Nursing Process and Pain Management (7)

Question 1

what is McCaffrey’s classic definition of pain?

Answer 1

pain is whatever the experiencing person says it is, existing whenever he says it does

Question 2

what does effective pain management do(5)?

Answer 2

1) improves quality of life

2) reduces physical discomfort

3) promotes earlier mobilization and return to baseline functional ability

4) results in fewer hospital and clinic visits

5) decreases hospital lengths of stay

These reduce healthcare costs

Question 3

caring for patients in pain requires recognition that…

Answer 3

pain can and should be relieved

Question 4

The Institute of Medicine (IOM) in conducting an extensive examination of pain as a public health problem. The results of the IOM study were released in the 2011 report, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.” This report…

Answer 4

acknowledges the tragic epidemic of pain in the United States and calls for major coordinated efforts to develop safe effective preventive and management strategies.

Question 5

what does The Joint Commission pain standard require?

Answer 5

requires healthcare providers to assess all patients for pain on a regular basis

Question 6

When a smiling and cooperative patient complains of discomfort, nurses caring for this patient often harbor misconceptions about the patient’s pain. Which of the following is true?
A. Chronic pain is psychological in nature.
B. Patients are the best judges of their pain.
C. Regular use of narcotic analgesics leads to drug addiction.
D. Amount of pain is reflective of actual tissue damage.

Answer 6

B

Question 7

A patient has just undergone an appendectomy. When discussing with the patient several pain-relief interventions, the most appropriate recommendation would be:
A. adjunctive therapy.
B. nonopioids.
C. NSAIDs.
D. PCA pain management.

Answer 7

D

Question 8

A postoperative patient is using PCA. You will evaluate the effectiveness of the medication when:
A. you compare assessed pain w/baseline pain.
B. body language is incongruent with reports of pain relief.
C. family members report that pain has subsided.
D. vital signs have returned to baseline.

Answer 8

A

Question 9

The nature of Pain(5):
* what components are involved?
* how is it perceived by people?
* what does pain reduce?
* how do you measure it?
* what can it lead to?

Answer 9

1) pain involves physical, emotional, and cognitive components

2) pain is subjective and individualized

3) pain reduces quality of life

4) pain is not measurable objectively

5) pain may lead to serious physical, psychological, social, and financial consequences

Question 10

what are the four physiological processes of normal pain?

Answer 10

1) transduction
2) transmission
3) perception
4) modulation

Question 11

describe the transduction of pain:

Answer 11

a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential.

Question 12

describe the transmission of pain:

Answer 12

excitatory neurotransmitters transmit the pain signal across synaptic clefts, spreading the “pain message” and causing an inflammatory response. This pain message is transmitted to the cerebral cortex for analysis.

Question 13

describe the perception of pain(3)

Answer 13

1) when pain stimulus reaches the cerebral cortex, the brain interprets the quality of the pain and processes information from past experience, knowledge, and cultural associations

2) Perception is the point at which the person is aware of pain

3) physiological and behavioral responses occur after perceiving pain.

Question 14

how does the brain process pain?

Answer 14

1) somatosensory cortex - identifies the location and intensity of pain

2) association cortex (limbic system) - determines how a person feels about it

there is no single pain center

Question 15

describe the modulation of pain:

Answer 15

once the pain perceives pain, there is a release of inhibitory neurotransmitters such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), that hinder the transmission of pain and help produce an analgesic effect

• inhibits pain impulse and serves as a protective reflex

Question 16

what do pain processes require physiologically?

Answer 16

an intact nervous system and spinal cord

Question 17

describe the sympathetic nervous systems involvement in pain

Answer 17

as pain impulses travel up the spinal cord, the stress response stimulate the ANS sympathetic nervous system; fight or flight

Question 18

describe the ANS parasympathetic nervous systems involvement in pain

Answer 18

continuous, severe, or deep pain typically involving visceral organs activates the parasympathetic nervous system

Question 19

what occurs when someone experiences severe traumatic pain?

