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Medical Surgical Exam 4 > Pain > Flashcards

Pain Flashcards

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USMLE® Step 1 flashcards
1
Q

Pain

A

Universal, complex personal experience

Pain is inadequately treated in all health care settings

One major reason people seek health care
Nurses have a central role in assessment and management

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2
Q

Populations at highest risk for inadequate pain control:

A

Older adults
Substance abusers
Those whose primary language differs from that of the health care professional

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3
Q

Definitions of Pain

A

Unpleasant sensory/emotional experience associated with actual or potential tissue damage
Whatever person experiencing it says it is; exists whenever person says it does
Self-report always most reliable indication of pain

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4
Q

Types of Pain

A

Acute pain
Short-lived
Results from sudden, accidental trauma; surgery; ischemia; inflammation
Chronic (persistent) pain-More than 3 months
Cancer pain
Non-cancer pain

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5
Q

Acute Pain

A

Major distinction from chronic pain is the effect on biologic responses
Acts as warning sign
Activation of sympathetic nervous system
“Fight-or-flight” reactions

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6
Q

Acute Pain Responses

A

Increased heart rate
Increased blood pressure
Increased respiratory rate
Dilated pupils
Sweating

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7
Q

Chronic (Persistent) Pain

A

Persists or recurs for indefinite period (more than 3 months)
Onset is gradual
Character and quality can change over time
Can result in emotional, financial, and relationship burdens, as well as depression/hopelessness

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8
Q

Categorization of Pain by Underlying Mechanisms

A

Nociceptive pain
Somatic-
Visceral
Neuropathic pain

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9
Q

Nociceptive Pain

A

Damage to somatic or visceral tissue
Surgical incision, broken bone, or arthritis
Usually responsive to opioids and nonopioid medications

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10
Q

Somatic Pain

A

Superficial or deep
Localized
Arises from bone, joint, muscle, skin, or connective tissue

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11
Q

Visceral Pain

A

Tumor involvement or obstruction
Arises from internal organs such as the intestine and bladder

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12
Q

Neuropathic Pain

A

Damage to peripheral nerve or CNS-Neurontin
Numbing, hot-burning, shooting, stabbing, or electrical in nature
Sudden, intense, short-lived, or lingering

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13
Q

Pain Transmission

A

Painful stimuli often originate in extremities
If pain is not transmitted to the brain, person feels no pain
Two specific fibers transmit periphery pain:
A delta fibers
C fibers

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14
Q

Pain Assessment

A

Patient’s self-report is “gold standard” for pain existence and intensity assessment
Nurse’s role
Accept patient self-report
Serve as advocate
Act promptly to relieve pain
Respect values and preferences of patient

Location
Intensity
Quality
Onset and duration
Aggravating and relieving factors
Effect of pain on function and quality of life
Comfort-function outcomes
Patient’s acceptable level of pain

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15
Q

Areas of Referred Pain

A
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16
Q

What is breakthrough pain?

A

Beyond the treated pain
Transient, moderate to severe
Occurs beyond treated pain
Usually rapid onset and brief duration with variable frequency and intensity

17
Q

What is End-of-dose failure

A

Dosage is not holding patient such as fentanyl patch good for 72 hours. Stops working after 48 hours

18
Q

Associated symptoms of Pain

A

Can worsen pain
Anxiety
Fatigue
Depression

19
Q

Psychosocial Assessment

A

All pain holds unique meaning for the

person experiencing it

Remain objective; advocate for proper pain control

Ask open-ended questions

20
Q

Pain Reassessment

A

Critical to reassess at appropriate intervals, guided by
Pain severity
Physical and psychosocial condition
Type of intervention
Risks of adverse effects- IE- opioids check resp
Institutional policy

21
Q

Assessment Challenges

A

Patients who cannot self-report pain are at highest risk for undertreated pain
Hierarchy of Pain Measures
Checklist of Nonverbal Pain Indicators (CNPI)
Pain Assessment in Advanced Dementia Scale (PAINAD)- Used a lot
CPOT-Critical care pain tool

22
Q

Pharmacologic Management of Pain

A

Analgesic agents are first-line therapy
Individualized treatment plan based on comprehensive assessment
Clarify desired outcomes
Discuss options and preferences with patient and family
Re-evaluate as needed

23
Q

Pharmacologic Management of Pain

Three categories of medications

A

Nonopioid- Tylenol, NSAIDS,
Opioid
Adjuvant

24
Q

Nonopioids

A

Analgesic ceiling
Increasing dose above upper limit produces no greater analgesia.
Do not produce tolerance or addiction
Many are OTC.

Aspirin and other salicylates (Trilisate)

Acetaminophen

NSAIDs

Some NSAIDs are equal to aspirin.

Others have better efficacy

Decrease production of pain –sensitizing chemicals .

Side effects include GI problems, renal insufficiency, and hypertension.

25
Q

Pharmacologic Management of Pain Epidural and PCA

A

Multimodal analgesia
Preemptive analgesia
Multiple routes of administration-

epidural-Respiratory depression, constipation, URINARY RETENTION
Around-the-clock dosing
Patient-controlled analgesia (PCA)-Respiratory status-double sign when handing off patient

26
Q

Analgesics by Classification: Non-Opioids Health Teaching

A

Ask about use of non-opioids
Clarify brand names vs. over-the-counter names
Inform patients about combination products containing non-opioids
Advise not to exceed safe maximum daily dose due to adverse side effects

Full or mu agonists
Morphine, fentanyl, hydromorphone, oxycodone, hydrocodone
Mixed agonists antagonists
Butorphanol, nalbuphine
Partial agonists
Buprenorphine

27
Q

Physical Dependence, Tolerance, and Addiction

A

Physical dependence: Normal response
Tolerance: Normal response
Opioid addiction: Chronic neurologic and biologic disease
Pseudoaddiction: Mistaken diagnosis of addictive disease

28
Q

Side Effects of Opioids

A

Constipation
Urinary retention
Nausea
Vomiting
Pruritus
Sedation
Respiratory depression (less common, most feared)

29
Q

Adjuvant Analgesics

A

Anticonvulsants and antidepressants
Local anesthetics

30
Q

Considerations for Older Adults: Opioids

A

Start with low doses and titrate slowly
Systematic assessment of patient response
Teach caregivers measures to reduce falls and accidents
Home safety assessment is recommended

31
Q

Nonpharmacologic Interventions

A

Should be used to complement, not replace, pharmacologic therapies
Physical modalities
Cognitive-behavioral strategies

32
Q

Physical Interventions

A

Physical therapy
Occupational therapy
Aquatherapy
Functional restoration-Patients with chronic conditions and are improving in the ADL type skills
Acupuncture
Low-impact exercise such as walking or yoga
Cutaneous stimulation – for example, TENS

33
Q

Cognitive/Behavioral Strategies

A

Prayer
Relaxation breathing
Artwork
Meditation
Hypnosis
Virtual reality

34
Q

Community-Based Care

A

Home care management
Self-management education
Health care resources

35
Q

The patient is receiving the first dose of an opioid analgesic for pain. The nurse expects the patient will also be ordered a(n):

A

Antacid agent
Anti-anxiety agent
Laxative or stool softener
Breakthrough pain reliever

36
Q

Which patient would benefit most from the use of a patient-controlled analgesia pump?

A

75-year-old woman with confusion who is in the last stages of the dying process
15-year-old girl who is recovering from a head injury from an automobile accident
42-year-old man who is mentally alert and is recovering from a fractured femur
60-year-old man who is mentally alert and is experiencing left-sided weakness after a stroke

37
Q
A

Medical Surgical Exam 4 (11 decks)

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