Pain

Question 0

International association for the study of pain definition of pain:

Answer 0

Pain is a unpleasant sensory and emotional experience associated with actual or potential tissue damage, or it is described in terms of such damage.

Question 1

Pain is:

Answer 1

Universal experience, reason why patients seek HC, very $$$, vital physiological warning sign, complex phenomena with NO simple definition, subjective, individualized, and personal

Question 2

McCaffery

Answer 2

1st RN to research pain as a patient problem. “Pain is whatever the patient says it is and exists whatever the patient says it does.” * nurse must believe patients pain experience, and is difficult to assess because we can neither see nor feel the patients pain.

Question 3

Effective pain management is:

Answer 3

Major aspect of nursing care - unbelievers pain can be harmful, mechanism to warn us about potential for physical harm ( body’s protective mechanism)

Question 4

Pain is categorized by:

Answer 4

Location, duration, intensity, underlying mechanism - promotes healing, prevent complications, reduce suffering, and prevents development of in curable pain states (chronic), severe pain = emergency

Question 5

Pain classified by location:

Answer 5

Useful in determining underlying problem but most patients do not fit neatly in single category; similar clinical presentations but different clinical needs. Ex: radiating or referred pain (backache, HA, CP)

Question 6

Pain classified by duration:

Answer 6

Acute, chronic, and intractable

Question 7

Acute pain:

Answer 7

Sudden, sharp, mild or severe, duration (6 months)

Question 8

Chronic pain:

Answer 8

Prolonged, interfere with functioning, recurrent >6 months, persists when injury has healed, without injury or evidence of body damage

Question 9

Intractable pain:

Answer 9

Resistant to relief, difficult to relieve, try multiple interventions, affects quality of life (ADLs) ex: cancer, orthopedic

Question 10

Pain classified by intensity:

Answer 10

Patient describes intensity of pain, on a scale, mild/moderate/severe, keep pain below 4/10,

Question 11

Pain classified by etiology:

Answer 11

Nociceptive and neuropathic

Question 12

Nociceptive pain:

Answer 12

most patients fall into this category intact/functioning NS, sends signal that tissues are damaged, requires attention and proper care, can be: somatic or visceral

Question 13

Somatic pain (nociceptive):

Answer 13

Skin/muscle/bone/tissue, nerves are highly organized, character/intensity/location match type and extent of injury

Question 14

Visceral pain (nociceptive):

Answer 14

Nerve fibers from organs or hollow viscera, poorly organized, patients c/o cramping, throbbing, aching associated with diaphoresis or nausea

Question 15

Neuropathic pain:

Answer 15

Damaged or malfunctioning nerves, difficult to treat, abnormal nerves due to illness, injury, undetermined cause, c/o burning, electric shock, tingling, dull, aching. Can be: peripheral, central, sympathetical

Question 16

Peripheral neuropathy (neuropathic):

Answer 16

Pain felt along peripheral nerves, DIABETICS

Question 17

Central neuropathic pain (neuropathic):

Answer 17

Caused by lesion (tumor) or dysfunction of CNS, post stroke pain, MS

Question 18

Sympathetically maintained pain (neuropathy):

Answer 18

Abnormal connections between pain fibers and sympathetic NS, becomes chronic and neuropathic, ex: phantom limb pain

Question 19

Cancer pain:

Answer 19

Tumor, specific pain syndromes, treatment related sources of pain (radiation/chemotherapy)

Question 20

Concepts associated with pain:

Answer 20

Pain threshold, pain tolerance, hyperalgesia, allodynia, and dysesthesia. nurses must assess these factors w/o stereotyping patients

Question 21

Dysesthesia:

Answer 21

Unpleasant abnormal sensation “bugs crawling in skin”

Question 22

Allodynia:

Answer 22

Nonpainful stimuli produce pain, ex: contact with wind, linens

Question 23

Hyperalgesia:

Answer 23

Heightened response to painful stimuli, ex: severe pain from paper cut

Question 24

Factors influencing responses to pain:

Answer 24

Consists of 5 dimensions- each influences response to pain. 1:physiologic, 2:sensory, 3:affective, 4:behavioral, 5:cognitive

