N212 Lecture 7 Flashcards
The IASP defines pain as
an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
McCafferys definition of pain
pain is whatever the experiencing person says it is, existing whenever he says it does
Effective pain management improves
quality of life, reduce physical discomfort, promotes earlier mobilization
The four physiological processes of normal pain are
transduction, transmission, perception, modulation
Transduction, 1st pain process
- begins in the periphery when a pain stimuli sends a impulse across a sensory nerve pain fiber (nociceptor), this initiates an action potential
neurotransmitters affect the nerve stimuli by
excite during transmission or inhibit during modulation
What enhances transmission of the pain impulse
excitatory neurotransmitters send impulses across the synaptic cleft between 2 nerve fibers
the cause of the inflammatory response and spreading the pain message is due to
the pain sensitizing substances surrounding the pain fibers in the extracellular fluid
When the pain stimulus reaches the cerebral cortex the brain interprets it as
the quality of the pain and process information from past experience, knowledge and cultural associations in perception of pain
perception is
the point at which a person is aware of the pain
the intensity and location of the pain is identified by
somatosensory cortex
what determines how a person feels about pain
the associated cortex, primarily the limbic system
the pain center is in one location
false, there is no single pain center
as a person becomes aware of pain what occurs
a complex reaction
psychological and cognitive factors interact with
neurophysiological ones
perception gives
awareness and meaning to pain, resulting in a reaction
the reaction to pain includes
physiological and behavioral responses that occur
nerve impulses from pain travel along
afferent sensory peripheral nerve fibers
the two types of peripheral nerve fibers that conduct painful stimuli
the fast myelinated A delta fibers and the small/slow unmyelinated C fibers
the A fibers send
sharp, localized distinct sensations
the C fibers relay impulses that
are poorly localized, visceral and persistent
modulation is
the release of inhibitory neurotransmitters ( endorphins/endogenous opioids, serotonin, norepinephrine, GABA) which hinder pain to produce analgesic effect
A delta fibers send sensory impulses to the spinal cord to
synapse with spinal motor neurons
spinal motor neurons travel via reflex arc along efferent nerve fibers to
a peripheral muscle near the site of stimulation, bypassing the brain
contraction of the muscle leads to
a protective withdrawal from the source of pain
pain processes require
an intact nervous system and spinal cord
the factors that disrupt pain process are
trauma, drugs, tumor growth and metabolic disorders
stimulation of the sympathetic branch of the ANS results in
physiological response
patients in pain always have changes in vital signs, true or false
false, patients in pain do not always have changes in vital signs
what are some behavioral responses to pain
clenching teeth, facial grimacing, holding painful part
what influences our perception when it comes to pain
patients ability to tolerate pain
patients who have low pain tolerance are sometimes
inaccurately perceived as complainers
how is pain caterogized
duration(chronic or acute) or pathology (cancer or neuropathic)
whats the primary nursing goal when it comes to pain
to provide pain relief that allows patients to participate in their recovery, prevent complications and improve functional status
chronic pain lasts longer than normal pain which can be
cancerous or noncancerous
examples of chronic noncancerous pain are
arthritis, headache, low back pain, peripheral neuropathy
referred pain is
pain at the actual site of the tumor or distant to the site
when there is no obvious source of pain healthcare providers stereotype patients as
malingerers, complainers, or difficult patients
a nurses personal opinion about a patients report of pain does what?
affects pain assessment and titration of opioid doses
pain is apart of aging, true or false
false its not apart of aging
pain perception does decrease with age, true or false
false, pain perception does not decrease with age
pain in older adults requires
aggressive assessment, diagnosis and management
increased attention is associated with increased pain whereas distraction is associated with
diminished pain response
when in pain spirituality stretches beyond what ?
