Pain Flashcards
Pain classification of A patient with metastatic cancer
Chronic pain
Pain classification of A patient with back pain that was the result of an automobile injury a year ago
Chronic pain, potentially neuropathic pain
pain classification of A patient who had bowel surgery yesterday
Acute visceral pain
Pain classification of A patient with a fractured hip
Acute deep somatic pain
Pain classification of A patient who just had his leg amputated but feels as though the leg is still there
Phantom pain, which is a type of neuropathic pain
Pain classification of A person with an abrasion on her knee after a fall
Cutaneous or superficial pain
What must occur to generate pain?
To generate a pain response, nociceptors must receive a sufficient number of noxious stimuli.
What are the four physiological steps involved in the pain process?
- Transduction • Transmission • Perception
* Modulation
What are the most common emotional responses to pain?
The most common emotional responses to pain are fear, guilt, anger, helplessness, hopelessness, isolation, and loneliness. However, pain can also produce confusion and helplessness. Anxiety and depression may also result from injury and pain.
What factors influence behavioral responses to pain?
- Emotions
- Developmental stage
- Sociocultural factors, such as the behavior associ- ated with pain learned through interaction with family and social support groups and the beliefs about the value of expressing pain or minimizing it
- Communication and cognitive impairments
What are the effects of untreated pain on the endocrine system
Endocrine system. Ongoing pain triggers release of excessive amounts of hormones. These hormone shifts activate carbohydrate, protein, and fat catabo- lism (breakdown); hyperglycemia; and poor glucose use. The inflammatory process, combined with these endocrine and metabolic changes, can result in weight loss, tachycardia, fever, increased respiratory rate, and even death.
What are the effects of untreated pain on the cardiovascular system
Cardiovascular system. Unrelieved pain leads to hypercoagulation and an increase in heart rate, blood pressure, cardiac workload, and oxygen demand.
What are the effects of untreated pain on the musculoskeletal system
Musculoskeletal system. Unrelieved pain causes impaired muscle function, fatigue, and immobility.
What are the effects of untreated pain on the immune system
Immune system. Untreated pain taxes the immune response and predisposes the patient to infection.
What are the effects of untreated pain on the respiratory system
Respiratory system. Pain causes splinting, which reduces tidal volumes and increases inspiratory and expiratory pressures. These changes can result in complications such as pneumonia and atelectasis.
What are the effects of untreated pain on the genitourinary system
Genitourinary system. Unrelieved pain causes release of excessive amounts of hormones that
lead to decreased urinary output, urinary retention, fluid overload, and hypokalemia.
What are the effects of untreated pain on the gastrointestinal system
Gastrointestinal system. In response to pain, intestinal secretions and smooth muscle tone increase and gastric emptying and motility decrease.
How might untreated pain affect the progress of a patient recovering from major illness?
In total, these effects result in impaired healing and the inability to participate in physical therapy, and they increase the risk of pneumonia, ileus, deep vein thrombosis, and cardiac events.
How often should you assess the patient for pain, if pain is a potential problem for the patient?
- On admission to the healthcare facility
- Before and after each potentially painful procedure or treatment
- When the patient is at rest, as well as when she is involved in a nursing activityBefore implementing a pain-management interven- tion and 30 minutes after the intervention
- With each check of vital signs, if the pain is an actual or potential problem
- When the patient complains of pain
What are some of the common pain scales used?
- VAS, visual analogue scale
- NRS, numerical rating scale
- SDS, simple descriptor scale
- Wong-Baker FACES scale
Who should determine if the patient is in pain?
The patient
How do NSAIDs induce pain relief?
NSAIDs relieve pain by interfering with the production of prostaglandins, thereby blocking the inflammatory process in the peripheral tissues.
What is the main side effect of NSAIDs?
Gastric irritation is the main side effect of NSAIDs.
In which patients are NSAIDs contraindicated?
NSAIDs are contraindicated in patients with impaired blood clotting, renal disease, and gastrointestinal bleeding or ulcers. Note that NSAIDs must be used with caution in the presence of a suspected infection because they may obscure a fever.
What are the most common side effects of opioids?
The most common side effects are nausea, vomiting, constipation, and drowsiness.
Identify at least three things that you should monitor when administering opioids.
- Sedation and respiratory depression
- Common side effects such as nausea, vomiting, and constipationOther side effects, such as difficulty with urina- tion, dry mouth, sweating, tachycardia, palpita- tions, bradycardia, rashes, urticaria, or pruritus
- Response to the medication—Is it effective?
- Breakthrough pain—Does the patient need additional medication?
What is the risk of addiction to opioids for patients with acute pain?
There is a low risk of addiction to opioids when prescribed to treat acute pain. The risk for addiction is higher among patients experiencing chronic pain.
Identify three types of chemical pain relief measures.
- Regional anesthesia (e.g., nerve block, spinal anesthesia)
- Local anesthesia
- Topical anesthesia
What type of patient might be suitable for surgical interruption of a pain pathway?
Suitable candidates for surgical interruption of a pain pathway include any patient with intractable pain, such as patients with terminal cancer, Raynaud’s disease, chronic trigeminal neuralgia, diabetic neuropathy pain, or phantom pain that cannot be controlled by other methods.
Pain is “
whatever the person says it is, and existing whenever the person says it does”
