Pain

Question 1

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage” is

Answer 1

pain

Question 2

Is pain a vital sign?

Answer 2

Should be checked as often as vital signs

Question 3

Is pain subjective?

Answer 3

Yes, determined by pt not nurse

Question 4

How long can acute pain last?

Answer 4

up to 6 months

Question 5

Components of acute pain

Answer 5

1. Inflammatory (redness, swelling, tenderness)

Not always present but…..
Sympathetic nervous system rxn (tachycardia/pnea, HTN)

Question 6

Acute pain is considered a _____ mechanism

Answer 6

protective

Question 7

How long does chronic pain last?

Answer 7

> 6 months

Question 8

Chronic pain is no longer considered protective and is considered_______

Answer 8

a disease or condition

Question 9

How do you treat chronic pain?

Answer 9

-complex, no set way or method

Question 10

What is Nociceptive Pain?

Answer 10

acute pain from surgery, injury, or active disease process

Question 11

What does somatic pain feel like?

Answer 11

aching, throbbing pain in bones, joints or skin

Question 12

What is visceral pain? what does it feel like?

Answer 12

organ related, poorly localized, cramping, squeezing, heavy

Question 13

What are the 4 phases that nociceptive pain transmits through?

Answer 13

1. Transduction (prostaglandins released to potentiate action potential)
2. Transmission (substance P is released: significant pain messenger)
3. Perception
4. Modulation

(tiny tiger paw massage)

Question 14

Which phase of nociceptive pain releases prostaglandins? why?

Answer 14

Transduction , potentiate action potential

Question 15

Which phase of nociceptive pain releases Substance P? why?

Answer 15

Transmission, significant pain messenger

Question 16

Which 2 phases offer treatment?

Answer 16

transduction and transmission

Question 17

What kind of pain medication is used in transduction phase of nociceptive pain?

Answer 17

NSAIDs or Steroids

Question 18

What kind of pain medication is used in transmission phase of nociceptive pain?

Answer 18

Opioids

Question 19

What causes neuropathic pain?

Answer 19

-damage to somatosensory nervous systems from nerve damage, chemotherapy, radiation

Question 20

What are the symptoms/pain descriptions of neuropathic pain?

Answer 20

-tingling, electric like, pins, and needles, number characteristic

Question 21

What is Allodynia?

Answer 21

things that cause pain that normally do not cause pain

Question 22

What is Hyperalgesia?

Answer 22

a heightened feeling of pain

Question 23

How do we treat neuropathic pain?

Answer 23

antidepressants
SNRI’s(selective NORepinephrine reuptake inhibitors)
Antiseizure (gabapentin, pregabalin)

Question 24

2 issues with neuropathic pain

Answer 24

allodynia

hyperalgesia

Question 25

What is Nociplastic or central pain?

Answer 25

-similar to nociceptive pain that does NOT HAVE DISCERNIBLE SOURCE

Question 26

How is nociplastic or central pain described?

Answer 26

like nociceptive or neuropathic - electric, sharp

Question 27

Example of nociplastic or central pain?

Answer 27

fibromyalgia

Question 28

Treatment goals for Nociplastic or central pain?

Answer 28

- complex - focus on RESTORING sleep/activity tolderance - NOT OPIOIDS

Question 29

Newborn and infant pain scales?

Answer 29

Neonatal Pain, Agitation and sedation Scale (N-PASS) FLACC behavioral pain assessment *newborn/infant pain is underrated

Question 30

Toddler and preschoolers pain assessment scale?

Answer 30

Wong-baker FACES Scale

Question 31

Toddler preschool pain manifests as

Answer 31

distrust

Question 32

School aged and adolescent pain scale?

Answer 32

0-10

Question 33

Persistent pain in school aged/adolescent can cause what?

Answer 33

developmental regression

Question 34

How do school aged/adolescents manifest pain?

Answer 34

-may hide pain

Question 35

Older Adult pain tools?

Answer 35

Checklist for Nonverbal Pain Indicators (CNPI) | Critical Care Pain Observation Tool (CPOT)

Question 36

Physiological effects of pain- what increases?

Answer 36

``` BP HR RR+ shallow CBG O2 needs Lactate Ketones ```

Question 37

Physiological effects of pain, what decreases?

Answer 37

Immune response | Ability to think/learn/decisions

Question 38

When asking about location of pain try to distinguish between somatic and visceral. What do those feel like?

Answer 38

somatic = localized | visceral =vague or radiating

Question 39

When assessing quality of pain distinguish between...

Answer 39

nociceptive: aching, sharp, deep, gnawing neuropathic: shocklike, burning, tingling, numb

Question 40

Physical non-pharmacological pain management

Answer 40

- heat - cold - Transcutaneous Electrical Nerve Stimulation - Massage

Question 41

When is heat contradindicated?

Answer 41

-areas of bleeding, topical ointments, burned/irradiated skin

Question 42

When is cold contraindicated?

Answer 42

- poor circulation - raynaud syndrome - radiated skin

Question 43

Cognitive and Behavioral Pain Management options

Answer 43

- distraction - relaxation - imagery - mindfulness

Question 44

When would you want to use distraction for pain mgmt and how would you do it?

Answer 44

- short duration of pain | - match type of distraction to something patient enjoys

Question 45

When to use relaxation for pain management?

Answer 45

-useful for all types of pain

Question 46

4 categories for pharmacological pain mgmt?

Answer 46

- nonopioid - opioid - adjuvant analgesic (gabapentin, pregabalin) - adjuvant (anxiolytics or sleep meds)

Question 47

What does a patient need to be in order to usa PCA Pump?

Answer 47

cognitively alert

Question 48

What safety parameters installed for PCA Pump?

Answer 48

- minimum time interval b/w doses - maximum dose allowed over time period - specific dosing mg or mcg

Question 49

Who can push the PCA button?

Answer 49

ONLY patient

Question 50

what 2 things must be added to monitor patient on PCA pump?

Answer 50

O2 sat, end tidal CO2

Question 51

When is PRN dosing more appropriate?

Answer 51

-someone is a few days post op and working towards discharge

Question 52

Benefits of around the clock dosing?

Answer 52

therapeutic drug levels and reduced harmful side effects

Question 53

Can RNs do spinal analgesia?

Answer 53

NO

Question 54

What size dose needed with spinal analgesia?

Answer 54

smaller dose

Question 55

Common side effect of spinal analgesia?

Answer 55

hypotension

Question 56

what are opioid side effects?

Answer 56

sedation respiratory depression constipation vasodilation and hypotension

Question 57

which 4 populations are at risk of opioid side effects?

Answer 57

-opioid naive -elders -use of other sedative meds obstructive sleep apnea

Question 58

what is POSS?

Answer 58

Pasero Opioid Induced Sedation Scale

Question 59

How do you score POSS?

Answer 59

s= sleep, easy to around 1=awake/alert 2=slightly drowsy easily arousable 3=frequent drowsy, arousable, drifts to sleep during conversations 4=somnolent, minimal or no response to physical stimulation