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J2 - Med Surg > Exam 2: Pain (unit 4) > Flashcards

Exam 2: Pain (unit 4) Flashcards

1
Q

Pain is ?

A

Whatever the person experiencing the pain says it is

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2
Q

What are 3 Barriers to Effective Pain Management ?

A
  • Tolerance
  • Physical dependance
  • Addiction
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3
Q

__________ barrier to effective pain management, requires a need for an increased dose to maintain the same degree of pain control ?

A

Tolerance

  • Rotate drug if tolerance develops, as increasing the dose could lead to hyperanalgesia
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4
Q

_____________ is the expected response to ongoing exposure to pharmacologic agents manifested by withdrawal syndrome when blood levels drop abruptly ?

A

physical dependence

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5
Q

In regards to physical dependence, what should be done to avoid withdrawal ?

A

Drug should be tapered off

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6
Q

What 2 Barriers to Effective Pain Management, DO NOT mean Addiction ?

A
  • Tolerance

- Physical dependence

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7
Q

___________ is a neurologic condition with the drive to obtain and take substance for other than the prescribed therapeutic value ?

A

Addiction

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8
Q

What is the best description of pain ?

A

Subjective descriptions of pain !

  • patients experience and self report is essential
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9
Q

___________________ are descriptions of pain that are also acceptable for special populations ?

A

Non-verbals, such as Behaviors

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10
Q

What is Nociceptive Pain ?

A

Damage to somatic or visceral tissue

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11
Q

What are 2 types of Nociceptive pain ?

A
  • Somatic pain

- Visceral pain

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12
Q

Nociceptive pain usually responds to what types of medications ?

A

Opioid and nonopioid medications

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13
Q

Examples of Nociceptive Pain ?

A
  • surgical incision
  • broken bone
  • arthritis
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14
Q

What type of Nociceptive pain does not involve nerves ?

A

Somatic pain !

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15
Q

Somatic pain presents as ?

A

Aching or throbbing

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16
Q

Somatic pain is _________ ?

A

Localized

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17
Q

Somatic pain arises from what ?

A
  • bone
  • joint
  • muscle
  • skin
    or
  • Connective tissue
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18
Q

What type of Nociceptive pain is associated with tumor involvement or obstruction ?

A

Visceral pain

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19
Q

Visceral pain arises from what ?

A

Internal organs such as the intestines and bladder.

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20
Q

Visceral pain feels like what ?

A

Cramping

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21
Q

What is an Example of Visceral pain ?

A

Pancreatitis

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22
Q

Neuropathic pain results from what ?

A

Damage to peripheral nerves or CNS

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23
Q

Neuropathic pain presents as what ?

A
  • Burning
  • Shooting
  • Stabbing
  • or electrical in nature
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24
Q

What type of pain is sudden, intense, short-lived, or lingering ?

A

Neuropathic Pain

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25
Q

What are examples of neuropathic pain ?

A
  • Diabetic Peripheral Neuropathy (DPN)
  • Phantom limb pain
  • Post-Herpetic Neuralgia (PHN)
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26
Q

What type of pain has a sudden onset, lasts less than 3 months or for the time it takes for normal healing to occur ?

A

Acute pain

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27
Q

The intensity of Acute Pain ranges from _______ to ________ .

A

Mild to Severe

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28
Q

What type of pain generally has a precipitating event or illness that can be identified (“because of something”) ?

A

Acute Pain

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29
Q

In what type of pain does the course of pain decrease over time and goes away as recovery occurs ?

A

Acute Pain

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30
Q

What is the treatment goal of Acute Pain ?

A

Pain control with eventual elimination

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31
Q

With Acute Pain manifestations reflect what ?

A

Sympathetic Nervous System activation

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32
Q

What are objective signs that we may see with Acute Pain ?

A
  • Increased heart rate
  • Increased respiratory rate
  • Increased BP
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33
Q

The onset of chronic pain may be _________ or _________ ?

A

Gradual or sudden

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34
Q

For pain to be classified as chronic, the duration is what ?

A

Greater than 3 months

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35
Q

What type of pain May start as acute pain, but continues past normal recovery or healing time ?

A

Chronic Pain

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36
Q

With Chronic Pain, the cause of pain may be what ?

A

unknown

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37
Q

What type of pain can be disabling and accompanied by anxiety and depression ?

A

Chronic Pain

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38
Q

What are treatment goals for Chronic Pain ?

A
  • Control to the extent possible

- Focus on enhancing function and quality of life

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39
Q

What type of pain does not go away, and is characterized by periods of waxing and waning ?

