Pain

Question 1

What are some things that can cause people to be reluctant to report pain

Answer 1

fear of being viewed as weak or complainer
dont want to be bothersome
fear of administration methods for pain relievers
viewing pain as normal

Question 2

What does a pain assessment consist of

Answer 2

history of the pain

observation of behaviors, injuries, and secondary physiological responses to it

Question 3

What are some things the nurse needs to be aware of when assessing pain

Answer 3

previous treatments and their effectiveness
when and what analgesics were lsat taken
other meds being taken
allergies to meds

Question 4

What data should be collected during an interview assessing pain

Answer 4

location 
quality
intensity
pattern
onset precipitating factors 
alleviating factors 
effect on ADL's
associated symptoms
meaning

Question 5

What is a question to ask for location

Answer 5

where is your discomfort

Question 6

What is a question to ask for quality

Answer 6

tell me what it feels like

Question 7

What is a question to ask for intensity

Answer 7

0-10 scale

Question 8

What is a question to ask for pattern

Answer 8

do you have pain free periods, if so how long do they last

Question 9

What is a question to ask for onset

Answer 9

when did it start

Question 10

What is a question to ask for alleviating F’s

Answer 10

have you found anything that helps with the pain

Question 11

What is a question to ask for precipitating

Answer 11

Does anything trigger the pain

Question 12

What is a question to ask for associated symptoms

Answer 12

Do you have any other symptoms before during or after the pain

Question 13

What is a question to ask for effect on ADL’s

Answer 13

How does the pain affect your daily activities

Question 14

What can the nurse do to ass pain for clients who cannot use a numerical scale

Answer 14

assess the level of pain based on the degree of interference with functioning

Question 15

What is the scale for pain based on functioning interference

Answer 15

0 = no pain
2 = pain only when paying attention to it 
4 = can ignore pain and do things 
6 = cannot ignore pain, interferes
8 = impairs ability to function or concentrate
10 = incapacitating

Question 16

What are good pain tests for patients who cannot use a numerical scale for pain

Answer 16

wong-baker faces rating scale

Question 17

What are some good pain tests for patients with chronic pain

Answer 17

Brief pain inventory (BPI)

short form McGill Pain Questionaire (SF-MPQ)

Question 18

What is a good pain test for children 2mo to 7yrs

Answer 18

FLACC

Question 19

What are some physiological responses to acute pain

Answer 19

increased BP, HR, RR, pallor, diaphoresis, and pupil dilation

Question 20

Are you more or less likely to see physiological reponses in people with chronic pain

Answer 20

no, bx of adaptation to the pain

Question 21

What is the framework for determinign pain in nonverbal patients

Answer 21

attempt to get a self-report
Consider potential causes
Observe behaviors
obtain info from fam members or cargivers if available
attempt an analgesic trial and observe changes in behavior

Question 22

What can be given to someone with chronic pain to help identify pain patterns and factors that mediate/exacerbate pain

Answer 22

a daily pain diary

Question 23

What are some things that need to be recorded in a pain diary

Answer 23

onset time 
activity or situation
quality 
intensity
emotions
any interventions
intensity after interventions

Question 24

What are some nursing diagnoses for pain

Answer 24

acute and chronic pain

Question 25

What should the nurse include in the diagnostic statement for pain

Answer 25

the location and related factors (when available)

Question 26

What else can pain be in the diagnosis

Answer 26

the etiology

Question 27

What are some examples of pain as the etiology

Answer 27

Impaired physical mobility related to pain Ineffective airway clearance related to weak cough secondary to postoperative incisional abdominal pain Hopelessness related to feelings of continual pain

Question 28

Before discharge, what data needs to be assessed

Answer 28

client knowledge and self care abilities Family/caregiver availability, skills, and willingness family role changes adn coping resources

Question 29

What are some things that should be taught for client teachign

Answer 29

skills for administration non-pharmacologic techniques to reduce pain how to access community resources

Question 30

Poor pain management can cause problem with

Answer 30

vitals like cardiac output and oxygen demand endocrine and metabolic response like increased cortisol, ADH, and insulin resistance Wound healing bx of decreased participation in therapy and immune system problems sleep

Question 31

What are patient influences that can affect pain management

Answer 31

previous experiences- ask them if past pain meds worked Ability to communicate- use FLACC scale or a translator Gender and culture- ways of expression including differences between genders Addiction- may cause them to need a higher dose

Question 32

What are some nurse influences that can affect pain management

Answer 32

Knowledge- of different types of meds and their properties Attitude- like biases Skill- judgement, observation/assessment skills, communication skills

Question 33

During intervention, what is used to determine whether nonpharm or pharm pain management is needed

Answer 33

the WHO 3 step analgesic ladder

Question 34

What is the first step in the 3 step ladder

Answer 34

For mild pain (1-3 on a 0-10 scale) | use nonopioid analgesics

Question 35

When do you move to step two of the 3 step ladder

Answer 35

if the mild pain doesnt go away when using a full dose of meds or pain is reported between 4-6 on a 0-10 scale

Question 36

What is done in the step two of the step ladder

Answer 36

use of an opioid like codeine or tramadol by themselves or in combination with a nonpharm intervention as well like oxycodone with acetaminophen

Question 37

When do you use the 3 step of the 3 step ladder

Answer 37

pain of 4-6 doesnt go away with full dose or pain reported 7-10 on a 0-10 scale

Question 38

What are some opioids that are used for step 3 on the 3 stap ladder

Answer 38

morphine hydromorphone fentanyl

Question 39

What is a scale that can be used to assess the sedation level of a client receiving opioids

Answer 39

the pasero opioid-induced sedation scale

Question 40

What are the rackings of the pasero opioid induced sedation scale

Answer 40

1- awake and alert 2- slightly drowsy and easily aroused 3- frequently drowsy, arousable, and drifts off to sleep during conversation 4- minimal or no response to physical stimulation

Question 41

What are the common sideeffects of opioids

Answer 41

``` constipation sedation N/V Respiratory depression pruritus urinary retention ```

Question 42

What are the three types of non-pharm pain management areas

Answer 42

physical cognitive-behavioral lifestyle

Question 43

What are the physical non-pharm pain management modalities

Answer 43

heat/cold TENS acupuncture cutaneous stimulation (massage)

Question 44

What are the cognitive-behavioral non-pharm pain management modalities

Answer 44

distraction relaxation techniques hypnosis emotional counceling

Question 45

What are the lifestyle non-pharm pain management modalities

Answer 45

stress management exercise nutrition symptom monitoring

Question 46

What is nociceptive pain

Answer 46

Pain directly from tissue damage

Question 47

Patients with visceral pain often have more problems with

Answer 47

N/V

Question 48

What is neuropathic pain

Answer 48

Pain that is related to damaged or malfunctioning nervous tissue in the peripheral and /or CNS

Question 49

What is intractable pain

Answer 49

Pain for which there is no cure - cancer

Question 50

What are some descriptor words for nociceptive pain

Answer 50

``` cramping crushing sharp throbbing tender pressing ```

Question 51

What are some descriptor words for neuropathic pain

Answer 51

``` drilling numb burning shooting stabbing tingling ```

Question 52

What are behavioral indicators of pain

Answer 52

``` Guarding Impaired thought processes Social withdrawal Introspection Altered time perception Moaning Crying Pacing, restlessness Mask of pain Diaphoresis, change in vital signs ```