Answer 19

this often causes people to go into shock

Question 20

describe the adaptation of pain

Answer 20

most people adapt to their pain reflexively and physical signs return to normal baseline; normal baseline is NOT the same for everyone

Question 21

what happens with vital signs when people experience pain?

Answer 21

patients in pain do not always present changes in their vitals; changes in vitals often indicate problems other than pain

Question 22

describe the behavioral responses associated with acute pain(4):

Answer 22

1) clenching teeth
2) facial grimacing
3) holding or guarding the painful area
4) a bent posture

be aware: not all patients show these responses when in pain

Question 23

describe the behavioral responses associated with chronic pain(4):

Answer 23

chronic pain affects patients’:
1) activities (eating, sleeping, socialization)
2) thinking (confusion, forgetfulness)
3) emotions (anger, depression, irritability)
4) quality of life and productivity

Question 24

people with a low pain tolerance are often perceived as…

Answer 24

complainers.. pff.. wimps

Question 25

why should you teach patients the importance of reporting their pain sooner rather than later?

Answer 25

to facilitate better control and optimal functional status

Question 26

what are the types of pain(5)?

Answer 26

1) acute/transient 2) chronic/persistent (noncancer) 3) chronic episodic 4) idiopathic 5) cancer pain

Question 27

describe acute/transient pain (definition and 2 points)

Answer 27

**protective, identifiable, and with a short duration; limited emotional response** * can inhibit ability to become active and involved in self-care * all focus is on pain relief which delays physical and psychological progress while pain persists

Question 28

describe chronic/persistent pain (noncancer) (definition and 2 points)

Answer 28

**is not protective, has no purpose, and may or may not have an identifiable cause** * may be viewed as a disease since it has a distinct pathology that causes changes which may worsen over time. * unknown cause of chronic pain frequently leads to psychological depression, and even suicide.

Question 29

what is the goal of healthcare workers treating chronic pain?

Answer 29

improve functional status

Question 30

describe cancer pain (description and 1 point)

Answer 30

**normal (nociceptive) pain, occuring due to abnormal or damaged pain nerves.** * A patient senses pain at the actual site of the tumor or distant to the site, called referred pain.

Question 31

what is referred pain?

Answer 31

pain felt in an area distant to the site of tissue damage

Question 32

describe chronic episodic pain

Answer 32

pain that occurs sporadically over an extended duration

Question 33

describe idiopathic pain

Answer 33

chronic pain without an identifiable physical or psychological cause

Question 34

when there is no obvious source of pain (e.g. low back pain etc...) healthcare providers sometimes do what?

Answer 34

stereotype pain sufferers as malingerers, complainers, or difficult patients

Question 35

studies of nurses attitudes regarding pain management show what?

Answer 35

that a nurse's personal opinion about a patient's report of pain affects pain assessment and titration of opioid doses

Question 36

what must a nurse accept regarding a patient's report of pain?

Answer 36

a nurse must accept the patient's report of pain and act according to professional guidelines, standards, position statements, policies and procedures, and evidence-based research findings

Question 37

what are the **physiological** factors that influence pain(4)?

Answer 37

1) age 2) fatigue 3) genes 4) neurological function

Question 38

what are some **social** factors that influence pain(4)?

Answer 38

1) attention 2) experiences 3) support 4) spirituality

Question 39

what does fatigue do to the perception of pain?

Answer 39

fatigue increases the perception of pain and can cause problems with sleep and rest

Question 40

describe the spirituality factor of pain influence

Answer 40

spirituality includes active searching for meaning in situations with questions such as "why am I suffering?"

Question 41

how does age influence pain and pain management?

Answer 41

are-related changes and increased frailty can lead to: 1) a less predictable response to analgesic medications 2) increased sensitivity to medications 3) potential harmful drug effects

Question 42

what does the presence of pain in an older adult require?

