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Therapeutics > Comfort and Pain Management (Chap 36) > Flashcards

Comfort and Pain Management (Chap 36) Flashcards

1
Q

*The FLACC behavioral pain scale is helpful when assessing pain in intubated or critically ill patients.

A. True
B. False

A

FALSE

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2
Q

*The multimodal approach to chronic pain management is used when treating pain in which of the following?

Patients with cognitive impairments
Older adult patients
Children
Postsurgical patients

A

Children

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3
Q

*Pain that is poorly localized and originates in body organs in the thorax, cranium, and abdomen is referred to as which of the following?

Visceral pain
Somatic pain
Nociceptive pain
Cutaneous pain

A

Visceral pain

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4
Q

*Pain occurring in the periphery that is caused by metabolic and vascular changes and damage to peripheral and autonomic nerves is called:

trigeminal neuralgia
postherpetic neuralgia
causalgia
diabetic neuropathy

A

diabetic neuropathy

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5
Q

*It is better to wait until pain is severe before giving a patient more pain medication to help lessen the side effects of pain medication.

A. True
B. False

A

FALSE

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6
Q

*The nociception process that involves the conversion of painful stimuli into electrical impulses that travel from the periphery to the spinal cord is referred to as which of the following?

Transduction
Transmission
Perception
Modulation

A

Transduction

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7
Q

*Referred pain is pain that is perceived in an area distant from its point of origin.

A. True
B. False

A

TRUE

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8
Q

*Pain is present whenever a person says it is, even when no specific cause of the pain can be found.

A. True
B. False

A

TRUE

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9
Q

*Patients who reside in low-income settings and minority populations are less likely to receive recommended treatments for pain in health care settings.

A. True
B. False

A

TRUE

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10
Q

*Pain is considered chronic when it lasts longer than:

2 weeks
6 weeks
12 weeks
16 weeks

A

12 weeks

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11
Q

A patient who has bone cancer is most
likely experiencing which of the following
types of pain?
A. Cutaneous
B. Somatic
C. Visceral
D. Referred

A

B. Somatic

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12
Q

A client comes to the emergency
department complaining of a shooting
pain in his chest. When assessing the
client’s pain, which behavioral response
would the nurse expect to find?
A. Decreased heart rate
B. Guarding of the chest area
C. Increased reparatory rate
D. High blood pressure

A

B. Guarding of the chest area

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13
Q

The best judge of the existence and
severity of a patient’s pain is the
physician or nurse caring for the patient.
A. True
B. False

A

B. False

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14
Q

Which of the following pain assessment
tools is recommended for use with
neonates ages 0 to 6 months?
A. Oucher pain scale
B. Wong-Baker FACES
C. PAINAD scale
D. CRIES pain scale

A

D. CRIES pain scale

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15
Q

A sedated patient is frequently drowsy
and drifts off during his conversation with
the nurse. What number on the sedation
scale best describes this patient?
A. 1
B. 2
C. 3
D. 4

A

C. 3

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16
Q

What are the four broad categories used when describing pain?

A
  • Duration
  • Source
  • Mode of transmission
  • Etiology
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17
Q

What are the two types of pain as it relates to duration of pain?

A

Acute - protective mechanism of body
Chronic - irregular but persistent (remission & exacerbation)

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18
Q

What are the sources of pain? (hint: 3)

A
  • Cutaneous
  • Deep somatic
  • Visceral
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19
Q

Describe cutaneous pain

A
  • originating from the mucous membrane damage
  • shock or burning sensation
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20
Q

Describe deep somatic pain

A
  • originating from blood vessels, ligaments, tendons, nerves, and bones
  • diffuse and scattered pain
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21
Q

Describe visceral pain

A
  • originating in organs
  • vague
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22
Q

What type of pain is categorized under mode of transmission?

A

Referred/ refractive pain - originates in one place and is felt in another
e.g. MI; pain starts in heart bit can be felt in the arm

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23
Q

What comes under the etiology of pain?

