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NRAD201A > Exam 2: Pain, Preoperative Care, Cultural Competency, Spirituality > Flashcards

Exam 2: Pain, Preoperative Care, Cultural Competency, Spirituality Flashcards

1
Q

Who can rate pain levels?

A

Only the patient experiencing the pain

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2
Q

Why should you trust your patient?

A

People express pain in different ways, so even though they may not look like they are experiencing pain, they are the only ones who can tell you what they are feeling.

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3
Q

What is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
OR
Whatever the person says it is, and existing whenever the person says it does.

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4
Q

What can you do is you sense that someone is drug-seeking?

A

Be honest with your patient, you can say things like: “It seems like your pan level is always a 10, and the opioids aren’t helping you, what would help?” or “I/m wondering if you are needing this or wanting this for more than your pain?”

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5
Q

Noxious Stimulus

A

Heat, knife cut, extreme cold, chemicals/acid, things that start the physiological process of feeling pain.

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6
Q

What steps are involved in the physiology of pain?

A
  1. Transduction: NT release, converts stimulus to electrical impulse.
  2. Transmission: impulse relayed to dorsal horn in CNS, processed by NT, sent to thalamus, then relayed to cerebral cortex.
  3. Perception: Pain perceived in cortex (almost right away)
  4. Modulation: Pathway that inhibits pain.
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7
Q

What is a nociceptor?

A

Pain neuron, nerve receptor that transmits pain.

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8
Q

Where are nociceptors located?

A

Everywhere except in the brain, mostly located at the ends of small afferent neurons.

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9
Q

What stimulates nociceptors? (2 bullet points)

A

-Direct cell damage
-NT including:
*substance P (released with inflammatory process)
*histamine (causes itching)
*bradykinin (vasodilator, releases pro inflammatory chemicals-redness, swelling, tenderness.)
prostaglandins (released by damaged cells, increase sensitivity of pain reception.)

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10
Q

What is nociceptive pain described as and what does it respond to?

A

Described as aching or throbbing, known as “normal pain.”

Responds to both non opioid and opioid analgesics.

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11
Q

What should you do after administering an analgesic?

A

After med is given, Re-assess patient.
If anticipated effect is not shown upon re assessment, something is wrong, contact the physician. (May need another med, may have an infection, etc.)

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12
Q

Conduction Velocity: bigger neuron=________ speed.

A

Faster

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13
Q

Conduction Velocity: More _______=Faster speed.

A

Myelinated

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14
Q

Characteristics of C fibers

A

Nociceptor, 1 um diameter, non myelinated, speed 2 m/second (slowest), sensory perception= dull, aching, burning pain; slow onset, longer duration

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15
Q

Characteristics of A-delta Fibers

A

Nociceptor, 4 um diameter, myelinated, speed 15 m/sec. Felt immediately, sharp localized pain, short duration.

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16
Q

Characteristics of A-beta fibers

A

Non-nociceptors (afferent nerve endings but not pain receptors) 13 um diameter, myelinated, speed 70m/sec , sensory transmission: touching the skin.

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17
Q

Characteristics of A-alpha fibers

A

Non-nociceptors (afferent nerve endings but not pain receptors), 20 um diameter, myelinated, speed 120 m/sec, sensory transmission: muscle impulses (massaging muscle)

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18
Q

What is the “Gate Theory” of Pain?

A

non-painful input closes the “gates” to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain. (If A-beta and A-alpha stimulus moves faster than nociceptor stimulus, they will arrive at the gate first and modulate how many pain impulses get through.)

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19
Q

Where is the “gate” located in the gate theory of pain?

A

At the dorsal horn synapse

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20
Q

What opens the “gate?”

A

Nociceptor input
Anxiety
Worry
Concentrating on pain

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21
Q

What closes the “gate?”

A

Non-nociceptor input
positive mood
Concentrating on other than pain

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22
Q

What are our endogenous opioids?

A

Our own narcotics, serotonin, Norepinephrine, endorphins, enkephalin

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23
Q

What can trigger our endogenous opioids to be released?

A 
Chili peppers
Alcohol
Exercise
Laughing
Meditation
Listening to music
Walking barefoot in the grass
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24
Q

What effect does Naloxin have on opioids? Does it affect our endogenous opioids?

A

Naloxin used for overdose, reverses effect of opioids and does the same to our endogenous opioids as well.