Answer 42

aggressive assessment, diagnosis, and management

Question 43

how does genetic makeup influence pain?

Answer 43

genes may affect a person's pain tolerance

Question 44

describe the effect attention has on the perception of pain

Answer 44

**Increased attention** - associated with increased perception of pain **Decreased attention** - associated with diminished pain response

Question 45

what are the **psychological** factors that influence pain(2)?

Answer 45

1) anxiety 2) coping style

Question 46

what are the **cultural** factors that influence pain(2)?

Answer 46

1) individual's meaning of pain 2) ethnicity

Question 47

describe how anxiety influences the perception of pain

Answer 47

anxiety often increases the perception of pain and the perception of pain causes anxiety

Question 48

describe how coping style influences pain

Answer 48

pain is a lonely experience that often causes patients to feel a loss of control. coping style influences the ability to deal with the pain

Question 49

describe the perception of pain people with internal loci of control have as opposed to those with external loci of control

Answer 49

**internal loci of control** - perceive themselves as having control over events in their life and the outcomes such as pain **external loci of control** - perceive that other factors in their life, such as nurses, are responsible for the outcome of events

Question 50

what does understanding the cultural meaning of pain help nurses to do?

Answer 50

helps them design culturally sensitive care for people with pain

Question 51

successful critical thinking associated with pain requires aa synthesis of(5):

Answer 51

1) knowledge 2) experience 3) information gathered from patients 4) critical thinking attitudes 5) intellectual and professional standards

Question 52

describe how **knowledge** factors into pain management:

Answer 52

knowledge of pain physiology and the many factors that influence pain will help you manage a patient's pain

Question 53

describe how critical thinking **attitudes** and **intellectual standards** relate to pain:

Answer 53

they ensure the aggressive assessment, creative planning, and thorough evaluation needed to obtain an acceptable level of patient pain relief, while balancing treatment benefits with treatment associated risks

Question 54

how do you assess a patient dealing with acute pain?

Answer 54

* streamline your assessment and assess: 1) location 2) severity 3) quality * collect a more detailed acute pain assessment when the patient is more comfortable

Question 55

what are the ABCs of pain management?

Answer 55

A - ask B - believe C - choose D - deliver E - empower

Question 56

what is a more in depth description of the ABCs of pain management?

Answer 56

**Ask** - ask about pain regularly and assess pain systematically **Believe** - believe the patient and family in their report of pain and what relieves it **Choose** - choose pain control options appropriate for the patient, family, and setting **Deliver** - deliver interventions in a timely, logical, and coordinated fashion **Empower** - enable them to control their course to the greatest extent possible.

Question 57

why is pain assessment not simply a number?

Answer 57

relying solely on a number fails to capture the multidimensionality of pain and may be unsafe Use other signs when you suspect a patient may be under reporting pain, but do not use them as a standard for titration

Question 58

what is the most reliable indicator of pain's existence and intensity?

Answer 58

a patient's self-report

Question 59

what happens if patients feel like you doubt the pain the are reporting exists?

Answer 59

they share less information about their pain experience or minimize their report

Question 60

pain assessments of people with cognitive impairments often require assessment approaches that involve:

Answer 60

1) close observation of vocal response 2) facial movements (grimacing, clenched teeth) 3) body movements (restlessness, pacing)

Question 61

patients with critical illnesses that have a clouded sensorium or the presence of an NG tube or artificial airway require what kinds of questions during pain assessment?

Answer 61

questions that can be answered with a head nod or written responses

Question 62

What are the characteristics of pain that need to be identified during a pain assessment?

Answer 62

1) timing - when did it start? how long does it last? 2) location - where does it hurt? 3) severity - can you rate your pain? 4) quality - can you describe the pain? (learn words pt uses to describe the pain and use them when assessing) 5) precipitating factors - does anything cause or make the pain worse? 6) relief measures - is there anything that helps with the pain? 7) effects of pain on the patient - does the pain affect your behavior or ADLs?

