Pain/Comfort Flashcards
Define: Nociception and Nociceptors
Nociception - ability to feel pain
Nociceptors - sensory pain receptors
What are the 4 physiological processes involved in nociception?
Transduction
Transmission
Perception
Modulation
Describe the mechanism of pain
(Include the 4 physiological process involved in nociception and what each does)
- Transduction – Activation of pain receptors, converts stimuli to electrical impulses.
- Transmission – Conduction of pain signals from via afferent (sensory) neurons in tissue -> spinal cord -> brain (CNS)
-
Perception – Awareness of pain
-> Adaptation may affect perception of pain -
Modulation – modify/inhibit pain by releasing endorphins (Enkephalins)
-> Enkephalins: less potent; widespread; reduce pain
What are Endorphins? What are Enkephalins?
- Endorphins: body natural pain reliever
- Enkephalins: an endorphin that is not extremly potent that is widespread and used to reduce pain
Tissue damage can be classified as mechanical, thermal, and chemical. Include an example of each
- Mechanical: Trauma
- Thermal: burns
- Chemical: tissue ischemia, CAD
Pain can be sourced somatically, viscerally, or cutanously. Describe each sensation and examples
- Somatic: Deep, diffuse (bone, tendon, nerves – e.g., sprain).
- Visceral: Dull, from body cavities and organs hard to pinpoint
- *Cutaneous: Sharp (paper cut)
Pain can be also be sourced from the Nervous System. Describe the sensation and examples
- Nervous System Malfunction: Burning, stabbing.
- Examples: Post-stroke, post-herpetic neuralgia (secondary to herpes zoster), multiple sclerosis, shingles
What is Referred Pain? Include illness in which referred pain would be felt
- Referred Pain: Pain felt in different locations than its source
- Ex: heart attack (myocardial infacrction) causing left arm, jaw, or neck pain
What is Phantom Pain?
feeling pain in a body part that has been amputated
What is Radiating Pain? Include illness in which radiating pain would be felt
- Radiating Pain: pain extends from its original site
- Ex: Sciatica
T/F: A nursing care plan is required for post op patients
True
What are the two patient activities that require patients’ pain to be controlled before the patient will want to engage in them?
- Physical therapy/Rehabilitation (give med 30-45 minutes before therapy to help with pain)
- Ambulation/ADL
What is Intractable Pain? What is the connection between addiction and intractable pain? What is the connection between intractable pain and pain clinics?
Intractable Pain
- pain resistant to treatment
Connection between addition and intractable pain
- constantly taking pain relievers = body no longer responds/body require higher doses
Intractable pain and Pain clinics
- Pain clinics will try other modalities of pain relief pt with intractable pain
Compare Acute vs Chronic pain
- Acute: Short-term, related to healing within normal time period
-
Chronic: Lasts beyond normal healing time (3+ months), can deteriorate condition/lead to death
-> Cancer may cause increasing pain until patients death
Compare Pain Threshold vs Pain Tolerance
(What does a pt with a low threshold mean in terms of pain stimulation? What does a pt with high tolerance mean in regards to pill taking?)
-
Pain Threshold: minimum intensity of a stimulus perceived as painful
-> Low threshold = pt req less pain stimulation to sense pain -
Pain Tolerance: maximum intensity of a stimulus that produces pain a person is willing to accept in a given situation
-> High tolerance = pt will required pain pill later
Why do patients with high pain tolerance be told to take meds ATC (around the clock)?
Some pt will not take pain meds until pain is excruciating, but itll take a while for the pain med to take effect, leaving them in severe pain for some time
The sympathetic nervous system responds to ____ pain, but the parasympathetic responds to ________/_______ pain
Sympathetic: acute pain
Parasympathetic: chronic/severe pain
Organize these findings to the correct categeory (Will these findings be seen in patients with acute pain or chronic pain?)
Findings
- Increase in BP
- Decrease in pulse
- Increase Respirations
- Decrease BP
- Pupil dilation
- Increase pulse
Categories
- Acute Pain
- Chronic Pain
Acute Pain (Sympathetic)
- Increase BP
- Increase pulse
- Increase respirations
- Pupil dilation
Chronic Pain (Parasympathetic)
- Decrease BP (can also be stable)
- Decrease pulse (can also be stable)
Endorphines may be released with a ______ and/or ________
massage
hot/cold packs
A mom comes into the clinic with her young toddler, who is here to recieve a shot. The toddler is crying and is scared to recieve the shot in his right arm, but the mom says that she will pinch his left arm so that the shot will not hurt as much. What theory supports this claim made by the mom? Explain what the theory is and how it works in this situation.
Gate Control Theory
- This theory states that the Nervous System can only process a limited amount of imput at a time
- If the mom pinches the toddlers skin, large fibers (ex: pressure, heat/cold) will be stimulated and compete with sensory input from the thin nerve fibers (needle) during brain recognition. The brain will “close” the gate for thin nerve fibers, so large nerve fibers can come in, thus decreasing pain felt from the thin nerve fibers.
In regards to the Gate Control Theory, how can you stimulate large nerve fibers to help relieve pain?
MAT
- Massage
- Application of Hot/cold compress
- Theraputic touch/Accupuncture
Describe how different factors affect a persons pain experience
(Age, Gender, Culture, Religion, Network, Past Pain Experience)
Age:
- Infants and children: sensitive to pain
- Older adults: may not report pain due to the fear of treatment/dulled pain sensations (aging or chronic disease)
-> May consider pain a normal part of aging
Gender:
- Gender expectations: Boys encouraged to be brave and not cry; Girls are allowed to express their pain more openly
-> Women may be more comfortable communicating discomfort, leading some to view their pain as emotionally or psychologically based
Culture and Ethnicity:
- