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461 - Exam 4 > ATI - Pain Management - 41 > Flashcards

ATI - Pain Management - 41 Flashcards

1
Q

_______ is the conversion of painful stimuli to an electrical impulse through peripheral nerve fibers (nociceceptors).

A

transduction

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2
Q

_______ occurs as the electrical impulse travels along the nerve fibers, where neurotransmitters regulate it.

A

transmission

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3
Q

________ is the point at which a person feels pain.

A

Pain threshold

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4
Q

________ is the amount of pain a person is willing.

A

pain tolerance

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5
Q

________ occurs in various areas of the brain, with influences from thought and emotional processes.

A

perception or awareness of pain

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6
Q

________ occurs in the spinal cord, causing muscles to contract reflexively, moving the body away from painful stimuli.

A

modulation

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7
Q

Substances that increase pain transmission and cause an inflammatory response

A

Substance P
Prostaglandins
Bradykinin
Histamine

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8
Q

Substances that decrease pain transmission and produce analgesia

A

serotonin

endorphins

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9
Q

Pain is categorized by ______ or by origin (nociceptive or neuropathic).

A

duration (acute or chronic)

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10
Q

______ is protective, temporary, usually self-limiting, has a direct cause, and resolves with tissue healing.

A

acute pain

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11
Q

With acute pain physiological responses (sympathetic nervous system) are fight-or-flight responses such as

A 
tachycardia
hypertension
anxiety
diaphoresis
muscle tension
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12
Q

With acute pain behavioral responses include grimacing, moaning, flinching, and _____.

A

guarding

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13
Q

With acute pain interventions include treatment of the _________.

A

underlying problem

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14
Q

Acute pain can lead to ______ if unrelieved.

A

chronic pain

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15
Q

_____ is not protective. It is ongoing or recurs frequently, lasting longer than 6 months and persisting beyond tissue healing.

A

Chronic pain

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16
Q

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.

A

depression

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17
Q

With chronic pain psychosocial implications can lead to _____.

A

disability

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18
Q

With chronic pain the management aims at ________. Pain does not always respond to interventions.

A

symptomatic relief

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19
Q

Chronic pain can be malignant or _____.

A

nonmalignant

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20
Q

_______ is a form of chronic pain without a known cause, or pain that exceeds typical pain levels associated with the client’s condition.

A

Idiopathic pain

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21
Q

_____ pain arises from damage to or inflammation of tissue, which is a noxious stimulus that triggers the pain receptors called nocioceptors and causes pain.

A

nociceptive

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22
Q

Nociceptive pain is usually throbbing, aching, and ______.

A

locaclized

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23
Q

Nociceptive pain typically responds to ________ and nonopoid medications.

A

opoids

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24
Q

Types of nociceptive pain

A

somatic
visceral
cutaneous

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25
Q

_______ pain is in the bones, joints, muscles, skin, or connective tissues.

A

somatic

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26
Q

______ pain is internal organs such as the stomach or intestines. It can cause referred pain in other body locations separate from the stimulus.

A

visceral

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27
Q

______ pain is in the skin or subcutaneous tissue.

A

cutaneous

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28
Q

_____ pain arises from abnormal or damaged pain nerves.

A

neuropathic

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29
Q

Neuropathic pain includes phantom limb pain, pain below the level of a spinal cord injury, and __________.

A

diabetic neuropathy

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30
Q

Neuropathic pain is usually ______, shooting, burning, or described as “pins and needles.”

A

intense

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31
Q

_____ pain typically responds to adjuvant medications (antidepressants, antispasmodic agents, skeletal muscle relaxants)

A

Neuropathic

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32
Q

Assessment and Data Collection : Pain Management

A

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.

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33
Q

Risk Factors: Undertreatment of Pain

A

Cultural and societal attitudes
Lack of knowledge
Fear of addiction
Exaggerated fear of respiratory depression

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34
Q

Populations at Risk for undertreatment of pain

A

infants
children
older adults
clients who have substance use disorder

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35
Q

Causes of acute and chronic pain

A

trauma
surgery
cancer (tumor invasion, nerve compression, bone metastases, associated infections, immobility)
Arthritis
Fibromyalgia
Neuropathy
Diagnostic or treatment procedures (injection, intubation, radiation)

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36
Q

Factors that affect the pain experience

A 
age
fatigue
genetic sensitivity
cognitive function
prior experiences
anxiety and fear
support systems and coping styles
culture
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37
Q

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.

