Topic 9

Question 1

transduction

Answer 1

conversion of one form of energy into another. In sensation, the transforming of stimulus energies, such as sights, sounds, and smells, into neural impulses our brains can interpret.

Question 2

transmission

Answer 2

Sending of impulse across a sensory pain nerve fiber (nociceptor)

Question 3

nerve impulses

Answer 3

Excitatory neurotransmitters send electrical impulses across the synaptic cleft between two nerve fibers, enhancing transmission of the pain impulse.

Question 4

pain impulses

Answer 4

These pain-sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response.

Question 5

A fibers

Answer 5

fast, myelinated
-Send sharp, localized, and distinct sensations that specify the source of the pain and detect its intensity

Question 6

C fibers

Answer 6

the very small, slow, unmyelinated
-Relay impulses that are poorly localized, visceral, and persistent

Question 7

perception

Answer 7

the point at which a person is aware of pain

Question 8

modulation

Answer 8

Inhibits pain impulse
-Once the brain perceives pain, there is a release of inhibitory neurotransmitters such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), which hinder the transmission of pain and help produce an analgesic effect.

Question 9

gate-control theory

Answer 9

the theory that the spinal cord contains a neurological “gate” that blocks pain signals or allows them to pass on to the brain. The “gate” is opened by the activity of pain signals traveling up small nerve fibers and is closed by activity in larger fibers or by information coming from the brain.

Question 10

pain threshold

Answer 10

the point at which a person feels pain

Question 11

the stress respond of pain stimulates the…

Answer 11

autonomic nervous system

Question 12

Continuous, severe, or deep pain typically involving the visceral organs activates the

Answer 12

parasympathetic nervous system

Question 13

what are common behavior al responses of acute pain?

Answer 13

Clenching the teeth, facial grimacing, holding or guarding the painful part, and bent posture

Question 14

chronic pain can affect a patients…

Answer 14

-activity (eating, sleeping, socialization)
-thinking (confusion, forgetfulness)
-emotions (anger, depression, irritability)
-quality of life and productivity.

Question 15

pain tolerance

Answer 15

level of pain a person is willing to accept

Question 16

Acute/transient pain

Answer 16

Protective, identifiable, short duration; limited emotional response

Question 17

what is a primary nursing goal for individuals with acute/transient pain?

Answer 17

to provide pain relief that allows patients to participate in their recovery, prevent complications, and improve functional status

Question 18

Chronic/persistent noncancer pain

Answer 18

Is not protective, has no purpose, may or may not have an identifiable cause

Question 19

what are some things that are considered chronic noncancerous pain?

Answer 19

arthritis, headache, low back pain, or peripheral neuropathy

Question 20

chronic episodic pain

Answer 20

Occurs sporadically over an extended duration

Question 21

cancer pain

Answer 21

is normal (nociceptive), resulting from stimulus of an undamaged nerve and/or neuropathic, arising from abnormal or damaged pain nerves. Can be acute or chronic.

Question 22

referred pain

Answer 22

pain that is felt in a location other than where the pain originates

Question 23

idiopathic pain

Answer 23

Chronic pain without identifiable physical or psychological cause

Question 24

factors influencing pain

Answer 24

-physiological (age, fatigue, genes, neurological functions)
-social factors
-spiritual factors
-psychological factors (anxiety/coping style)
-cultural factors

Question 25

how does fatigue affect pain

Answer 25

Fatigue increases the perception of pain and can cause problems with sleep and rest

Question 26

how does anxiety affect pain

Answer 26

Anxiety often increases the perception of pain, and pain causes feelings of anxiety. It is difficult to separate the two sensations.

Question 27

ABCDEs of pain management: A

Answer 27

A: Ask about pain regularly. Assess pain systematically.

Question 28

ABCDEs of pain management: B

Answer 28

B: Believe the patient and family in their report of pain and what relieves it.

Question 29

ABCDEs of pain management: C

Answer 29

C: Choose pain control options appropriate for the patient, family, and setting

Question 30

ABCDEs of pain management: D

Answer 30

D: Deliver interventions in a timely, logical, and coordinated fashion.

Question 31

ABCDEs of pain management: E

Answer 31

E: Empower patients and their families. Enable them to control their course to the greatest extent possible

Question 32

PQRSTU of Pain

Answer 32

P: Palliative or Provocative factors Q: Quality: R: Region/Relief measure S: Severity T: Timing U: Effect of Pain

Question 33

P: Palliative or Provocative factors questions

Answer 33

What makes pain better/worse?

Question 34

Q: Quality questions

Answer 34

Describe your pain

Question 35

R: Region/Relief measure questions

Answer 35

Show me where, what gives you relief?

