Chapter 10 Pain Flashcards
Where are nociceptors located?
Skin, connective tissue, muscle, and thoracic, abdominal, and pelvic viscera
What are nociceptors?
Nociceptors are specialized nerve endings that detect painful sensations and transmit it to the CNS
What is transduction?
A traumatic or chemical injury occurs and takes place in the periphery.
What is transmission?
The pain impulse moves from the spinal cord to the brain.
What is perception?
The conscious awareness of a painful sensation
What is modulation?
The neurons from the brain stem release neurotransmitters that block the pain impulse.
What is neuropathic pain?
Neuropathic pain is an abnormal processing of the pain message from an injury to the nerve fibers.
Neuropathic pain
Neuropathic pain is the most difficult pain to treat!
The nurse is assessing a patient’s pain. The nurse knows that the most reliable indicator of pain would be the:
A. patient’s vital signs.
B. physical examination.
C. results of a computerized axial tomography scan.
D. subjective report.
D. Subjective report
The nurse is reviewing the principles of nociception. During which phase of nociception does the conscious awareness of a painful sensation occur?
A. Modulation
B. Transmission
C. Transduction
D. Perception
D. Perception
When assessing the quality of a patient’s pain, the nurse should ask which question?
A. “Is it a sharp pain or dull pain?”
B. “When did the pain start?”
C. “What does your pain feel like?”
D. “Is the pain a stabbing pain?”
What does your pain feel like?
A patient has been admitted to the hospital with vertebral fractures related to osteoporosis. She is in extreme pain. This type of pain would be classified as: A. deep somatic. B. visceral. C. cutaneous. D. referred.
A. Deep somatic
The articulation of the mandible and the temporal bone is known as the:
A. condyle of the mandible.
B. intervertebral foramen.
C. temporomandibular joint.
D. zygomatic arch of the temporal bone.
C. Temperomandibular joint
A patient states that the pain medication is "not working" and rates his postoperative pain at a 10 on a 1 to 10 scale. Which of these assessment findings indicates an acute pain response to poorly controlled pain? A. Increased blood pressure and pulse B. Confusion C. Hyperventilation D. Depression
A. Increased blood pressure and pulse
What is visceral pain?
Visceral pain originates from the larger interior organs (I.e. Kidneys, stomach, gall bladder, etc)
What typically accompanies visceral pain?
Nausea, vomiting, pallor, diaphoresis
What is deep somatic pain?
Pain comes from sources like blood vessels, joints, tendons, muscles, and bone.
What is cutaneous pain?
Pain that comes from the skin surfaces, and subcutaneous tissues. This type of pain is typically a sharp, burning sensation.
What is referred pain?
Pain is felt at a particular site but originates from another location
What is acute pain?
Pain that is short term and self-limiting and often follows a predictable path and goes away after an injury heals. less than 6 months.
What is the most reliable indicator for pain?
The patient’s report which is subjective
What is persistent or chronic pain?
Diagnosed when the pain continues for 6 or more months.
Ex: malignant cancer, fibromyalgia, arthritis, etc
Is pain normal in the aging adult?
NO!!!! Pain is NOT normal but it is COMMON.
Do people with dementia feel pain?
Yes they do!
Pain and gender differences
Typically men are more stoic about pain.
Hormonal changes strongly influence pain among women. Women are three times more likely to experience migraines during childbearing years.
Black and Hispanic patients
These two groups are often prescribed and and administered pain medication much less compared to other groups.
What is the definition of pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
What questions do you ask when assessing pain?
Ask open ended questions such as:
What does your pain feel like?
How much pain do you have now?
What makes your pain better or worse?
What are some nonverbal signs of pain?
- Grimacing
- Guarding
- stiffness
- moaning
- agitation
- stillness
What are some pain assessment tools?
Initial pain assessment
Brief pain inventory
McGill Pain questionnaire
Inspect the skin and tissues for color, swelling, and any masses or deformity
Look for bruising, lesions, open wounds, tissue damage, atrophy, bulging, etc
Joints
Note the size and contour of the joints, check for active and passive range of motion and if any pain is associated with it.
Also, palpate the joint for any crepitation (like a crunching sound)
Normal findings of the abdomen
Look for contour and symmetry. Palpate for muscle guarding, and organ size.
What are some physiologic responses to increased pain?
Increased blood pressure and pulse Nausea Vomiting Anxiety Fear Stiffness Confusion
Chronic pain behaviors
Bracing Rubbing Diminished activity Sighing Change in appetite
Pain in the aging adult
Pain is common in the older adult but NOT normal
Signs to look for in aging adults:
Observe for changes in dressing, toileting, slowness, rigidity, fatigue, confusion
The nurse is preparing to percuss the abdomen of a patient. The purpose of the percussion is to assess the underlying tissue:
A. turgor.
B. density.
C. consistency.
D. texture.
B. Density
When percussing over the liver of a patient, the nurse notices a dull sound. The nurse should:
A. consider this an abnormal finding and refer the patient for additional treatment.
B. consider this a normal finding.
C. palpate this area for an underlying mass.
D. reposition the hands and attempt to percuss in this area again.
B. Consider this a normal finding
A man is at the clinic for a physical examination. He states that he is “very anxious” about the physical examination. What steps can the nurse take to make him more comfortable?
A. Appear unhurried and confident when examining him.
B. Stay in the room when he undresses in case he needs assistance.
C. Ask him to change into an examining gown and take off his undergarments.
D. Defer measuring vital signs until the end of the examination, which allows him time to become comfortable.
A. Appear unhurried and be confident and take your time
The nurse is unable to identify any changes in sound when percussing over the abdomen of an obese patient. What should the nurse do next?
A. Decrease the amount of strength used when attempting to percuss over the abdomen
B. Ask the patient to take deep breaths to relax the abdominal musculature
C. Increase the amount of strength used when attempting to percuss over the abdomen
D. Consider this a normal finding and proceed with the abdominal assessment
C. Increase the amount of strength used when percussing the abdomen
When performing a physical assessment, the technique the nurse will always use first is: A) Percussion B) Inspection C) Palpation D) Auscultation
B. Inspection
When evaluating a patient's pain, the nurse knows that an example of acute pain would be: A) Arthritic pain B) Low back pain C) Kidney stones D) Fibromyalgia
C. Kidney stones
Which statement indicates that the nurse understands the pain experience in the elderly?
A) “Older persons must learn to tolerate pain.”
B) “Pain is a normal process of aging and is to be expected.”
C) “Older individuals perceive pain to a lesser degree than younger individuals.”
D) “Pain indicates pathology or injury and is not a normal process of aging.”
D. Pain indicated pathological pain and injury and is not a normal process of aging
When assessing a patient's pain, the nurse knows that an example of visceral pain would be: A) Hip fracture B) Cholecystitis C) Pain after a leg amputation D) Second-degree burns
B. Chole cystitis
pain not relieved by typical measures
intractable pain
pain in the body part that has been amputated
phantom pain
choleystitis cause which type of pain?
viseral
