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MS1 Exam Two > Pain > Flashcards

Pain Flashcards

1
Q

Types of Comfort

A
  • Physical: bodily sensations and homeostatic mechanisms
  • Psychospiritual: individual awareness of oneself and one’s relationship to a higher being
  • Sociocultural: family and societal relationships
  • Environmental comfort: external surroundings
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2
Q

Comfort

A
  • Increases patient satisfaction with shorter hospital days (pain relief, reduced stress, and healing environment)
  • Maintains normal vital signs
  • Provides for adequate sleep and nutrition
  • Provides a sense of control
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3
Q

The Sensory Experience

A

Requires:

  • An experience that is received through the sense organs
  • An intact CNS
  • Stimuli that reaches appropriate brain center for perception of the stimuli to take place
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4
Q

The Stimuli

A
  • External: visual, auditory, olfactory, tactile, gustatory

- Internal: gustatory, visceral, kinesthetic

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5
Q

Components of Stimuli Transmission/Sensory Experience

A
  • Reception: receiving of stimuli or data
  • Perception: the conscious organization and translation of the stimuli/data into meaningful information
  • Reaction: response to the stimuli/data
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6
Q

Sensory Alterations

A

Sensory deprivation:

  • A decrease or lack of meaningful stimuli
  • Pts become more aware of remaining stimuli
  • Alters perception, cognition, and emotion
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7
Q

S&S Sensory Deprivation

A
  • Yawning
  • Drowsy, sleepy
  • Decreased attention span
  • Disorientation
  • Nocturnal confusion (sun-downing)
  • Apathy
  • Hallucinations, Delusions
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8
Q

Sensory Overload

A

inability to process or manage the amount/intensity of sensory stimuli

3 factors:
-internal stimuli

  • external stimuli
  • inability to disregard stimuli selectively
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9
Q

S&S Sensory Overload

A

-irritability

-disorientation
(periodic/general)

  • fatigue, sleeplessness
  • reduced problem-solving ability
  • scattered attention
  • increased muscle tension
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10
Q

Those at risk for Sensory Deprivation

A
  • confinement in a non-stimulating environment in a home or facility
  • impaired vision/hearing
  • mobility restrictions (para or quadriplegic)
  • communicable diseases (AIDS)
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11
Q

Those are risk for Sensory Overload

A
  • pain/discomfort

- ICU’s with IVs, tubes, machines, overhead pages, disruptions

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12
Q

Factors influencing sensory function

A
  • Developmental
  • Medications
  • Cultural
  • Stress
  • Pre-existing illnesses
  • Lifestyle & Personality
  • Smoking
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13
Q

What is Pain

A
  • whatever the patient experiencing the pain says it is, whenever the patient says it is, and for as long as the patient says it exists
  • subjective, unpleasant sensation caused by noxious stimulation of sensory nerve endings
  • A sensation in which a person experiences discomfort due to irritation of sensory nerves
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14
Q

Pain Characteristics

A
  • very complex and individualized
  • ranges from minor to severely debilitating
  • impact one’s quality of life
  • major reason people seek healthcare
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15
Q

Function of Pain

A
  • Warning system
  • Aids in locating and diagnosing a problem
  • Serves as a measure of effectiveness of treatments
  • initiates the fight/flight mechanism
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16
Q

Nurse’s Role in The Pain Process

A
  • Assessing: pain scale, site, intensity
  • Communicating: findings to others (MD, NP, PA)
  • Assuring: adequate relief
  • Evaluating: effectiveness of interventions
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17
Q

Consequences of Untreated Pain

A
  • unnecessary suffering
  • physical and psychosocial dysfunction
  • increased respiratory and cardiac workload
  • impaired recovery
  • immunosuppression
  • sleep disturbances
  • decreased GI motility
  • Increased catabolism
  • increased morbidity
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18
Q

Physiology of Pain Perception

A

Nociceptors:

-primary sensory neurons

-detect tissue
injury/damage

-evoke the sensations of: touch, heat, cold, pain, pressure

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19
Q

Processes of Nociception

A
  1. Transduction: conversion of a stimulus into a neural action potential (mechanical, thermal, chemical)
  2. Transmission: movement of the painful impulse to the brain
    Substance P is the believed neurotransmitter to be responsible for pain transmission up the cord
  3. Perception: pain is recognized, defined, and responded to. Dependent upon the pain and its site
  4. Modulation: The “descending” system. Neurons send signals down the spinal column to release various substances. Inhibition of the nociceptive ascending impusles
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20
Q