religion
what increases the perception of pain
anxiety
anxiolytic medications are not a substitute for
analgesia
pain is a lonely experience which causes patients to feel loss of control but coping style influences
the ability to deal with pain
persons with internal loci of control perceive
having control over events in their life and the outcomes such as pain
persons with external loci perceive
other factors in their life such as nurses are responsible for the outcome
successful critical thinking for pain requires
knowledge, experience, information gathered from patients, critical thinking attitudes intellectual and professional standards
successful pain management means pain elimination, true or false
false, it means attainment of a mutually agreed on pain relief goal that allows patient to control their pain
whats the first step in helping patient regain control of pain
asking a patient about his or her tolerable pain level
abc’s of pain management
ask ( pain regularly), believe(patient and family in their report of pain), choose ( pain control options), deliver ( interventions in a timely fashion) and empower( them to control their course)
is pain static or dynamic
dynamic
a patients self report of pain is
the most reliable indicator of existence and intensity
when assessing patient for pain we ask
onset of pain, duration of pain and time sequence
the most subjective and useful characteristic for pain is
severity
an accurate nursing clinical problem may be made only after you
perform a complete assessment
one strategy for planning care is
concept map
whats the outcome of care for patients with pain
helping them learn how to manage their pain
relaxation and guided imagery allow patients to
alter affective motivational and cognitive pain perception
relaxation is
mental and physical freedom form tension or stress that provides individuals a sense of self control
a form of cutaneous stimulation is
transcutaneous electrical nerve stimulation (TENS) -stimulates of the skin with mild electrical current
most common and effective method of pain relief is
analgesics
3 types of analgesics
nonopioids (acetaminophen and NSAIDS), opioids (traditionally narcotics), co analgesics or adjuvants ( variety of medications that enhance analgesics or have analgesics properties that were originally unknown)
nsaids work on
peripheral nerve receptors to reduce transmission of pain stimuli
Provides mild to moderate pain relief
nsaids
has no anti inflammatory or antiplatelet effects
acetaminophen
long term use of nonopiods is associated with
GI bleeding and renal insufficiency
prescribed for moderate to severe pain
opioids
one adverse effect of opioids is
sedation that precedes respiratory depression
to maximize pain relief with opioid use is
administer analgesics around the clock rather than prn
when switching from IV to oral form of opioid its much higher because
the first pass effect of medication metabolized in the liver
opioids are usually necessary and effective for
acute pain and cancer pain of moderate or severe intensity
patients at higher risk for opioid related adverse drug events, true or false
true
why should you avoid partial doses at more frequent intervals for opioids
to not under dose patients with small, frequent ineffective doses
adjuvants and co analgesics are
used to treat other conditions but have analgesics qualities
what is PCA
patient controlled analgesia involving IV or subq drug administration
range for PCA to deliver a dose at specific time intervals
range of 8-15 minutes
commonly used topical agents include
nsaid products (ketoprofen patch) and capsaicin
Eutectic mixture of local anesthetics (EMLA) are not used around the eyes, tympanic membrane or over large surfaces, true or false
true
lidoderm patch is used for cutaneous neuropathic pain, postherpetic neuralgia, true or false
true
lidoderm patch use a 12 hour on and 12 hour off schedule, true or false
true
local anesthesia is during brief surgical procedures such as skin lesion, suturing a wound, true or false
true
regional anesthesia is
injection or infusion of local anesthetics to block a group of sensory nerve fibers
a perinerural local anesthetic infusion is when the surgeon
places the tip of an unsutured catheter near a nerve or group of nerves and catheter exits from the surgical wound
common side effects of topical applications of local anesthetics are
pruritus or burning of the skin or localizes rash
applying local anesthetics to a vascular mucous membrane will
increase chance of systemic effects such as increased heart rate
the use of local anesthetics in peripheral nerve and epidural infusions may block motor nerves as well as sensory nerves, true or false
true
epidural analgesia effectively treats
acute postoperative pain, rib fracture pain, labor and delivery, chronic cancer pain
epidural analgesia is short or long term depending on patients condition, true or false
true
cancer pain is either chronic or acute, true or false
true
the american pain society primary goal in treating chronic noncancer pain with opioids is
increase patients level of function
patients on chronic opioid therapy require
monitoring and follow ups
when patients are unable to swallow, have nausea or vomiting, or near death we administer analgesics by
rectally
patient barriers for effective pain management
fear of addiction, side effects, fear of tolerance
health care barriers for effective pain management
inadequate pain assessment, no pain management protocols, concern with addiction or accidental overdose
healthcare system barriers for effective pain management
concern with creating addicts, difficulty filling Rx, limitation on reimbursement for Rx
experiencing a physical dependency does not imply addiction, true or false
true
what does a comprehensive pain center do
treat persons on an inpatient or outpatient basis
the goal for palliative care is
to learn to live life fully with an incurable condition
what does hospice do
helps terminally ill patient continue to live at home or in a health care setting in comfort
main priority for hospices
pain control
a patients behavioral responses to pain relief interventions are not always obvious, true or false
true