A
  • Nociceptive - nociceptor damage
  • Neuropathic - nerve damage (e.g. phantom limb)
  • Physical - location and organ can be found
  • Psychogenic- pain cannot be identified
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23
Q

Which type of pain is characterized as a protective mechanism of the body?

A) Chronic pain
B) Acute pain
C) Nociceptive pain
D) Neuropathic pain

A

B) Acute pain

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24
Q

Which type of pain originates from damage to the mucous membranes?

A) Deep somatic pain
B) Cutaneous pain
C) Visceral pain
D) Neuropathic pain

A

B) Cutaneous pain

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25
Q

Deep somatic pain is characterized by:

A) Sharp, localized pain
B) Vague pain from internal organs
C) Diffused and scattered pain
D) Pain that cannot be identified

A

C) Diffused and scattered pain

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26
Q

Visceral pain typically originates from:

A) Muscles and tendons
B) Skin and mucous membranes
C) Internal organs
D) Nerves and bones

A

C) Internal organs

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27
Q

Which type of pain is defined as having an identifiable location and origin?

A) Nociceptive pain
B) Psychogenic pain
C) Deep somatic pain
D) Physical pain

A

D) Physical pain

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28
Q

What steps are included in the pain process?

A
  • Transduction
  • Transmission
  • Perception of pain
  • Modulation
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29
Q

The Pain Process (gen notes)

A

● Transduction: pain threshold is reached to cause activation of pain receptors
● Transmission: conduction along afferent pathways (A-delta and C fibers)
● Perception of pain: awareness of the characteristics of pain
● Modulation: inhibition or modification of pain

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30
Q

During transduction, what occurs when the pain threshold is reached?

A) Pain is perceived
B) Pain receptors are activated
C) Pain is transmitted to the brain
D) Pain is inhibited

A

B) Pain receptors are activated

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31
Q

Which type of fibers are involved in the transmission of pain along afferent pathways?

A) A-beta and B fibers
B) A-delta and C fibers
C) C and D fibers
D) Alpha and gamma fibers

A

B) A-delta and C fibers

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32
Q

What does the perception of pain refer to?

A) The modulation of pain signals
B) The conduction of pain along nerve pathways
C) Awareness of the characteristics of pain
D) The activation of pain receptors

A

C) Awareness of the characteristics of pain

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33
Q

What is the function of modulation in the pain process?

A) To amplify pain signals
B) To inhibit or modify pain
C) To transmit pain to the brain
D) To activate pain receptors

A

B) To inhibit or modify pain

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34
Q

Which of the following statements about A-delta and C fibers is true?

A) A-delta fibers transmit sharp, localized pain; C fibers transmit dull, throbbing pain.
B) Both A-delta and C fibers transmit the same type of pain.
C) C fibers are faster than A-delta fibers in conducting pain signals.
D) A-delta fibers are responsible for emotional responses to pain.

A

A) A-delta fibers transmit sharp, localized pain; C fibers transmit dull, throbbing pain.

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35
Q

In which stage of the pain process does the body become aware of the pain?

A) Transduction
B) Transmission
C) Perception
D) Modulation

A

C) Perception

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36
Q

Stimulators of nociceptors/ pain receptors

A
  • Bradykinin: causes blood vessels to dilate, bringing blood to injury site
  • Prostaglandins: group of lipids made at damaged or infected tissue sites
  • Substance P
37
Q

Pain modulators / neuromodulators

A
  • Endorphins: chem produced by body to relieve stress and pain
  • Dynorphins
  • Enkephalins: involved in regulating nociception
38
Q

Gate control theory

A

This theory describes how pain signals travel and how the brain decides to feel or not feel the pain

39
Q

Modulation of pain

A

How sensation is modified based on person e.g. endorphins

40
Q

What are the fibers involved in pain and how are they significant?

A

A-delta fibers: LARGE diameter allows fast conduction
C fibers: smallest nerve for slow conduction

p.s. you have to stimulate the large ones if you want to stop the pain

41
Q

What does it mean when there is a ‘closed gate?’

