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Nursing > NRS 110 Comfort/ Pain Management > Flashcards

NRS 110 Comfort/ Pain Management Flashcards

Exam 3

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1
Q

Pain

A

Whatever the pt says it is.

Psychological effects of pain:

  • hyperglycemia
  • increased cardiac workload
  • immune system dysfunction
  • GI ileum
  • urinary retention
  • decreased lung volume and fatigue
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2
Q

Nociceptive Pain

A

Ability to feel painful stimuli.
Hurtful/ injurious.

Transduction
Transmission
Perception
Modulation

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3
Q

Neuropathic Pain

A

Abnormal functioning- diabetics

Pain caused by a lesion/ Disease of the peripheral/ central nerves. Cause is unknown.

Short but frequently chronic.

Described as burning/ electric/ tingling/ stabbing

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4
Q

Psychogenic Pain

A

Physical cause can’t be identified. Mental event

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5
Q

Referred Pain

A

Perceived from point distant from point of origin.

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6
Q

Cutaneous Pain

A

Involves skin and subs tissue- superficial.

ex: paper cut

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7
Q

Breakthrough Pain*

A

RAPID ONSET of pain. Needs a rapid acting medication.

Anticipate ordering medication for breakthrough pain if pain persists after administering original pain med. OPIOIDS

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8
Q

Sources of Pain

A

Somatic

Visceral

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9
Q

Somatic Pain

A

Diffuse and scattered and originates in:

  • Tendons
  • Ligaments
  • Bones
  • Nerves
  • Blood Vessels

caused by mechanical/ chemical/ thermal/ electrical disorders/ injury affecting bones, joints, muscles, skin, or other structures composed of CONNECTIVE TISSUE.

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10
Q

Visceral Pain

A

Poorly localized. Originates in Body organs:

  • Cranium
  • Thorax
  • Abdomen

Produced by disease. Occurs as organs become distended, ischemic, or inflamed.

Reface contraction of abdomen wall may occur to protect additional trauma.- GUARDING

Organs: HEART, KIDNEYS, INTESTINES that are diseased/ injured.

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11
Q

Acute Pain

A

Rapid onset. Varies in intensity from MILD to SEVERE.

Tissue damage/ disease and triggers autonomic responses as increased HR, fight or flight, increased BP.

Ends once healing occurs. Not longer than 6 months.

ex: pricked finger, sore throat, surgery

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12
Q

Chronic Pain

A

Intermittent/ consistent.

  • May lead to withdrawal, depression, anger, frustration and dependency.
  • Exacerbation.

Lasts after normal healing pain.
Time varies: 6 months or longer.

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13
Q

Transduction

A

Nociceptive

Activation on pain receptors. Injured chemicals release chemicals that excite nerve endings.

  • Bradykinin triggers release of histamine- produces redness, swelling, pain when inflammation happens
  • Prostaglandins: hormone like substance that sends additional pain stimuli to CNS
  • Substance P: sensitives receptors on nerve to feel pain and increases firing of nerves.
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14
Q

Transmission

A

Pain sensations from site of injury are sent to the spinal cord and then higher centers

Protective Pain Reflex: responsible for withdrawal of endangered tissue from a damaging stimulus.

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15
Q

Perception

A

Sensory process that occurs when a stimulus for pain is present.

Person’s interpretation of the pain.

hot shower- increasing heat- pain threshold

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16
Q

Modulation

A

Process that the sensation of pain is inhibited.

Regulated by: Neuromodulators: morphine like chemical regulators in spinal cord and brain.

Endorphine: most potent

Enkephalins: least potent. Reduce pain sensation by inhibiting the release of substance P from the terminals of afferent neurons

opioid neuromodulators.

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17
Q

Gate Control Theory of Pain

A

Relation between pain and the projection of pain info to the brain.

Factors that have an impact on opening and closing:

  • past experiences
  • cultural/ social environment
  • personal expectations
  • beliefs about pain
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18
Q

Interventions to close gate

A
  • Massages, warm compress to a painful lower back area will stimulate large nerve fibers to close the gate.

Blocks impulses from that area.

Teach: self management techniques that activate closing the gate also minimize the experience of pain.

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19
Q

Common Responses to Pain

A
  • Physiological
  • Behavioral
  • Affective
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20
Q

Physiological

A

Responses are involuntary body responses.

Sympathetic stimulation: MODERATE/ SUPERFICIAL PAIN

Parasympathetic stimulation: PROLONGED/ SEVERE/ VISCERAL PAIN

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21
Q

Sympathetic Stimulation

A

Physiological

MODERATE/ SUPERFICIAL PAIN:

  • Increased vital signs (BP, P, RR)
  • Pupil dilation
  • Muscle tension
  • Rigidity
  • Pallor
  • Increased adrenaline
  • Increased blood glucose
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22
Q

Parasympathetic Stimulation

A

Physiological

PROLONGED/ SEVERE/ VISCERAL PAIN

  • Decreased BP, P
  • Rapid and irregular RR
  • Pupil constrictions
  • Nausea/ vomiting
  • Warm dry skin
  • Fainting/ unconsciousness.
23
Q

Factors that effect pt pain:

Cultural norms that effect pain

A
  • Asians- don’t show pain
  • African- pain may be viewed as illness/ disease- inevitable. Praying may help with pain.
  • Greek: evil eye that needs to be eradicated.
  • Mexican: delay medical help- hope it goes away.
ethics
family, gender, age
religious beliefs
environment
anxiety
past pain experience
24
Q

