Ch 6: Pain assessment Flashcards
What is a nurses role in pain
How would a nurse know pain control interventions are working
Nurse is an advocate for effective care management
Nurse would know pain control interventions are working by assessing and reassessing
What is a common causes of patients seeking help
What can pain affect
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
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? 
In PNS two main type of nerve fibers include
- A-delta:
- immediate
- large fibers
- Transmit sharp localized pain
- covered by myelin sheath - C fibers
- slow reaction
- smaller fibers
- transmit secondary dull poorly localized pain (achy)
- Non-myelinated
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
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
What is Brady cayman what does it cause
Brady came in: pain facilitating substance (neurotransmitter) released at site of injury
Brady came in function: causes continuous irritation at injury
What is the function of modulating substances and give three examples
Modulating substances decrease pain transmission and produce analgesia
Examples:
- Opiates
- endorphins
- enkephalins
What treatment is used for chronic pain
How are these treatments used
Give examples of treatments
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
What is the gate control theory of pain in relation to pain
What is there to know about the gate control theory (aspects)
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
What can help or hinder the pain process
Pain facilitating/inhibiting substances can hinder the pain process
What is the most common clinical interpretation of pain transmission
How do you define the most common clinical interpretation of paint transmission
Nociceptors are the most common clinical interpretation of pain transmission
Nociceptors are defined as the perception of pain by sensory perception
What are the four steps in nociception
Four steps of nociception:
- Transduction:
- activate pain receptors - Transmission:
- conduction along A delta and C fibers ➡️spinal cord ➡️cortex - Perception:
- awareness of characteristics of pain -  modulation:
- inhibition of pain at level of spinal cord
Give the main categories of types of pain
Acute pain musculoskeletal pain chronic pain neuropathic pain referred pain
Describe acute pain (what it warns)
How fast is acute pain
Where is acute pain most prevalent
Acute pain warns of tissue damage
-protective in nature

Acute pain is rapid onset
Acute pain most prevalent in hospitals and primary care clinics
Under musculoskeletal pain  Describe visceral pain -description -characteristics -includes  Describe somatic pain -A.k.a. -Description -characteristics
Describe cutaneous pain
- description
- characteristics
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”


What are criteria to categorize chronic pain
What does chronic pain result from
Patient must experience chronic pain daily for 3+ months with no control To be classified chronic 
Chronic pain results from poor treatment of pain
What is neuropathic pain known as

How do you characterize neuropathic pain
who is neuropathy more common in and to where
Neuropathic pain =Nerve pain
Neuropathic pain characterized as “burning”
Neuropathy is most common in your diabetics to feet
Under neuropathic pain describe :
peripheral Sensitization
- How do you describe peripheral sensitization
- characteristics
- causes
neuronal wind up
- characteristics
- causes
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”
Define phantom limb pain
 what’s the cause and how do we panel Phantom paint
Phantom limb pain: is pain to amputated limb
There is no physical cause but it is real and we must treat
What are Causes of pain
Think of the big and bad
MVC DVT strangulated hernia compartment syndrome Testicular torsion surgery cancer
What is another name for cancer pain
Cancer pain is intractable malignant pain
What is the best way to get a patient to show you where it hurts especially for referred pain
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
Where does cardiac pain refer to
Cardiac pain is referred to :
-epigastric (substernal)
Or
-radiating to left arm neck jaw
How is gallbladder pain referred to
Gallbladder pain begins in right upper quadrant radiates to right shoulder
 How does bladder pain radiate
How does kidney pain radiate
Bladder pain starts at bladder and moves to rectal area
Kidney pain radiates to hip/thigh area
How does liver pain radiate
How does pancreatic pain radiate
Liver pain radiates to right shoulder and right back
Pancreatic pain preferred to epic gastric area
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
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
What is the percentage of long-term care patients who report pain and why
85% of long-term Care patient reports pain due to nursing assessment
What are the greatest barriers to pain when it comes to healthcare providers
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
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
Regardless of order always ensure correct dose
Under treatment may result in psychiatric disorders do to constant pain
Why is newborn pain often under treated and what me at least two
Newborn pain often under treated because they cannot communicate pain
May lead to:
• Learning disability
• psychological disorder
• neurological disorder
What must you complete with accuracy in patients with dementia and delirium and why
How do you assess someone with dementia or delirium
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
What cultural populations receive less pain meds
In what circumstances
And why
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
Define gender differences in pain And when does it start
what are most common Pains among your women as compared to human
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
Describe fibromyalgia
Fibromyalgia is a neuropathic pain that is poorly localized
Signs and symptoms of fibromyalgia include:
-⬆️heart rate ⬆️ blood pressure
What are sociocultural variables for care
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
What are things that affect/enhance pain
-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
What are the types of pain med Classifications a patient can get
PCA pumps
Breakout pain medications (PRN)
Scheduled “around the clock meds”
When are breakout (PRN) pain meds used
how often
what are breakout meds considered
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