A

Chronic Pain

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40
Q

In regards to chronic pain, vital sign changes are what ?

A

NOT likely !

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41
Q

What type of pain is associated with behavioral manifestations such as:

  • Decreased physical movement/activity
  • Fatigue
  • Withdrawal from others and social interaction
  • Vital sign changes not likely
A

Chronic Pain

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42
Q

What is the best way to do a pain assessment ? (using what technique?)

A

OLDCARTS

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43
Q

What is Breakthrough pain ?

A

occurs beyond treated pain

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44
Q

Breakthrough pain can be what ?

A

Transient & moderate to severe

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45
Q

What is the onset time for Breakthrough pain ?

A

rapid onset

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46
Q

What type of pain has a brief duration with variable frequency and intensity ?

A

Breakthrough pain

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47
Q

What is an example of Breakthrough pain ?

A

Working with PT getting up out of bed etc.

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48
Q

Pain scales are considered what type of data (subjective or objective) ?

A

Subjective data !

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49
Q

Why is it important to use observational skills when assessing a patients pain ?

A

Not everybody will be able to rate their pain !

- Examples: Pt’s who are non-verbal, are confused, have dementia, etc.

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50
Q

What pain assessment tool is used most often ?

A

0-10 Numeric Pain Intensity Scale

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51
Q

The Wong-Baker pain face skill is good tool for which type of individuals ?

A

Good for those who don’t understand the numerical scale & for kids (3-4yrs who can’t read yet) !

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52
Q

What two pain assessment tools aren’t used as much ?

A
  • Simple descriptive pain intensity scale

- Visual analog scale (VAS)

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53
Q

What is the most important thing to do first before treating pain ?

A

ALWAYS get an accurate assessment first!

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54
Q

Whats an important aspect to remember when treating pain ?

A

Every patient deserves adequate pain management !

  • Ex: A frequent flyer in the ER–> Its our job to treat the patients pain. Not our job to determine if they are drug seeking
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55
Q

When treating a patients pain, its important to treat the pain based on what ?

A

The patients goals !
(Whatever makes them able to participate in ADLs, etc.. Not everybody has a goal of 0 out of 10 pain. Some individuals are just fine with a 3 or 4 out of 10 pain)

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56
Q

What is standard practice when treating pain ?

A

Using drug and non-drug therapies

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57
Q

when treating pain its important to use a what ?

A

Multidisciplinary approach

-Example: PT/OT if the patient is stiff
Anastisiologist if pt. has sever pain
Neurologist is pt. has neuropathic pain
etc.,

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58
Q

After giving medicine for pain, its important to do what ?

A

Go back and evaluate the pain

59
Q

When treating pain its important to do what with the pt/family ?

A

Involve patient and family teaching through assessment and treatment

  • Example: If a Pt. is taking an opioid medication, we want to inform the pt/family that opioids cause constipation & that they may want to take a stool softener with it.
60
Q

What is the LAST thing we want to do after providing pain relief for a patient ?

A

Reassess and document the pain after we have performed an intervention.

  • Within the hour, we should be documenting what our re-assessment was & if it was effective
61
Q

What is the time frame for documenting oral medication pain relief ?

A

Document in an hour

62
Q

What is the time frame for documenting/re-assessing pain relief administered through an IV ?
-Example: IV Morphine

A

Check back in 30 minutes

63
Q

What is the time frame for re-assessing/documenting pain relief via a PCA pump ?

A

At least every 2hrs along with a few sets of vital signs since it is continuous pain.

64
Q

In terms of pain relief medications, what are the 3 categories of medications ?

A
  • Nonopioid
  • Opioid
  • Co-analgesics or adjuvant
65
Q

What are examples of Nonopioid medications ?

A
  • Acetaminophen
  • Aspirin and other salicylates
  • NSAIDS
66
Q

What is an Analgesic ceiling ?

A

Increasing the dose above the upper limit produces no greater analgesia

67
Q

What category of medications do not produce tolerance or addiction ?

A

Nonopioids

68
Q

Many Nonopioid medications are _________ ?

A

Over the counter (OTC’s)

69
Q

Aspirin and NSAIDS are not the same as what ?

A

Acetominophen

70
Q

Tylenol is NOT an _______ ?

A

NSAID

71
Q

Nonopioids are used for what ?

A

Mild to moderate pain

72
Q

Nonopioids can be used in conjunction with what ?

A

Opioids

- to produce an opioid sparring effect, which helps to produce less side-effects

73
Q

What are major side effects of NSAIDS ?

