Comfort and Pain Management Flashcards
During postconference, nursing students are exploring definitions of pain and its nature. Which statements should be included in this discussion? Select all that apply.
a. “It is whatever the health care provider treating the pain says it is.”
b. “Pain exists whenever the person experiencing it says it is present.”
c. “It is an emotional and sensory reaction to tissue damage.”
d. “Pain is a simple, universal, and easy-to-describe phenomenon.”
e. “When a cause cannot be identified, pain is psychological in nature.”
f. “It is classified by duration, location, source, transmission, and etiology.”
b, c, f
Nurses must respect patients’ reports of pain and consider the patient an expert on their pain experience. An accepted definition of pain is that pain is whatever the patient says it is, existing whenever the person says it does, even if the cause is not clearly established.” Pain is a complex, unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain may be classified according to its duration, its location or source, its mode of transmission, or its etiology.
A nurse in a rehabilitation facility is evaluating patients with chronic pain to develop an interprofessional plan of care. Which patients would the nurse identify who could benefit from a multimodal approach to pain management? Select all that apply.
a. Patient receiving chemotherapy for bladder cancer
b. Adolescent who had an appendectomy
c. Patient who is experiencing a ruptured aneurysm
d. Patient with fibromyalgia requesting pain medication
e. Patient having back pain related to an accident that occurred last year
f. Patient experiencing pain from second-degree burns
a, d, e
Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain. Acute pain is generally rapid in onset and varies in intensity from mild to severe, as occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.
A patient reports diffuse abdominal pain that is difficult to localize. The nurse documents this as which type of pain?
a. Cutaneous
b. Visceral
c. Superficial
d. Somatic
b
Visceral pain, which is poorly localized and can originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually involves the skin or subcutaneous tissue. A paper cut that produces sharp pain with a burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain.
Which question by the nurse will be most helpful in determining whether a patient who is experiencing a myocardial infarction has referred pain?
a. “Did your chest pain last 2 minutes or less?
b. “Was the pain on the surface of your chest?”
c. “Is this pain in your residual limb shooting or burning?”
d. “Are you having any arm or shoulder pain?”
d
Referred pain is perceived in an area distant from its point of origin, whereas transient pain is brief and passes quickly. One example is the pain of MI (heart attack) that can be felt in the shoulder or chest, among other areas. Superficial pain originates in the skin or subcutaneous tissue. Phantom pain may occur in a person who has had a body part amputated, either surgically or traumatically.
A nurse is caring for patients who are nonverbal. What are examples of behavioral responses to pain? Select all that apply.
a. Cradling a wrist that was injured in a car accident
b. Moaning and crying from abdominal pain
c. Increasing pulse following a myocardial infarction
d. Striking out at a nurse who attempts to provide a bath
e. Acting depressed and withdrawn while experiencing chronic cancer pain
f. Pulling away from a nurse trying to give an injection
a, b, f
Physiologic responses are involuntary body responses; behavioral responses reflect body movements; affective responses reflect mood and emotions. Protecting or guarding a painful area, moaning and crying, and moving away from painful stimuli are behavioral responses. Examples of a physiologic or involuntary response would be increased blood pressure or dilation of the pupils. Affective responses, such as anger, withdrawal, and depression, are psychological in nature.
A nurse is caring for patients in a hospital setting. Which patient would the nurse place at risk for pain related to the mechanical activation of pain receptors?
a. Older adult on bedrest following cervical spine surgery
b. Patient with a severe sunburn being treated for dehydration
c. Industrial worker who has burns caused by a caustic acid
d. Patient experiencing cardiac disturbances from an electrical shock
a
Receptors in the skin and superficial organs may be stimulated by mechanical, thermal, chemical, and electrical agents. Friction from bed linens causing pressure sores is a mechanical stimulant. Sunburn is a thermal stimulant. An acid burn is the result of a chemical stimulant. An electrical shock is an electrical stimulant.
A nurse plans to promote a patient’s natural pain mediators by using a whirlpool following intensive physical therapy to the legs. What is a potent pain-blocking neuromodulator, released through relaxation techniques?
a. Prostaglandins
b. Substance P
c. Endorphins
d. Serotonin
c
Endorphins are produced at neural synapses at various points along the CNS pathway. They are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that endorphins are released through pain relief measures, such as relaxation techniques. Prostaglandins, substance P, and serotonin (a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vasoconstriction) are neurotransmitters or substances that either excite or inhibit target nerve cells.
A postoperative patient asks the nurse about pain management following surgery. What teaching will the nurse provide?
a. “Avoid asking for pain medication often, as it can be addictive.”
b. “It is better to wait until the pain is severe before asking for pain medication.”
c. “It’s natural to have pain after surgery; it will lessen in intensity in a few days.”
d. “You will be more comfortable if you take the medication at regular intervals.”
d
While many analgesics are ordered on a PRN (as needed) basis, patients should be taught that it is more difficult to relieve pain that prevent it. The patient should not wait until pain is severe or unbearable to request pain medication. Few people become addicted to the medications if used for a short period of time. Pain following surgery can be controlled and should not be considered a natural part of the experience that will lessen in time.
