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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
How do we emotionally interpret pain?
Thalmus sends a message to the limbic system
26
Modulation:
Inhibition or modification of pain
27
What is local management of pain?
Putting something on the site of pain.
28
What is central management of pain?
Taking medication
29
What are the two types of fibers associated with transmission?
A-Delta C-Delta
30
A-Delta fiber
myelinated- for acute pain
31
C-Delta fiber
unmyelinated- for chronic pain
32
What is acute pain indicative of?
Usually indicates tissue damage and resolves with healing of injury
33
What does acute pain stimulates what
Stimulates nocireceptors and is protective
34
Chronic pain:
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
Types of pain based on etiology
1. Nociceptive 2. Neuropathic
36
Nociceptive pain
Nervous system functioning is intact
37
Examples of nociceptive pain
chemical burns, sunburn, cuts, appendicitis, bladder distention
38
Neuropathic pain
Due to malfunctioning of the peripheral or central nervous system
39
Examples of neuropathic pain
Post traumatic and post surgical peripheral nerve injuries, pain after spinal cord injury metabolic neuropathies phantom limb pain after amputation post stroke pain
40
Two locations of pain
1. Somatic pain 2. Visceral pain
41
Somatic pain
Develops in the tissues
42
Two types of somatic pain?
1. Superficial pain 2. Deep pain
43
Somatic: Superficial pain
Cutaneous, stimulation of nocireceptors in skin, subcutaneous tissue, or mucous membranes. Are well localized
44
Somatic: Deep pain
Involves the muscles, tendons, joints, fasciae, and bones
45
Factors affecting the pain experience
Cultural and ethnicity variables Environment and support people Anxiety and other stressors- you feel more pain because you are afraid Past pain experience
46
Cultural and ethnicity variables that affect pain include:
Family biologic sex gender age variables religious beliefs/spirituality
47
Terms to describe QUALITY of pain
Sharp Dull Diffuse Shifting
48
Terms to describe SEVERITY of pain
Severe or excruciating Moderate Slight or mild
49
Terms to describe PERIODICITY of pain?
Continuous Intermittent Brief or transient
50
Assessment parameters for pain
Psychological Sociocultural Spiritual Physiologic
51
General Assessments of Pain (1-4)
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
General Assessments of Pain (5-9)
5. Quality, character and intensity of pain 6. Aggravating or causal factors 7. Alleviating or relieving causal factors 8. Effect on function 9. Pain management goal
53
Basic Methods of Assessing Pain
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
Pain assessment Tools #1
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
Pain Assessment Tools #2
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
Which pain assessment tool do we usually use for children?
Wong-Baker Assessment- one with the faces
57
Which pain assessment tool do we use for babies?
FLACC Pain Scale Is used especially after babies have procedures
58
FLACC Pain Scale
F-Faces L-Legs A-Activity C-Cry C-Consolability
59
Nursing Interventions for Pain
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
Complementary Health Approaches and Integrative Health Care
Distraction Humor Music Imagery Mindfulness practice Cutaneous stimulation Acupuncture Hypnosis Biofeedback Healing/therapeutic touch Animal-assisted intervention
61
Pharmacologic Pain Relief Measures
Analgesic administration: Opioid Adjuvant Nonopioid
62
Numeric Sedation Scale
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
General Principles for Analgesic Administration
Ongoing assessment Management of breakthrough pain Concern about prescription analgesic abuse
64
Pain Management Regimens for Cancer or Chronic Pain
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
Pain Treatment in Special Populations
Children Older adults -Communication difficulties -Denial of pain -Altered physiologic response to analgesics
66
Additional Methods for Administering Analgesics
Patient-controlled analgesia Epidural analgesia and peripheral nerve blocks Topical anesthesia
67
Teaching About Pain
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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