Question 63

what is the purpose of the pain scale?

Answer 63

to identify pain intensity over time

Question 64

what are some common precipitating factors(7)?

Answer 64

1) physical movement 2) positions 3) drinking coffee or alcohol 4) urination 5) swallowing 6) eating food 7) psychological stress

Question 65

what are some symptoms that can either cause worsening pain or be caused by pain(8)?

Answer 65

1) depression 2) anxiety 3) fatigue 4) sedation 5) anorexia 6) sleep disruption 7) spiritual distress 8) guilt

Question 66

what are some common methods patients report relieves some of the pain they're feeling(5)?

Answer 66

1) using ritualistic behavior (pacing, rocking, rubbing) 2) eating 3) meditation 4) praying 5) applying heat or cold to painful site

Question 67

what are some effects pain can have on a patients life(5)?

Answer 67

1) less able to participate in routine activities, leading to physical deconditioning 2) impaired sleeping 3) impaired sexual relations 4) threaten ability to work 5) can impair social life

Question 68

what are some symptoms that are often related to pain(7)?

Answer 68

1) nausea 2) headache 3) dizziness 4) urge to urinate 5) constipation 6) depression 7) restlessness **the symptoms depend on the cause and location of the pain**

Question 69

what are Concomitant symptoms?

Answer 69

symptoms that exist at the same time

Question 70

what do Concomitant symptoms do to pain severity?

Answer 70

usually increases pain severity

Question 71

professional standards of care regarding pain management are available where(2)?

Answer 71

1) agency policies 2) through professional organizations such as the American Society for Pain Management Nursing (ASPMN)

Question 72

a comprehensive pain management plan includes a variety of resources from the healthcare team such as(8):

Answer 72

1) APRNs 2) Doctors of pharmacology 3) PTs 4) OTs 5) physicians 6) social workers 7) psychologists 8) clergy

Question 73

what are some nonpharmacological pain-relief interventions(9)?

Answer 73

1) cognitive and behavioral approach 2) relaxation and guided imagery 3) distraction 4) music 5) cutaneous stimulation massage 6) cold and heat application 7) transcutaneous electrical nerve stimulator (TENS) 8) herbals 9) reducing pain perception and reception

Question 74

describe relaxation and guided imagery interventions for pain

Answer 74

allows patients to alter affective-motivational and cognitive pain perception

Question 75

describe relaxation interventions for pain

Answer 75

serves as a mental and physical freedom from tension or stress that provides individuals a sense of self-control

Question 76

describe distraction interventions for pain

Answer 76

directs a patients attention to something other than pain and thus reduces awareness of it

Question 77

describe music therapy interventions for pain

Answer 77

may be useful in treating acute or chronic pain, stress, anxiety, and depression

Question 78

describe cold and heat application, massage, and TENS interventions for pain

Answer 78

stimulation of the skin may be helpful in reducing pain perception

Question 79

describe cold and heat interventions for pain

Answer 79

relieve pain and promote healing

Question 80

describe transcutaneous electrical nerve stimulation interventions for pain

Answer 80

stimulation of the skin with a mild electrical current which is passed through external electrodes

Question 81

describe herbal and dietary supplements such as echinacea, ginseng, ginkgo biloba, and garlic for pain

Answer 81

conflicting research evidence; many still use them to treat pain

Question 82

what is the most common and effective method of pain relief?

Answer 82

analgesics

Question 83

what are the three types of analgesics?

Answer 83

1) nonopioids (acetaminophen, NSAIDs) 2) opioids 3) co-analgesics/adjuvants

Question 84

describe acetaminophen

Answer 84

1) nonopioid analgesic 2) has no anti-inflammatory or antiplatelet effects

Question 85

describe NSAIDs (4)

Answer 85

1) nonopioid analgesics (aspirin and ibprofen) 2) provide mild/moderate pain relief 3) most NSAIDs work on peripheral nerve receptors to reduce transmission of pain stimuli 4) long-term use associated with GI bleeding and renal insufficiency

Question 86

what level of pain are opioids prescribed for?