Question 25

Social dimensions of pain:

Answer 25

Demographics (gender), support systems (family, friends), social roles, and culture

Question 26

Developmental stage of pain:

Answer 26

Newborns feel pain, pain threshold doesn’t change with aging,

Question 27

Effect of analgesics may increase due to physiological changes:

Answer 27

Elder slowly metabolize medications, stay in body longer, and enhanced effect

Question 28

Past pain experience:

Answer 28

Threatened by anticipated pain, previous pain experience alter how pain is perceived

Question 29

Meaning of pain:

Answer 29

Patients interpretation of significance of pain, positive outcome = tolerated better (childbirth, colostomy reversal), chronic pain = may have anxiety or depression

Question 30

Anxiety and stress:

Answer 30

Fatigue increases pain perception, helplessness increases pain perception, and control over the pain decreases perception

Question 31

Components of pain pathway:

Answer 31

Primary sensory neurons (nociceptors), neural pathways, spinal cord tracts, brainstem/thalamus/cortex, descending pathways

Question 32

Nociception:

Answer 32

Physiological processes related to pain perception

Question 33

Physiology of pain:

Answer 33

Neural mechanism consists of four parts: transduction, transmission, perception, and modulation

Question 34

Transduction:

Answer 34

Nociceptors activated by exposure to noxious mechanical, chemical, or thermal stimuli - electrical impulse conducted along nerve

Question 35

Transmission:

Answer 35

Occurs in 3 segments: peripheral nerve to spinal cord > ascension to the brain stem/thalamus > somatic sensory cortex (were pain is perceived)

Question 36

Perception:

Answer 36

Become conscious of pain (opioids help with this phase), complex process, three key factors: threshold (IDs pain), distractibility (degree to ignore), and tolerance (act to stop pain)

Question 37

Modulation:

Answer 37

Descending system, neurons (in thalamus and brainstem) send signals back down spinal chord and release substances that inhibit pain impulses. Ex: endogenous opioids, serotonin, norepinephrine

Question 38

Gate control theory:

Answer 38

Peripheral nerve fibers carrying pain to SC have input modified before transmission to brain. Synapses in dorsal horn act as gate that closes to keep impulses from reaching brain. Small fibers = carry pain stimulus, large fibers = inhibit transmission of pain, when gate open, pain impulses reach the brain, when closed stimulus blocked

Question 39

Sympathetic NS stimulation of pain:

Answer 39

“Fight or flight” initial response to pain; increase in all functions EXCEPT GI motility to conserve energy

Question 40

Parasympathetic NS stimulation:

Answer 40

“Rest n digest” body’s adaptation as pain continues. Muscle tension (fatigue), decrease HR/RR (vagal stimulation), N/V (increased intestinal motility), weakness/exhaustion from expenditure of energy

Question 41

Pain management:

Answer 41

nursing priority 5th vital sign, affects every aspect of life

Question 42

Barriers to pain management:

Answer 42

Professional, patient, and system

Question 43

Pain assessment:

Answer 43

Joint commission standards, factors, two parts: subjective and objective data

Question 44

Subjective pain data:

Answer 44

P (provoke, what causes it?) Q (quality, intensity?) R (region)S (severity, scale?) T (timing, duration?)

Question 45

Objective pain data:

Answer 45

PE, VS, N/V, withdrawal, facial expression, verbal cues, posture

Question 46

Physical pain relief techniques:

Answer 46

Cutaneous stimulation - induces analgesia or endorphins release, ex: acupuncture, massage, exercise, TENS, heat/cold therapy, externally applied preparation ( icy hot)

Question 47

Surgical interventions for pain:

Answer 47

Nerve block, cordotomy, rhizotomy, nerurectomy, sympathectomy

Question 48

Rhizotomy:

Answer 48

Usually on cranial nerve root (neuroablation)

Question 49

Analgesic ladder:

Answer 49

Mild pain (non-opioid drug), moderate pain (weak opioid drugs, PO), and severe pain (strong opioid drugs, IVP)

Question 50

Routes for opiate delivery:

Answer 50

Oral (<72 hrs), rectal (used for N/V), SQ (long term), IM (^risk), IV (rapid, PCA), epidural