Chp 36 Pain Study Guide Flashcards
results from nerve injury
neuropathic pain
physiological pain
somatic pain
excessive sensitivity
hyperalgesia
occurs after an amputation when the brain continues to receive messages from the area of the amputation
phantom pain
pain that extends to other areas
radiating pain
pain that is perceived by an individual but has no physical cause
psychogenic pain
pain from non injury stimuli
allodynia
greatly exaggerated pain reaction to stimuli
hyperpathia
the administration of medications before a painful event
preemptive analgesia
unpleasant abnormal sensation
dysethesia
identify two causes of unrelieved pain
health care professional failure to assess pain, failure to accept a patients reported pain, failure to initiate pain relief
when should nurses assess pain
along with other vital signs, before and after pain control interventions are performed, or analgesic medication is administered
A patient is having severe, acute pain from the kidney stones. On the basis of the patients experience, the nurse anticipates which of the following in the patients assessment
tachycardia, diaphoresis, pupil dilation, hypertension
What areas of the body is the most sensitive to pain
skin
identify and briefly describe the four steps in the pain indication process
Transduction: conversion of the energy from the pain stimuli into electrical energy through nociceptors at the place of tissue injury
Transmission: The action potential, or electrical energy signal, is sent to the spinal cord and brain
Perception: Occurs when the brain translates the signals as pain
Modulation: Once the pain is recognized, the brain can change the perception of pain by sending inhibitory input to the spinal cord to impede the transmission
Difference between pain threshold and pain tolerance
Threshold: the point at which the brain recognizes the stimulus as pain
Tolerance: intensity or duration of pain that a patient is able or willing to endure
Three major types of pain
acute, cancer, and non cancer
What are the specific sensations associated with neuropathic pain
burning aching, crushing, stabbing, shooting, tingling, or numbing
What are pathologies that can influence the pain experience
This that damage or create hypersensitivity along the pain pathway, such as spinal cord injuries, peripheral neuropathy secondary to diabetes mellitus or peripheral vascular disease, and psychological dysfunction
Physiological changes that occur with pain include
Endocrine system: release of excessive amounts of hormones, leading to hyperglycemia
Cardiovascular: an increase in the heart rate, force of contraction, BP, and coagulation
Respiratory system: respiratory rate increases and becomes irregular
Musculoskeletal: impaired muscle function, muscle spasms, muscle tension, and fatigue
Genitourinary: increase in BP through activation of the renin-angiotensin system. Urine output decrease, and urinary retention increases, with possible fluid overload and hypokalemia
GI: decrease in gastric emptying and motility, increased GI secretions, and smooth muscle tone. Metabolism is slowed, resulting in indigestion and constipation.
Immune: inflammatory mediators are released in an attempt to prevent and fight infection and to reduce the pain
How is pain influenced by gender
Women have reported being in more pain, women seek help for pain more often than mend do, but women are less likely to receive treatment. Women are more lily to be given sedatives for pain, and men are more likely to be given analgesics.
How is pain influenced by disability
Patient with impaired cognition may not be able to communicate pain. Facial expressions, vocalization of noises, or changes in physical activity or routines may be signs of pain. Patients who are intubated may be able to write or point to a pain assessment tool to indicate their level of pain. Elevated BP and/or pulse rate, as well as restlessness, may signal increased pain levels in patients who are intubated and sedated and unable to communicate verbally or in writing
How is pain influenced by morphology
Obese people tend to experience more pain in more locations than individual of normal weight, and pain medication dosages need to be adjusted on the basis of the heigh and weigh of patients of all ages due to body surface area and metabolic differences
How is medication administration adapted for older adults with pain
lower dosage
Legal risks can be reduced by
Checking allergies Six rights Nursing process Monitering for side effects Reporting uncommon responses Communication with patient Teaching Documenting accurately Evaluating the effect of medication on the patient, and document patient response. Use equipment such as patient controlled anesthesia pumps properly Following policies and procedures Arranging appropriate referrals
advantages of transdermal fentanyl system
eliminate having to program an intravenous pump
minimize preparation time, making it less time consuming for nurses
eliminate med errors
greater pain control for patients
enable patients to do ADLs easier
move and ambulate earlier due to improved pain
Opioid analgesics
Morphine, hydromorphone, pentazocine, oxycodone
Major side effects of narcotic analgesics
respiratory depression
what is nerve block used for
migraines, dental work, back pain, herniated disks, cancer pain
T/F a large percentage of patients become addicted to analgesic medications
F
Joint Commission Standards for pain
Recognize the right of patients to have appropriate assessment and management of pain
Identify patients with pain in an initial screening assessment
Perform a more comprehensive pain assessment when pain is identified
Record the results of the assessment in a way that facilitates regular reassessment and follow-up
Educate
Determine and ensure stop competency
Address pain assessment and management to new staff
Establish policies and procedures
Ensure that pain does not interfere with participation in rehabilitation
Educate patients and family
Address needs at discharge
Collect data to monitor
What nursing intervention for a patient in pain is based on gate control theory
giving a back massage
Burning sensation in the epigastric area. what type of pain?