Answer 86

prescribed for moderate/severe pain

Question 87

what are some adverse effects of opioid analgesics?

Answer 87

1) nausea 2) vomiting 3) constipation 4) itching 5) urinary retention 6) altered mental process 7) sedation **can cause respiratory depression**

Question 88

when a patient is converted from IV opioid analgesics to PO, why do the dosages become much higher?

Answer 88

because of the first-pass effect of medication metabolized in the liver

Question 89

what type of analgesic is usually necessary for patients with acute pain or cancer pain of moderate to severe intensity?

Answer 89

opioid analgesics

Question 90

Follow these guidelines from the American Society for Pain Management Nurses:

Answer 90

1) Avoid administration of partial doses at more frequent intervals so as to not under dose a patient with small, frequent, ineffective doses from within a range. 2) Avoid making a patient wait a full time interval after giving a partial dose within the allowed range. 3) Wait until peak effect of the first dose has been reached before giving a subsequent dose.

Question 91

what is PCA?

Answer 91

patient controlled analgesia

Question 92

what form of administration is patient controlled analgesia?

Answer 92

1) IV 2) SUBQ 3) oral (rare)

Question 93

what does PCAs allow?

Answer 93

allows patients to control when they take their PRN medications including analgesics, antiemetics, and anxiolytics

Question 94

what are the benefits of PCAs?

Answer 94

1) patient gains control over pain 2) pain relief does not depend upon nurse availability 3) decreases anxiety 4) decreased medication use 5) stabilizes serum drug concentrations for sustained relief

Question 95

what is the analgesic ladder?

Answer 95

a three step approach to manage cancer pain that begins with NSAIDs and/or adjuvants and progresses to opioids

Question 96

what is the bidirectional approach to the analgesic ladder?

Answer 96

* the original analgesic ladder progresses up the steps starting from NSAIDs or adjuvants and progressing toward opioids * the bidirectional approach would include a step down approach for patients with intense acute pain, uncontrolled cancer pain, and breakthrough pain

Question 97

what do all patients on chronic opioid therapy require?

Answer 97

monitoring and follow up

Question 98

how many people with chronic persistent pain become addicted to opioids?

Answer 98

6-10%

Question 99

when patients are unable to swallow, have nausea or vomiting, or are near death, what method is preferred over PO?

Answer 99

rectal

Question 100

what is step one of the analgesic ladder?

Question 101

what are commonly used topical analgesics(2)?

Answer 101

1) NSAID products (ketoprofen patch) 2) capsaicin

Question 102

where do you not place eutectic mixture of local anesthetics (EMLA)(3)?

Answer 102

1) around the eyes 2) tympanic membrane 3) over large skin surfaces

Question 103

describe a Lidoderm patch

Answer 103

a topical analgesic that is effective for cutaneous neuropathic pain (e.g. postherpetic neuralgia)

Question 104

how do you use a Lidoderm patch?

Answer 104

Adults: place three patches, cut to size, on and around the pain site using 12h on 12h off schedule

Question 105

what is local anesthesia used for?

Answer 105

used during brief surgical procedures (e.g. removal of skin lesion or suturing a wound)

Question 106

how are local anesthetics administered(2)?

Answer 106

1) topically on the skin or mucous membranes 2) injecting them subcutaneously or intradermally 3) perineural local anesthetic infusion

Question 107

what is perineural local anesthetic infusion?

Answer 107

a surgeon places the tip of an un-sutured catheter near a nerve or group of nerve fibers and the catheter exits from the surgical wound

Question 108

what is regional anesthesia?

Answer 108

injection or infusion of local anesthetics to block a group of sensory nerve fibers

Question 109

what are common side effects for a skin applied topical anesthetic(2)?

