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
2
Q
Weight loss and increased RR endocrine/metabolic can be caused by what response of untreated acute pain:
A
Increased ACTH (adrenocorticotropic hormone)
3
Q
Increased HR endocrine/metabolic can be caused by what response of untreated acute pain:
A
increased levels of cortisol
4
Q
Shock endocrine/metabolic can be caused by what response of untreated acute pain:
A
Increased leves of antidiuretic hormone (ADH)
5
Q
Glucose intolerance endocrine/metabolic can be caused by what response of untreated acute pain:
A
Increased levels of epinephrine/norepinephrine
6
Q
Hyperglycemia of endocrine/metabolic can be caused by what response of untreated acute pain:
A
increased levels of renin/aldosterone
7
Q
Fluid overload of endocrine/metabolic can be caused by what response of untreated acute pain:
A
Decreased levels of insulin
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)
9
Q
Increased HR of cardiovascular can be caused by what response of untreated acute pain:
A
HTN
10
Q
Angina of cardiovascular can be caused by what response of untreated acute pain:
A
Increased cardiac output
11
Q
MI of cardiovascular can be caused by what response of untreated acute pain:
A
Increased peripheral vascular resistance
12
Q
DVT of cardiovascular can be caused by what response of untreated acute pain:
A
Increased myocardial O2 consumption and increased coagulation
13
Q
Atelectasis of the respiratory can be caused by what response of untreated acute pain:
A
Decreased tidal volume
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
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)
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
17
Q
Immobility of the musculoskeletal can be caused by what response of untreated acute pain:
A
muscle spasms
18
Q
Weakness and fatigue of the musculoskeletal can be caused by what response of untreated acute pain:
A
Impaired muscle function
19
Q
Neurologic confusion can be caused by what response of untreated acute pain:
A
impaired cognitive function
20
Q
Immunologic infection and sepsis can be caused by what response of untreated acute pain:
A
decreased immune response
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
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
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
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)
25
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:
cognitive (ABCs)
26
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:
affective (ABCs)
27
The genetic, anatomic, and physical determents of pain influence how painful stimuli are processed , recognized, and described are all under what dimension of pain:
physiologic
28
What is the framework that acknowledges the multiple dimensions of pain:
biopsychosocial model of pain (physiologic, affective, cognitive, behavioral, and sociocultural
29
The emotional distress of pain or the state of distress associated with loss is defined as:
suffering
30
Which gender experiences more chronic pain, are more likely to report HA, back pain, arthritis; identifies stress as pain:
women
31
What gender are less likely to report pain, reports pain as being controlled, are less likely to use alternative Tx for pain:
men
32
The physiologic process by which info about tissue damage is communicated by the CNS is defined as;
Nocieption
33
What are the four processes of nocieption:
transduction, transmission, perception, modulation
34
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:
Transduction
35
tissue damage is defined as what medical term:
noxious stimuli
36
sunburns is defined as what medical term:
thermal stimuli
37
surgical wounds are defined as what medical term:
mechanical stimuli
38
What happens when noxious stimuli causes cell damage inorder to induce an inflammatory response:
Sensitizing chemicals are released from injured cells: prostaglandins, bradykinin, serotonin, substance P, histamine; inflammation response also occurs
39
What do the sensitizing chemicals do upon release;
They activate nocieptors (specialized receptors or nerve endings) and lead to the generation of action potentials
40
Which of the four processes in pain mechanism will you find action potential occurring and what occurs once action potentials are created:
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
41
During the transduction process of pain mechanism, inflammation and the subsequent release of chemical mediators will do what to nocieptor thresholds:
Inflammation and the release of chemicals will LOWER the nocieptor thresholds INCREASING sensitivity to more pain from non-noxious stimuli (e.g light touch)
42
Increased susceptibility to nocieptor activation is defined as:
peripheral sensitization (The enzyme COX produced by inflammation, plays a key role; sunburn is a clinical example of the definition)
43
Pain produced from activation of peripheral nocieptors is defined as what type of pain:
nociceptive pain
44
Abnormal processing of painful stimuli by the nervous system is defined as:
neuropathic pain
45
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:
NSAIDS, naproxen, corticosteroids exert their analgesic effects by blocking pain-sensitizing chemicals
46
Which of the four processes of pain mechanisms is the movement of pain from the periphery to the spinal cord then to the brain:
Transmission
47
What are the three segments involved with the transmission of nociception signals:
transmission along nocieptors fibers to the spinal cord (A-delta and C fibers); dorsal horn processing; transmission to the thalamus/cerebral cortex
48
In the transmission segment, what is meant by a first-order neuron and how can pain be block:
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
49
Areas on the skin that are innervated by a single spinal cord segment that may cause patterns of rash (shingles) is defined as:
Dermatomes
50
What are the two types of nerves in the transmission of pain and what types of pain are associated with those nerves/fibers?