The nurse applies the gate control theory of pain to provide pain relief to a patient with chronic lower back pain. What nursing intervention will help relieve pain by “closing the gate”?
a. Encouraging regular use of analgesics
b. Applying moist heat to the area at intervals
c. Reviewing the pain experience with the patient
d. Ambulating the patient after administering medication
b
The gate control theory states that a limited amount of sensory information can be processed by the nervous system at any given moment. When too much information is sent through, certain cells in the spinal column interrupt the signal as if closing a gate, interfering with pain perception. Nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain. The other choices do not involve attempts to stimulate large nerve fibers that interfere with pain transmission as explained by the gate control theory.
The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient?
a. CRIES
b. COMFORT
c. FLACC
d. FACES
a
The CRIES Pain Scale is a tool intended for use with neonates and infants from 0 to 6 months. The COMFORT Scale, used to assess pain and distress in critically ill pediatric patients, relies on six behavioral and two physiologic factors that determine the level of analgesia needed to adequately relieve pain in these children. The FLACC Scale (F—Faces, L—Legs, A—Activity, C—Cry, C—Consolability) was designed for infants and children from age 2 months to 7 years who are unable to validate the presence or severity of pain. The FACES Scale is used for children who can compare their pain to the faces depicted on the scale.
When the nurse assists a patient recovering from abdominal surgery to walk, the nurse observes that the patient grimaces, moves stiffly, and becomes pale. The nurse received in shift report that the patient has consistently refused pain medication. To help promote comfort, which additional data will the nurse gather? Select all that apply.
a. Patient’s understanding of or fear of taking prescribed analgesics
b. Assessment of any current pain
c. Presence of anxiety or additional stressors
d. Assessment of the surgical incision for infection
e. What the patient has eaten to this point
f. Whether the patient is using the incentive spirometer
a, b, c, d
While it seems the patient’s immediate problem is unrelieved pain because the patient refuses to take pain medication, through further assessment, the nurse can plan to address fears of medication, teach about use of the pump, determine if anxiety is interfering with pain, or an infection is causing increased pain. While decreased oral intake may be a response to pain, the patient’s dietary intake will not uncover the underlying reason for refusing medications. Use of the incentive spirometer is not included in pain assessment; rather, it is an intervention to prevent atelectasis.
When developing the care plan for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain not related to cancer or palliative/end-of-life care is most effectively relieved through which method?
a. Providing the highest effective dose of an opioid on a PRN (as needed) basis
b. Using nonopioid drugs conservatively
c. Applying multimodal nonpharmacologic and nonopioid pharmacologic therapies
d. Administering a continuous intravenous infusion on a regular basis
c
Nonpharmacologic and nonopioid pharmacologic therapies (multimodal) are the preferred choices for chronic pain that is unrelated to active cancer, palliative care, or end-of-life care. If progression to opioids becomes necessary, the lowest effective dose of an immediate-release opioid should be initiated first. Ongoing assessment and careful monitoring should guide the prescription of opioids for the management of chronic pain (Dowell et al., 2016). A PRN (as needed) drug regimen has not been proven effective for people experiencing chronic or acute pain. When caring for a patient with acute pain, such as postoperative pain, medication should be offered or requested before pain becomes severe or unbearable. Once pain is adequately treated, such as later in the postoperative course, a PRN schedule may be effective.
When assessing pain in a child, the nurse needs to be aware of what considerations?
a. Immature neurologic development results in reduced pain sensation
b. Inadequate or inconsistent relief of pain is widespread
c. Reliable assessment tools are currently unavailable
d. Narcotic analgesic use should be avoided
b
Health care personnel are placing awareness of pain relief in children as a priority. The evidence supports the fact that children do indeed feel pain, and reliable assessment tools are available specifically for use with children. Opioid analgesics may be safely used with children as long as they are carefully monitored.
A pregnant woman has received an epidural analgesic prior to delivery. Assessment for which outcome to the medication will the nurse prioritize?
a. Pruritus
b. Urinary retention
c. Vomiting
d. Respiratory depression
d
An opioid drug given by way of an epidural catheter or a displaced catheter may result in the occurrence of respiratory depression. Pruritus, urinary retention, and vomiting may occur but are not life threatening.
A nurse is assessing a patient receiving a continuous opioid infusion. For which outcome of treatment would the nurse immediately notify the primary care provider?
a. A respiratory rate of 11/min with normal depth
b. A sedation level of 4
c. Mild forgetfulness
d. Reported constipation
b
Sedation levels predict respiratory depression. The sedation scale uses: S = sleep, easy to arouse: no action necessary; 1 = awake and alert; no action necessary; 2 = occasionally drowsy but easy to arouse; requires no action; 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose; and 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone. A respiratory level of 11 with normal depth of breathing is usually not a cause for alarm. Mild forgetfulness or confusion may result from opioids; additional observation is necessary. Constipation is not life threatening; it should be reported to the health care provider but is not the priority.
