Chapter 13: Comfort & Pain Management

Question 1

How might a patient non verbally communicate that they are in pain?
How might the body compensate (think assessment).

Answer 1

Grimacing, guarding, crying, groaning, aggressive behaviors, etc…

Increased vitals + sweating, changes in sleep (don’t rule out sleeping a lot), change in appetite.

Question 2

The value of non pharmacological methods ( think why would we try them first, or in combination with med tx)

Answer 2

Non pharmacological methods are typically minimally invasive, address the emotional component of pain, and may offer supplemental support.
e.g. Yoga, prayer, massage, herbs, quality time…

Question 3

Pain tolerance vs Pain threshold

Answer 3

Tolerance: The maximum point a person is willing to endure pain
Threshold: The longest period of time someone is willing to endure pain.

Question 4

Nutrition: list as many examples of inflammatory foods as you can!
This is what we DONT want to eat.

Answer 4

Foods high in arachidonic acid: animal products, high-fat dairy products, egg yolks, beef fat, safflower, corn, sunflower, soybean, and peanut oils. White flour, sugars, and “junk foods”

Question 5

Nutrition: list as many anti inflammatory foods as you can!
Foods we SHOULD eat 👍🏼

Answer 5

Omega-3 fatty acids: salmon, tuna, sardines, mackerel, halibut, fish oils… + flaxseed and flaxseed oil, canola oils, walnuts, pumpkin seeds, & omega-3 enhanced eggs.
Antioxidants (flavonoids): red, blue & purple fruits [& their juices], fresh pineapple, black or green tea, red wine; chocolate, & cocoa.
Herbs: Garlic, ginger, turmeric.

Question 6

Nutrition: The effect of vitamin B deficiency & a good food(s) with vitamin B.

Answer 6

Effects: Damaged or misfiring nerves, therefore contributing to pain.
Food: Green leafy vegetables
Green leafy vegetables also boost serotonin.

Question 7

Rule for starting a medication

Answer 7

Start low and go slow.

Question 8

Rule for opioids

Answer 8

Trialing non-opioid options before opioids.

Question 9

Most common drug used for the elderly with mild to moderate pain.

Answer 9

Acetaminophen.

Question 10

What does NSAID stand for and what is the most commonly used one?

Answer 10

Non-steroidal anti inflammatory drug.
Ibuprofen

Question 11

Class of drug + examples for moderate to severe pain

Answer 11

Opioids.
Codeine, oxycodone, & hydrocodone.

Question 12

Drugs for severe pain

Answer 12

Morphine & fentanyl patches.

Question 13

Pentazocine

Answer 13

Pentazocine is contraindicated for older persons because of its high risk of causing delirium, seizures, and cardiac and CNS toxicity.

Question 14

Why are we cautious about opioid use in the older population?

Answer 14

Older adults are more likely to experience nausea, constipation, urinary retention, pruritus, myoclonus, irregular breathing, and cognitive dysfunction from opioids. Addiction also is a risk.

Question 15

Critical thinking exercise: Why could prayer offer relief to someone who is suffering physically and emotionally?

Answer 15

Prayer may encourage spiritual well being & emotional support. They could have an easier recovery & healing if they felt protected by a greater power.

Question 16

A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain?

Answer 16

Phantom pain.

Question 17

A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. What kind of pain is the client experiencing?

Answer 17

Visceral pain.

Question 18

A nurse is caring for a client who’s receiving continuous wound perfusion pain management. Arrange the following steps in the correct order.
- Assess the clients pain.
- Inspect tubing for kinks
- Check the flow restrictor to ensure it’s in contact with the patients skin.
- Check the medication order against the original medical order.
- Review the function of the device & reason for use with the client.
- Assess the incision site for any warmth, redness, swelling, pain, or drainage.

Answer 18

• Check the medication order against the original medical order.
• Assess the clients pain.
• Inspect the tubing for kinks.
• Check the flow restrictor to ensure it’s in contact with the patients skin.
• Assess the incision site for any warmth, redness, swelling, pain, or drainage.
• Review the function of the device & reason for use with the client.

Question 19

Nociceptive vs. Neuropathic

Answer 19

Nociceptive: Pain arises from mechanical, thermal, or chemical noxious stimuli.
Somatic: Well localized pain in the bone or soft tissue masses. Throbbing or aching
Visceral: Associated with injuries or disorders of the internal organs that may cause generalized or referred pain. Deep, cramping, pressing, aching.
Neuropathic: Arises from an abnormal processing of sensory stimuli by the central or peripheral nervous system(s). Often associated with diabetic neuropathies, Postherpetic neuralgias, etc… Stabbing, shooting, tingling, or burning with a sudden onset of high intensity.

Question 20

Acute vs. Chronic

Answer 20

Acute: Sudden onset, short duration.
Chronic or Persistent: Lasts at least 3 months and may be of mild to severe intensity.
Acute pain has the potential to develop into persistent pain.