Types of Nerve Fibers

A
  • “A” Fibers: Myelinated, fatty covering, sharp, pricking, localized pain
  • “C” Fibers: Unmyelinated, no fatty sheath, dull, burning, diffuse pain, aching
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21
Q

Interactional Responses to Pain

A
  • Physiologic: stimulus transmission
  • Sensory: recognition, pattern, area, intensity, nature
  • Affective: motivational, fear, anger, depression, anxiety
  • Behavioral: observable actions, facial expressions, guarding, crying
  • Cognitive: beliefs, attitudes, memories, and meaning attributed to pain
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22
Q

Sources of Pain

A
  • Physiological
  • Psychological
  • Environmental
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23
Q

Physiological Pain Types

A

Types:
-Mechanical: Tearing (kidney stone), Pressure (edema), Infection, muscle spasm

  • Thermal: Electrical currents, sunburn, lightning
  • Chemical: histamines, enzymes, prostaglandins, Caustic Agents (lye)
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24
Q

Physiological Effects of Pain

A
  • Dilation of bronchi
  • Increase RR and HR
  • Peripheral vasoconstriction (pallor, elevated BP)
  • Elevated Glucose
  • Diaphoresis (sweating)
  • increased muscle tension
  • decreased GI motility
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25
Q

Decompensated Physiological Effects of Pain

A
  • Rapid, irregular breathing
  • N/V
  • Weakness
  • Exhaustion
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26
Q

Physiological Variables

A
  • body image
  • personality
  • previous experiences
  • pain trajectory
  • Anticipatory pain
  • pain control
  • anxiety
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27
Q

Increased Tolerance: Physiological effects of pain

A
  • happy, contented, actively involved

- experiences little discomfort from moderate pain

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28
Q

Increased Perception: Physiological effects of pain

A
  • depressed, loneliness, anger, bored

- concentrates on pain more

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29
Q

Psychological Sources of Pain

A

-Intrapersonal: stress, coping, cultural, ethnic

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30
Q

Environmental Sources of Pain

A

-Extrapersonal: occupational noises

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31
Q

Environmental Variables

A

Night: Increases pain perception

Day: Decreases pain perception

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32
Q

Sociocultural Variables

A
  • Demos
  • Support Systems
  • Social Roles
  • Culture: pain expression, drug use, pain-related beliefs, coping
  • Cognitive style: high achievers, high intelligence
  • Cultural: affects ones attitudes and beliefs
  • Attitudes & Values: Gives meaning to pain
  • Sex: Females are more expressive
  • Birth Order: First born usually less tolerant to pain
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33
Q

Sociocultural Effects of Pain

A
  • Depends on past experiences: inability to cope if none
  • Depends on ones value system: personal weakness, deserved punishment
  • Cultural Variables
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34
Q

Developmental Variable

A

Age:

  • Younger: Fearful, Unfamiliar experience
  • Older: Experienced (know what to expect)
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35
Q

Spiritual Variable

A
  • Persons with deep religious faith have higher pain tolerance
  • Affects attitudes and beliefs
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36
Q

Endorphins

A
  • Natural supply of opium-like substances
  • Endogenous Morphine
  • “morphine within”
  • Produces analgesia, inhibits pain perception
  • Activated by stress and pain
  • Located in the brain, spinal cord, and GI tract
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37
Q

Pain Transmission Theory

A

Gate Control Theory:

  • Peripheral nerve fibers can be altered at the spinal cord level
  • Synapses in the dorsal horn act as gates
  • Backrubs (touch), warm compresses (temp), TENS, & distraction CLOSE the gates
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38
Q

Which statement is true?