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)
51
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:
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
52
When enhanced excitability occurs in spinal neurons, it is defined as:
central sensitization (needs to be maintained by pain that travels via C fibers); plays a huge role in chronic pain
53
What can occur with ongoing stimulation of C-fiber nociceptors:
Sprouting WDR (wide dynamic range) neurons and induction of NMDA receptors
54
The process of WDR neurons and NMDA receptors is classified as:
windup (dependent on the activations of NMDA receptors ans is induced by C-fiber inputs)
55
What is the difference between windup and central sensitization and hyperalgesia:
Windup is typically short-lasting whereas central sensitization and hyperalgesia persists over time
56
Central sensitization of the dorsal horn will result in what 4 consequences:
1=hyperalgesia; 2=allodynia; 3=persistant pain; 4=referred pain/secondary hyperalgesia
57
Painful responses to normally innocuous stimuli is defined as:
allodynia
58
Prolonged pain after the original noxious stimulus ends is defined as:
persistent pain
59
The extension of tenderness or increased pain sensitivity outside of an area of injury to include uninjured tissue is defined as
referred pain/secondary hyperalgesia
60
Referred pain of the lungs and diaphragm is located where:
anterior & posterior part of neck
61
Referred pain of the heart is located where:
Cheeks by mouth, between scapulas of back, L pectoralis region w/L arm
62
Referred pain of the liver is located where:
R anterior & posterior part of neck; Lateral to R side of sternum, R part of posterior flank area
63
Referred pain of the ovaries is located where:
anterior and posterior at the hips (2 in from either side of belly button)
64
Referred pain of the appendix is located where:
RLQ
65
Referred pain of the gallbladder is located where:
R anterior and posterior shoulder
66
Referred pain of the stomach is located where:
Midback and near R lateral side of ziphoid process of sternum
67
Referred pain of the kidneys is located where:
Bilateral to posterior spine above/at hips and lateral aspect of RLE of upper thigh
68
Referred pain of the bladder is located where:
Buttocks and inner thighs
69
Release of neurotransmitters belongs to which of the three segments in transmission:
Dorsal horn processing
70
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:
Transmission to thalamus and cortex
71
What therapeutic approaches may be effective in targeting pain transmission of the thalamus and cortex segment in transmission:
opioid analgesics that bind to opioid receptors
72
Which of the four processess occurs when pain is recognized, defined, and responded to by the pt experiencing pain:
Perception
73
Where is the construction of the meaning of pain occurs:
Occurs in the cerebral cortex of the brain
74
These structures of the brain: RAS, somatosensory, limbic system, and the cerebral cortex; are involved with what brain processess:
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
What therapies work best during the perception process of pain mechanism:
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
Which of the four processess is where an action potential continues from site of injury to spinal cord-->brainstem/thalamus-->cortex for processing:
Transmission
77
Which of the four processes of pain mechanism is where conscious experience of pain takes place:
Perception
78
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:
Modulation
79
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:
Modulation
80
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:
Modulation (REMEMBER ENDOGENOUS OPIOIDS, serotonin, norepinephrine)
81
IN the modulatory systems of the Modulation process of pain, what type of meds work at the: periphery, spinal cord, brainstem, and cerebral cortex:
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
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:
Gate control theory (heat and pressure can cause the gate to close on pain signals)
83
Pain is classified in what two categories:
nociceptive or neuropathic
84
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:
nociceptive pain
85
Pain that's superficial or deep is further classified as:
Somatic pain
86
Pain arising from the skin, mucous membranes, subcut; often described as sharp, burning, prickly and tends to be well localized is defined as:
superficial somatic pain
87
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:
Deep somatic pain
88
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:
visceral pain
89
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:
Neuropathic pain
90
What are the ABCs of pain:
Affective (emotional response), Behavioral (observable actions), Cognitive (beliefs, attitudes, memories, perceptions)
91
Which of the two types of pain is a sudden/slow onset regardless of intensity for less than 3 mo:
Acute pain
92
Which of the two types of pain is prolong, and persists over 3 mo, and wax or wane over time:
Chronic pain
93
Increased HR/RR/BP, diaphoresis/pallor, anxiety, agitation, confusion, urinary retention are manifestations cause by what type of pain:
acute pain
94
Flat affect, decreased physical movement/activity, fatigue, social withdrawal are behavioral manifestions of which type of pain:
chronic pain
95
Untreated acute pain can lead to:
chronic pain through central sensitization
96
What type of pain arises from the skin & subcut:
cutaneous
97
What is a type of pain that's perceived at the source of pain and extends to nearby tissue:
radiating
98
What type of pain is felt in a part of the body that is considerably removed from the tissue causing pain:
referred
99
Pain that's highly resistant to TX, difficult to manage w/standard interventions (advance CA) is defined as:
intractable
100
A painful sensation perceived in body part that is missing (limb) is defined as:
phantom
101
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...
