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Med Surg II > Lewis on Pain 127- > Flashcards

Lewis on Pain 127- Flashcards

1
Q

Among health care providers, what are the three reasons for the under-treatment of pain:

A

inadequate knowledge/skills to tx pain; unwillingness to believe pt’s report of pain; lack of time/expertise; inadequate/inaccurate info of pt’s tolerance/addiction to drugs

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2
Q

Weight loss and increased RR endocrine/metabolic can be caused by what response of untreated acute pain:

A

Increased ACTH (adrenocorticotropic hormone)

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3
Q

Increased HR endocrine/metabolic can be caused by what response of untreated acute pain:

A

increased levels of cortisol

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4
Q

Shock endocrine/metabolic can be caused by what response of untreated acute pain:

A

Increased leves of antidiuretic hormone (ADH)

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5
Q

Glucose intolerance endocrine/metabolic can be caused by what response of untreated acute pain:

A

Increased levels of epinephrine/norepinephrine

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6
Q

Hyperglycemia of endocrine/metabolic can be caused by what response of untreated acute pain:

A

increased levels of renin/aldosterone

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7
Q

Fluid overload of endocrine/metabolic can be caused by what response of untreated acute pain:

A

Decreased levels of insulin

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8
Q

HTN/Urinary retention/decreased urin output of endocrine/metabolic can be caused by what response of untreated acute pain:

A

gluconeogenesis (HTN) and glycogenesis (urine related)

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9
Q

Increased HR of cardiovascular can be caused by what response of untreated acute pain:

A

HTN

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10
Q

Angina of cardiovascular can be caused by what response of untreated acute pain:

A

Increased cardiac output

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11
Q

MI of cardiovascular can be caused by what response of untreated acute pain:

A

Increased peripheral vascular resistance

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12
Q

DVT of cardiovascular can be caused by what response of untreated acute pain:

A

Increased myocardial O2 consumption and increased coagulation

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13
Q

Atelectasis of the respiratory can be caused by what response of untreated acute pain:

A

Decreased tidal volume

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14
Q

PNA of the respiratory can be caused by what complications of untreated acute pain:

A

hypoxemia due to decreased cough and sputum retention

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15
Q

Fluid imbalances and electrolyte disturbances of the renal/urologic can be caused by what response of untreated acute pain:

A

Decreased urinary output (fluid imbalance) and urinary retention (electrolyte disturbances)

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16
Q

Constipation, anorexia, and paralytic ileus of the GI can be caused by what response of untreated acute pain:

A

Decreased gastric and intestinal motility

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17
Q

Immobility of the musculoskeletal can be caused by what response of untreated acute pain:

A

muscle spasms

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18
Q

Weakness and fatigue of the musculoskeletal can be caused by what response of untreated acute pain:

A

Impaired muscle function

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19
Q

Neurologic confusion can be caused by what response of untreated acute pain:

A

impaired cognitive function

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20
Q

Immunologic infection and sepsis can be caused by what response of untreated acute pain:

A

decreased immune response

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21
Q

Who defines pain as “whatever the person experiencing the pain says it is, existing whenever the person says it does:”

A

Margo McCaffery

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22
Q

Who states that’ “pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage:”

A

IASP: internal association study of pain

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23
Q

Demographics, support systems, social roles, culture, age/gender influence nocieptive processes and response to opioids; families and care givers influence pt’s response to pain; cultural affects pain expression all falls under what dimension of pain:

A

Sociocultural

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24
Q

Observable actions used to express or control pain (e.g. facial expressions); people unable to communicate may have behavioral changes are all under what dimension of pain:

A

behavioral (ABCs)

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25
Q

The beliefs, attitudes, memories, and meaning attributed to pain influences the way in which a pt responds to pain; includes pain related beliefs and cognitive coping strategies used to deal with pain are all under what dimension of pain:

A

cognitive (ABCs)

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26
Q

Emotional responses to pain such as anger, fear, depression, and anxiety; negtive emotions impair pt’s quality of life; negative link between depression resulting in impaired function are all under what dimension of pain:

A

affective (ABCs)

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27
Q

The genetic, anatomic, and physical determents of pain influence how painful stimuli are processed , recognized, and described are all under what dimension of pain:

A

physiologic

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28
Q

What is the framework that acknowledges the multiple dimensions of pain:

A

biopsychosocial model of pain (physiologic, affective, cognitive, behavioral, and sociocultural

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29
Q

The emotional distress of pain or the state of distress associated with loss is defined as:

A

suffering

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30
Q

Which gender experiences more chronic pain, are more likely to report HA, back pain, arthritis; identifies stress as pain:

A

women

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31
Q

What gender are less likely to report pain, reports pain as being controlled, are less likely to use alternative Tx for pain:

A

men

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32
Q

The physiologic process by which info about tissue damage is communicated by the CNS is defined as;

A

Nocieption

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33
Q

What are the four processes of nocieption:

A

transduction, transmission, perception, modulation

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34
Q

Which one of the four processes of pain mechanisms is the conversion of a noxious mechanical, thermal, or chemical stimulus into an electrical signal called an action potential; occurs at peripheral nociceptors; releases sensitizing chemicals inducing an inflammatory response:

A

Transduction

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35
Q

tissue damage is defined as what medical term:

A

noxious stimuli

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36
Q

sunburns is defined as what medical term:

A

thermal stimuli

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37
Q

surgical wounds are defined as what medical term:

A

mechanical stimuli

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38
Q

What happens when noxious stimuli causes cell damage inorder to induce an inflammatory response:

A

Sensitizing chemicals are released from injured cells: prostaglandins, bradykinin, serotonin, substance P, histamine; inflammation response also occurs

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39
Q

What do the sensitizing chemicals do upon release;

A

They activate nocieptors (specialized receptors or nerve endings) and lead to the generation of action potentials

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40
Q

Which of the four processes in pain mechanism will you find action potential occurring and what occurs once action potentials are created:

A

The creation of action potentials occur in the transduction process of pain mechanism; Action potentials are carried from the nocieptors to the spinal cord via A-delta and C fibers

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41
Q

During the transduction process of pain mechanism, inflammation and the subsequent release of chemical mediators will do what to nocieptor thresholds:

A

Inflammation and the release of chemicals will LOWER the nocieptor thresholds INCREASING sensitivity to more pain from non-noxious stimuli (e.g light touch)

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42
Q

Increased susceptibility to nocieptor activation is defined as:

A

peripheral sensitization (The enzyme COX produced by inflammation, plays a key role; sunburn is a clinical example of the definition)

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43
Q

Pain produced from activation of peripheral nocieptors is defined as what type of pain:

A

nociceptive pain

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44
Q

Abnormal processing of painful stimuli by the nervous system is defined as:

A

neuropathic pain

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45
Q

What types of therapies are most commonly used to alter the local environment or sensitivity of the peripheral nocieptors to prevent transduction/initiation of action potentials via decreasing the effects of chemicals released at the periphery:

A

NSAIDS, naproxen, corticosteroids exert their analgesic effects by blocking pain-sensitizing chemicals

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46
Q

Which of the four processes of pain mechanisms is the movement of pain from the periphery to the spinal cord then to the brain:

A

Transmission

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47
Q

What are the three segments involved with the transmission of nociception signals:

A

transmission along nocieptors fibers to the spinal cord (A-delta and C fibers); dorsal horn processing; transmission to the thalamus/cerebral cortex

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48
Q

In the transmission segment, what is meant by a first-order neuron and how can pain be block:

A

A first order neuron has no synapses as it extends the entire distance from the periphery to the dorsal horn of the spinal cord; pain can be block by sodium channel blockers or disruption of signal via a lesion

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49
Q

Areas on the skin that are innervated by a single spinal cord segment that may cause patterns of rash (shingles) is defined as:

A

Dermatomes

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50
Q

What are the two types of nerves in the transmission of pain and what types of pain are associated with those nerves/fibers?

