Pain

Question 1

Pain classification of A patient with metastatic cancer

Answer 1

Chronic pain

Question 2

Pain classification of A patient with back pain that was the result of an automobile injury a year ago

Answer 2

Chronic pain, potentially neuropathic pain

Question 3

pain classification of A patient who had bowel surgery yesterday

Answer 3

Acute visceral pain

Question 4

Pain classification of A patient with a fractured hip

Answer 4

Acute deep somatic pain

Question 5

Pain classification of A patient who just had his leg amputated but feels as though the leg is still there

Answer 5

Phantom pain, which is a type of neuropathic pain

Question 6

Pain classification of A person with an abrasion on her knee after a fall

Answer 6

Cutaneous or superficial pain

Question 7

What must occur to generate pain?

Answer 7

To generate a pain response, nociceptors must receive a sufficient number of noxious stimuli.

Question 8

What are the four physiological steps involved in the pain process?

Answer 8

• Transduction • Transmission • Perception

* Modulation

Question 9

What are the most common emotional responses to pain?

Answer 9

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.

Question 10

What factors influence behavioral responses to pain?

Answer 10

• 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

Question 11

What are the effects of untreated pain on the endocrine system

Answer 11

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.

Question 12

What are the effects of untreated pain on the cardiovascular system

Answer 12

Cardiovascular system. Unrelieved pain leads to hypercoagulation and an increase in heart rate, blood pressure, cardiac workload, and oxygen demand.

Question 13

What are the effects of untreated pain on the musculoskeletal system

Answer 13

Musculoskeletal system. Unrelieved pain causes impaired muscle function, fatigue, and immobility.

Question 14

What are the effects of untreated pain on the immune system

Answer 14

Immune system. Untreated pain taxes the immune response and predisposes the patient to infection.

Question 15

What are the effects of untreated pain on the respiratory system

Answer 15

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.

Question 16

What are the effects of untreated pain on the genitourinary system

Answer 16

Genitourinary system. Unrelieved pain causes release of excessive amounts of hormones that
lead to decreased urinary output, urinary retention, fluid overload, and hypokalemia.

Question 17

What are the effects of untreated pain on the gastrointestinal system

Answer 17

Gastrointestinal system. In response to pain, intestinal secretions and smooth muscle tone increase and gastric emptying and motility decrease.

Question 18

How might untreated pain affect the progress of a patient recovering from major illness?

Answer 18

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.

Question 19

How often should you assess the patient for pain, if pain is a potential problem for the patient?

Answer 19

• 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

Question 20

What are some of the common pain scales used?

Answer 20

• VAS, visual analogue scale
• NRS, numerical rating scale
• SDS, simple descriptor scale
• Wong-Baker FACES scale

Question 21

Who should determine if the patient is in pain?

Answer 21

The patient

Question 22

How do NSAIDs induce pain relief?

Answer 22

NSAIDs relieve pain by interfering with the production of prostaglandins, thereby blocking the inflammatory process in the peripheral tissues.

Question 23

What is the main side effect of NSAIDs?

Answer 23

Gastric irritation is the main side effect of NSAIDs.

Question 24

In which patients are NSAIDs contraindicated?

Answer 24

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.

Question 25

What are the most common side effects of opioids?

Answer 25

The most common side effects are nausea, vomiting, constipation, and drowsiness.

Question 26

Identify at least three things that you should monitor when administering opioids.

Answer 26

• 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?

Question 27

What is the risk of addiction to opioids for patients with acute pain?

Answer 27

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.

Question 28

Identify three types of chemical pain relief measures.

Answer 28

• Regional anesthesia (e.g., nerve block, spinal anesthesia)
• Local anesthesia
• Topical anesthesia

Question 29

What type of patient might be suitable for surgical interruption of a pain pathway?

Answer 29

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.

Question 30

Pain is “

Answer 30

whatever the person says it is, and existing whenever the person says it does”