Pain

Question 1

Pain: 3 important principles

Answer 1

Patient is always believed- pain is real even if the cause is unknown.

A nurse who Suspects pain when a patient denies it must explore the concern with the client.

Perception is reality

Question 2

Chronic pain

Answer 2

Usually persists at least six months (not a hard and fast rule)
Constantly or intermittently over a period of time

Question 3

Assessing for pain

Answer 3

Location
 intensity
 quality
 pattern 
precipitating factors 
alleviating factors 
associated symptoms

Question 4

Nocicepters

Answer 4

Transmit pain

Question 5

Bradykinin

Answer 5

One of a group of endogenous (produced by body)proteins that act on nociceptor nerve endings. directly activates the nociceptors and causes the release of inflammatory chemicals, such as histamine.
Causes vasodilation and increases capillary permeability resulting in redness and tender tissues

Question 6

Substance P

Answer 6

Chemical that increases the inflammatory response and acts on blood vessels in the damaged area to release chemicals that contribute to the conduction of nociception.

Question 7

Breakthrough pain

Answer 7

Pain that occurs beyond the chronic pain already being treated by appropriate analgesics

Question 8

Difference between:
neuropathic pain and
somatic pain

Answer 8

neuropathic pain- caused by damage to peripheral nerves or to CNS

somatic pain- pain that is localized and arises from bone,joint, muscle or connective tissue

Question 9

What could explain why people feel different amounts of pain for similar pain stimuli?

Answer 9

The presence of enkephalins and endorphins.

Anxiety can affect levels.

Question 10

How is absorption and metabolism of medications altered in Elderly?

Answer 10

Decreased liver, kidney and GI function.

Watch for toxicity.

Metabolism is slowed and elderly may obtain more pain relief for a longer period of time.

Smaller doses are required.

Question 11

What does a nurse do if pain scale number reported is not matching the external appearance of pain?

Example patient says pain is 10 but is smiling and moving easily. OR patient says 2 and is crying and guarding.

Answer 11

Educate patient on pain scale system.

Question 12

What other problem should be assessed for in chronic pain patients?

Answer 12

Depression

Question 13

What is the rationale for a TENS?

Answer 13

Block painful stimuli traveling over small nerve fibers.

Question 14

How is pain determined in a Patient?

McCaffery’s definition

Answer 14

“Pain is whatever the person says it is.”

Question 15

What is extended gate theory?

Answer 15

Theory proposes that Information is processed in neuromatrix from which a pattern emerges called a neurosignature. The pattern changes when a limb is removed and then is interpreted as a painful limb.

Question 16

How do you morphine and morphine agonists alter the clients pain experience?

Answer 16

They bind to naturally occurring opioid receptor sites and alter the clients perception of the painful experience. They do not change the cause or transmission of pain.

Question 17

What pre-operative factor is most likely to result in increased postoperative pain?

Answer 17

Anxiety

Question 18

What is a good choice for a site of a continuous subcutaneous infusion of opioid analgesia?

Answer 18

Just below the clavicle. Extremities are avoided to prevent restricted movement. Also often times circulation is impaired or edema is present if the patient is terminally ill.

Question 19

What is a nursing intervention for a client and pain that is based on the gate control theory?

Answer 19

Massage.
The gate control theory suggests that cutaneous stimulation activates larger faster transmitting a-beta sensory nerve fibers.

Question 20

What are common complications of an epidural analgesia?

Answer 20

Vital signs must be monitored every 15 minutes. Some complications include nausea and vomiting, urinary retention, constipation, respiratory depression, and pruritus.
Hypotension is very common.
Strict surgical a sepsis is needed to prevent serious and potentially fatal infections.

Catheter should clearly label “epidural catheter”

Question 21

Why would blood glucose levels be elevated with acute pain?

Answer 21

Parasympathetic stimulation from body’s normal response to pain

Question 22

What is deafferentation pain?

Answer 22

Pain comes from injury to either the peripheral or central nervous system. Phantom pain reflects injury to the peripheral nervous system.

Question 23

Types of pain

Answer 23

1-Nociceptive pain
a- somatic
b- visceral

2- neuropathic

Question 24

How does ibuprofen relieve pain?

Answer 24

Decreases production of pain sensitizing chemicals. Decreases prostaglandins at the site of injury