Pain

Question 1

What are four categories of pain?

Answer 1

1) acute - recent, sudden onset, related to injury
2) procedural - brief, intense from procedure or therapy
3) chronic - persistent beyond expected healing time or from underlying disease, over 6 months
4) cancer-related - can be acute or chronic, from the cancer or from cancer treatment

Question 2

What is pain?

Answer 2

whatever the patient says it is, fifth vital sign

Question 3

Can pain affect vitals?

Answer 3

Yes - it can increase heart rate, respiratory rate and blood pressure.

Question 4

What is the gate theory of pain?

Answer 4

pain perception in the brain can be inhibited by distraction

Question 5

What are eight factors that can affect pain and pain response?

Answer 5

1) past experience - most often does not increase threshold, rather it causes patients to fear future pain
2) anxiety - can increase pain if anxiety is related to the pain, if it is about something else it can serve as a distraction… more effective to treat the pain first
3) culture - but variations within culture due to age, sex/gender, education, income
4) age
5) sex - women more likely to experience certain painful conditions like migraines, TMJ
6) gender - men often socialized to be stoic
7) genetics
8) expectations - placebo

Question 6

What are some special considerations when dealing with infants and children in pain?

Answer 6

• infants DO feel pain
• harder to assess… look for visual cues, use mom and dad, make use of pain scale tools
• use topical anesthetics before procedures (usually need to apply 30 mins - 1 hour before)
• toddlers are egocentric, may think you know they are in pain, also do not have concept of time (don’t say it will only hurt for a minute)
• DO NOT give ASA
• give medications dosed by weight

Question 7

What are some important roles the nurse plays in pain management?

Answer 7

• assess, reassess
• identify goals
• advocate if prescribed treatment is not effective
• establish a positive relationship (necessary for good pain assessment)

Question 8

What are two key points related to pain management with pain medications?

Answer 8

1) teach patient to request pain medications early on before pain is severe to maintain a therapeutic serum level
2) combination therapy is more effective than simply increasing dose

Question 9

What are some non-pharmacologic interventions for pain?

Answer 9

• massage
• heat
• distraction
• relaxation techniques
• guided imagery
• hypnosis
• music therapy
• reflexology
• aromatherapy

etc.

Question 10

The doctor fears your patient is at risk for developing opioid addiction and does not want to increase the drug dose. Your patient is experiencing 9/10 pain. What is your priority? Pain or fear of addiction?

Answer 10

control of pain is priority over fear of medical addiction

Question 11

What is the WHO pain ladder?

Answer 11

A three-step approach to pain management:

1) use nonopioids once pain has been IDed and assessed
2) if pain persists or increases, use opioids with or without nonopioids
3) if pain persists or increases, use opioids for moderate-severe pain with or without nonopioids