Ch 30 Pain Mgmt Flashcards
What is pain?
Unpleasant sensory/emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Can have destructive effects (cause sleep loss, irritability, cognitive impairment, functional impairment and immobility)
Can warn of potential injury (touch hot stove, tells you to remove hand)
A multidimensional experience (can affect hob performance, social life, sexual intimacy, sleep rest, exercise and ADLs)
T or F: Pain is objective and can be measured.
False! It is subjective. Although the pt can give you a number between 1-10, you cannot measure it like HR or BP
T or F: Pain can be classified by the origin of pain, cause, duration and quality.
True
By origin: subcutaneous, radiating, etc…
By cause: Nociceptive or Neuropathic
By quality: Stabbing, radiating, pinching
By duration: Acute, Chronic, Intractable – 24 hr/7day pain; MS; Fibromyalgia
The origin of pain refers to the site where pain is felt and not necessarily the source of pain. List examples:
Superficial/cutaneous: skin or subcutaneous; paper cut!
Visceral: ORIGINATES IN ORGAN; stimulate deep internal pain receptors; usually abd cavity , cranium, thorax
Examples: menstrual cramps, labor pain, GI Infections, etc.
Somatic: MUSCULOSKELTAL;originates in ligaments, tendons, nerves, blood vessels, bones. Causes-fracture or sprain, arthritis, bone cancer (osteosarcoma).
Radiating: PAIN MOVES; starts at origin, extends to other locations. Example: sore throat extends to ears and head.
Referred: occurs in area distant from the original site; Example: pain from heart attack is experienced down the arm.
Phantom: perceived to originate from an area surgically removed. Amputees who lost leg, have leg pain in the limb that isn’t there.
Psychogenic: pain arising from the mind (PSYCH PAIN LIKE PTSD, FROM TRAUMATIC EXP); no cause can be identified.
Review Figure 30-1
_______ pain is the most common type of pain. It occurs when pain receptors respond to stimuli that are potentially damaging. Can occur as a result of trauma, surgery or inflammation.Two types of this pain are visceral and somatic.
Nociceptive
______ pain is complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli. This type of pain is described as burning numbness, itching and pins and needles.
neuropathic
It is most important for the nurse to understand the various ways in which pain is classified
a. so that he can document the client’s pain using accurate terms b. so that he can be clear in his communication with the physician c. so that he can develop an effective pain management plan d. so that he can educate the client thoroughly
Correct answer: C
Different modalities are used in the treatment/ management of pain and are often based on how the pain is classified (e.g., acute vs. chronic).
What is the difference between acute, chronic, and intractable pain?
Acute - short duration, associated with injury or surgery. Can last up to 6 months, but is brought on suddenly.
Chronic - 6 months or longer, interferes with ADLs, Can be related to progressive disorder. Can come and go. May lead to anger, frustration and dependence.
Intractable -Pain is 24 hr/7day; Highly resistant to relief, Examples: MS,Fibromyalgia
Name some adjectives for describing the quality of pain…
Sharp, dull, aching, throbbing, stabbing, burning, ripping, searing, tingling.
The length of time: episodic, intermittent or constant.
Intensity: mild, distracting, moderate, sever or intolerable.
_____ is the process of nociceptor activation by perception (by noci) of potentially damaging mechanical (friction against body/incisions), thermal (extreme heat/cold), and chemical stimuli (internal-chest pain from MI/external-lemon juice in a cut).
Transduction - activation of nociceptors by stimuli/perception of potentially damaging mechanical, thermal & chemical stimuli
Examples:
Pain sensitive nociceptors found in skin(highest level),subcutaneous tissue, joints, wall of arteries & most internal organs(lowest level)
Mechanical stimuli: external forces that result in pressure or friction against the body (bleeding, swelling, surgical incisions, friction from sheets, pressure from cast
Thermal stimuli: exposure to extreme heat or cold
Chemical stimuli: lemon on an open cut causes sharp, sudden pain
When tissue is damaged, it triggers the release of substances like _______, histamine, prostaglandins. These activate nociceptors. ________ also is a powerful vasodilator that triggers a release of inflammatory chemicals causing signs of inflammation in injured area
Bradykinin;bradykinin
Remeber the signs of inflammation:
Calor, Dolor, Tumor, Rubor
Heat, pain, swelling, redness
Peripheral nerves carry the pain message to the dorsal horn of the spinal cord in a process known as ________.. Pain across synapses require neurotransmitters (esp Substance P)
transmission
The pain transmits a signal to the brain!
