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Health Assessment > Ch 6: Pain assessment > Flashcards

Ch 6: Pain assessment Flashcards

1
Q

What is a nurses role in pain

How would a nurse know pain control interventions are working

A

Nurse is an advocate for effective care management

Nurse would know pain control interventions are working by assessing and reassessing

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2
Q

What is a common causes of patients seeking help

What can pain affect

A

Common cause of seeking help is Pain

Paint in affect:
-Quality of life
-limit ADLs
• decrease his independence/self-care as patient now needs help

-decrease family/friend interactions
• patient isolates, withdrawals

-decrease sense of well-being/self-esteem
• increase anxiety and depression levels with constant pain

-Financial resources
• missing work, hospitalized, meds

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3
Q

In the peripheral nervous system what are the two main types of nerve fibers

Describe each nerve: 
speed of action
size
what kind of pain transmitted
covered? 
A

In PNS two main type of nerve fibers include

  1. A-delta:
    - immediate
    - large fibers
    - Transmit sharp localized pain
    - covered by myelin sheath
  2. C fibers
    - slow reaction
    - smaller fibers
    - transmit secondary dull poorly localized pain (achy)
    - Non-myelinated
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4
Q

What is the definition of neural transmitters

Where is substance P and what does it do

Glutamate: what does it responsible for
What does glutamate ativate/intensifies

A

Neurotransmitters: pain transmission substances

Substance P in synaptic junction
-is a pain substance that Quicken‘s transmission of pain stimuli

Glutamate: responsible for communication among PNS and CNS
-glutamate activates pain receptors/intensifies prolongs persistent pain

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5
Q

What is Brady cayman what does it cause

A

Brady came in: pain facilitating substance (neurotransmitter) released at site of injury

Brady came in function: causes continuous irritation at injury

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6
Q

What is the function of modulating substances and give three examples

A

Modulating substances decrease pain transmission and produce analgesia

Examples:

  • Opiates
  • endorphins
  • enkephalins
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7
Q

What treatment is used for chronic pain

How are these treatments used

Give examples of treatments

A

Adjuvant drugs are used for CHRONIC pain

Advocate meds used with pain medications to decrease pain
-not labeled for pain


Examples of adjuvant Chronic treatment:
-TCA/SSRI
-calcium channel blockers
-anti-inflammatory/antidepressants
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8
Q

What is the gate control theory of pain in relation to pain

What is there to know about the gate control theory (aspects)

A

The gate control theory is the theory with the widest acceptance as to how the body responds to pain

Aspects of gate control theory:

  • once stimuli is identified as pain
  • stimuli passes through afferent pathway
  • create reaction
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9
Q

What can help or hinder the pain process

A

Pain facilitating/inhibiting substances can hinder the pain process

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10
Q

What is the most common clinical interpretation of pain transmission

How do you define the most common clinical interpretation of paint transmission

A

Nociceptors are the most common clinical interpretation of pain transmission

Nociceptors are defined as the perception of pain by sensory perception

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11
Q

What are the four steps in nociception

A

Four steps of nociception:

  1. Transduction:
    - activate pain receptors
  2. Transmission:
    - conduction along A delta and C fibers ➡️spinal cord ➡️cortex
  3. Perception:
    - awareness of characteristics of pain
  4.  modulation:
    - inhibition of pain at level of spinal cord
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12
Q

Give the main categories of types of pain

A 
Acute pain 
musculoskeletal pain 
chronic pain 
neuropathic pain 
referred pain
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13
Q

Describe acute pain (what it warns)

How fast is acute pain

Where is acute pain most prevalent

A

Acute pain warns of tissue damage
-protective in nature

Acute pain is rapid onset

Acute pain most prevalent in hospitals and primary care clinics

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14
Q 
Under musculoskeletal pain

Describe visceral pain
-description
-characteristics
-includes

Describe somatic pain
-A.k.a.
-Description
-characteristics

Describe cutaneous pain

  • description
  • characteristics
A 
Visceral pain: abdominal organ pain
Characteristics: “crampy, gnawing”
Includes: 
-distention
-ischemic
-inflammatory

 somatic pain = arthritic pain
: pain of tissue, bones, joints
Characteristics: “sharp/aching”