  1. Psychogenic pain is not real.
  2. Regular administration of analgesics will not cause dependency.
  3. Tolerance to analgesics means a person has become addicted.
  4. The amount of tissue damage will describe the amount of pain associated with it.
A
  1. Regular administration of analgesics will not cause dependency.
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39
Q

Common Biases & Misconceptions

A
  • Pts with minor illnesses have less pain than those with severe illnesses
  • Administering analgesics regularly will lead to drug addiction
  • The amount of tissue damage in an injury accurately indicates the amount of pain
  • Psychogenic pain in not real
  • Drug abusers and alcoholics over-react to pain
  • Health care personnel are the best authorities on the nature of the client’s pain
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40
Q

Tolerance

A

A “neuroadaptive” mechanism characterized by decreasing effects of a drug at a constant dose or the need for higher doses to maintain an effect

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41
Q

Pain Threshold

A

The point at which a person first perceives the pain

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42
Q

At Risk Population for Pain

A
  • Pre-op patients
  • Patients preparing for childbirth
  • Patients with altered internal or external integrity
  • Clients with localized area of inflammation
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43
Q

Nursing History

A
  • Client Interview: Most important
  • full description of characteristics of pain
  • pain trajectory
  • client’s response
  • variable affecting the pain
  • assessment of previous records regarding pain
44
Q

Nursing Assessment

A
  • Location
  • Type
  • Intensity
  • Quality
  • Duration
  • Control
  • Nonverbal & physiological expressions
  • Verbalization of fears and expectations
45
Q

Pain Intensity

A

Verbal scales: 0-10 & Wong-Baker FACES

ANVPS: Adult non-verbal pain scale

DVPRS: Defense and Veterans Pain Rating Scale (0-10 and faces)

RASS: Richmond Agitation-Sedation Scale

46
Q

Behavioral Cues during Physical Assessment

A
  • Nonverbal: facial grimacing, guarding position, clinched teeth/fist, crying, moaning
  • Physiological: Increased HR, RR, BP, Diaphoresis, Increased muscle tension
47
Q

Acute vs. Chronic

A
  • Rapid vs Sudden
  • External agent or disease process vs unknown or ineffective treatment
  • Mild to severe vs Difficult to evaluate
  • Up to 6 months and diminishes with time vs prolonged
  • Can ID the pain areas vs difficult to distinguish pain from non-pain
  • self-limited or readily corrected vs continuous or intermittent
  • suffering decreases over time vs suffering usually increases over time
  • Action is to relieve the pain vs modify the pain experience
  • Prognosis eventually complete relief vs complete relief not usually possible
  • Tx: Analgesics vs Opioids
48
Q

Chronic Pain

A

considered a specific disease

  • treated at pain clinics or as in-patients
  • types: intractable, benign, or persistent
49
Q

Intractable pain

A

having no relief

50
Q

Benign pain

A

no known disease or injury

51
Q

Persistent

A

does not subside after injury heals

52
Q

Chronic Pain Management

A
  • Lasts more than 6 months
  • Nerve blocks, epidurals
  • Acupuncture
  • Biofeedback: alteration of body function through mental concentration
  • TENS
  • Hypnosis
  • Neurosurgery
  • Operant conditioning
53
Q

Neurosurgery

A
  • neurectomy
  • rhizotomy
  • chordomtomy
54
Q

TENS

A

Transcutaneous Electric Nerve Stimulation (TENS)

  • Stimulates Endorphin Production
  • Battery transmitter, wires and electrodes attached to the skin at pain point
  • Turned on when pain felt
  • Produces buzzing/tingling sensation
  • Nerve function not damaged
  • Study: Greater pain relief than narcotics
55
Q

Operant Conditioning

A

Reward and Praise for “pain work”

56
Q

Hypnosis

A
  • alters the perception of pain
  • works through positive suggestions made to the subconscious
  • used when pain is aggravated by stress and tension
57
Q

Nursing Diagnoses for pain

A
  • Altered Comfort
  • Knowledge Deficit
  • Ineffective Coping
58
Q

Altered Comfort Nursing Diagnoses

A
  • interventions that explore methods to alleviate pain for the client
  • Criteria for evaluation:
  • pain is minimized, controlled or relieved
  • Ability to resume ADL’s
  • Uninterrupted sleep
  • Patient report
59
Q

Knowledge Deficit

A
  • assess what is known
  • explain cause of pain
  • include family members

Criteria for Evaluation:
-client is aware of precipitating factors

-can verbalize methods for relief

60
Q

Ineffective Coping

A
  • determine how client dealt with pain in the past
  • Meet psychological needs
  • Be non-judgmental and accepting

Criteria for Evaluation:

  • client identifies coping patterns
  • verbalizes fears associated with pain
61
Q

The best indicator for evaluation of a client’s pain is:

1) The amount of pain medication asked for and taken.
2) The use of a pain scale.
3) The client’s verbal report of pain.
4) An increasing amount of medication required to relieve pain.

