ATI - Pain Management - 41 Flashcards
_______ is the conversion of painful stimuli to an electrical impulse through peripheral nerve fibers (nociceceptors).
transduction
_______ occurs as the electrical impulse travels along the nerve fibers, where neurotransmitters regulate it.
transmission
________ is the point at which a person feels pain.
Pain threshold
________ is the amount of pain a person is willing.
pain tolerance
________ occurs in various areas of the brain, with influences from thought and emotional processes.
perception or awareness of pain
________ occurs in the spinal cord, causing muscles to contract reflexively, moving the body away from painful stimuli.
modulation
Substances that increase pain transmission and cause an inflammatory response
Substance P
Prostaglandins
Bradykinin
Histamine
Substances that decrease pain transmission and produce analgesia
serotonin
endorphins
Pain is categorized by ______ or by origin (nociceptive or neuropathic).
duration (acute or chronic)
______ is protective, temporary, usually self-limiting, has a direct cause, and resolves with tissue healing.
acute pain
With acute pain physiological responses (sympathetic nervous system) are fight-or-flight responses such as
tachycardia hypertension anxiety diaphoresis muscle tension
With acute pain behavioral responses include grimacing, moaning, flinching, and _____.
guarding
With acute pain interventions include treatment of the _________.
underlying problem
Acute pain can lead to ______ if unrelieved.
chronic pain
_____ is not protective. It is ongoing or recurs frequently, lasting longer than 6 months and persisting beyond tissue healing.
Chronic pain
With chronic pain physiological responses do not usually alter vital signs, but clients can have ______, fatigue, and a decreased level of functioning. It is not usually life-threatening.
depression
With chronic pain psychosocial implications can lead to _____.
disability
With chronic pain the management aims at ________. Pain does not always respond to interventions.
symptomatic relief
Chronic pain can be malignant or _____.
nonmalignant
_______ is a form of chronic pain without a known cause, or pain that exceeds typical pain levels associated with the client’s condition.
Idiopathic pain
_____ pain arises from damage to or inflammation of tissue, which is a noxious stimulus that triggers the pain receptors called nocioceptors and causes pain.
nociceptive
Nociceptive pain is usually throbbing, aching, and ______.
locaclized
Nociceptive pain typically responds to ________ and nonopoid medications.
opoids
Types of nociceptive pain
somatic
visceral
cutaneous
_______ pain is in the bones, joints, muscles, skin, or connective tissues.
somatic
______ pain is internal organs such as the stomach or intestines. It can cause referred pain in other body locations separate from the stimulus.
visceral
______ pain is in the skin or subcutaneous tissue.
cutaneous
_____ pain arises from abnormal or damaged pain nerves.
neuropathic
Neuropathic pain includes phantom limb pain, pain below the level of a spinal cord injury, and __________.
diabetic neuropathy
Neuropathic pain is usually ______, shooting, burning, or described as “pins and needles.”
intense
_____ pain typically responds to adjuvant medications (antidepressants, antispasmodic agents, skeletal muscle relaxants)
Neuropathic
Assessment and Data Collection : Pain Management
Noted pain experts agree that pain is whatever the person experiencing it says it is, and it exists whenever the person says it does. The client’s report of pain is the most reliable diagnostic measure of pain.
Self-report using standardized pain scales is useful for clients over the age of 7 years. Specialized pain scales are available for use with younger children or individuals who have difficulty communicating verbally.
Assess and document pain (the fifth vital sign) frequently.
Use a symptom analysis to obtain subjective data.
Risk Factors: Undertreatment of Pain
Cultural and societal attitudes
Lack of knowledge
Fear of addiction
Exaggerated fear of respiratory depression
Populations at Risk for undertreatment of pain
infants
children
older adults
clients who have substance use disorder
Causes of acute and chronic pain
trauma
surgery
cancer (tumor invasion, nerve compression, bone metastases, associated infections, immobility)
Arthritis
Fibromyalgia
Neuropathy
Diagnostic or treatment procedures (injection, intubation, radiation)
Factors that affect the pain experience
age fatigue genetic sensitivity cognitive function prior experiences anxiety and fear support systems and coping styles culture
Factors that affect the pain experience called _____. Infants cannot verbalizes or understand their pain. ____ clients can have multiple pathologies that cause pain and limit function.