A

A-delta fibers are activated as an inhibitory neuron in the dorsal horn and this activation prevents pain from being delivered to the brain

42
Q

What does it mean when there is an ‘open gate?’

A

C fibers are activated to allow the transmission of pain to the brain

43
Q

TENS

A

Transcutaneous Electrical Nerve Stimulation (TENS): method of pain relief that uses a mild electrical current

44
Q

What are some sympathetic physiologic responses to pain?

A

■ Increased blood pressure, pulse, and respirations
■ Pupil dilation
■ Muscle tension and rigidity
■ Pallor (pale)
■ Increased glucose

45
Q

What are some parasympathetic physiologic responses to pain?

A

■ Nausea and vomiting
■ Decreased blood pressure
■ Decreased pulse rate
■ Rapid and irregular breathing
■ Fainting and unconsciousness

46
Q

What are some behavioral responses to pain?

A

○ Posture
○ Gross motor activities
○ Facial features
○ Verbal expressions

47
Q

What are some affective responses to pain?

A

○ Anxiety
○ Depression
○ Interactions with others

48
Q

List some factors that affect the pain experience

A

● Culture
● Ethnic variables
● Family, gender, and age variables
● Religious beliefs
● Environment and support people
● Anxiety and other stressors
● Past pain experience

49
Q

The CRIES pain scale tool is used for what age group? (see image in PP)

A

0 - 6 months

50
Q

The FLACC pain scale is used for which age group? (see image in PP)

A

0- 8 years

51
Q

What age group is the Wong-Baker FACES pain scale used for? p? (see image in PP)

A

3-18 years

52
Q

What age group is the Beyer Oucher pain scale used for? p? (see image in PP)

A

3-18 years

53
Q

Who is the PAINAD scale used for?

A

For patients with advanced dementia

○ Breathing: normal to noisy, labored breathing
○ Negative vocalization: moans and groans
○ Facial expression: inexpressive, frown
○ Body language: relaxed, tense, rigid
○ Consolability: unable to console

54
Q

Who is the COMFORT scale used for?

A

Unconscious and ventilated infants, children and adolescents

○ Alertness
○ Calmness/agitation
○ Respiratory response
○ Physical movement
○ Blood pressure
○ Heart rate
○ Muscle tone
○ Facial tension

55
Q

What is the primary function of A-delta fibers in pain sensation?

A) Slow conduction of pain signals
B) Fast conduction of pain signals
C) Transmission of emotional responses to pain
D) Inhibition of pain signals

A

B) Fast conduction of pain signals

56
Q

According to the gate control theory of pain, what happens when the gate is “closed”?

A) C fibers are activated to transmit pain.
B) Pain is transmitted to the brain.
C) A-delta fibers activate inhibitory neurons to prevent pain transmission.
D) Pain perception is enhanced.

A

C) A-delta fibers activate inhibitory neurons to prevent pain transmission.

57
Q

Which of the following physiological responses is associated with the sympathetic response to moderate and superficial pain?

A) Decreased blood pressure
B) Nausea and vomiting
C) Increased blood pressure and pulse
D) Fainting and unconsciousness

A

C) Increased blood pressure and pulse

58
Q

What type of pain does the sympathetic nervous system respond to?

A

Moderate and superficial pain

59
Q

What type of pain does the parasympathetic nervous system respond to?

A

Severe and deep pain

60
Q

What is a common parasympathetic response to severe and deep pain?

A) Muscle tension and rigidity
B) Increased glucose levels
C) Nausea and vomiting
D) Pupil dilation

A

C) Nausea and vomiting

61
Q

Which factor does NOT typically affect an individual’s pain experience?

A) Family and gender variables
B) Environmental support
C) Time of day
D) Cultural beliefs

A

C) Time of day

62
Q

C fibers are responsible for which type of pain transmission in the gate control theory?