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25
Q

How does the endogenous analgesia system work? (2 bullet points)

A
  • Pain impulse activates descending nerve fibers, triggers release of NT including endogenous opioids, they bind to opiate receptors on nerve cells, inhibit substance P release, decrease pain transmission to the brain.
  • Pleasurable experiences also trigger release
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26
Q

What is acute pain? (7 bullet points)

A
  • Normal, expected, and treatable
  • Sudden onset, localized, lasts < 3 months
  • Result of tissue injury or inflammation
  • Resolves with healing of disorder (LTG: @ this point, pain should be gone)
  • Initiates Protective response; facilities healing by making injured area surrounding tissue hypersensitive
  • Stimulates fight or flight response: Tachycardia, tachypnea, increased BP, fear, anxiety, etc.
  • Therapy aimed at treating underlying cause & interrupting nociceptive signals.
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27
Q

What might you expect during assessment of acute pain?

A

Tachycardia, tachypnea, increased BP, fear, anxiety in initial pain perception, may be elevated during assessment before pain med administration. Still not absolute as people handle pain differently.

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28
Q

What is chronic pain? (3 bullet points)

A
  • Malignant, disease state, can’t really treat
  • Serves no biological purpose, can be debilitating
  • May originate with illness or injury, but no clear cause.
29
Q

What often accompanies chronic pain? (3 bullet points)

A
  • Fatigue, sleep disturbances, decreased appetite, mood changes, depression, anxiety.
  • Decreased physical activity results in reduced flexibility, strength and stamina, and weight gain.
  • Increased mortality from heart and respiratory disease
30
Q

What can be used to treat chronic pain?

A

Difficult to treat pharmacologically. Complementary or alternative medicine can provide relief. Behavioral modification, massage, acupuncture. etc.

31
Q

What is referred pain?

A

Pain felt in a part of the body other than its actual source. Happens because nerves converge on their way to the spinal cord.

32
Q

What is neuropathic pain? (6 bulletpoints)

A
  • More chronic, abnormal pain.
  • Abnormal pain from DAMAGE to nerve cells (shingles)
  • Described as burning, numb, pins and needles, tingling or shooting sensation (electrical sounding)
  • Normal stimuli can cause significant discomfort
  • Opioid analgesics and NSAID’s usually ineffective.
  • Adjuvant thérapies more effective (antidepressants, anticonvulsants, capsacin) more effective. ex: gabapentin is an anti seizure med but can be somewhat effective for this type of pain.
33
Q

What is capsaicin?

A

Cayenne pepper, can be used for sore joints, burns at first but will stop burning at some point and then pain is gone.

34
Q

What are the four types of neuropathic pain?

A
  • Central Pain
  • Peripheral Neuropathies
  • Differentiation Pain
  • Sympathetically maintained pain
35
Q

What is Central Pain? What is an example of central pain?

A

A type of neuropathic pain due to damage or dysfunction of the CNS. ex: Multiple Sclerosis

36
Q

What is an example of peripheral neuropathy?

A

Diabetic neuropathy

37
Q

What is differentiation pain? What is an example?

A

A type of neuropathic pain, complete or partial interruption of afferent nerve sensations, ex: Phantom limb sensation. Pain will be treated pharmacologically and non pharmacologically even though the limb is not there. Contralateral stimulation works well.

38
Q

What is an example of sympathetically maintained pain?

A

Complex regional pain syndrome (CRPS)

39
Q

What are s/sx of CRPS?

A

Continuous burning, throbbing. Touch/cold sensitivity, swelling, changes win temp or color= mottled red/blue. Shiny skin texture, thinned and very tender, weakness, atrophy, decreased ability to move body part. Difficult to manage. Sooner recognized=better. Usually in arm or leg, results after injury or surgery, stroke or MI. Uncommon form of chronic pain.

40
Q

What are the harmful effects of unrelieved pain on the endocrine system?

A

Hyperglycemia, weight loss, tachycardia, fever, tachypnea.

41
Q

Harmful effects of unrelieved pain on the CV system

A

Angina, MI, DVT

42
Q

Harmful effects of unrelieved pain on the Musculoskeletal system

A

Muscle fatigue and immobility

43
Q

Harmful effects of unrelieved pain on the Respiratory system

A

Shallow breathing, pneumonia, atelectasis, respiratory acidosis

44
Q

Harmful effects of unrelieved pain on the GU system

A

decreased output, urinary retention, HTN, hypokalemia, increased cardiac output

45
Q

Harmful effects of unrelieved pain on the GI system

A

Decreased gastric emptying and motility

46
Q

Harmful effects of unrelieved pain on the Neurological System

A

Impaired thinking

47
Q

Harmful effects of unrelieved pain on the Immunologic System

A

Impaired response-Infection

48
Q

What is the fifth vital sign?