A

A-delta (conducts pain rapidly due to myelinated fibers; pricking sharp pain; short duration pain) and C fibers (unmyelinated fibers transmits pain more slowly; dull, aching pain; slow onset;long duration/chronic pain)

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51
Q

Where is nociceptive signal processed when it arrives in the CNS eventually releasing neurotransmitters and which of the three segments of pain mechanism is involved:

A

Once a nociceptive signal arrives in the CNS, it is processed w/in the dorsal horn of the spinal cord and releases neurotransmitters ; Dorsal horn processing

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52
Q

When enhanced excitability occurs in spinal neurons, it is defined as:

A

central sensitization (needs to be maintained by pain that travels via C fibers); plays a huge role in chronic pain

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53
Q

What can occur with ongoing stimulation of C-fiber nociceptors:

A

Sprouting WDR (wide dynamic range) neurons and induction of NMDA receptors

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54
Q

The process of WDR neurons and NMDA receptors is classified as:

A

windup (dependent on the activations of NMDA receptors ans is induced by C-fiber inputs)

55
Q

What is the difference between windup and central sensitization and hyperalgesia:

A

Windup is typically short-lasting whereas central sensitization and hyperalgesia persists over time

56
Q

Central sensitization of the dorsal horn will result in what 4 consequences:

A

1=hyperalgesia; 2=allodynia; 3=persistant pain; 4=referred pain/secondary hyperalgesia

57
Q

Painful responses to normally innocuous stimuli is defined as:

A

allodynia

58
Q

Prolonged pain after the original noxious stimulus ends is defined as:

A

persistent pain

59
Q

The extension of tenderness or increased pain sensitivity outside of an area of injury to include uninjured tissue is defined as

A

referred pain/secondary hyperalgesia

60
Q

Referred pain of the lungs and diaphragm is located where:

A

anterior & posterior part of neck

61
Q

Referred pain of the heart is located where:

A

Cheeks by mouth, between scapulas of back, L pectoralis region w/L arm

62
Q

Referred pain of the liver is located where:

A

R anterior & posterior part of neck; Lateral to R side of sternum, R part of posterior flank area

63
Q

Referred pain of the ovaries is located where:

A

anterior and posterior at the hips (2 in from either side of belly button)

64
Q

Referred pain of the appendix is located where:

A

RLQ

65
Q

Referred pain of the gallbladder is located where:

A

R anterior and posterior shoulder

66
Q

Referred pain of the stomach is located where:

A

Midback and near R lateral side of ziphoid process of sternum

67
Q

Referred pain of the kidneys is located where:

A

Bilateral to posterior spine above/at hips and lateral aspect of RLE of upper thigh

68
Q

Referred pain of the bladder is located where:

A

Buttocks and inner thighs

69
Q

Release of neurotransmitters belongs to which of the three segments in transmission:

A

Dorsal horn processing

70
Q

Nocieptive stimuli that are transmiited from the dorsal horn of the spinal cord to the third-order neuron, in the thalamus, and to other areas of the brains is which of the three segments of transmission:

A

Transmission to thalamus and cortex

71
Q

What therapeutic approaches may be effective in targeting pain transmission of the thalamus and cortex segment in transmission:

A

opioid analgesics that bind to opioid receptors

72
Q

Which of the four processess occurs when pain is recognized, defined, and responded to by the pt experiencing pain:

A

Perception

73
Q

Where is the construction of the meaning of pain occurs:

A

Occurs in the cerebral cortex of the brain

74
Q

These structures of the brain: RAS, somatosensory, limbic system, and the cerebral cortex; are involved with what brain processess:

A

RAS=warning to attend to pain; somatosensory=localization/characterization of pain; limbic system=emotional/behavioral responses to pain; cerebral cortex=construction of the meaning of pain

75
Q

What therapies work best during the perception process of pain mechanism:

A

Behavioral strategies such as diversional activities or relaxation to reduce sensory and affective components of pain; antiseizures/antidepressants/opioids work by modifying pain perception

76
Q

Which of the four processess is where an action potential continues from site of injury to spinal cord–>brainstem/thalamus–>cortex for processing:

A

Transmission

77
Q

Which of the four processes of pain mechanism is where conscious experience of pain takes place:

A

Perception

78
Q

Which of the four processes of pain mechanism is where we find neurons originated in the brainstem descending to the spinal cord and releasing substances (endogenous substances) that inhibit nociceptive impulses:

A

Modulation

79
Q

Which of the four processes of pain mechanisms involves the activation of descending pathways that exert inhibitory or facilitatory effects on the transmission of pain:

A

Modulation

80
Q

Which of the four processes of pain mechanisms can induce alterations of pain signals occuingr at the periphery, spinal cord, brainstem, and cerebral cortex where descending fibers release chemicals (serotonin, norepinephrine, endogenous opioids) to inhibit pain transmission:

A

Modulation (REMEMBER ENDOGENOUS OPIOIDS, serotonin, norepinephrine)

81
Q

IN the modulatory systems of the Modulation process of pain, what type of meds work at the: periphery, spinal cord, brainstem, and cerebral cortex:

A

Peripheral nocieptors=antiinflammatory, local anesthetics; peripheral nerve=local anesthetics; dorsal horn=local anesthetics, opioids, alpha2 agonists; brainstem and cerebral cortex=opioids and alpha2 agonists (antidepressants may be used to potentiate norepinephrine inhibitory of pain)

82
Q

When a limited amount of sensory info that can reach the brain, from the dorsal horn, at a given time; stimulation (heat or pressure) of lrg nerve fibers by interventions can inhibit transmission of painful stimuli is defined as:

A

Gate control theory (heat and pressure can cause the gate to close on pain signals)

83
Q

Pain is classified in what two categories:

A

nociceptive or neuropathic

84
Q

Pain caused by damage to somatic or visceral tissue; aching and throbbing; normal processing of stimulus that damages normal tissue and is usually responsive to nonopioid/opioid drugs is defined as:

A

nociceptive pain

85
Q

Pain that’s superficial or deep is further classified as:

A

Somatic pain

86
Q

Pain arising from the skin, mucous membranes, subcut; often described as sharp, burning, prickly and tends to be well localized is defined as:

A

superficial somatic pain

87
Q

Pain that arises from the bones, tendons, joints, muscles, bld vessels/nerves, skin, or connective tissue; characterize as throbbing, aching, localized/diffused/radiating is defined as:

A

Deep somatic pain

88
Q

Pain that comes from the activation of nociceptors in the internal organs and lining of the body cavities (thoracic, abd cavities) characterize by response to inflammation, stretching, ischemia causing intense cramping, referred to cutaneous sites is defined as:

A

visceral pain

89
Q

Abnormal processing of pain that’s caused by damage to peripheral nerves or structures in he CNS; characterized by numbing, long-lasting, hot-burning, shooting, stabbing, sharp, or electric shock, treated by adjuvant analgesics is defined as:

A

Neuropathic pain

90
Q

What are the ABCs of pain:

A

Affective (emotional response), Behavioral (observable actions), Cognitive (beliefs, attitudes, memories, perceptions)

91
Q

Which of the two types of pain is a sudden/slow onset regardless of intensity for less than 3 mo:

A

Acute pain

92
Q

Which of the two types of pain is prolong, and persists over 3 mo, and wax or wane over time:

A

Chronic pain

93
Q

Increased HR/RR/BP, diaphoresis/pallor, anxiety, agitation, confusion, urinary retention are manifestations cause by what type of pain:

A

acute pain

94
Q

Flat affect, decreased physical movement/activity, fatigue, social withdrawal are behavioral manifestions of which type of pain:

A

chronic pain

95
Q

Untreated acute pain can lead to:

A

chronic pain through central sensitization

96
Q

What type of pain arises from the skin & subcut:

A

cutaneous

97
Q

What is a type of pain that’s perceived at the source of pain and extends to nearby tissue:

A

radiating

98
Q

What type of pain is felt in a part of the body that is considerably removed from the tissue causing pain:

A

referred

99
Q

Pain that’s highly resistant to TX, difficult to manage w/standard interventions (advance CA) is defined as:

A

intractable

100
Q

A painful sensation perceived in body part that is missing (limb) is defined as:

A

phantom

101
Q

To describe the pt’s multidimensional pain experience for the purpose of identifying and implementation of pain management, and to identify the pt’s goal for therapy and resources for self management are…

A

…goals of nsg pain assessment

102
Q

When asking older pts if they have pain, what should you expect or listen for:

A

Older adults may deny that they have pain, but may respond positively if the nsg asks if they have any soreness or aching.