age
older adults
Factors that affect the pain experience called _____ can increase sensitivity to pain.
fatigue
Factors that affect the pain experience called ________ can increase or decrease pain tolerance.
genetic sensitivity
Factors that affect the pain experience called _______ in which clients who have cognitively impairment might not be able to report pain or report it accurately.
cognitive function
Factors that affect the pain experience called _______ can increase or decrease sensitivity depending on whether clients obtained adequate relief.
prior experiences
Factors that affect the pain experience called _______ which can increase sensitivity to pain.
ansiety and fear
Factors that affect the pain experience called __________ in the presence of these can decrease sensitivity to pain.
support systems and coping styles
Factors that affect the pain experience called ________ can influence how clients express pain or the meaning they give to pain.
culture
The expected findings of pain includes behaviors that complement self-report and assist in pain assessment of _________.
nonverbal clients
Nonverbal client cues
facial expressions (grimacing, wrinkled forehead), body movements (restlessness, pacing, guarding)
moaning, crying
decreased attention span
BP, pulse, and RR increases temporarily with ________. Eventually, increases in vital signs will stabilize despite the persistence of pain. Therefore, physiologic indicators might not be an accurate measure of pain over time.
acute pain
_______ strategies should not replace phamacological pain measures, but can be used along with them.
nonpharmacological
______ change the way a client perceives pain, and physical approaches to improve comfort.
cognitive-behavioral measures
_______ includes transcutaneous electrical nerve stimulation (TENS), heat, cold, therapeutic tough, and message.
cutaneous (skin) stimulus
Examples of Cutaneous (skin) stimulation
Interruption of pain pathways
cold for inflammation
heat to increase blood flow and to reduce stiffness
Nonpharmacological pain management strtegies
cognitive behavioral measures cutaneous (skin) stimulation distraction relaxation imagery acupuncture and acupressure reduction of pain stimuli elevation of edematous extremities
_______ is a nonpharmacological pain management strategy that includes ambulation, deep breathing, visitors, televention, games, prayer, and music.
distraction
_______ is a nonpharmacological pain management strategy that includes decreased attention to the presence of pain can decrease the perceived pain level.
distraction
_______ is a nonpharmacological pain management strategy that includes meditation, yoga, and progressive muscle relaxation.
relaxation
_______ is a nonpharmacological pain management strategy that includes focusing on a pleasant thought to divert focus and requires the ability to concentrate.
imagery
_______ is a nonpharmacological pain management strategy that includes stimulating subcutaneous tissues at specific points using needles or the digits.
acupuncture and acupressure
This is a nonpharmacological pain management strategy that includes the __________ in the enviornment.
reduction of pain stimuli
_______ is a nonpharmacological pain management strategy that includes promoting return and decrease swelling.
elevation of edematous extremities
______ are the mainstay for relieving pain.
analgesics
The three classes of anlgesics
nonopioids
opiods
adjuvants
__________ (acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), including salicylates) are appropriate for treating mild to moderate pain.
Nonopiod analgesics
With nonopiod analgesics be aware of the hepatotoxic effects of ___________.
acetaminophen
With nonopiod analgesics clients who have a healthy liver should take no more than _____/day. Make sure clients are aware of opiods that contain acetaminophen, such as hydrocodone bitartrate ______/acetaminophen 500 mg.
4g/day
5 mg
With _____ analgesics monitor for salyicylism (tinnitus, vertigo, decreased hearing acuity)
nonopioid analgesics
With nonopiod analgesics prevent ______ by administering the medication with food or antacids.
gastric upset
Monitor for ______ with long-term NSAID use.
bleeding
_______ analgesics, such as morphine sulfate, fentanyl, and codeine, are appropriate for treating moderate to server pain 9postoperative pain, myocardial infarction pain, cancer pain)
opioid
Managing acute severe pain with short-term (24 to 48 hr) around the clock administration of opiods is preferable to following a _______.
PRN schedule
The ________ route is best for immediate, short-term relief of acute pain. The oral route is better for chronic, no fluctuating pain.
parenteral
Consistent timing and dosing of opioid administration provide _______ pain control.
consistent
It is essential to monitor and intervene for _______ of opioid use.
adverse effects
When using opioid analgesics (_______) monitor level of consciousness and take safety precautions. _______ usually precedes respiratory depression.
sedation
sedation
When using opioid analgesics (_______) monitor respiratory rate prior to and following administration of opioids (especially for clients who have little previous exposure to opioid medications.)
respiratory depression
Initial treatment of respiratory depression and sedation is generally a reduction in _______.
opioid dose
If necessary, slowly administer diluted naloxone to reverse opiod effects until the client can deep breathe with a respiratory rate of at least ____/min.