A

age

older adults

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38
Q

Factors that affect the pain experience called _____ can increase sensitivity to pain.

A

fatigue

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39
Q

Factors that affect the pain experience called ________ can increase or decrease pain tolerance.

A

genetic sensitivity

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40
Q

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.

A

cognitive function

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41
Q

Factors that affect the pain experience called _______ can increase or decrease sensitivity depending on whether clients obtained adequate relief.

A

prior experiences

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42
Q

Factors that affect the pain experience called _______ which can increase sensitivity to pain.

A

ansiety and fear

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43
Q

Factors that affect the pain experience called __________ in the presence of these can decrease sensitivity to pain.

A

support systems and coping styles

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44
Q

Factors that affect the pain experience called ________ can influence how clients express pain or the meaning they give to pain.

A

culture

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45
Q

The expected findings of pain includes behaviors that complement self-report and assist in pain assessment of _________.

A

nonverbal clients

46
Q

Nonverbal client cues

A

facial expressions (grimacing, wrinkled forehead), body movements (restlessness, pacing, guarding)

moaning, crying

decreased attention span

47
Q

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.

A

acute pain

48
Q

_______ strategies should not replace phamacological pain measures, but can be used along with them.

A

nonpharmacological

49
Q

______ change the way a client perceives pain, and physical approaches to improve comfort.

A

cognitive-behavioral measures

50
Q

_______ includes transcutaneous electrical nerve stimulation (TENS), heat, cold, therapeutic tough, and message.

A

cutaneous (skin) stimulus

51
Q

Examples of Cutaneous (skin) stimulation

A

Interruption of pain pathways
cold for inflammation
heat to increase blood flow and to reduce stiffness

52
Q

Nonpharmacological pain management strtegies

A 
cognitive behavioral measures
cutaneous  (skin) stimulation
distraction
relaxation
imagery
acupuncture and acupressure
reduction of pain stimuli
elevation of edematous extremities
53
Q

_______ is a nonpharmacological pain management strategy that includes ambulation, deep breathing, visitors, televention, games, prayer, and music.

A

distraction

54
Q

_______ is a nonpharmacological pain management strategy that includes decreased attention to the presence of pain can decrease the perceived pain level.

A

distraction

55
Q

_______ is a nonpharmacological pain management strategy that includes meditation, yoga, and progressive muscle relaxation.

A

relaxation

56
Q

_______ is a nonpharmacological pain management strategy that includes focusing on a pleasant thought to divert focus and requires the ability to concentrate.

A

imagery

57
Q

_______ is a nonpharmacological pain management strategy that includes stimulating subcutaneous tissues at specific points using needles or the digits.

A

acupuncture and acupressure

58
Q

This is a nonpharmacological pain management strategy that includes the __________ in the enviornment.

A

reduction of pain stimuli

59
Q

_______ is a nonpharmacological pain management strategy that includes promoting return and decrease swelling.

A

elevation of edematous extremities

60
Q

______ are the mainstay for relieving pain.

A

analgesics

61
Q

The three classes of anlgesics

A

nonopioids
opiods
adjuvants

62
Q

__________ (acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), including salicylates) are appropriate for treating mild to moderate pain.

A

Nonopiod analgesics

63
Q

With nonopiod analgesics be aware of the hepatotoxic effects of ___________.

A

acetaminophen

64
Q

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.

A

4g/day

5 mg

65
Q

With _____ analgesics monitor for salyicylism (tinnitus, vertigo, decreased hearing acuity)

A

nonopioid analgesics

66
Q

With nonopiod analgesics prevent ______ by administering the medication with food or antacids.

A

gastric upset

67
Q

Monitor for ______ with long-term NSAID use.

A

bleeding

68
Q

_______ analgesics, such as morphine sulfate, fentanyl, and codeine, are appropriate for treating moderate to server pain 9postoperative pain, myocardial infarction pain, cancer pain)

A

opioid

69
Q

Managing acute severe pain with short-term (24 to 48 hr) around the clock administration of opiods is preferable to following a _______.

A

PRN schedule

70
Q

The ________ route is best for immediate, short-term relief of acute pain. The oral route is better for chronic, no fluctuating pain.

A

parenteral

71
Q

Consistent timing and dosing of opioid administration provide _______ pain control.

A

consistent

72
Q

It is essential to monitor and intervene for _______ of opioid use.

