Comfort and Sleep (CH 35)

Question 1

Pain

Answer 1

a response to a noxious stimuli; warning of potential tissue damage

Question 2

Cutaneous pain

Answer 2

caused by stimulation of the cutaneous nerve endings in the skin and results in a well-localized “burning” or “prickling” sensation

Question 3

Somatic pain

Answer 3

nonlocalized and originates in support structrues such as tendons, ligaments and nerves or may be deep pain (jamming a knee or finger, for example)

Question 4

Visceral pain

Answer 4

discomfort in the internal organs and is less localized and more slowly transmitted than cutaneous pain; location of pain may not be directly related to the cause

Question 5

Referred pain

Answer 5

sensation of pain is not felt in the organ itself, but instead perceived at the spot wher the organs were located during fetal development (for abd pain)

Question 6

Acute pain

Answer 6

sudden onset and short duration

Question 7

Recurrent acute pain

Answer 7

repetitive painful episodes that may recure over a prolonged period of time throughout life

Question 8

Chronic persistent pain

Answer 8

longer than 6 months, nearly constant or recurrent pain that produces significant problems in the clients life

Question 9

Chronic acute pain

Answer 9

occurse almost daily over a period of months or years, but has the high probability of ending (severe burns or cancer)

Question 10

Chronic nonmalignant pain

Answer 10

daily and last for at least 6 months, intensity is mild to severe
*neuralgia *phantom limb *myofascial pain syndrome

Question 11

Nociceptors

Answer 11

receptive neurons for painful sensation; with axons of neurons, they convey info to the spinal cord where reflexes are activated

Question 12

Afferent vs Efferent

Answer 12

Afferent (ascending)/ Efferent (descending)

Question 13

Nocioception

Answer 13

the process by wich an individual becomes consciously aware of pain

Question 14

Transduction

Answer 14

chainging of noxious stimuli in sensory nerve endings to energy impulses; releases chemicals that alter electrical charge on neuronal membrane

Question 15

Transmission

Answer 15

movement of impulses from the site of the origin to the brain; faster in cutaneous pain than visceral pain

Question 16

Perception

Answer 16

developing conscious awareness of pain; interpreted in light of previous experience (this is when the client has the ability to describe the pain in detail)

Question 17

Modulation

Answer 17

the changing of pain impulses; descending fibers will release substances that produce analgesia by blocking transmission of noxious stimuli (endorphins/enkaphalins)

Question 18

Ischemic pain

Answer 18

pain occuring when the blood supply of an area is restriced or cut off completely; more rapid onset in active muscle than passive muscles

Question 19

Neuropathic pain

Answer 19

arises from damage to portions of the peripheral or CNS; not nocioceptive pain

Question 20

Types of neuropathic pain

Answer 20

1. allodynia- nonpainful stimulus is felt as painful despite tissue appearing normal
2. parasthesia- an abnormal sensation, such as burning, prickling, or tingling

Question 21

Myofascial pain

Answer 21

pain that occurs as a reslut of a small, hypersensitive region in a muscle ligament, fascia, or joint capsule called a trigger point; often accompanied by localized, deep ache that is surrounded by a referred area of hyperalgesia

Question 22

Gate Control Theory of Pain

Answer 22

pain perception is regulated through a gating mechanisn at the dorsal horn of the spinal cord; gating mechanism caused vasoconstriction and decreased nerve conduction velocity, reducing the transmission of noxious stimuli, resulting in the level of conscious awareness of pain to be altered

Question 23

Age and pain

Answer 23

• infants and children: crying; don’t understand why pain happens and can be frightened or resentful
• adolescents/young adults: peer pressure might influence reluctance to admit pain
• odler adults: may ignore pain b/c its “unavoidable”; undertreated and underdetected

Question 24

Culture and pain

Answer 24

cultural values regarding pain can affect the clients beliefs about pain (intensity they’re willing to endure, duration, etc); expression of pain can be cultural (“suffering in silence” or overanimation); nurse considers cultural influence when assessing pain and is careful not to equate level of pain with level of expression

Question 25

Assessment

Answer 25

fifth vital sign is pain; look for nonverbal signs; ask family members about subtle changes; determin pain threshold and pain tolerance

Question 26

Pain threshold

Answer 26

level of intensity at which pain becomes appreciable or perceptible and will vary with individual and type of pain

