CH 8 Infection Flashcards
What is the most common reason patients seek medical advice?
Pain management.
How does Margo McCaffery define pain?
“Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does.”
How does the International Association for the Study of Pain (IASP) define pain?
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
What is the purpose of pain?
It acts as a protective mechanism or warning signal to prevent further injury.
What is suffering in relation to pain?
Continuous distress that often accompanies pain and affects emotional, social, and spiritual well-being.
What are some complications of untreated pain?
Tissue breakdown, increased metabolic rate, impaired immune function, and emotional distress.
Why might a post-surgical patient avoid deep breathing or coughing?
Due to pain, which can lead to retained pulmonary secretions and pneumonia.
How can culture influence pain expression?
Some cultures are stoic and quiet about pain, while others may be more expressive.
Why is the patient considered central to the healthcare team in pain management?
Because they maintain autonomy and should be informed about their pain management options.
What are some common myths about pain?
“Laughing and talking means no pain,” “Respiratory depression is common with opioids,” and “Pain medication is more effective via injection.”
What is the difference between addiction, tolerance, and physical dependence?
Addiction is compulsive drug-seeking behavior, tolerance is a reduced response to a drug over time, and physical dependence is the body’s adaptation leading to withdrawal symptoms.
What is pseudoaddiction?
Drug-seeking behavior due to inadequate pain control, which resolves when pain is properly treated.
What are the four processes of pain transmission?
Transduction, transmission, perception, and modulation.
What are nociceptive and neuropathic pain?
Nociceptive pain results from tissue damage, while neuropathic pain results from nerve injury.
How is nociceptive pain categorized?
Into somatic pain (localized, musculoskeletal) and visceral pain (internal organ pain, often cramping or pressure-like).
What is referred pain?
Pain felt in a location different from the actual source (e.g., back pain from kidney stones).
How does neuropathic pain differ from nociceptive pain?
It is often described as numbness, tingling, sharp, or shooting pain and is caused by nerve damage.
What is acute pain?
Pain that follows injury and subsides as healing occurs.
What is chronic pain?
Pain lasting more than 3 months, often persisting beyond the expected healing period.
What are the three main classes of analgesics?
Opioids, nonopioids, and adjuvants.
What are some examples of nonopioid analgesics?
NSAIDs (ibuprofen, aspirin), COX-2 inhibitors (celecoxib), and acetaminophen.
What is the ceiling effect in nonopioids?
A dose beyond which no additional pain relief occurs but side effects may increase.
What is the mechanism of NSAIDs?
They block the synthesis of prostaglandins, reducing pain and inflammation.
Why is acetaminophen not an NSAID?
It has no anti-inflammatory or antiplatelet effects.
What is a key risk of acetaminophen?
Liver toxicity at doses >4g/day.
What is the first-line opioid for moderate to severe pain?
Morphine.
What is hyperalgesia?
Increased sensitivity to pain, sometimes caused by long-term opioid use.
What are common side effects of opioids?
Constipation, confusion, nausea, sedation, and respiratory depression.
Why is meperidine (Demerol) rarely used?
It produces a toxic metabolite (normeperidine) that can cause seizures.
What is the role of opioid antagonists like naloxone (Narcan)?
They reverse opioid effects, especially in overdose cases.
What is breakthrough pain?
Transient pain that occurs despite generally effective pain control.
What is a balanced approach to analgesia?
Combining different analgesic classes to maximize pain relief and minimize side effects.
What is the WHO analgesic ladder?
A stepwise approach to pain management, starting with nonopioids and progressing to strong opioids.
What are patient-controlled analgesia (PCA) pumps?
Devices that allow patients to self-administer IV opioids with preset limits.
Why should family members not push a PCA button for the patient?
It can lead to overdosing if the patient is already sedated.
What is the maximum safe dose of acetaminophen per day?
4 grams.
What are adjuvant analgesics?
Medications that enhance pain relief, such as antidepressants and anticonvulsants.
Why are antidepressants used for pain management?
They help relieve neuropathic pain by altering neurotransmitter activity.
What are some nonpharmacological pain management techniques?
Heat, cold, massage, exercise, guided imagery, relaxation, and acupuncture.
What is biofeedback?
A technique where patients learn to control physiological responses to pain.
What are signs of opioid overdose?
Decreased respiratory rate, constricted pupils, and extreme sedation.
What are the benefits of the transdermal fentanyl patch?
Continuous pain relief for chronic pain conditions.
Why are IM injections not recommended for pain management?
They are painful, have inconsistent absorption, and a lag in peak effect.
What are common barriers to effective pain management?
Myths, fear of addiction, inadequate assessment, and provider biases.
What tool is commonly used to assess pain?
The numeric pain scale (0-10).
What is the FACES pain scale?
A visual tool with facial expressions for rating pain, commonly used for children and nonverbal patients.
How is pain assessed in dementia patients?
Using the PAINAD scale (Pain Assessment in Advanced Dementia).
What is a major risk of epidural analgesia?
Epidural hematoma if the patient is on anticoagulants.
Why are opioids classified as “high-alert” medications?
Because they can cause severe harm or death if misused.
What are the primary functions of pain?
Protection and warning against injury.
What are the three primary types of pain?
Acute pain, chronic pain, and breakthrough pain.
What is the difference between somatic and visceral pain?