A) Fast transmission of sharp pain
B) Slow transmission of dull, throbbing pain
C) Complete inhibition of pain
D) Rapid transmission of acute pain

A

B) Slow transmission of dull, throbbing pain

63
Q

Which of the following factors can influence an individual’s pain experience?

A) Time of day
B) Culture
C) Physical activity level
D) All of the above

A

B) Culture

64
Q

A nurse is assessing a patient who reports severe pain. Which of the following findings would the nurse expect to observe as a sympathetic response to this pain?

A) Decreased pulse rate
B) Nausea and vomiting
C) Pupil dilation
D) Pallor

A

C) Pupil dilation

65
Q

A patient in the emergency department is experiencing deep, severe pain. Which of the following physiological responses would most likely be observed?

A) Increased blood pressure and pulse
B) Rapid and irregular breathing
C) Muscle tension and rigidity
D) Increased glucose levels

A

B) Rapid and irregular breathing

66
Q

A patient reports pain but also displays an anxious demeanor. Which response by the nurse is most appropriate?

A) “You shouldn’t feel anxious; the pain will go away.”
B) “Let’s focus on your pain and how we can manage it.”
C) “Your anxiety is making the pain worse.”
D) “Take a deep breath and try to relax.”

A

B) “Let’s focus on your pain and how we can manage it.”

67
Q

A nurse is assessing pain in an infant who is 4 months old. Which pain assessment tool is most appropriate to use?

A) Wong-Baker FACES scale
B) CRIES pain scale
C) FLACC scale
D) PAINAD scale

A

B) CRIES pain scale

68
Q

Which pain assessment tool is specifically designed for patients with advanced dementia?

A) FLACC scale
B) Wong-Baker FACES scale
C) PAINAD scale
D) COMFORT scale

A

C) PAINAD scale

69
Q

A child aged 6 years is unable to verbally express their pain. Which assessment tool would be most appropriate for the nurse to use?

A) COMFORT scale
B) Beyer Oucher pain scale
C) CRIES pain scale
D) Wong-Baker FACES scale

A

D) Wong-Baker FACES scale

70
Q

The nurse is using the COMFORT scale to assess pain in a ventilated child. Which of the following parameters should the nurse assess? (Select all that apply.)

A) Alertness
B) Blood pressure
C) Vocalization
D) Facial tension
E) Muscle tone

A

All but C. Patient is unconscious

71
Q

When assessing a patient using the PAINAD scale, which of the following findings indicates severe pain?

A) Normal breathing pattern
B) Relaxed body language
C) Tense body language and unable to console
D) Inexpressive facial expression

A

C) Tense body language and unable to console
The facial expression can also be inexpressive

72
Q

A nurse is assessing pain in an adolescent patient using the Beyer Oucher pain scale. Which age range is this scale intended for?

A) 0-6 months
B) 3-18 years
C) 3-8 years
D) 0-8 years

A

B) 3-18 years

73
Q

Parameters to assess for pain (gen notes)

A

● Location of pain
○ Ask the patient where they are experiencing pain and if it is external or internal
○ Suggest pointing to the area
● Duration of pain
○ Determine how long they have been experiencing pain
○ If the pain occurs in episodes, ask how often this occurs
● Quantity of pain
○ Ask the patient the degree of pain they are currently experiencing on a scale from
0-10
● Quality of pain
○ Allow the patient an opportunity to describe their pain using words
■ Ex: burning, tingling, aching
● Chronology of pain
○ Ask the patient about how the pain has developed and progressed
○ Is it better or is it getting worse?
● Etiologic factors
○ Identify if there is a specific cause or origin of the pain
● Aggravating factors
○ Determine if there is something that makes the pain occur or intensify
● Alleviating factor
○ Ask if there is something that helps reduce the pain or make it go away
○ Ask if any methods have been used
● Physiologic, behavioral, affective response
○ Physiological responses to pain could include decreased blood pressure and pulse,
rapid respirations, pupil constriction, and nausea
○ Behavioral changes could be seen in how a person moves or acts
○ Affective responses are dealing with emotions and could involve anxiety,
depression, and how they act with others

74
Q

Assessment for pain

A

● Location of pain
● Duration of pain
● Quantity of pain
● Quality of pain
■ Ex: burning, tingling, aching
● Chronology of pain
● Etiologic factors
● Aggravating factors
● Alleviating factor
● Physiologic, behavioral, affective response
○ decreased blood pressure and pulse,
rapid respirations, pupil constriction, and nausea
○ Behavioral changes
○ Affective responses: anxiety,
depression, and how they act with others

75
Q

How can nurses intervene with pain management?