A delta fibers: (fast pain impulse)
Initial sharp pain from knee bump or massage
(Ay! that was fast)
C fibers: (slow pain impulse)
Lingering ache in tissue of bumped knee
(See…it still hurts)
________ involves recognizing and defining pain in the frontal cortex. The point at which the brain recognizes and defines a stimulus as pain is called ______ threshold.
perception - brain perceives stimulus
pain threshold - brain defines stimulus as pain; some people have higher pain threshold. what makes me say ow, might make my sister cry.
The duration and intensity of pain a person is willing to endure is ______ _______
pain tolerance
A parent donating a kidney might not report as much pain as someone who had a cancerous kidneyr emoved.
Extreme sensitivity to pain is called …
hyperalgesia
A process called modulation changes the perception of pain by either facilitating or inhibiting pain signals. There are two mechanism that allow this. Name and describe them:
EAS - endogenous analgesia system (trigger release of endogenous opioids and other substances to block the pain impulse, providing relief)
Side note: Nonpharmacological measures: exercise, meditation, visualization & music therapy can prompt the release of endogenous opioids
GCT - Gate Control Theory (The reason for using TENS)
(As impulses travel to brain - gate either allows or blocks pain signal to brain; If non painful - gate blocks. If noxious, keeps gate open) p.729
T or F: Pain is influenced by emotions, age, socio-cultural factors, and communication and cognitive impairments.
True
Factors that influence pain:
Past experience with pain (If pt had good/bad experience with pain, can change how they handle it. If bad, will be anxious of treatment. If good, will be less anxious)
Emotions (fear of injury being fatal, drugs being addictive, being judged for using drugs, etc.; confusion/helplessness/anger/depression)
Developmental stage (neonates will grimace, twitch, cry, won’t eat etc.; Older adults-labored breathing, altered gait, withdrawal of activity)
Sociocultural factors (some people are stoic while others cry it out)
Communication skills and Cognitive impairments (may not be able to report. look for signs: withdrawal of activity, facial expressions, profanity/noisy breathing, confusion, BP/Resp/Pulse, )
Other illnesses contributingto pain
Unrelieved pain can cause harmful effects in various body systems such as: endocrine, cardiovascular, musculoskeletal, respiratory, genitourinary, and GI. GIve some examples of issues that arise:
endocrine - ongoing triggers causes exceseive release of hormones; Insulin and testosterone levels decrease; can result in weight loss, tachycardia, fever, inc resp rate, and death
cardiovascular - leads to hypercoagulation and increase in HR/BP/Cardiac workload/O2 demand; symptoms chest pain, clots, heart attack
musculoskeletal-prevents ADLs/self-care
respiratory-Splinting (reduction of tidal vol due to shallow breathing); Increases insp/exp pressures leadin to pneumonia/underventilation/resp acidosis.
genitourinary - excessive hormone release leads to decreased urinary output/retention. fluid overload, hypokalemia, HTN, and inc CO.
GI - intertinal secretions and smooth muscle tone increase; gastric emptying and motility decrease
p.733
What are the steps to assess pain? What do you include in theRN Dx?
Obtain a complete pain history; use oldcart. Watch body language. Check vitals for hints.
When writing a pain nursing diagnosis specify location/precipitating factors/deficits found when using oldcart. p. 735
T or F: Pain if the fifth vital sign and should be assessed for intensity whenever you take a full set of vital signs.
True.
Perform pain assessments routinely but not limited to:
- on admission
- before/after each painful procedure/treatment
- When pt is at rest/and when active
- before administering pain med and 30 minutes after (60 at most)
- with each vital sign check (is pain actual or potential prob?)
- when pt complains about pain
T or F: when assessing pediatric pain, you should consult with parents about the child’s stress signals
True
Nonverbal signs of pain
Elevated pulse/blood pressure - acute Decreased BP - chronic pain Crying, moaning Grimacing ashen - of the pale gray color of ash. (of a person's face) very pale with shock, fear, or illness.
Morphine or Norco?
Choose norco first, if that doesn’t work go IV morphine.
PO works longer but takes longer. IV is quick but stops working quick.
What are some common pain scales used?
Pain Scales (0 to 10): Visual Analogue Scale (VAS) Numeric Rating Scale (NRS) Simple descriptor scale Wong-Baker Faces Pain Rating Scale
The nurse is assessing the confused client. In trying to determine the client’s level of pain, the nurse should
a. be aware that confused clients don’t feel as much pain due to their confusion b. observe the client carefully for changes in behavior or vital signs c. ask the client’s family how much pain the client normally has d. use only pain scales that feature numbers or “faces” the client can point to
Correct answer: B
The nurse should observe the confused client for nonverbal cues to pain.