Pain 3

Question 1

What is the best way to assess pain or to support using the nursing diagnosis “alteration in comfort”?

Answer 1

anxiety, ineffective coping, fatigue, acute pain, chronic pain, ineffective role performance, disturbed sleep patterns

Question 2

the ultimate goal is for the client to

Answer 2

to function to the best possible extent

Question 3

setting priorities

Answer 3

nurse and patient discuss realistic expectations

Question 4

continuity of care

Answer 4

who do you want on your team? variety of resources (team concept)

Question 5

Health Promotion -

Answer 5

Clients are better able to handle a situation when they understand what to expect. Take time to teach the patient what to expect. Fear increases the perception of painful stimuli.

Question 6

The concept of Holistic Health

Answer 6

looks at the emotional meaning of health and the significance of the problem in light of their purpose in life.

Question 7

Non-pharmacological Pain Relief:

Answer 7

relaxation and guided imagery, distraction, biofeedback, cutaneous stimulation, herbals, reducing painful stimuli and perception

Question 8

relaxation and guided imagery -

Answer 8

“see yourself lying in the cool grass…”

Question 9

distraction -

Answer 9

pleasurable stimuli causes release of endorphins – block pain / close the gate; music is often used

Question 10

biofeedback -

Answer 10

behavioral therapy involves getting information about physiological responses to produce deep relaxation; may use polygraph machine to record muscle tension; takes several weeks to learn.

Question 11

cutaneous stimulation -

Answer 11

touch & massage, hot/cold; TENS; accupressure

Question 12

herbals -

Answer 12

no significant research to show correlation with pain management; ask what they are taking to avoid drug/herb interactions

Question 13

reducing painful stimuli and perception -

Answer 13

remove the source of stimulation (ie: constipation = abdominal cramping; arthritic knee = painful ambulation); administer medications to minimize pain experience.

Question 14

Controlling Painful Stimuli:

Answer 14

Managing the client’s environment – bed, linens, temperature; Positioning; Changing wet clothes and dressing; Monitoring equipment, bandages, hot and cold applications; Preventing urinary retention and constipation

Question 15

Analgesics –

Answer 15

(regulated according to pain scale) NSAIDS or Nonopiods, opiods, adjuvants

Question 16

if patient has pain scale of 0-3 then use

Answer 16

comfort measures

Question 17

NSAIDS or nonopiods

Answer 17

mild to moderate acute intermittent pain (headache)

Question 18

opiods

Answer 18

moderate to severe acute pain (cancer or post-op pain)

Question 19

adjuvants

Answer 19

drugs with analgesic properties that where not originally developed for pain control (antidepressants, anticonvulsants, corticosteroids)

Question 20

Patient Controlled Analgesia (PCA) –

Answer 20

only patient can push the button

Question 21

other pharmacological pain relievers

Answer 21

Local analgesic Infusion Pump; Topical analgesic & anesthetics; Local anesthetics; Regional anesthetics ; Epidural analgesia

Question 22

Rhizotomay

Answer 22

surgically cutting dorsal nerve roots as they enter the spinal cord; relieves localized acute pain in specific nerve area

Question 23

Chordotomy

Answer 23

more extensive and involves resection of the spinothalmic tract; used to treat unrelieved pain; risk for paralysis

Question 24

Procedural Pain Management:

Answer 24

(same procedures may cause pain) turning, wound care, suctioning, catheter insertion/removal

Question 25

Chronic / Cancer Pain Management:

Answer 25

Over time, patient builds up a tolerance to opioids and the body builds up tolerance to respiratory depression – meaning they may require higher dose to sustain comfort level but does not mean they are addicted to the drugs.

Question 26

Three-Step Approach to managing Cancer Pain -

Answer 26

incident pain, end of does pain, spontaneous pain

Question 27

breakthrough pain -

Answer 27

extends beyond treated steady chronic pain

Question 28

incident pain -

Answer 28

predictable and elicited by specific behaviors

Question 29

end of dose pain -

Answer 29

occurs toward end of the usual dosing interval

Question 30

spontaneous pain -

Answer 30

unpredictable and not associated with activity

Question 31

the biggest barrier for both health care providers and patients.

Answer 31

fear of addiction

Question 32

dependence -

Answer 32

manifested by a drug withdrawal (most common alcohol)

Question 33

drug tolerance -

Answer 33

effectiveness diminishes over time

Question 34

addiction -

Answer 34

- impaired, compulsive use despite need/harm

Question 35

pseudoaddiction -

Answer 35

drug seeking

Question 36

pseudotolerance -

Answer 36

need to increase dose for reason other than tolerance (disease progression)

Question 37

placebos -

Answer 37

use is discouraged in pain management even though 30-50% recipients have positive effects. Use is considered unethical and deceitful and jeopardizes trust between clients and health care providers.

Question 38

Barriers to Effective Pain Management:

Answer 38

dependence, drug tolerance, addiction, pseudoaddiction, pseudotolerance

Question 39

Restorative Care:

Answer 39

Pain clinics; Palliative care; Hospice

Question 40

pain clinics

Answer 40

know the real pain clinics because most are not good

Question 41

palliative care

Answer 41

there to help with comfort measures, most not always are dying patients

Question 42

hospice

Answer 42

referred if 6 month life expectancy

Question 43

evaluation -

Answer 43

The client’s response is not always obvious.

Question 44

Be an intent observer and know what response to anticipate on the basis of:

Answer 44

The type of pain; The intervention; The timing of the interventions; The physiological nature of the injury/disease; The client’s previous responses

Question 45

Client expectations –

Answer 45

the patient expects YOU to be sensitive to his pain and to be diligent in attempts to manage the pain.