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Nursing Fundamentals > Comfort and Sleep (CH 35) > Flashcards

Comfort and Sleep (CH 35) Flashcards

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1
Q

Pain

A

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

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2
Q

Cutaneous pain

A

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

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3
Q

Somatic pain

A

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

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4
Q

Visceral pain

A

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

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5
Q

Referred pain

A

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)

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6
Q

Acute pain

A

sudden onset and short duration

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7
Q

Recurrent acute pain

A

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

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8
Q

Chronic persistent pain

A

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

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9
Q

Chronic acute pain

A

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

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10
Q

Chronic nonmalignant pain

A

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

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11
Q

Nociceptors

A

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

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12
Q

Afferent vs Efferent

A

Afferent (ascending)/ Efferent (descending)

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13
Q

Nocioception

A

the process by wich an individual becomes consciously aware of pain

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14
Q

Transduction

A

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

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15
Q

Transmission

A

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

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16
Q

Perception

A

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)

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17
Q

Modulation

A

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

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18
Q

Ischemic pain

A

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

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19
Q

Neuropathic pain

A

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

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20
Q

Types of neuropathic pain

A
  1. allodynia- nonpainful stimulus is felt as painful despite tissue appearing normal
  2. parasthesia- an abnormal sensation, such as burning, prickling, or tingling
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21
Q

Myofascial pain

A

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

22
Q

Gate Control Theory of Pain

A

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

23
Q

Age and pain

A
  • 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
24
Q

Culture and pain

A

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

25
Q

Assessment

A

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

26
Q

Pain threshold

A

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

27
Q

Pain tolerance

A

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

28
Q

Distraction

A

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

29
Q

Pain assessment questions

A

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

30
Q

Psychosocial pain assessment

A

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

31
Q

Poker Chip Tool

A

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

32
Q

Adjuvant medications

A

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

33
Q

Types of adjuvant meds

A
  • 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
34
Q

Serum levels

A

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

35
Q

Cieling effect

A

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

36
Q

Mixed agonist-antagonists (opiods)

A

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

37
Q

Meperidine

A

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

38
Q

Epidural analgesia

A

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

39
Q

TAC

A

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)

40
Q

Tx of neuropathic pain

A

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

41
Q

Reframing

A

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

42
Q

Biofeedback

A

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

43
Q

Counterstimulation

A

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

44
Q

TENS

A

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

45
Q

Stages of sleep

A

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

46
Q

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

A

Ask the client

47
Q

Which statement regarding IM injections of analgesics is true?

A

It is discouraged in current practice

48
Q

Which statement regarding pain and sleep is most correct?

A

A client may sleep despite being in pain

49
Q

Which statement best describes clients in chronic pain?

A

They often experience depression

50
Q

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?

A

Substance abuse is both a physical and psychologicla disorder

51
Q

Which actions are required to ensure safe use of PCAs?

A
  • 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

Nursing Fundamentals (10 decks)

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