...goals of nsg pain assessment
102
When asking older pts if they have pain, what should you expect or listen for:
Older adults may deny that they have pain, but may respond positively if the nsg asks if they have any soreness or aching.
103
Subjective assessment of pain should include:
-personal report, OLDCART
104
Objective assessment of pain should include:
parameters (V/S), direct observations of pt's behaviors
105
When would a FLACC SCALE be used:
A pain scale used for non-verbal pts
106
How is mild, moderate, and severe pain numbered:
mild=1-3; moderate=4-6; severe=7-10
107
What does the Mnemonics OLDCART stand for:
Onset, Location, Characteristics, Aggravated, Relieved, Tx
108
Transient, moderate to severe pain that occurs in pts whose pain is otherwise well controlled is defined as:
breakthrough pain
109
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:
Nurse Practice Act 1997
110
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:
BRN
111
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:
JCAHO standards
112
The fear of hastening death by administration of narcotics; physician assisted suicides, and use of placebos are what type of issues:
Ethico-legal issues
113
Therapeutic communications, guided imagery; anticipatory guidance; distraction; breathing exercises; relaxation techniques are all types of what intervention:
Independent Nsg interventions
114
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:
Collaborative interventions
115
The adjustment of dosage medication to obtain efficacy with the least side effects is defined as:
Titration of drugs
116
Administration of pain meds prior to painful procedures is defined as:
Preemptive analgesia
117
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:
placebos
118
Which step of the WHO ladder are opioids (like morphine) given for pain @ 7-10
step 3
119
Which step of the WHO ladder are non-opioids (NSAIDs) given for 1-3 level of pain:
step 1
120
Which step of the WHO ladder is when opioids (oxycodone, codeine) are given for 4-6 level of pain
step 2
121
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):
NSAIDs
122
What medications can inhibit the cehemicals that activate the peripheral afferent nociceptors (PAN):
non-opioids
123
Acetaminophen can cause what common side effect:
hepatoxicity if dose is >400 mg
124
Aspirin can have what most common side effect:
bleeding and gastric upset
125
NSAIDs can cause what most common side effect:
upper GI bleed
126
What are the 2 most common side effects for non-opioids:
Bleeding and GI disturbances
127
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:
acute opioid naive pt
128
What mechanisms does using adjuvant meds: antidepressants, antisz, muscle relaxants, local anesthetics:
used as adjuvant analgesic
129
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:
Lil wayne (sz) chronic opioid tolerant pt
130
What are the types of pharmacologic pain interventions currently recommended:
multimodel approach, adjuvent meds, nerve blocks
131
TENS (electric shock), Heat, cold are what type of therapies:
physical therapies
132
Assisting with ADLs, music, recreation are what types of therapy:
occupational therapy
133
Innovations of pain managment include: Neural blockads, gabapentin, and opioid polymorphism. What do they mean
Killing the nerves, antisz used for pain (adjuvnt analgesic), genetic research where wach pt reacts differently to a specific med
134
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:
"low and slow; non-pharm approach such as complimentary and alternative intervention
