Neurological system (Pain)

Question 1

Pain

Answer 1

Defined as an unpleasant sensory and emotional experience

Associate with actual or potential tissue damage or described in terms of such damage

Question 2

Pain assessment tools

Answer 2

• Initial pain assessment
  (-) Ask patient questions about the pain using COLDSPA
• Brief pain inventory
  (-) using a scale to rate the pain within the past 24 hours
• McGill Questionnaire
  (-) Ask patient to rank a list of descriptors in terms of their intensity and to give an overall intensity rating to his or her pain

Question 3

Three main pain rating scales

Answer 3

The FLACC (face, legs, activity, crying and consolability)

Wong-Baker Faces pain rating scale

Numeric Rating Scale

Question 4

Complex regional pain syndrome (CRPS)

Answer 4

is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg

Question 5

Factors influencing the perception of pain

Answer 5

 Past experience
 Anxiety and Depression
 Culture
 Gender
 Genetics

Question 5

Harmful effects of Pain

Answer 5

Unrelieved pain causes
 Undue suffering
 Sleep deprivations – produces hyperalgesic changes.
 Pulmonary, cardiovascular, gastrointestinal, endocrine and immunological changes
 Promotes tumor growth
 Depression and disability

Question 6

Types of pain

Answer 6

Acute
Chronic
Cancer-related pain

Question 7

Acute pain

Answer 7

• Sudden onset
  
  • Associated with a specific injury
  • Last no longer than the healing of trauma or injury
  • Lasts from 6 seconds to 6 months

Question 8

Chronic pain/ persistent pain

Answer 8

 Often has a poorly defined onset
 Lasts beyond 6 months
 Pain that is intermittent or constant and lasts beyond the expected time of healing

Question 9

Cancer related pain

Answer 9

 May be acute or chronic

 May be associated with tumors or cancer treatment (radiation, surgery)

Question 10

Classification

Answer 10

• Nociceptive pain
• Visceral pain
• Neuropathic pain

Question 11

Nociceptive pain

Answer 11

 Somatic (result of thermal, mechanic, or chemical injury)
 Skeletal muscle, fascia , joints, tendons, cornea
 May be sharp ,pricking or sticking in nature

Question 12

Visceral pain

Answer 12

 Result of inflammation, stretching, ischemia, dilation of internal organs

 May be dull aching cramping in nature

Question 13

Neuropathic pain

Answer 13

 Occurs there has been damage to the peripheral nervous system
 Pain continues after healing has taken place
 May be also associated with a diabetic neuropathy
 Post herpetic neuralgia (Shingles)
 May be described as burning in nature

Question 14

Pain classified by etiology

Answer 14

 Post Mastectomy Syndrome
 Hemiplegia-Associated Shoulder Pain Syndrome
 Pain Associated with Sickle Cell Disease
 Aids Related Pain
 Burn Pain

Question 15

Pain classified by location

Answer 15

 Abdominal Pain
 Headaches
 Chest pain

Question 16

Goals for pain management

Answer 16

 Based on the client’s needs
 No Pain
 Reduced pain
 Reduced on the person’s ability to function
 Person’s ability to rest

Question 17

Management

Answer 17

Establish the nurse client relationship by:
 Acknowledging the client’s pain is real to the client
 Teaching, managing and preventing side effects
 Providing physical care

Pharmacological Interventions

Non-pharmacological Interventions

Question 18

Pharmacological interventions

Answer 18

Analgesia
- Opioids- may be given PO,SC, I.V intraspinal, intranasal, rectal transdermal
(-) Side effects: Respiratory depression, Nausea and vomiting, constipation, allergic responses,

Nonsteroidal Ant-inflammatory Drugs
    - Aspirin, ibuprofens
        (-)Side effects: may cause 
gastrointestinal bleeding , bruising, renal 
impairment.

Local anesthetics
- Lidocaine injected around the site of injury,
- Emla cream that is applied directly to the
skin

Question 19

Approaches of giving pain drugs

Answer 19

Balanced approach
- more than one approach. Better relief with fewer side effects. Require less of one type of analgesia

Pro Re Nata (PRN)
- as necessary, usually when patient is in severe pain

Preventative Approach
- Administer on time rather than on the patient’s report of pain

Question 20

Non-pharmacological interventions

Answer 20

Cutaneous Stimulation and massage

Thermal therapies

 - Ice – joint injuries no longer than 15-20 mins at a time
- Heat- do not apply to sites which are areas of untreated infection.

Tens- transcutaneous electrical nerve stimulation

Distraction

• Relaxation techniques- breathing exercises
• Guided imagery
• Music
• Hypnosis

Other aromatherapy, acupressure, reflexology

Question 21

Neurosurgical Approaches to pain.

Answer 21

Cordotomy- interrupts the transmission of pain by dividing certain tracts in the spinal cord.

Rhizotomy- nerve roots are destroyed as they enter the spinal cord.

Question 22

What are the benefits of epidural versus systemic administration of opioids?

Answer 22

Epidural analgesia provides better pain management than systemic opioids.

It significantly reduces the number of people who will suffer heart damage, time to return of unassisted respiration, gastrointestinal bleeding, and intensive care unit length of stay

Question 23

Epidural

Answer 23

a procedure that injects a local anaesthetic in to the space around the spinal nerves in your lower back.