Question 36

S: Severity questions

Answer 36

on a scale from 1-10

Question 37

T: Timing questions

Answer 37

Do you have pain all the time or only at certain times.

Question 38

U: Effect of Pain questions

Answer 38

What are you not able to do because of pain?

Question 39

what is the single most reliable report for pain

Answer 39

patients self report

Question 40

if a patients is unable to communicate pain; what should the nurse pay attention to during the assessment

Answer 40

Vocal response, facial movements (e.g. grimacing, clenched teeth) and body movements (e.g., restlessness, pacing). Social interaction, does the patient avoid conversation?

Question 41

characteristics of pain

Answer 41

Timing Location Severity Quality Aggravating and precipitating factors Relief measures

Question 42

what is the nurses job related to pain relief?

Answer 42

Administering and monitoring therapies ordered by health care providers for pain relief and independently providing pain-relief measures that complement those prescribed.

Question 43

what are the common holistic health approaches

Answer 43

wellness education, regular exercise, rest, attention to good hygiene practices and nutrition, and management of interpersonal relationships.

Question 44

when should nonpharmacologic measures never be used in place of pharmacologic therapies

Answer 44

in the ace of acute pain

Question 45

Nonpharmacological pain-relief interventions

Answer 45

-Cognitive and behavioral approach -Relaxation and guided imagery -Distraction -Music -Cutaneous stimulation -Cold and heat application -Transcutaneous electrical nerve stimulator (TENS) -Herbals -Reducing pain perception and reception

Question 46

guided imagery allows

Answer 46

patients to alter affective-motivational and cognitive pain perception

Question 47

relaxation

Answer 47

mental and physical freedom from tension or stress that provides individuals a sense of self-control.

Question 48

Distraction

Answer 48

directs a patient's attention to something other than pain and thus reduces awareness of it

Question 49

Cutaneous stimulation

Answer 49

Stimulation of the skin through a massage, warm bath, cold application, and TENS may be helpful in reducing pain perception.

Question 50

Transcutaneous electrical nerve stimulator (TENS)

Answer 50

Involving stimulation of the skin with a mild electrical current passed through external electrodes.

Question 51

Herbals for Pain

Answer 51

echinacea, ginseng, ginkgo biloba, and garlic despite conflicting research evidence supporting their use in pain relief.

Question 52

Nonopioid analgesics

Answer 52

analgesics that are not classified as opioids, these include acetaminophen, and NSAIDS

Question 53

Opioids (narcotics)

Answer 53

are prescribed for moderate to severe pain. They are associated with respiratory depression and adverse effects of nausea, vomiting, constipation, itching, urinary retention, and altered mental processes. Sedation is an adverse effect of opioids that always precedes respiratory depression.

Question 54

physical dependence

Answer 54

A state of adaptation that is manifested by a drug class-specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist

Question 55

addiction

Answer 55

A physiological or psychological dependence on a drug Þ primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations

Question 56

drug tolerance

Answer 56

A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time

Question 57

placebos

Answer 57

are pharmacologically inactive preparations or procedures that produce no beneficial or therapeutic effect.

Question 58

Adjuvants/co-analgesics

Answer 58

drugs used to treat other conditions, but they also have analgesic qualities (tricyclic antidepressants and anticonvulsants).

Question 59

Patient-controlled analgesia (PCA)

Answer 59

a drug delivery system that uses a computerized pump with a button the patient can press to deliver a dose of an analgesic keeping constant plasma level (minimal risk of overdose)

Question 60

what are the safety guidelines for the PCA

Answer 60

-The patient is the only person who should press the button to administer the pain medication -Monitor the patient for signs and symptoms of oversedation and respiratory depression. -Monitor for potential side effects of opioid analgesics.

Question 61

Topical analgesics

Answer 61

Creams, ointments, patches

Question 62

Local anesthesia

Answer 62

Local infiltration of an anesthetic medication to induce loss of sensation to a small area, like an inscison site for example

Question 63

Regional anesthesia

Answer 63

the injection or infusion of local anesthetics to block a group of sensory nerve fibers. *for a whole body part

Question 64

Perineural local anesthetic infusion

Answer 64

a surgeon places the tip of an unsutured catheter near a nerve or groups of nerves and the catheter exits from the surgical wound.

Question 65

Nursing implications for local and regional anesthesia

Answer 65

Provide emotional support Protect patient from injury

Question 66

providing emotional support: local and regional anesthesia

Answer 66

Explaining the insertion technique and warning patients that they will temporarily lose sensory function within minutes of injection.

Question 67

protect patient from injury: local and regional anesthesia

Answer 67

-Protect the patient from injury until full sensory and motor function return. Patients are at risk for injuring an anesthetized body part without knowing it. -When patients receive epidural analgesia, initially monitor them as often as every 15 minutes, including assessment of vital signs, respiratory effort, and skin color. -Once stabilized, monitoring occurs every hour in the first 12 to 24 hours and then with less frequency if the patient is stable.