Answer 109

1) pruritus (burning of the skin) 2) localized rash

Question 110

application of a topical anesthetic to a vascular mucous membrane increases the chance of what?

Answer 110

increases the chance of systemic effects like a change in HR

Question 111

the use of local anesthetics in peripheral nerves and epidural infusions may do what?

Answer 111

block motor nerves in addition to sensory nerves leading to temporary paralysis of affected body part

Question 112

what does epidural analgesia treat(4)?

Answer 112

effectively treats: 1) acute postoperative pain 2) rib fracture pain 3) labor and delivery pain 4) chronic cancer pain

Question 113

what does epidural analgesia accomplish?

Answer 113

controls or reduces pain and reduces a patient's overall opioid requirement which minimizes adverse effects

Question 114

is epidural analgesia a long-term or a short-term therapy?

Answer 114

can be either or depending on a patient's condition and life expectancy

Question 115

because the epidural space is a highly vascular area, patients with epidural catheters are at risk for what?

Answer 115

the development of epidural hematomas which can lead to ischemia of the spinal cord. if unaddressed, serious neurological complications can occur

Question 116

you maintain the (BLANK) to patients receiving local or regional anesthesia

Answer 116

responsibility for providing emotional support

Question 117

why do you not administer supplemental doses of opioids or sedative/hypnotics to someone receiving epidural analgesia??

Answer 117

because of possible additive central nervous system adverse effects

Question 118

anticoagulant and antiplatelet medications should not be administered to a patient receiving epidural analgesia until safe use can be verified with a pain specialist. why?

Answer 118

because of increased risk of bleeding and hematoma formation

Question 119

patients need to receive thorough education about epidural analgesia including...

Answer 119

action of thee medication and the advantages and disadvantages related to the therapy

Question 120

how do you provide emotional support to a patient receiving local or regional anesthesia?

Answer 120

explain the insertion technique and warn them that they will temporarily lose sensory function within minutes of injection

Question 121

when patients receive epidural analgesia, how often do you monitor them?

Answer 121

initially check vitals, respiratory status, and skin color about every 15 minutes. once stabilized, monitoring occurs about every hour for 12-24 hours

Question 122

when severe pain persists despite medical treatment, what are some more invasive treatments available(6)?

Answer 122

1) intrathecal implantable pumps or injections 2) spinal cord and deep brain stimulation 3) neuroblative procedures 4) trigger point injections 5) cryoablation 6) intraspinal meds

Question 123

what is breakthrough cancer pain?

Answer 123

BTCP - a transient worsening of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger

Question 124

The American Pain Society reports that the primary goal in treating chronic noncancer pain with opioids is to...

Answer 124

increase patients' level of function rather than just to provide pain relief

Question 125

define physical dependence on a drug

Answer 125

a state of adaptation that is manifested by a drug class-specific withdrawal syndrome produced by an abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist

Question 126

define addiction

Answer 126

a primary, chronic, neurobiological disease with genetic, psychological, and environmental factors influencing its development and manifestations

Question 127

define drug tolerance

Answer 127

a state of adaptation in which exposure to a drug induces changes that result in diminution of one or more effects of the drug over time

Question 128

what are barriers to effective pain management?

Answer 128

1) patient barriers 2) healthcare provider barriers 3) healthcare system barriers

Question 129

what are examples of patient barriers to effective pain management(3)?

Answer 129

1) fear of addiction 2) fear of side effects 3) fear of tolerance

Question 130

what are examples of healthcare provider barriers to effective pain management(3)?

Answer 130

1) inadequate pain assessment skills 2) no pain management protocols available 3) concern with addiction or accidental overdose

Question 131

what are examples of healthcare system barriers to effective pain management(3)?

Answer 131

1) concern with creating addicts 2) difficulty filling prescriptions 3) limitation on reimbursement for prescriptions