Cutaneous pain: of skin layers
Character six: “burning, sharp”



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15
Q

What are criteria to categorize chronic pain

What does chronic pain result from

A

Patient must experience chronic pain daily for 3+ months with no control To be classified chronic 

Chronic pain results from poor treatment of pain

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16
Q

What is neuropathic pain known as

How do you characterize neuropathic pain
who is neuropathy more common in and to where

A

Neuropathic pain =Nerve pain

Neuropathic pain characterized as “burning”

Neuropathy is most common in your diabetics to feet

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17
Q

Under neuropathic pain describe :

peripheral Sensitization

  • How do you describe peripheral sensitization
  • characteristics
  • causes

neuronal wind up

  • characteristics
  • causes
A

Peripheral sensitization
: result of prolonged inflammatory process
-described as hypersensitivity to touch and pressure
-extremely painful”

Neuronal wind up:
Causes hypersensitivity in areas not usually identified as painful
Characteristic: “extremely sensitive”

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18
Q

Define phantom limb pain

 what’s the cause and how do we panel Phantom paint

A

Phantom limb pain: is pain to amputated limb

There is no physical cause but it is real and we must treat

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19
Q

What are Causes of pain

Think of the big and bad

A 
MVC
DVT 
strangulated hernia 
compartment syndrome 
Testicular torsion 
surgery 
cancer
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20
Q

What is another name for cancer pain

A

Cancer pain is intractable malignant pain

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21
Q

What is the best way to get a patient to show you where it hurts especially for referred pain

A

The best way to get a patient to show you where it hurts it’s by asking them to point to the place of pain

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22
Q

Where does cardiac pain refer to

A

Cardiac pain is referred to :
-epigastric (substernal)

                Or

-radiating to left arm neck jaw

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23
Q

How is gallbladder pain referred to

A

Gallbladder pain begins in right upper quadrant radiates to right shoulder

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24
Q

 How does bladder pain radiate

How does kidney pain radiate

A

Bladder pain starts at bladder and moves to rectal area

Kidney pain radiates to hip/thigh area

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25
Q

How does liver pain radiate

How does pancreatic pain radiate

A

Liver pain radiates to right shoulder and right back

Pancreatic pain preferred to epic gastric area

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26
Q

When assessing pain Why when especially palpating is it vital to look at patients facial expressions and why
-how do they describe their pain

What is MOST Important to remember about pain with age

What is not diminished in relation to pain in older adults

A

Especially when palpating it’s vital to look at patients facial expressions because they may deny or minimize their pain as an ache or discomfort

PAIN WITH AGE IS NOT COMMON!

Pain sensation is not diminished in older

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27
Q

What is the percentage of long-term care patients who report pain and why

A

85% of long-term Care patient reports pain due to nursing assessment

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28
Q

What are the greatest barriers to pain when it comes to healthcare providers

A

Barriers of pain involving healthcare providers include

-afraid of overmedicating patient and increasing complications with opiatesso providers under treat

In patients with cognitive/psychological disorders pain reports may be considered less valid because of condition

29
Q

When it comes to the risk of over medicating regardless of order what do you always want to ensure

What can under treatment result in due to what

A

Regardless of order always ensure correct dose

Under treatment may result in psychiatric disorders do to constant pain

30
Q

Why is newborn pain often under treated and what me at least two

A

Newborn pain often under treated because they cannot communicate pain

May lead to:
• Learning disability
• psychological disorder
• neurological disorder

31
Q

What must you complete with accuracy in patients with dementia and delirium and why

How do you assess someone with dementia or delirium

A

In patients with dementia or delirium complete and accurate assessment of patient as they may not be able to fully expressed extent of pain

Assess using facial grimacing

32
Q

What cultural populations receive less pain meds

In what circumstances

And why

A

Hispanics and African-Americans receive less pain meds in the ER, postop, or cancer due to:

  • lack of complaint of pain
  • don’t ask for pain meds(Tough it out)
  • Often minimize pain
33
Q

