attention
Increased muscle tension

10

Who are more at risk for sensory deprivation?

Patients who:
- are in confinement in nonstimulating environment (home or facility)
- have impaired vision or hearing
- have mobility restrictions
- have communicable diseases (AIDS)

11

Who are more at risk for sensory overload?

Patients:
- with pain/discomfort
- in ICU with IV's, tubes, and machines

12

What factors influence sensory function?

Developmental (age)
Medications
Cultural
Stress
Preexisting illnesses
Lifestyle and personality
Smoking

13

What are some consequences of untreated pain?

Unnecessary suffering
Physical and psychosocial dysfunction
Increased respiratory and cardiac workload
Impaired recovery
Immunosuppression
Sleep disturbances
Decreased GI motility
Increased catabolism
Increased morbidity

14

What are nociceptors?

Primary neurons
Detect tissue injury and damage

15

What sensations does nociceptors evoke?

Touch
Heat
Cold
Pain
Pressure

16

What does the process of nociception consist of ?

Transduction (conversion of stimulus into neural action potential)
Transmission (movement of impulse to brain (substance P))
Perception (pain recognized, defined, and responded)
Modulation ("descending system")

17

What are the type of nerve fibers?

'A'
'C'

18

What are 'A' fibers?
And what type of pain do they sense?

Myelinated
- Fatty covering
- Sharp, prickling, localized pain

19

What are 'C' fibers?
And what type of pain do they sense?

Unmyelinated
- No fatty sheath
- Dull, burning, diffuse pain, aching

20

What are some interactional responses to pain?

Physiologic (transmission)
Sensory (recognition, patten, area, intensity)
Affective (motivational, fear, anger, depression)
Behavioral (observable: facial expressions)
Cognitive (beliefs, attitudes, memories)

21

What are some sources of pain?

Mechanical (tearing, pressure, muscle spasm, infection)
Thermal (electrical current, sunburn, lightning)
Chemical (histamines, enzymes, caustic agents)

22

What are some physiological effects of pain?

Dilation of bronchi
Increase RR and HR
Peripheral vasoconstriction
Elevated glucose
Diaphoresis
Increased muscle tension
Decreased GI motility

23

Environmental variable: Night vs Day?

Night increases pain perception
Daytime decreases pain perception

24

What are some sociocultural variables?

Demographics
Support systems
Social roles
Culture
- Pain expression
- Drug use
- Pain related beliefs
- Coping

25

How does each of these affect pain?
1. Culture
2. Attitude&Value
3. Sex
4. Birth order

1. Affects attitude and beliefs
2. Gives meaning to pain
3. Females are more expressive
4. First born usually less tolerant of pain

26

What are endorphins?

Natural supply of opium like substances
"morphine within"
Produces analgesia

27

Where are endorphins located?

Brain
Spinal cord
GI tract

28

Endorphins are activated by what?

Pain and stress

29

What is the gate control theory ?

Peripheral nerve fibers can be altered at the spinal cord level

30

Gate Control Theory: What can be used to "close" the gates?

Backrubs
Warm compresses
TENS
Distraction

31

What are some common biases and misconceptions?

- Pts with minor illnesses have less pain than those with severe illnesses
- Giving analgesics regularly will lead to drug addiction
- Amount of tissue damage in an injury accurately indicates the amount of pain
- Psychogenic pain is not real
- Drug abusers and alcoholics over react to pain
- Health care personnel are the best authorities on the nature of the client's health

32

What is pain threshold?

Point at which a person first perceives the pain

33

Who is at risk for pain?

Pre-op patients
Clients preparing for childbirth
Clients with altered internal or external integrity
Clients with localized area of inflammation

34

What is the most important part of nursing assessment?

Client interview

35

What do you want the client to answer about pain?

Full description of characteristics of pain
Pain trajectory
Clients response to pain
Variables affecting pain
Assessment of previous records regarding pain

36

What should be included in the physical assessment when dealing with pain?

Location
Type
Intensity (0-10)
Quality
Duration (how long?)
Control (what can client do to minimize pain)
Nonverbal and physiological expressions
Verbalization of fears and expectations

37

What different scales can be used to measure pain intensity?

0-10 Scale
Wong-Baker Faces rating scale (children)
Adult Non-Verbal Pain Scale (ANVPS) (18+ who cant communicate)
Defense and Veterans Pain Rating Scale (DVPRS)
Richmond Agitation Sedation Scale (RASS) (ICU)

38

What are the different types of chronic pain?

Intractable (having no relief)
Benign (no known disease or injury)
Persistent (does not subside after injury heals)

39

What can be part of chronic pain management?

Nerve blocks (epidurals)
Acupuncture
Biofeedback (alteration of body function through mental concentration)
TENS (Transcutaneous Electrical Nerve Stimulation)
Hypnosis
Neurosurgery
- Neurectomy (removal of nerve)
- Rhizotomy (removal of root nerve)
- Chordotomy (cut pathway at spinal column)
Operant conditioning

40

What is TENS?

Stimulates endorphin production

Battery transmitter, wires, electrodes attached to skin at pain point
Produces buzzing/tingling sensation
Nerve function not damaged

41

What is the best indicator for evaluation of a client's pain?

Client's verbal report of pain

42

What are some techniques for pain control?

- Distraction
- Progressive relaxation techniques (contraction and relaxation of muscle groups)
- Promote rest (cluster care, mild sedation)
- Cutaneous stimulation (lightly rubbing affected area)
- Guided imagery
- Therapeutic touch

43

The Analgesic Ladder:
What is included in Step 1?
For what pain intensity ?

ASA (acetylsalicylic acid)
Acetaminophen
NSAID's

1-3/10

"Ceiling effect"
OTC
Do not produce tolerance/dependence

44

The Analgesic Ladder:
What is included in Step 2?
For what pain intensity ?

Codeine
Oxycodone
Hydrocodone

4-6/10

Common opioids combined with nonopioid
Persistent pain despite nonopioid therapy

45

The Analgesic Ladder:
What is included in Step 3?
For what pain intensity ?

Morphine
Fentanyl
Hydromorphone
Methadone
Oxycodone

7-10/10

No "ceiling effect"

46

What is adjuvant therapy used for?

Enhance pain therapy
- Enhance effects of opioid and non-opioids
- Possess analgesic properties
- Counteracts side effects of analgesics

Used at all steps of the analgesia ladder

47

What are some drugs used with adjuvant therapy?

Antidepressants
Anti-seizure
a2 Adrenergic agonists
Corticosteroids
Local anesthetics

48

What is the route of choice?

Oral

49

What is the most effective route of administration for pain medication?

IV

50

What are the routes of administration?

Oral
SL/Buccal
Intranasal
Rectal
Transdermal
Parenteral
Intraspinal

51

What are some intraspinal complications?

Catheter dislodgment/migration
Neurtoxicity
Infection

52

Advantages of PCA

Fewer post op complication
Less total analgesic
Great sense of control for patient
Earlier ambulation

53

What is a basal rate?

PCA run as a continuous infusion