Question 27

Pain tolerance

Answer 27

level of intensity or duration of pain the client is willing or able to endure

Question 28

Distraction

Answer 28

focusing attention on stimuli other than pain; laughter is especially effective for coping with pain

Question 29

Pain assessment questions

Answer 29

*quality *intensity *location *duration *triggers *effects *knowledge level

Question 30

Psychosocial pain assessment

Answer 30

indentifies the clients attitudes and beliefs regarding pain and social support; include clients mood, coping skills, self efficacy and concerns

Question 31

Poker Chip Tool

Answer 31

four chips are placed in front of a child as "pieces of hurt", ask the child how many pieces of hurt they have; used in ages 4-13

Question 32

Adjuvant medications

Answer 32

drugs used to enhance the analgesic efficacy of opiods, to treat concurrent symptoms that exacerbate pain and to provide independent analgesia for specific types of pain; helpful in chronic pain

Question 33

Types of adjuvant meds

Answer 33

* tricyclic antidepressants: neuropathic pain * anticonvulsants: neuropathic (shooting, burning or lancinating) * corticosteroids: cerebral or spinal cord edema, pain in peripheral nerves * antihistamine: pain/nausea in anxious clients * neuroleptic: alternative analgesic for opiod-tolerant or opiod-limiting patients * psychostimulants: continued pain w/ opiod-induced sedation

Question 34

Serum levels

Answer 34

nurses must help maintain therapeutic seum levels when giving PRN medication; clients response to interval of meds should be evaluated, documented and communicated by the nurse

Question 35

Cieling effect

Answer 35

as the dose of medication increases above a certain level, the analgesic effect remains the same; NSAIDS, not opiods

Question 36

Mixed agonist-antagonists (opiods)

Answer 36

compounds that block opiod effects on some receptor types while producing opiod effects on a second receptor type

Question 37

Meperidine

Answer 37

pure agonist; NOT recommended due to neurotixicity; used briefly in otherwise healhty clients who have unusual rx or allergic rx to other opiods

Question 38

Epidural analgesia

Answer 38

used for pain management (especially oncology clients) when other pain control is insufficient

Question 39

TAC

Answer 39

anesthesia during closure of lacerations; has tetracaine, adrenaline and cocaine; causes vasoconstriction and can't be used in areas supplied by end-arteriolar blood supply (digits, ears and nose)

Question 40

Tx of neuropathic pain

Answer 40

ticyclic antidepressants (amitriptyline is recommended especially in clients with sleep deprivation due to pain); carbamazepine for lancinating (pierceing/stabbing); corticosteroids like dexamethasone or prednisone

Question 41

Reframing

Answer 41

monitor negative thougths and replace them with ones that are more positive

Question 42

Biofeedback

Answer 42

individuals learn to influence their physiological response to pain, altering pain experience

Question 43

Counterstimulation

Answer 43

identify techniques believed to activate the endogenous opiod analgesia systems (heat and cold therapy)

Question 44

TENS

Answer 44

application of minute amounts of electrical stimulation to large diamater nerve fibers via electrodes placed on the skin

Question 45

Stages of sleep

Answer 45

NREM: 4 phases increasing in depth and time; sleep walk, talk and nightmares occure in 3 & 4 phase; 1st 2 phases are light sleep REM: happens after 90 min of NREM; 4-6 cycles per night; more need for REM for healing and restedness

Question 46

Which is the best way for a nurse to assess for pain in a communicative client?

Answer 46

Ask the client

Question 47

Which statement regarding IM injections of analgesics is true?

Answer 47

It is discouraged in current practice

Question 48

Which statement regarding pain and sleep is most correct?

Answer 48

A client may sleep despite being in pain

Question 49

Which statement best describes clients in chronic pain?

Answer 49

They often experience depression

Question 50

The nurse is preparing to teach a class to a group of new graduate nurses on substance abuse disorders. Which statemen should the nurse include in the class?

Answer 50

Substance abuse is both a physical and psychologicla disorder

Question 51

Which actions are required to ensure safe use of PCAs?

Answer 51

* two nurses must sign when therapy begins and with all dosing orders * Standard order sets * PCA solutions and concentrations are standardized * competency of all nurses who use PCA in their practice must be documented annually