A
  • Dispepsia
  • Gastric ulcerations
  • Possible hemorrhage
74
Q

NSAIDS care considered ___ -_____________, but if used excessively can cause ___________ ?

A
  • Ant-inflammatories

- Bleeding

75
Q

What is a side effect/what do you want to watch for when taking Aspirin ?

A

Want to watch for GI bleeding also if used on chronic bases & on an empty stomach

76
Q

With Tylenol what do you want to watch for ?

A

Watch how much is given, as it can lead to Hepatotoxicity.

potential to over tax the liver

77
Q

What is an example of an opioid sparring effect ?

A

Percocet - is a combination of Oxycodone & Tylenol

78
Q

How do opioids work in the body ?

A

Bind to receptors in the CNS

  • inhibit the transmission of nociceptive input
79
Q

Opioids alter what ?

A

Limbic activity (Balance & coordination may be off)

80
Q

opioids are what type of agonists ?

A

Pure agonists

81
Q

What are examples of Pure aganoists ?

A
  • Morphine
  • Oxycodone
  • Codeine
82
Q

True or False : Pure agonists are potent ?

A

True

83
Q

Do Pure agonists have an analgesic ceiling ?

A

No

84
Q

Do opioids allow for several routes of administration ?

A

Yes

85
Q

Opioids are often combined with what for relief of moderate pain ?

A

nonopijoid analgesic’s

86
Q

opioids are often available in ________ & ___________ release formulations ?

A

Immediate & Sustained

87
Q

What does it mean when “ER” is located behind a medication name ?

A

Extended release

88
Q

What does it mean when “SR” is located behind a medication name ?

A

Sustained release

89
Q

What does it mean when “IR” is located behind a medication name ?

A

Immediate release

90
Q

partial agonists also fall under which category of medications used to treat pain ?

A

opioids

91
Q

What type of agonists are not used as often/almost never ?

A

Partial agonists

92
Q

What are examples of Partial Agonists ?

A
  • Pentazocine (Talwin)

- Butorphanol (stadol)

93
Q

Why aren’t partial agonists used as often for treating pain ?

A
  • Less respiratory depression
  • Increased dysphoria, agitation, and hallucinations
  • Have an analgesic ceiling
94
Q

What is the MOST COMMON side effect of Opioids ?

A

Constipation

95
Q

What are other side effects of opioids ?

A
  • Constipation
  • Nausea/vomiting
  • Sedation
  • Respiratory depression (RR < 8 is definitely cause for concern)
  • Pruritus
    • Some side effects resolve after the medication is taken for a period of time. (not constipation)
96
Q

What is the Antidote for opioids ?

A

Narcan

- Reverses the binding of the opioid to the receptor; ultimately reversing the narcotics effects !

97
Q

When giving Opioids, if the pt’s RR fall below 8bpm, what should be done ?

A

Need to get the Antidote (Narcan) on board immediately !

98
Q

When is Adjuvant Therapy used ?

A

Used in conjunction with opioids and nonopioids

99
Q

What is Adjuvant Therapy ?

A

Generally developed for other purposes, but also effective for pain control under certain circumstances.

100
Q

What are Examples of Adjuvant Therapy ?

A
  • Antidepressants
  • Antiseizure drugs
  • 2-Adrenergic agonists
  • corticosteroids
  • Local anesthetics
101
Q

In regards to Adjuvant Therapy, Antidepressents can help control pain how ?

A

High levels of serotonin & Norepinephrine can block nociceptive singles to the CNS, so it blocks the pain signals. So it may help I that respect!

  • Will not directly help with the pain, but it might help send out those feel good neurotransmitters, to block pain signals to our CNS.
102
Q

In regards to Adjuvant Therapy, how can Corticosteroids help with pain control ?

A

They can help reduce swelling

Good for pt’s with spinal cord pain/injuries

103
Q

Overall, what is the takeaway of Adjuvant Therapy ?

A

Other categories of drugs may be helpful when treating pain, in conjunction with pain medications !

104
Q

In regards to administration of pain meds, Constant pain requires what ?

A

Requires around-the-clock administration (Not PRN)

105
Q

In regards the administration of pain meds, Its important to do what ?

A

Stay AHEAD of pain NOT behind it !!

  • Don’t want to be chasing pain
  • Much harder to catch up on pain than to keep up on it
106
Q

What type of drugs should be used for Breakthrough pain ?

A

Fast-acting drugs

*If take an ER medication, the pt. may need Breakthrough pain medication to fill the gaps

107
Q

What is Titration ?

A

Dose adjustment based on assessment of analgesic effect versus side effects.