A
  • establish trusting relationship with patient
  • manipulating factors (alter: cause or pain tolerance)
  • review other pain control measures
  • initiates non and pharmacologic pain relief measures
  • teach patient about pain
  • consider ethical and legal responsibility
76
Q

What are some nonpharmacologic pain relief measures?

A

● Distraction
● Humor
● Music
● Imagery
● Relaxation
● Cutaneous stimulation (TENS) - uses low
voltage electrical current to provide pain relief
● Acupuncture
● Hypnosis
● Biofeedback
● Therapeutic Touch

77
Q

What are some pharmacologic pain relief measures?

A

● Analgesic administration
○ Nonopioid analgesics Ex: NSAID
● Opioids or narcotic analgesics
○ Ex: morphine, codeine
● Adjuvant drugs
○ Anticonvulsants: used for seizures
○ Antidepressants
○ Corticosteroids

78
Q

What are the big THREE effects of opioid use?

A

Sedation
Nausea
Constipation

79
Q

What are all the effects of opioid use?

A

● Sedation
● Nausea
● Constipation
● Physical dependence
● Tolerance
● Addiction

80
Q

What does the numeric sedation scale compose of?

A
  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 use
    - Consider use of naloxone (Narcan)

**Naloxone/Narcan is a synthetic medicine which blocks the nociceptor

81
Q

What are some regimens for pain management?

A
  • allow patients to have as much control as possible
  • give meds orally if possible
  • dose should be max effect w min side effects
  • administer meds consistently
82
Q

What are some additional methods for administering analgesics?

A

● Patient-controlled analgesia (PCA): gives patients power
● Intravenously or epidural route
○ Epidurals are inserted between L3 and L4 into
the epidural space of the spine
○ If the dura is accidentally punctured, the patient
will feel pain as spinal fluid leaks
○ Patient should remain in the supine position
● Morphine
● Fentanyl
● Hydromorphone

83
Q

A nurse is caring for a patient receiving opioids for pain management. Which side effect should the nurse closely monitor for?

A) Increased energy levels
B) Diarrhea
C) Constipation
D) Elevated blood pressure

A

C) Constipation

84
Q

Which of the following is an appropriate nursing action when a patient is rated a level 3 on the Numeric Sedation Scale?

A) No action necessary
B) Increase the opioid dosage
C) Reduce the dosage of the opioid
D) Discontinue the opioid immediately

A

C) Reduce the dosage of the opioid

85
Q

Which nonpharmacologic method uses the patient’s own body awareness to help manage pain?

A) Distraction
B) Biofeedback
C) Humor
D) Music

A

B) Biofeedback

86
Q

Which of the following medications is commonly used in epidural analgesia?

A) Fentanyl
B) Ibuprofen
C) Acetaminophen
D) Aspirin

A

A) Fentanyl

87
Q

What is the purpose of cold therapy?

A

To reduce swelling and inflammation, pain relief
- immediately after injury, 3-5 days
- inhibits inflammation, vascular dilation, warmth, and swelling

88
Q

What is the purpose of hot therpay?

A

To increase blood circulation, promote healing, relax stiff muscles and joints, increase ROM, soothe soreness
- promotes inflammation, vascular dilation, warmth, and swelling
- pain increased or decreased

89
Q

Don’t apply cold or heat for longer than 20 minutes.

A. True
B. False

A

A. True

Therapeutics (12 decks)

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