Question 68

WHO analgesic ladder

Answer 68

Recommended guidelines for prescribing, based on pain level (0-10, 10 = severe pain) Level 1 (1-3 rating)—Use non-opioids Level 2 (4-6 rating)—Use weak opioids alone or with adjuvant drug Level 3 (7-10 rating)—Use strong opioids Level 4- nerve block, epidural, PCA pump

Question 69

pain centers

Answer 69

treat patients on an inpatient or outpatient basis

Question 70

What is the goal of palliative care?

Answer 70

to learn how to live life fully with an incurable condition

Question 71

what kind of program is hospice

Answer 71

end of life care; helps terminally ill patients continue to live at home or in a health care setting in comfort and privacy.

Question 72

olfactory

Answer 72

smell

Question 73

gustatory

Answer 73

taste

Question 74

kinesthetic

Answer 74

position and motion

Question 75

Stereognosis

Answer 75

a sense that allows a person to recognize the size, shape, and texture of an object.

Question 76

Reception

Answer 76

stimulation of a receptor such as light, touch, or sound

Question 77

Perception

Answer 77

integration and interpretation of stimuli

Question 78

Reaction

Answer 78

only the most important stimuli will elicit a reaction

Question 79

what can losing visual and hearing acuity cause...

Answer 79

the person to withdraw by avoiding communication or socialization with others in an attempt to cope with the sensory loss

Question 80

what are the three types of sensory deprivation

Answer 80

-reduced sensory input -elimination of patterns or meaning from input -restrictive environments that produce monotony and boredom

Question 81

Reduced sensory input

Answer 81

sensory deficit from visual or hearing loss

Question 82

Elimination of patterns or meaning from input

Answer 82

e.g., exposure to strange environments

Question 83

Restrictive environments that produce monotony and boredom.

Answer 83

e.g., bed rest

Question 84

sensory deprivation

Answer 84

Inadequate quality or quantity of stimulation

Question 85

sensory deficits

Answer 85

Deficit in the normal function of sensory reception and perception

Question 86

Sensory overload

Answer 86

Reception of multiple sensory stimuli

Question 87

factors affecting sensory function

Answer 87

Age Meaningful Stimuli Amount of Stimuli Social Interaction Environmental Factors Cultural Factors

Question 88

Visual changes occur during adulthood that result in the need for glasses around what age

Answer 88

40 to 50 years old

Question 89

Glaucoma

Answer 89

increased intraocular pressure results in damage to the retina and optic nerve with loss of vision

Question 90

Hearing loss usually begins around...

Answer 90

30 years of age

Question 91

Smell and taste changes usually begin around...

Answer 91

around 50 years

Question 92

meaningful stimuli

Answer 92

Reduce the incidence of sensory deprivation

Question 93

Meaningful stimuli include those activities and people who have...

Answer 93

a positive influence on the patient, such as pets, music, TV, movies, family, clock, and calendar.

Question 94

amount of stimuli

Answer 94

Can cause sensory overload

Question 95

Social interaction

Answer 95

The amount and quality of social contact with supportive family members and significant others influence sensory function. The absence of visitors during hospitalization or residency in an extended care facility influences the degree of isolation a patient feels.

Question 96

Environmental factors

Answer 96

Occupation, recreation, and sports activities

Question 97

audiologist or otolaryngologist

Answer 97

specialist in the ear and throat

Question 98

expressive aphasia

Answer 98

A motor type of aphasia, is the inability to name common objects or express simple ideas in words or writing. For example, a patient understands a question but is unable to express an answer.

Question 99

receptive aphasia

Answer 99

Is the inability to understand written or spoken language. A patient is able to express words but is unable to understand questions or comments of others.

Question 100

global aphasia

Answer 100

The inability to understand language or communicate orally.

Question 101

when do individuals need to have hearing screenings

Answer 101

at least every decade through age 50 and every 3 years thereafter

Question 102

what is important to remember in patients using assistive devices

Answer 102

Patients who wear corrective contact lenses, eyeglasses, or hearing aids need to make sure that they are clean, accessible, and functional.

Question 103

what are some ways to promote meaningful stimuli

Answer 103

Take measures to improve lighting, hearing, and tactile, taste, and smell sensations. If a patient is overly sensitive to tactile stimuli (hyperesthesia), minimize irritating stimuli.

Question 104

what are ways a nurse can control sensory stimuli

Answer 104

Combining activities such as dressing changes, bathing, and vital sign measurement in one visit prevents the patient from becoming overly fatigued. Try to control extraneous noise in and around a patient's room.