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NURS 402: Lecture > Comfort and Pain Management > Flashcards

Comfort and Pain Management Flashcards

1
Q

Definition of Pain:

A

It is whatever the patient says it is

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2
Q

What is pain influenced by

A

Pain is a personal experience influenced by biologic, psychological and social factors

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3
Q

How is pain learned?

A

Learned through an individual’s life experiences

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4
Q

What does pain serve as?

A

An adaptive role

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5
Q

Gate Control Theory of Pain describes what

A

Describes the transmission of painful stimuli and recognizes a relationship between pain and emotions

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6
Q

What do the small and large nerve fibers do in the Gate Control Theory or Pain?

A

Small- and large-diameter nerve fibers conduct and inhibit pain stimuli toward the brain

Gating mechanism determines the impulses that reach the brain

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7
Q

What does the gating mechanism do in the Gate Control Theory of Pain?

A

Gating mechanism determines the impulses that reach the brain

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8
Q

What is pain a reflection of?

A

Pain is a reflection of nervous system functioning

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9
Q

How can you control the transmission of pain?

A

Transmission of this type of stimuli, you can control it by recognizing the connection between emotions and the actual pain.

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10
Q

What are the steps of the pain process? Four steps to the physiology of pain:

A
  1. Transduction
  2. Transmission
  3. Perception of pain
  4. Modulation
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11
Q

Transduction

A

Activation of pain receptors (nosireceptors) by three different stimuli

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12
Q

What are the pain receptors that are activated during transduction?

A

Nocireceptors

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13
Q

Three types of stimuli that activation nocireceptors

A
  1. Thermal stimuli
  2. Mechanical stimuli
  3. Chemical stimuli
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14
Q

Example of Thermal Stimulus

A

Putting hand on the stove

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15
Q

Mechanical stimulus for nocireceptors

A

You are walking and tripped and fell on the ground.

Women is in labor and has a contraction

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16
Q

Example of chemical stimulus of activation of nocireceptors?

A

If there is an inflammatory response in the body, like appendicitis

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17
Q

Transmission

A

Conduction along pathways (A-delta and C-delta fibers)

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18
Q

Myelination

A

sheet that covers nerve fibers

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19
Q

What happens to the information if you have a myelin sheet around a nerve fiber?

A

That information travels very fast

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20
Q

Putting hands on hot stove, does the info get to brain via myelinated or unmyelinated nerve transmission?

A

myelinated nerve transmission

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21
Q

What kind of transmission is protective aka for acute pain?

A

Myelinated

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22
Q

Chronic pain is myelinated or unmyelinated?

A

Chronic pain is not protective

Transmission to brain is slower

This is pain that is transmitted along unmyelinated fibers

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23
Q

Perception of pain:

A

awareness of the characteristics of pain

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24
Q

How does perception of pain work?

A

information is in the brain, in the thalamus, thalamus sends information to the limbic system (how we emotionally interpret pain), it goes to the cortex and the somatic sensory system (which is how we physically feel pain)

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25
Q

How do we emotionally interpret pain?

A

Thalmus sends a message to the limbic system

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26
Q

Modulation:

A

Inhibition or modification of pain

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27
Q

What is local management of pain?

A

Putting something on the site of pain.

28
Q

What is central management of pain?

A

Taking medication

29
Q

What are the two types of fibers associated with transmission?

A

A-Delta

C-Delta

30
Q

A-Delta fiber

A

myelinated- for acute pain

31
Q

C-Delta fiber

A

unmyelinated- for chronic pain

32
Q

What is acute pain indicative of?

A

Usually indicates tissue damage and resolves with healing of injury

33
Q

What does acute pain stimulates what

A

Stimulates nocireceptors and is protective

34
Q

Chronic pain:

A

Continues past the expected point of healing

Provides no protective function

Continuous or intermittent , with or without periods of exacerbation or remission

Impairs a person’s ability to function

35
Q

Types of pain based on etiology

A
  1. Nociceptive
  2. Neuropathic
36
Q

Nociceptive pain

A

Nervous system functioning is intact

37
Q

Examples of nociceptive pain

A

chemical burns, sunburn, cuts, appendicitis, bladder distention

38
Q

Neuropathic pain

A

Due to malfunctioning of the peripheral or central nervous system

39
Q

Examples of neuropathic pain

A

Post traumatic and post surgical peripheral nerve injuries,

pain after spinal cord injury

metabolic neuropathies

phantom limb pain after amputation

post stroke pain

40
Q

Two locations of pain

A
  1. Somatic pain
  2. Visceral pain
41
Q

Somatic pain

A

Develops in the tissues

42
Q

Two types of somatic pain?

A
  1. Superficial pain
  2. Deep pain
43
Q

Somatic: Superficial pain

A

Cutaneous, stimulation of nocireceptors in skin, subcutaneous tissue, or mucous membranes.