visceral
when asking about quality of pain, nurse should ask?
what does pain feel like
Nurse tells patient in advance that the urinary catheter insertion may feel uncomfortable. Example of?
anticipating a response
Patient has an order for transcutaneous electrical nerve stimulation. This is contraindicated for?
pacemaker
terminally ill patient with cancer with pain. realistic goal is?
adapt the analgesics as the nursing assessment reveals the need for specific medications
example of multimodal analgesia
tylenol with codeine
knowing the major side effect of non steroidal anti-inflammatory drug medications, the nurse instructs the patient to
take the medication with food
the nurse expects to administer which of the following for narcotic overdose
Naloxone
When does pain need to be assessed?
on a regular basis ( the golden question)
what does the nurse do regarding pain?
The monitor pain management, evaluates the level of pain relief, advocates for the patient, and educates the patient
What are nociceptors?
free endings of afferent nerve fibers, which are sensory neurons that are sensitive to noxious thermal, mechanical, chemical.
What is pattern theory?
when an injury occurs, a signal is carried along large-diameter nerve fibers (touch fibers) that may inhibit a signal carried by thin fibers.
What is Gate Control Theory?
Explains why thoughts and emotions influence pain perception.
What is Neuromatrix Theory ?
Suggests that pain is a multidimensional experience controlled by a body-self neuromatrix. It addresses the distinctive experience of pain as it is perceived and regulated by each person. Proposes that people have a genetically controlled network of neurons that is unique.
What is nociceptive pain?
most common type of pain; its physiologic (physical) pain occurs when nociceptors are stimulated in response to trauma, inflammation, or tissue damage from surgery.
May be sharp, burning, aching, cramping, or stabbing
What is Visceral pain?
Organs of the body and occurs in conditions such as appendicitis, pancreatitis, inflammatory bowel disease, bladder distention, and cancer
What is Somatic pain?
skin, bones, muscles, and joints. Occurs in conditions such as sunburn, lacerations, fractures, arthritis, and bone cancer
What is referred and radiating pain?
Referred: originates in one area but hurts in another area such as pain from a heart attack.
Radiating: extends from the source to an adjacent area of the body. Ex. GERD; pain radiates up to the esophagus
What is Neuropathic pain?
results from nerve injury, and the pain continues even after the painful stimuli are gone. aka pathologic pain. This pain may stem from CNS or PNSS injuries. Normally, its chronic pain and it may be continuous or episodic.
It may be burning, aching, crushing, stabbing, shooting, tingling, or numbing
What is dysesthesia?
unpleasant, abnormal sensation
What is allodynia?
pain from noninjury stimuli
What is hyperalgesia?
excessive sensitivity
What is hyperpathia?
greatly exaggerated pain reaction to stimuli
What is Phantom pain?
when brain continues to receive messages from the area of an amputation.
What is Psychogenic pain?
Pain is perceived by an individual but has no physical cause
may be caused by increased or prolonged mental, emotional, or behavioral factors
When treating an elderly person for patient, what are some special considerations when it comes to medication?
Start with a low dose within the prescribed range and slowly increase the dosage to relieve pain. Opioid doses should start 50% to 75% lower than the normal adult dose to avoid oversedation
What is polypharmacy?
common concern with elderly or chronically ill patients who take multiple medications simultaneously, including prescription drugs, OTC, and herbal supplements.
How would you communicate with a patient who is in excruciating pain?
A rapid, narrowed assessment to determine location, onset, quality, and severity of pain must be completed before emergency treatment.
Use short, closed-ended questions.
What changes will you see in a patient’s vital signs if they are experiencing pain?
Elevated pulse and blood pressure (acute pain)
Decreased BP and pulse rate indicate chronic pain.
What behaviors will a patient in pain exhibit?
facial grimaces, clenched teeth, rubbing or guarding of the painful area, agitation, restlessness, and withdrawal from painful stimuli. They might also be crying, moaning, or screaming.
psychological responses: anxiety, depression, anger, irritability, helplessness and hopelessness.
What is Multimodal analgesia?
the use of more than one means for controlling pain. When more than one type of agent is used, analgesia is more effective, requires lower doses of each agent, and provides fewer side effects.
Ex. acetaminophen with codeine, morphine sulfate with gabapentin