108
Q

What do you want to keep in mind when administering pain medications ?

A

Use the smallest dose to provide effective pain control with the fewest side effects

109
Q

What is Equianalgesic dosing ?

A

Dose of one analgesic that is equivalent in pain relieving effects compared with another analgesic

  • Example In Text: Table 8-12
110
Q

What are the different kinds of routes for medication administration ?

A
  • Oral
  • Sublingual and Buccal
  • Intranasal
  • Rectal
  • Transdermal
  • Parenteral routes (IV, SQ, IM, etc.)
  • PCA
  • Intraspinal delivery
111
Q

What is the medication route of choice if there is a functioning GI tract ?

A

Oral

112
Q

What are different types Oral administration ?

A
  • IR (immediate release)
  • Regular onset of action
  • Delayed release
113
Q

what is the buccal route ?

A

in the cheek

114
Q

What medication route Exempts drugs from the first-pass effect ?

A

Sublingual and Buccal

  • because it gets absorbed directly into the bloodstream, as opposed to the oral route where this a first pass effect
115
Q

What kinds of patients are rectal meds best for ?

A
  • Pt’s who can’t take PO meds (i.e.: N/V)
  • decreased level of consciousness
  • can’t swallow properly
116
Q

Who do transdermal pain patches work ?

A

You can place the medication at a specific site

117
Q

What type of pain are transdermal patches used for ?

A

Chronic pain

118
Q

What should you never use a transdermal patch for ?

A

An immediate pain need

119
Q

When dealing with transdermal patches what do you want to make sure to do ?

A

Document where you put the patch and also that you removed it

120
Q

What are parenteral routes ?

A

Anything that is injectable

121
Q

What is the most common parenteral route ?

A

IV

122
Q

What are Examples of Parenteral routes ?

A
  • IV
  • SQ
  • IM
123
Q

Which route of administration is highly potent, and thus requires smaller doses ?

A

parenteral routes

124
Q

Which parenteral rout is fast acting ?

A

IV route

125
Q

when giving meds through the IV route, what should you monitor for ?

A

Respiratory depression

126
Q

What parenteral route does not work as quickly and is not used as often ?

A

SQ route

127
Q

Which parenteral route is not recommended because of variable time for absorption and effectiveness

A

IM route

128
Q

How do Nerve blocks work ?

A

They interrupt any signals going up to the brain or down to the extremities

129
Q

When are nerve block used ?

A

During and after surgery to manage pain

130
Q

What is an example of Nerve blocks ?

A

C-section: Pt’s are alert and awake but they don’t feel anything from the waste down

131
Q

If you have had a nerve block, you automatically get what ?

A

A Foley catheter !

132
Q

What are examples of NONdrug therapies ?

A
  • massage
  • exercise
  • TENS or PENS
  • acupuncture
  • heat or cold therapy
  • cognitive therapies (distraction, hypnosis, imagery, relaxation)
133
Q

How do TENS units work ?

A

Block pain through electrical impulses

134
Q

When patients report pain, how do we want to perceive it ?

A

We need to believe it and not perceive it as “complaining”

135
Q

What is a major ethical issue related to pain management ?

A

Fear of hastening death by administering analgesics

  • Big Myth* - There is actually evidence that opioids will haste the death of a terminally ill patient
  • It is actually our moral obligation to provide comfort and pain relief
136
Q

True or False : The use of placebos in pain assessment and treatment is extremely un-ethical ?

A

True

  • We NEVER give a placebo, instead of pain medications
137
Q

Chronic pain often results in ?

A
  • Depression
  • Sleep disturbances
  • Decreased mobility
  • Decreased health care utilization
  • Physical and social role dysfunction
138
Q

What are the most common painful musculoskeletal conditions of the gerontology population ?

A
  • Osteoarthritis
  • Low back pain
  • Previous fracture sites
139
Q

What barriers do gerontologic pt’s face in terms of pain ?

A
  • Believe that pain is inevitable for aging
  • Greater fear of using opioids
  • Use words like aching, soreness, or discomfort instead of pain
140
Q

What age population metabolizes drugs more slowly ?

A

Gerontologic population

  • Start low and go slow !
141
Q

What age population is at greater risk for adverse effects ?

A

Gerontologic population

142
Q

What is the drug of choice for mild aches in the elderly ?

A

Tylenol

143
Q

Pt’s with a history of substance abuse still have the right for what ?

A

the right to receive effective pain management

144
Q

For Pt’s with a history of substance abuse, increased pain may be a trigger for what ?

A

re-lapse

J2 - Med Surg (16 decks)

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