Are well localized

44
Q

Somatic: Deep pain

A

Involves the muscles, tendons, joints, fasciae, and bones

45
Q

Factors affecting the pain experience

A

Cultural and ethnicity variables

Environment and support people

Anxiety and other stressors- you feel more pain because you are afraid

Past pain experience

46
Q

Cultural and ethnicity variables that affect pain include:

A

Family

biologic sex

gender

age variables

religious beliefs/spirituality

47
Q

Terms to describe QUALITY of pain

A

Sharp
Dull
Diffuse
Shifting

48
Q

Terms to describe SEVERITY of pain

A

Severe or excruciating
Moderate
Slight or mild

49
Q

Terms to describe PERIODICITY of pain?

A

Continuous
Intermittent
Brief or transient

50
Q

Assessment parameters for pain

A

Psychological
Sociocultural
Spiritual
Physiologic

51
Q

General Assessments of Pain (1-4)

A
  1. Pt’s verbalization and description of pain
  2. Onset and duration of pain
  3. Etiology or mechanism of injury, if known
  4. Location of pain
52
Q

General Assessments of Pain (5-9)

A
  1. Quality, character and intensity of pain
  2. Aggravating or causal factors
  3. Alleviating or relieving causal factors
  4. Effect on function
  5. Pain management goal
53
Q

Basic Methods of Assessing Pain

A
  1. Patient self-report
  2. Identify pathologic conditions or procedures that may be causing pain; consider physiologic measures (increased blood pressure and pulse)
  3. Report of family member, other person close to the patient or caregiver familiar with the person
  4. Nonverbal behaviors: restlessness, grimacing, crying, clenching fists, protecting the painful area
  5. Physiologic measures: increased blood pressure and pulse
  6. Attempt an analgesic trial and monitor the results
54
Q

Pain assessment Tools #1

A
  1. 0-10 Numeric Rating Scale
  2. Adult Nonverbal Pain Scale (NVPS)
  3. Behavioral Pain Scale (BPS)
  4. Checklist of Nonverbal Indicators
  5. COMFORT Behavior Scale
  6. CRIES Instrument
55
Q

Pain Assessment Tools #2

A

Critical-Care Pain Observation Tool (CPOT)

Faces Pain Scale- revised FPS-R

FLACC Behavioral Scale

Iowa Pain Thermometer (IPT) and Revised IPT-R

Oucher Pain Scale

Pain Assessment in Advanced Dementia Scale (PAINAD)

Wong-Baker FACES

56
Q

Which pain assessment tool do we usually use for children?

A

Wong-Baker Assessment- one with the faces

57
Q

Which pain assessment tool do we use for babies?

A

FLACC Pain Scale

Is used especially after babies have procedures

58
Q

FLACC Pain Scale

A

F-Faces

L-Legs

A-Activity

C-Cry

C-Consolability

59
Q

Nursing Interventions for Pain

A

Establishing trusting nurse–patient relationship

Manipulating factors affecting pain experience

Initiating complementary health approaches and integrative health care

Managing pharmacologic relief measures

Ensuring ethical and legal responsibility to relieve pain

Understanding the placebo controversy

60
Q

Complementary Health Approaches and Integrative Health Care

A

Distraction
Humor
Music
Imagery
Mindfulness practice
Cutaneous stimulation
Acupuncture
Hypnosis

Biofeedback
Healing/therapeutic touch
Animal-assisted intervention

61
Q

Pharmacologic Pain Relief Measures

A

Analgesic administration:

Opioid
Adjuvant
Nonopioid

62
Q

Numeric Sedation Scale

A

S: sleep, easy to arouse: no action necessary

1: awake and alert; no action necessary

2: occasionally drowsy, but easy to arouse; no action necessary

3: frequently drowsy, drifts off to sleep during
conversation; reduce dosage

4: somnolent with minimal or no response to stimuli; discontinue opioid, consider use of naloxone

63
Q

General Principles for Analgesic Administration

A

Ongoing assessment

Management of breakthrough pain

Concern about prescription analgesic abuse

64
Q

Pain Management Regimens for Cancer or Chronic Pain

A

Give medications orally if possible

Administer medications ATC rather than PRN

Adjust the dose to achieve maximum benefit with minimum side effects

Allow patients as much control as possible over the regimen

65
Q

Pain Treatment in Special Populations

A

Children

Older adults
-Communication difficulties
-Denial of pain
-Altered physiologic response to analgesics

66
Q

Additional Methods for Administering Analgesics

A

Patient-controlled analgesia

Epidural analgesia and peripheral nerve blocks

Topical anesthesia

67
Q

Teaching About Pain

A

Should include family members or caregivers

Explanation about pain scales

Safety: avoid driving, operating machinery, alcohol or other CNS depressants

Keep diary of pain and medications taken

Diet: do not take on an empty stomach

Do not breastfeed without checking with provider

NURS 402: Lecture (17 decks)

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