A

3) The client’s verbal report of pain.

62
Q

Nonpharm Techniques for Pain Control

A
  • Distraction
  • Progressive relaxation techniques
  • Promote rest
  • Cutaneous stimulation
  • Guided imagery
  • Therapeutic touch
63
Q

Distraction

A

painful stimuli is inhibited through excessive meaningful sensory input

attention is directed away from the pain to other stimuli in the environment

64
Q

Progressive relaxation techniques

A

contraction and relaxation of muscle groups in a systematic way

begins with face and ends at the feet

65
Q

Promote Rest

A
  • client becomes fatgued and exhausted
  • usual rest and sleep pattern
  • decrease the number of interruptions
  • admin mild sedation
  • maintain a quiet environment
  • offer warm, non-caffeinated drink before sleep
  • provide rest periods during the day
66
Q

Cutaneous Stimulation

A

-interferes with pain perception by lightly rubbing the affected area

  • backrubs
  • massage
  • apply heat or cold packs
67
Q

Guided Imagery

A

purposeful use of one’s imagination in a specific way to achieve relaxation and control

68
Q

Therapeutic Touch

A
  • mechanism not understood

- works for some, but not all

69
Q

Basic Principles of Pain Management

A
  • patient must be believed
  • patient deserves adequate pain management
  • treatment must be based on the patient’s goals
  • treatment plan should include combinations of drug and nondrug therapies
  • multidisciplinary approach should be used
  • ongoing evaluation to ensure patient goals are being met
  • prevention of drug side effects are managed
  • patient/family teaching is the cornerstone of the treatment plan
70
Q

WHO

A

World Health Organization

The analgesic ladder

71
Q

The Analgesic Ladder

A

Step 1: ASA, Acetaminophen, NSAID’s

Step 2: Codeine, Oxycodone

Step 3: Morphine, Hydromorphone, Methadone

72
Q

Step 1

A

ASA, Acetaminophen, NSAID’s

  • Mild pain (1-3 pain score)
  • nonopioid analgesics & Adjuvant drugs

ACTION: “Ceiling effect”, do not produce tolerance/dependence, available without a prescription

73
Q

Step 2

A

Codeine, Oxycodone

  • Mild to moderate pain (4-6 pain score)
  • persistent pain despite Nonopioid therapy
  • use of opioids with adjuvant drugs
74
Q

Common opioids (Combined with nonopioid)

A

Codeine –> Tylenol #3

Hydrocodone –> Vicodin

Oxycodone –> Darvon

75
Q

Step 3

A

Morphine, Hydrocodone, Methadone

  • Moderate to severe pain (7-10 pain score)
  • Opioids with Step 1 & Adjuvant Drugs (Morphine, Fetanyl, Hydromorphone, Methadone, Oxycodone)
  • More potent, No “ceiling effect”, dose limiting side effects
76
Q

Adjuvant Therapy

A
  • enhance pain therapy by 3 mechanisms

- used at all steps of the analgesia ladder

77
Q

3 Mechanisms of Adjuvant Therapy

A
  1. enhance the effects of opioid & non-opioids
  2. possess analgesic properties
  3. counteracts the side effects of analgesics
78
Q

Antidepressant Adjuvant Therapy

A
  • prevent cellular reuptake of seratonin & norepinephrine
  • inhibit the transmission of nociceptive signals
  • Elavil, Sinequan, Tofranil PM, Paxil, Zoloft, Prozac
79
Q

Antiseizure Agents Adjuvant Therapy

A
  • stablize neuron membrane & prevent transmission

- Neurontin, Tegretol, Klonopin

80
Q

a2 Adrenergic Agonists Adjuvant Therapy

A
  • possibly effect modulation and transmission

- Catapres (Clonidine)

81
Q

Corticosteroids Adjuvant Therapy

A
  • ability to decrease edema & inflammation

- Decadron & Medrol

82
Q

Local Anethetics Adjuvant Therapy

A
  • interrupt transmission of pain signals

- Given oral, parenteral, & topical

83
Q

Placebos

A

any medication or treatment that produces an effect because of its intent and not its physical properties

  • requires a physician’s order
  • most frequent types are 9% NS and sugar pills
  • increases endorphin levels
  • decreases pain perception
  • create a psychological sense of pain relief (psychogenic effect)
84
Q

