1: Pain assessment and management

Question 1

is pain subjective or objective?

Answer 1

Pain is subjective and individualized

Question 2

How can pain be objective

Answer 2

it is not measurably objective, although we can report objective evidence

Question 3

Transduction

Answer 3

stimulus converted into energy

Question 4

Transmission

Answer 4

electrical impulses communicated

Question 5

perception

Answer 5

recognition in the brain

Question 6

modulation

Answer 6

release of inhibitors

Question 7

Gate control theory

Answer 7

• First theory propose emotional and cognitive components of pain
• Gates along the nervous system open/close to allow or block pain impulses
• Explains pain threshold and why sometimes vital signs do not change

Question 8

Noniceptive

Answer 8

Normal stimulation of peripheral nerve endings

Question 9

What does nociceptive stimulation respond to

Answer 9

Non opioids and/or opioids

Question 10

Classification of pain

Answer 10

• Nociceptive

- Neuropathic

Question 11

Neuropathic

Answer 11

Abnormal processing of sensory input by peripheral OR central nervous system

Question 12

Example of neuropathic pain

Answer 12

Phantom limb pain

Question 13

Diabetic neuropathy

Answer 13

Tingling, burning, etc.

Question 14

Types of pain

Answer 14

• Acute (Transient pain)
• Chronic episodic
• Chronic persistent
• Idiopathic

Question 15

Chronic episodic

Answer 15

Sporadically over an extended duration (migraines)

Question 16

Chronic persistent

Answer 16

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

Question 17

Idiopathic

Answer 17

Chronic pain without identifiable cause

Question 18

Factors that influence pain experience

Answer 18

• Physiological
• Social
• Psychological
• Pain tolerance
• Cultural

Question 19

Sympathetic reaction to pain

Answer 19

Increase..
Cortisol level 
RR, HR,BP 
Blood glucose 
-Sweating (Diaphoresis)
-Muscle Tension 
-Dilation of pupils and bronchial tubes 
Decreased gastrointestinal motility

Question 20

Parasympathetic responses to pain

Answer 20

Pallor
decreased HR/BP
Rapid irregular breathing
Nausea and vomiting

Question 21

Is sleep an indication of pain?

Answer 21

NO!

Question 22

Intractable pain

Answer 22

Severe, constant, not curable, bed bound/house bound

Question 23

Phantom pain

Answer 23

Pain in a body part that is no longer there

Question 24

Referred pain

Answer 24

Pain perceived at a location other than the site of the painful stimulus

Question 25

Pain threshold

Answer 25

The paint at which a person feels pain

Question 26

Pain tolerance

Answer 26

level of pain you are willing to accept

Question 27

Radiating

Answer 27

Pain extends from initial site to other part

Question 28

Negative outcomes of pain

Answer 28

Decreased socialization/withdrawal 
Decreased ability to do ADLs
Fatigue 
sleep disturbance 
irritability 
Malnutrition 
stress
depression

Question 29

OLD CART

Answer 29

Onset 
Location 
Duration 
Characteristics 
Aggravating factors 
Relieving factores 
Treatment

Question 30

NANDA pain

Answer 30

Activity intolerance 
Anxiety 
Fatigue 
Insomnia 
Impaired social interaction 
ineffective coping 
Impaired physical mobility 
Impaired mood regulation

Question 31

Non pharmacological pain relief

Answer 31

Cognition and behavioral approach
Relaxation and guided imagery
Music
Cutaneous stimulation

Question 32

Pharmacological pain relief intervention

Answer 32

Topicals: ointments, creams, patches

Analgesia

Question 33

Bolos/loading dose of analgesia

Answer 33

to get on top of the pain

Question 34

Basal dose of analgesia

Answer 34

Consistent to maintain plasma level

Question 35

PCA dose of analgesia

Answer 35

On demand

Question 36

Acute care pain therapies

Answer 36

Epidural
Local anesthesia
Perineural local anesthetic infusion

Question 37

Goal of palliative care

Answer 37

Learn how to live life fully with an incurable condition