Behavioral

A

Reflect body movements

Grimacing
Moaning
Moving away from pain stimuli
Crying
Restlessness
Protecting the area- Guarding
Refusal to move
25
Q

Affective

A

Reflect mood and emotions

Anxiety
Anger
Withdrawal
Fear
Fatigue
Hopelessness
Powerlessness
Depression
26
Q

Nursing Process: Assessing

A

Pain is 5th vital sign

Parameters for pain:

  • physiological
  • emotional
  • psychological
27
Q

Pain Assessment Scale

A

Numeric Rating Scale: Adults/ Children >9

Wong Baker Faces: adults and children (.3 years old) in all patient settings

Checklist of Non Verbal Indicators: Adults who are unable to validate the presence of or quantify the severity of pain using either the Numeric or Wong

28
Q

Adults Nonverbal Pain Scale (NVPS)

A

Adults who are sedated and non responsive

29
Q

Behavioral Pain Scale (BPS)

A

Useful with intubated critically ill pt

Measurement of bodily indicators of pain and tolerance of intubation.

30
Q

COMFORT Behavior Scale

A

Infants, children, adults who are unable to use the numeric rating scale of Wong-Baker

31
Q

CRIES Instrument

A

Neonates (ages 0-6 months)

32
Q

Critical-Care Pain Observation Tool (CPOT)

A

Adults who are sedated and non responsive

33
Q

Faces Pain Scale- Revised (FPS-R)

A

Children (4-16) in parallel with numerical self rating; choose the depiction of a facial expression that best corresponds to pain.

34
Q

FLACC Behavioral Scale

A

Infants and children (2months-7 years) who are unable to validate the presence of or quantify the severity of pain

35
Q

Iowa Pain Thermometer

A

Older adults with cognitive impairment

36
Q

Oucher Pain Scale

A

Young children who can point to a face to indicate their level of pain

37
Q

Pain Assessment in Advanced Dementia Scale (PAINAD)

A

Patients whose dementia is so advanced that they cannot verbally communicate

38
Q

Implementation of Pain

A

Est. trusting nurse pt relationship
Initiate non pharm relief
Consider ethical/ legal responsibility
Teach about pain

Pain comfort

39
Q

Nonpharm Measures

A
  • Distraction
  • Imagery
  • Relaxation Tech
  • Cutaneous Stimulation
  • Hypnosis
  • Biofeedback
  • Therapeutic Touch
40
Q

Distraction

A

Focus on something other than pain

Auditory- MUSIC*
Visual- counting objects, TV

41
Q

Imagery

A

Mind body interaction to decrease pain. Involves the senses.

More effective for chronic pain.

42
Q

Relaxation Technique

A

Deep breathing

Reduces skeletal muscle tension and decreased anxiety.

Positive effect on arthritis pain

43
Q

Cutaneous Stimulation

A

Stimulate skin surface

Massage, heat/ cold application

Acupuncture
TENS (transcutaneous electrical nerve stimulation)

44
Q

Biofeedback

A

use of a machine to monitor physiological responses through electrode sensors on pt skin.

Displays HR, RR, muscle tension, sweat responses.

45
Q

Nonopioid Analgesic

A

Relieves pain of any nature

Major side effect: Respiratory depression
Constipation

46
Q

Opiod

A

Narcotic. Antagonist naloxone.

Causes sedation, nausea constipation
Morphine- prototype.
Fentanyl: synthetic opiod. 50/100 times stronger than morphine.

Respiratory depress- common feared adverse effect of opioid use.

47
Q

Opioid Scale

A 
S= sleep, easy to arouse- no action needed
1= awake/ alert- no action needed
2= occasionally drowsy but easy to arouse- no action needed
3= frequently drowsy/ drifts off to sleep- decreased opiod.
4= somnolent with min response to stimuli- decrease opioid- naloxone *
48
Q

Adjuvant drugs

A

Antidepressants
Anticonvulsants
Corticosteroids
Bisphosphonates

Used for surges, burns, trauma.
Fibromyalgia, diabetic, neuropathy, postherpetic neuralgia.

49
Q

Pain Management for Cancer

A

Give meds orally

Administer meds ATC than PRN

Adjust the dose to achieve max benefits

Allow pt as much control as possible over med.

50
Q

PCA Pump

A
  • Older adults
  • Infants
  • Very young children
  • Cognitively impaired
  • pt with conditions for which sedation poses a sign health risk
  • pt taking other meds that potentiate opioids
    ARE NOT RECOMMENDED

Present to prevent accidental overdose.

51
Q

Epidural Analgesia

A

Used during immediate post phase
Chronic pain situations
Children w terminal cancer
Children having hip, spinal, lower ex surgery.

Inserts catheter in mid lumbar region in the epidural space btwn walls of vertebral canal and dura matter or outermost connective tissue surrounding spinal cord.

S/E: Pruritis

  • urinary retention
  • nausea
  • infection
52
Q

Local Anesthesia

A

May be applied topically to the skin/ mucous membrane or injected into the body to produce a temporary loss of sensation in localized area.

53
Q

Endorphins/ Enkephalins

A

Opioid neuromodulators that are powerful pain-blocking chemicals
- have prolonged analgesic effect and produces euphoria

Nursing (3 decks)

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