Define gender differences in pain And when does it start

what are most common Pains among your women as compared to human

A

Within gender differences there’s a stigma that girls can cry but boys cannot and that starts young

Most common pains among women as compared to men are

  • fibromyalgia
  • IBS
  • migraines
  • TMJ pain
34
Q

Describe fibromyalgia

A

Fibromyalgia is a neuropathic pain that is poorly localized

Signs and symptoms of fibromyalgia include:
-⬆️heart rate ⬆️ blood pressure

35
Q

What are sociocultural variables for care

A

Social cultural variables are ways of alternative care mostly religious include:

  • hope that pain goes away
  • Belief that pain is caused by lack of goodness
36
Q

What are things that affect/enhance pain

A

-The environment
• should be quiet, Low light, no odors

  • anxiety, stress, fatigue
  • past experience with pain

-lack of support system
• those with Systems have lower pain

37
Q

What are the types of pain med Classifications a patient can get

A

PCA pumps

Breakout pain medications (PRN)

Scheduled “around the clock meds”

38
Q

When are breakout (PRN) pain meds used

how often

what are breakout meds considered

A

Breakout (PRN) pain meds used if experiencing pain even on “around the clock” meds

Break out meds given every 4 to 6 hours mostly

Breakout meds considered effective pain management



39
Q

What type of pain is needed to receive scheduled “around the clock” meds

How often are around the clock meds given



A

Around the clock meds given with pain or no pain

Around the clock meds given every 8 to 12 hours

Usually given post pump

40
Q

What is vital to keep in mind about pain and when medicating


What do you want to teach a patient on break through (PRN) pain about pain meds and why

A

You should medicate before pain becomes severe

For patient on breakthrough (PRN)
Pain meds teach to request meds before severe pain because:
Longer weight = harder to treat

41
Q

What do you want to teach patient in relation to pain

  • Addiction
  • what can develop from inadequately treated pain
  • what do meds cause
A

Teach patients in relation to pain:

For those fearful of addiction the meds are calculated by week to be able to taper when going home

From inadequate treatment of acute pain because patient cannot call for breathe properly they may develop pneumonia

We want to teach about the side effects such as nausea vomiting, constipation, sedated state



42
Q

What do you do if a patient is refusing there around the clock scheduled medication

A

If a patient is refusing around the clock schedule medication FIND OUT WHY 

43
Q

Give the mnemonics for pain assessment

What is pain

Define pain threshold
Define pain tolerance

A
  1. OPQRST
    
  2. OLDCARTS

Pain is whatever the patient says it is

Pain threshold: when you feel the pain

Pain tolerance: amount of pain patient can tolerate

44
Q

What is the most important scale to use when assessing postop pain

Break the scale into threes and describe how it is classified

A

The numeric scale is the best To use when assessing postop pain

Numeric skill broken down:
1-3: mild
4 -6: moderate
7 -10: severe

45
Q

 when collecting subjective data other than your pain assessment what are the 3 most important aspects/Questions to get from your patient

A

Pain management goal:
-what is an acceptable level on the scale for the patient

Functional goal:
-how does pain affect ADLs

Assess precipitating factors:
-what were you doing when pain started

46
Q

Give physiological signs of pain

A

⬆️ BP/glucose

  • pupils dilated
  • muscles tense
  • vomiting
  • pallor
  • Diaphoresis
47
Q

What are signs of inadequately treated pain

A

N/V and diaphoresis are signs of continuous pain that has not been resolved (inadequately treated)

48
Q

Give behavioral signs of pain

A 
Frequently repositioning
 rubbing/ cradling
 guarding
Grimacing/ teeth clenching
 splinting 
moaning/crying
 vocal complaints 
forehead wrinkles
49
Q

Give examples of affective data collection in combination with behavioral data

A

Effective data collection incomination with behavioral data includes:

  • Anxiety
  • depression
  • withdraw
  • fear
  • anger
  • anorexia
50
Q

What do one dimensional paint scales measure

Give the three examples of one dimensional pain scales

A

When dimensional pain scales measure only one element and that is INTENSITY

Examples of one dimensional paint scales:
-Visual analog scale (VAS): small paper
-verbal descriptor scale (VDS)
-Numeric pain intensity scale (NPI): 
      •most widely used
51
Q