A

adverse effects

73
Q

When using opioid analgesics (_______) monitor level of consciousness and take safety precautions. _______ usually precedes respiratory depression.

A

sedation

sedation

74
Q

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.)

A

respiratory depression

75
Q

Initial treatment of respiratory depression and sedation is generally a reduction in _______.

A

opioid dose

76
Q

If necessary, slowly administer diluted naloxone to reverse opiod effects until the client can deep breathe with a respiratory rate of at least ____/min.

A

8/min

77
Q

Advise clients to sit or lie down if lightheadedness or dizziness occur because _______ can be caused when using opioid analgesics.

A

orthostatic hypotension

78
Q

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.

A

orthostatic hypotension

79
Q

_______ can be a side effect of opioid analgesics. You should monitor I&O, assess for distention, administer bethanechol, and catheterize.

A

urinary retention

80
Q

______ can be a side effect of opioid analgesics. By administering antiemetics, advise clients to lie still and move slowly, and eliminate odors.

A

nausea/vomiting

81
Q

______ can be a side effect of opioid analgesics. Use a preventative approach (monitoring bm, fluids, fiber intake, exercise, stool softeners, stimulant laxatives, enemas)

A

constipation

82
Q

_____ analgesics enhance the effects of nonopiods, help alleviate other manifestations that aggravate pain (depression, seizures, inflammation), and are useful for treating neuropathic pain.

A

adjuvant

83
Q

Adjuvant analgesics

A 
anticovulsants
antianxiety agents
tricyclic antidepressants
anesthetics
antihistamine
glucocorticoids
antiemetics
bisphosphonates and calcitonin
84
Q

Examples of anticonvulsants

A

carbamazepine

gabapentin

85
Q

Examples of antianxiety agents

A

diazepam

lorazepam

86
Q

Examples tricyclic antidepressants

A

amitriptyline

nortriptyline

87
Q

Examples of anesthetics

A

infusional lidocaine

88
Q

Examples of antihistamine

A

hydroxyzine

89
Q

Examples of glucocorticoids

A

dexamethasone

90
Q

Examples of antimetics

A

ondansetron

91
Q

Examples of bisphophonates and calcitonin:

A

for bone pain

92
Q

______ analgesia (PCA) is a medication delivery system that allows clients to self-administer safe doses of opioids.

A

patient controlled

93
Q

With patient–controlled analgesia there should be small, frequent dosing to ensure consistent _______.

A

plasma levels

94
Q

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.

A

lag

95
Q

With patient–controlled analgesia, morphine, hydromorphone, and fentanyl are typical opiods for ________.

A

PCA delivery

96
Q

With patient-controlled analgesia clients should let the nurse know if using the pump does not _______.

A

control the pain

97
Q

To prevent inadvertent overdosing with patient controlled analgesia, the client is the only person who should _____ the PCA button.

A

push

98
Q

Additional pharmacological pain interventions include both ______ and ______ anesthesia and topical analgesia

A

local and regional

99
Q

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.

A

too severe

100
Q

To effectively manage pain instruct clients to report developing or _____ pain and do not wait until pain is severe (for PRN pain medication).

A

recurrent

101
Q

To effectively manage pain explain _______ about pain (medication dependence, pain measurement and perception.)

A

misconceptions

102
Q

To effectively manage pain help clients reduce ______.

A

fear and anxiety

103
Q

Create a treatment plan that includes both nonpharmacological and pharmacological _________ measures.

A

pain-relief

104
Q

Strategies specific for relieving chronic pain include administering long acting or ___________ (including the transdermal route)

A

controlled release opiod analgesics

105
Q

Chronic pain relief strategies involve administering analgesics ________ rather than PRN.

A

around the clock

106
Q

______ 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.

A

undertreatment

107
Q

Sedation, ______, and coma can occur as a result of overdosing. Sedation always precedes ______.

A

respiratory depression

respiratory depression

108
Q

A nursing implication for pain management identify _______ clients (older adult clients, clients who are opioid naive).

A

high-risk

109
Q

A nursing implication for pain management is to carefully ______ client dose while closely monitoring respiratory status.

A

titrate

110
Q

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.

A

antagonist naloxone

111
Q

A nursing implication for pain management involves identifying the cause of ____.

A

sedation

112
Q

A nursing implication for pain management use a ______ in addition to a pain rating scale to assess pain, especially when administering opioids.

A

sedation scale

461 - Exam 4 (6 decks)

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