103
Q

Subjective assessment of pain should include:

A

-personal report, OLDCART

104
Q

Objective assessment of pain should include:

A

parameters (V/S), direct observations of pt’s behaviors

105
Q

When would a FLACC SCALE be used:

A

A pain scale used for non-verbal pts

106
Q

How is mild, moderate, and severe pain numbered:

A

mild=1-3; moderate=4-6; severe=7-10

107
Q

What does the Mnemonics OLDCART stand for:

A

Onset, Location, Characteristics, Aggravated, Relieved, Tx

108
Q

Transient, moderate to severe pain that occurs in pts whose pain is otherwise well controlled is defined as:

A

breakthrough pain

109
Q

Who stated that the Rn is to provide direct/indirect pt care services should ensure the comfort of pt; and that management of pt’s pain is a nsg function incorporated w/in the RN’s role as a pt’s advocate:

A

Nurse Practice Act 1997

110
Q

Who adopted a pain management policy and curriculum that requires facilities to educate staff on pain management and to integrate pain as a 5th vital sign:

A

BRN

111
Q

Whose standards require that pts should: be involved in their care, have the right for appropriate assessment/management of pain, all pts are assessed for pain, procedures are implemented for safe medications, and pts should be educated on pain management:

A

JCAHO standards

112
Q

The fear of hastening death by administration of narcotics; physician assisted suicides, and use of placebos are what type of issues:

A

Ethico-legal issues

113
Q

Therapeutic communications, guided imagery; anticipatory guidance; distraction; breathing exercises; relaxation techniques are all types of what intervention:

A

Independent Nsg interventions

114
Q

Pharmacological management in using the WHO ladder; types of medications: non-opioids=analgesics, opioids=narcotics, adjuvant=coanalgesics in enhancing pain treatment ware all what type of interventions:

A

Collaborative interventions

115
Q

The adjustment of dosage medication to obtain efficacy with the least side effects is defined as:

A

Titration of drugs

116
Q

Administration of pain meds prior to painful procedures is defined as:

A

Preemptive analgesia

117
Q

Any medication or procedure, including surgery, that produces an effect in a pt that’s not due to specific chemical or physical properties is defined as:

A

placebos

118
Q

Which step of the WHO ladder are opioids (like morphine) given for pain @ 7-10

A

step 3

119
Q

Which step of the WHO ladder are non-opioids (NSAIDs) given for 1-3 level of pain:

A

step 1

120
Q

Which step of the WHO ladder is when opioids (oxycodone, codeine) are given for 4-6 level of pain

A

step 2

121
Q

What type of non-opioids are potent analgesia for inflammation and bone pain, can potentiate analgesic effects when used with opioids, and has an opioid-sparing effect (allows a reduction in dose of opioids due to potentiating the analgesic effect):

A

NSAIDs

122
Q

What medications can inhibit the cehemicals that activate the peripheral afferent nociceptors (PAN):

A

non-opioids

123
Q

Acetaminophen can cause what common side effect:

A

hepatoxicity if dose is >400 mg

124
Q

Aspirin can have what most common side effect:

A

bleeding and gastric upset

125
Q

NSAIDs can cause what most common side effect:

A

upper GI bleed

126
Q

What are the 2 most common side effects for non-opioids:

A

Bleeding and GI disturbances

127
Q

Which type of side effect (acute or chronic) to opioids would you see in a pt with N/V, sedation, respiratory depression, pruiritus, urinary retention, constipation:

A

acute opioid naive pt

128
Q

What mechanisms does using adjuvant meds: antidepressants, antisz, muscle relaxants, local anesthetics:

A

used as adjuvant analgesic

129
Q

Which type of side effect (acute or chronic) to opioids would you see in a pt with: N/V, constipation, myocionus (sz due to high doses), urinary retention:

A

Lil wayne (sz) chronic opioid tolerant pt

130
Q

What are the types of pharmacologic pain interventions currently recommended:

A

multimodel approach, adjuvent meds, nerve blocks

131
Q

TENS (electric shock), Heat, cold are what type of therapies:

A

physical therapies

132
Q

Assisting with ADLs, music, recreation are what types of therapy:

A

occupational therapy

133
Q

Innovations of pain managment include: Neural blockads, gabapentin, and opioid polymorphism. What do they mean

A

Killing the nerves, antisz used for pain (adjuvnt analgesic), genetic research where wach pt reacts differently to a specific med

134
Q

Because older pts metabolize drugs more slowly and NSAIDS may cause GI bleeds, opioids causes bowel obstruction due to constipation, what would be a more effective type of therapy:

A

“low and slow; non-pharm approach such as complimentary and alternative intervention

Med Surg II (3 decks)

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