What are the components of a combined thermometer scale

A

combined thermometer scale combines visual descriptor scale (VDS) + Numeric pain intensity scale (NPI)


52
Q

What do multi dimensional paint scales evaluate for

Give the two examples of multi dimensional paint scales and a very brief description

A

Multi dimensional paint scales evaluate for chronic malignant research (CA pain)

  1. McGill pain questionnaire: verbal descriptor
  2. Brief pain inventory (BPI) mostly used for cancer pain but also chronic 
53
Q

What is the scale classification and scale name that is used mostly for cancer but sometimes chronic pain


A

The brief pain inventory (BPI) which is part of a multi dimensional pain scale is mostly used for cancer but sometimes chronic pain

54
Q

If you give a pain medication when do you go back to reassess and what do you do after reassessing

A

After giving a pain medication reassess

  • POST 30 MIN
  • And document if pain medication was effective
55
Q

How will infants with pain present as far as facial expressions

A

Infant with pain will present:

-Bulging in the area of the brow
-squeezing ice tight
-opening lips stretching mouth
-pursing lips
-protrusion of tongue
-chin quiver


56
Q

Who do you use the FLACC scale on and what does the FLACC scale stand for

A

FLACC scale used in infants
(2 months to 7 years old)

F-acial expressions
L-eg movement
A-ctivity (running or just sitting?)
C-rying
C-onsolability
57
Q

Who do you use the Wong baker faces scale on

A

Use the Wong baker faces scale on children 3 years+

58
Q

What are vital lifespan considerations for our older adults

Pain and aging
Chronic illness
Stoicism
Fear of what

A

 in older:

-pain is NOT a normal part of aging
-Chronic illness such as
• osteoarthritis, neuropathic
-older patients have stoicism will not complain
-fear increased costs so do not complain


59
Q

What are patient populations unable to report pain

 Because patient is unable to report pain what must be observed and who can we ask for help when reading the patient

A 
CVA 
ventilator patients
 newborns 
impaired patiients
 opioid tolerant patients

If patient cannot report pain we must observe behaviors and even ask family for help in reading the patient

60
Q

What can being opioid tolerant lead to as far as pain

in what time frame Can addiction develop

How do we as healthcare professionals prevent opioid use (addiction) When patients go home

A

Being opioid tolerant can lead to the body being more sensitive to pain

Opioid tolerance can develop opioid use (addiction) after one month

Sending patients home to prevent addiction we only give one week worth of opioids and begin tapering

61
Q

In opioid tolerant patients what is their a risk for and what is required to accommodate opioid hyper analgesia

A

In opioid tolerant patients there’s a risk for opioid hyper analgesia

Opioid hyper analgesia requires a patient to have more drug for the same pain control
-addiction

62
Q

What are patients with opioid hyper analgesia often labeled as

+ what action exacerbates the label put on them

How must be treat people who have opioid hyper analgesia

A

If a patient presents with opioid hyper analgesia they are often labeled as drug seekers
-Especially if seeking certain drugs

Regardless of opioid hyper analgesia we are still care for the patient

63
Q

What medications do we use for mild pain what do we wanna monitor for

A

If using aspirin
-Monitor for bleeding

If using Tylenol
-Monitor for liver damage



64
Q

What pain medication’s to be used for moderate pain and what do we wanna watch for

A

For moderate pain we use NSAIDs (Motrin)

-Monitor for ulcers/bleeding/gastric upset

65
Q

What drugs do we use for severe pain

A

For severe pain we use control three medications like morphine Dilaudid 

66
Q

What are medication’s for chronic pain

A

For chronic pain: anticonvulsants, antihistamines

67
Q

As part of the nurses responsibility what do you prioritize in patient care

A

As part of the nurses responsibility prioritize patients needs

68
Q

Give nursing interventions for pain assessment

A

Assess pain initially

Reassess as indicated

Create nursing care plans

69
Q

What are nursing diagnosis is related to pain assessment

A

Acute pain

chronic pain

Health Assessment (20 decks)

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