Nursing Interventions for Placebos

A
  • explain its intent to relieve pain when administered
  • administer as if it was a medication
  • do not use as a form of punishment
  • not to be used to prove the client is or not in pain or addicted
85
Q

Aspirin

A

Acetylsalicylic Acid (ASA)

  • most frequently used OTC drug
  • May cause GI bleeding, epigastric distress, tinnitus
  • contains anticoagulation properties
86
Q

Tylenol

A

Acetaminophen

  • similar to ASA, but NO ANTICOAGULATION OR ANTI-INFLAMMATORY PROPERTIES
  • no epigastric distress
87
Q

NSAID’s

A

Nonsteriodal Anti-inflammatory Agents

  • anti-inflammatory
  • antipyretic
  • inhibits an enzyme key to the formation of prostaglandins
  • may cause GI disturbance
  • Ibuprofen (Motrin)
88
Q

Narcotics & Opiates

A
  • Opium Alkaloids (Morphine Sulfate & Codeine)
  • Synthetic (Meperidine)
  • Modify perception and reaction to pain
  • Used in severe pain
  • Respiratory depression, major side effect
89
Q

Morphine Sulfate

A

PO, IM, SQ, IV

90
Q

Meperidine HCL

A

Demerol

PO, IM, or IV

91
Q

Codeine

A

PO, SL

92
Q

Oxycodone

A

Percocet, Percodan, Oxycontin

PO

93
Q

Fetanyl

A

Siblimaze

IM, IV, Transmucosal

94
Q

Oral Route of Administration

A
  • route of choice
  • less expensive
  • oral dose > IM due to first-pass effect
95
Q

Sublingual & Buccal Route of Administration

A
  • Under the tongue
  • Absorbed directly into systemic circulation
  • Avoids first-pass effect
96
Q

Intranasal Route of Administration

A
  • Enters highly vascular mucosa
  • Few on the market
  • For Acute HA & other intense, recurrent pain
97
Q

Rectal Route of Administration

A
  • Useful if unable to take PO
  • Suppository form
  • Very effective
98
Q

Transdermal Route of Administration

A
  • Absorption is slow
  • Most common: Fentanyl & Lidoderm
  • Creams & Lotions: Aspercreme, Myoflexcream
  • Ointments, Gels, Liniments, Balms: OTC products, usually strong hot/cold sensation, skin testing advisable
99
Q

Parenteral Route of Administration

A
  • SQ, IM, IV
  • Single, repeated, & continuous dosing
  • IM NOT recommended
  • SQ administration is slow
  • IV best route (immediate analgesia, rapid titration, continuous infusion for steady analgesia)
100
Q

Intraspinal Delivery Route of Administration

A
  • Epidural & Intrathecal
  • intermittent bolus or continuous infusion
  • surgically implanted for long term use
  • highly potent drugs due to closeness to receptors
  • smaller doses required
  • Morphine, Fentanyl, Hydromorphone, Clonidine
101
Q

Intraspinal Complications

A
  • Catheter dislodgment/migration, noted by decreased pain control
  • Neurotoxicity caused by many preservatives
  • Infection. Rare but serious. Acute bacterial infection (Meningitis)
102
Q

PCA Pump

A
  • computerized pump activated by the patient
  • timer permits the patient to have a certain amount of medication per minute and hour (lockout period)
  • Can run as a continuous infusion (basal rate)
103
Q

Advantages of PCA pump

A
  • fewer post-op complication
  • less total analgesic
  • great sense of control
  • earlier ambulation
104
Q

How will you see PCA pump med orders

A

1/6/10 or 2/1/6/12

(1mg, q 6 mins, for a total of 10mg per hour)

or

(2mg basal, 1mg, q 5 mins, for a total of 10mg per hour)

105
Q

Continuous IV Infusion Pump

A
  • Provides for steady level of narcotic analgesia
  • Ambulatory infusion pumps
  • system the size of a radio transmitter
  • worn in a pouch on the belt
  • Narcotics may lead to addiction when administered over long periods of time (1% of 12,000 clients in one study)
106
Q

Documentation

A
  • Always include patients subjective description of pain
  • Pain scale
  • Always include location of pain
  • Type of pain
  • Medication given
  • Effectiveness of the pain medication
107
Q

The most effective route of administration for pain medication is…

A

IV

MS1 Exam Two (6 decks)

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