8/min
Advise clients to sit or lie down if lightheadedness or dizziness occur because _______ can be caused when using opioid analgesics.
orthostatic hypotension
Instruct clients to avoid sudden changes in position by slowly moving from a lying to a sitting or standing position and provide assistance with ambulation since ________ occurs with the use of opiod analgesics.
orthostatic hypotension
_______ can be a side effect of opioid analgesics. You should monitor I&O, assess for distention, administer bethanechol, and catheterize.
urinary retention
______ can be a side effect of opioid analgesics. By administering antiemetics, advise clients to lie still and move slowly, and eliminate odors.
nausea/vomiting
______ can be a side effect of opioid analgesics. Use a preventative approach (monitoring bm, fluids, fiber intake, exercise, stool softeners, stimulant laxatives, enemas)
constipation
_____ analgesics enhance the effects of nonopiods, help alleviate other manifestations that aggravate pain (depression, seizures, inflammation), and are useful for treating neuropathic pain.
adjuvant
Adjuvant analgesics
anticovulsants antianxiety agents tricyclic antidepressants anesthetics antihistamine glucocorticoids antiemetics bisphosphonates and calcitonin
Examples of anticonvulsants
carbamazepine
gabapentin
Examples of antianxiety agents
diazepam
lorazepam
Examples tricyclic antidepressants
amitriptyline
nortriptyline
Examples of anesthetics
infusional lidocaine
Examples of antihistamine
hydroxyzine
Examples of glucocorticoids
dexamethasone
Examples of antimetics
ondansetron
Examples of bisphophonates and calcitonin:
for bone pain
______ analgesia (PCA) is a medication delivery system that allows clients to self-administer safe doses of opioids.
patient controlled
With patient–controlled analgesia there should be small, frequent dosing to ensure consistent _______.
plasma levels
With patient–controlled analgesia clients have less ____ time between identified need and delivery of medication, which increases their sense of control and can decrease the amount of medication they need.
lag
With patient–controlled analgesia, morphine, hydromorphone, and fentanyl are typical opiods for ________.
PCA delivery
With patient-controlled analgesia clients should let the nurse know if using the pump does not _______.
control the pain
To prevent inadvertent overdosing with patient controlled analgesia, the client is the only person who should _____ the PCA button.
push
Additional pharmacological pain interventions include both ______ and ______ anesthesia and topical analgesia
local and regional
To effectively manage pain take a proactive approach by giving analgesics before pain becomes _______. It takes less mediation to prevent pain then to treat pain.
too severe
To effectively manage pain instruct clients to report developing or _____ pain and do not wait until pain is severe (for PRN pain medication).
recurrent
To effectively manage pain explain _______ about pain (medication dependence, pain measurement and perception.)
misconceptions
To effectively manage pain help clients reduce ______.
fear and anxiety
Create a treatment plan that includes both nonpharmacological and pharmacological _________ measures.
pain-relief
Strategies specific for relieving chronic pain include administering long acting or ___________ (including the transdermal route)
controlled release opiod analgesics
Chronic pain relief strategies involve administering analgesics ________ rather than PRN.
around the clock
______ of pain is a serious complication and can lead to increased anxiety with acute pain and depression with chronic pain. Assess clients for pain frequently and intervene as appropriate.
undertreatment
Sedation, ______, and coma can occur as a result of overdosing. Sedation always precedes ______.
respiratory depression
respiratory depression
A nursing implication for pain management identify _______ clients (older adult clients, clients who are opioid naive).
high-risk
A nursing implication for pain management is to carefully ______ client dose while closely monitoring respiratory status.
titrate
A nursing implication for pain management stop the opioid and give the _______ if respiratory rate is below 8/min and shallow, or the client is difficult to arouse.
antagonist naloxone
A nursing implication for pain management involves identifying the cause of ____.
sedation
A nursing implication for pain management use a ______ in addition to a pain rating scale to assess pain, especially when administering opioids.
sedation scale