What type of pain is needed to receive scheduled “around the clock” meds
How often are around the clock meds given

Around the clock meds given with pain or no pain
Around the clock meds given every 8 to 12 hours
Usually given post pump
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
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
What do you want to teach patient in relation to pain
- Addiction
- what can develop from inadequately treated pain
- what do meds cause
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

What do you do if a patient is refusing there around the clock scheduled medication
If a patient is refusing around the clock schedule medication FIND OUT WHY 
Give the mnemonics for pain assessment
What is pain
Define pain threshold
Define pain tolerance
- OPQRST
 - OLDCARTS
Pain is whatever the patient says it is
Pain threshold: when you feel the pain
Pain tolerance: amount of pain patient can tolerate
What is the most important scale to use when assessing postop pain
Break the scale into threes and describe how it is classified
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
 when collecting subjective data other than your pain assessment what are the 3 most important aspects/Questions to get from your patient
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
Give physiological signs of pain
⬆️ BP/glucose
- pupils dilated
- muscles tense
- vomiting
- pallor
- Diaphoresis
What are signs of inadequately treated pain
N/V and diaphoresis are signs of continuous pain that has not been resolved (inadequately treated)
Give behavioral signs of pain
Frequently repositioning rubbing/ cradling  guarding Grimacing/ teeth clenching splinting moaning/crying vocal complaints forehead wrinkles
Give examples of affective data collection in combination with behavioral data
Effective data collection incomination with behavioral data includes:
- Anxiety
- depression
- withdraw
- fear
- anger
- anorexia
What do one dimensional paint scales measure
Give the three examples of one dimensional pain scales
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
What are the components of a combined thermometer scale
combined thermometer scale combines visual descriptor scale (VDS) + Numeric pain intensity scale (NPI)

What do multi dimensional paint scales evaluate for
Give the two examples of multi dimensional paint scales and a very brief description
Multi dimensional paint scales evaluate for chronic malignant research (CA pain)
- McGill pain questionnaire: verbal descriptor
- Brief pain inventory (BPI) mostly used for cancer pain but also chronic 
What is the scale classification and scale name that is used mostly for cancer but sometimes chronic pain

The brief pain inventory (BPI) which is part of a multi dimensional pain scale is mostly used for cancer but sometimes chronic pain
If you give a pain medication when do you go back to reassess and what do you do after reassessing
After giving a pain medication reassess
- POST 30 MIN
- And document if pain medication was effective
How will infants with pain present as far as facial expressions
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

Who do you use the FLACC scale on and what does the FLACC scale stand for
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
Who do you use the Wong baker faces scale on
Use the Wong baker faces scale on children 3 years+
What are vital lifespan considerations for our older adults
Pain and aging
Chronic illness
Stoicism
Fear of what
 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

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
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
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
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
In opioid tolerant patients what is their a risk for and what is required to accommodate opioid hyper analgesia
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
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
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
What medications do we use for mild pain what do we wanna monitor for
If using aspirin
-Monitor for bleeding
If using Tylenol
-Monitor for liver damage

What pain medication’s to be used for moderate pain and what do we wanna watch for
For moderate pain we use NSAIDs (Motrin)
-Monitor for ulcers/bleeding/gastric upset
What drugs do we use for severe pain
For severe pain we use control three medications like morphine Dilaudid 
What are medication’s for chronic pain
For chronic pain: anticonvulsants, antihistamines
As part of the nurses responsibility what do you prioritize in patient care
As part of the nurses responsibility prioritize patients needs
Give nursing interventions for pain assessment
Assess pain initially
Reassess as indicated
Create nursing care plans
What are nursing diagnosis is related to pain assessment
Acute pain
chronic pain