A

Pain, only subjective vital sign.

49
Q

What is PAIN?

A

P: Pattern: onset and duration of pain, any other symptoms that accompany. (What makes it better/worse? When did it start? How long does it last? Does it come and go?)
A: Area: Origin/location (point to it, if pain in two separate areas document each w/separate PAIN)
I: Intensity: Level of pain on rating scale. (also ask, what is a manageable level of pain to you?)
N: Nature: quality, how pain feels using descriptive words (Does it throb, ache, cramp>)

50
Q

When are we obligated to address pain?

A

If pain exceeds a 2 we are obligated to address it. Offer intervention, if declined it needs to be charted.

51
Q

What is FACES?

A

Wong-Baker SELF-REPORT pain scale for children or patients with dementia.

52
Q

What is FLACC?

A

(Face, Legs, Activity, Cry, Consolability) A behavioral pain scale, not as good as self report, only used if patient can not rate pain for you.

  • Used for children, not able to verbalize/uncomfortable
  • Interact with patient at bedside for 10 minute period, leave bedside and do scoring to reflect what you saw
  • If can’t choose between 1 or 2, choose higher.
53
Q

What are CAM therapies?

A

Complementary and Alternative Modalities, non pharmacologic interventions that supplement conventional medical care. They may reduce the amount of drug needed to control pain.

54
Q

What is the nursing role in CAM therapy?

A

It is inherent in nursing role to touch the patient, apply nursing process and perform preventative, supportive and restorative functions with physical, emotional, mental and spiritual domains.

55
Q

CAM therapy guidelines

A

Within nursing scope, Nurse must be competent in therapy and operate within legal scope of practice and agency policies.

56
Q

What is a TENS Unit?

A

(Transcutaneous Electrical Nerve Stimulation). which are predominately used for nerve related pain conditions (acute and chronic conditions). TENS machines works by sending stimulating pulses across the surface of the skin and along the nerve strands. The stimulating pulses help prevent pain signals from reaching the brain.

57
Q

What are independent CAM Therapies?

A
  • Positioning
  • Pillows
  • Massage
  • Contralateral stimulation
  • Distraction
  • Relaxation
  • Guided imagery
  • Expressive writing
  • Therapeutic Touch (Reiki, needs hospital approval first)
58
Q

What are other CAM Therapies that require certified individual to perform?

A

Acupuncture
TENS Unit
Hypnosis

59
Q

What are the degrees of urgency for surgical classification?

A

Elective-Necessary but not urgent

Emergency- Urgent/Stat

60
Q

What are the two surgical settings?

A

Inpatient- Admitted to hospital prior to surgery and recover in hospital after.
Outpatient- Physician offices, ambulatory surgery (day stay, same day surgery) Endoscopy centers

61
Q

What are the degrees of risk in surgery?

A

Major: Major body cavity opened/exposed, chest, abdomen, skull.
Minor: No major body cavity opened ( C-section considered minor b/c abdomen is not opened)

62
Q

What does it mean to have a surgery for Diagnostic purposes?

A

To find possible tumors, diagnose a disease

63
Q

What does it mean to have a surgery for Curative purposes?

A

Ablation, removal of tissue, to eliminate or repair a pathological condition.

64
Q

What does it mean to have a surgery for Palliative purposes?

A

To remove pain, ex: debulking tumors

65
Q

What does it mean to have a surgery for preventative purposes?

A

Suspicious moles removed, etc.

66
Q

What does it mean to have a surgery for Cosmetic improvement?

A

Plastic surgery, not health producing.

67
Q

What does it mean to have a surgery for explorative purposes?

A

For diagnostic purposes

68
Q

What needs to be done BEFORE surgery? Preparation for surgery.

A
  • Nursing history-comprehensive admission assessment
  • Physical assessment
  • Lab/diagnostic results
  • Confirm H and P in chart (Cant proceed w/o this, done by physician)
  • Confirm surgical consent is obtained
  • Pre-operative teaching
  • Confirm NPO status
  • Skin Prep
  • Bowel Prep
  • Urinary elimination
  • Pre-operative Medications (What TO give and what NOT to give)
  • Remove glasses, contacts, prosthesis, dentures, wig, makeup, jewelry.
  • Antiembolic stockings (TED Hose)

NRAD201A (1 decks)

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