Somatic pain is localized in muscles/bones, while visceral pain arises from internal organs.
What type of pain is caused by nerve damage?
Neuropathic pain.
What are common descriptions of neuropathic pain?
Burning, tingling, shooting, or electric-like pain.
What neurotransmitters are released during transduction?
Prostaglandins, bradykinin, serotonin, and substance P.
What is the primary function of modulation in pain processing?
The body’s attempt to inhibit pain by releasing endogenous opioids.
What is the role of endorphins in pain relief?
They act like opioids and inhibit pain impulses.
What is a common misconception about pain in older adults?
That pain is a normal part of aging.
How do cultural beliefs influence pain management?
Some cultures are stoic, while others may openly express pain.
What is one key challenge in assessing pain in non-verbal patients?
Reliance on non-verbal indicators like facial expressions or body movements.
What is nociception?
The body’s normal response to painful stimuli.
What is the role of prostaglandins in pain?
They contribute to inflammation and increase sensitivity to pain.
Why is untreated pain problematic?
It can lead to complications such as immobility, respiratory issues, and depression.
What is the first-line treatment for mild pain?
Nonopioid analgesics (NSAIDs, acetaminophen).
What is the main risk associated with long-term NSAID use?
Gastrointestinal bleeding and kidney damage.
What is the preferred route for opioid administration?
Oral, unless rapid relief is needed.
What is the main disadvantage of IM opioid injections?
Painful administration and unpredictable absorption.
What is a common side effect of opioid analgesics?
Constipation.
What is the benefit of patient-controlled analgesia (PCA)?
Allows patients to self-administer opioids within preset limits.
Why should opioid-naïve patients be monitored closely?
They have a higher risk of respiratory depression.
How does fentanyl differ from morphine?
Fentanyl is more potent and has a rapid onset.
What is an advantage of the fentanyl transdermal patch?
Provides continuous pain relief for chronic pain conditions.
Why should fentanyl patches be used cautiously in fever patients?
Heat increases absorption, leading to overdose risk.
What is equianalgesia?
The concept of comparing opioid doses to achieve equal pain relief.
Why is methadone used for opioid addiction treatment?
It has a long half-life and reduces withdrawal symptoms.
What is the role of naloxone (Narcan)?
It reverses opioid overdose effects.
What is the ceiling effect in nonopioids?
Increasing the dose beyond a certain point does not improve pain relief but increases side effects.
What are adjuvant analgesics?
Medications that enhance pain relief but were not originally developed for pain (e.g., antidepressants, anticonvulsants).
How do antidepressants help with pain management?
They alter neurotransmitter levels and reduce neuropathic pain.
What type of pain are anticonvulsants commonly used for?
Neuropathic pain.
Why is balanced analgesia important?
It reduces opioid requirements and minimizes side effects.
What is multimodal analgesia?
The use of multiple pain relief strategies, including medications and non-drug therapies.
What is the role of corticosteroids in pain management?
They reduce inflammation, which helps alleviate pain.
What is a benefit of muscle relaxants in pain management?
They help relieve muscle spasms that contribute to pain.
What is breakthrough pain?
Pain that occurs despite generally effective pain control.
How can pain be effectively managed postoperatively?
Through scheduled pain medications and PCA pumps.
What is a common nonpharmacological intervention for pain?
Heat therapy to relax muscles and increase circulation.
When is cold therapy recommended for pain relief?
For acute injuries, swelling, and inflammation.
Why is guided imagery used in pain management?
It helps divert attention from pain and promotes relaxation.
What is the PAINAD scale used for?
Assessing pain in dementia patients.
What is an opioid-naïve patient?
Someone who has not been exposed to opioids and is more sensitive to side effects.
What is patient-centered pain management?
Individualizing pain treatment based on patient needs and preferences.
Why should opioids be tapered off gradually?
To prevent withdrawal symptoms.
What is an epidural analgesia used for?
Postoperative pain, labor pain, and chronic pain management.
What is the maximum daily dose of acetaminophen?
4 grams per day.
How do nurses assess pain in children?
Using tools like the FACES pain scale.
What is a common side effect of chronic opioid therapy?
Tolerance, requiring higher doses for the same pain relief.
What is an alternative to opioids for treating chronic pain?
Adjuvant analgesics, physical therapy, and cognitive-behavioral therapy.
What is pseudoaddiction?
Drug-seeking behavior due to inadequate pain relief, which resolves when pain is properly treated.
What is an opioid antagonist?
A drug that blocks the effects of opioids, like naloxone.
What is the role of a pain management team?
To provide a multidisciplinary approach to pain control.
What is the World Health Organization (WHO) analgesic ladder?
A stepwise approach to pain management based on severity.
What are the three levels of the WHO analgesic ladder?
Nonopioids for mild pain, weak opioids for moderate pain, and strong opioids for severe pain.
What is the main disadvantage of long-term opioid use?
Risk of addiction and dependence.
How do patients with chronic pain often present?
They may not exhibit typical pain behaviors, such as grimacing or high blood pressure.
What is a major risk of epidural pain management?
Epidural hematoma if the patient is on anticoagulants.
What should be assessed before administering opioids?
Respiratory rate and sedation level.
What is the primary reason nurses under-treat pain?
Fear of causing addiction or respiratory depression.
What is a common misconception about PCA pumps?
That patients can overdose easily—PCA pumps have built-in safety limits.
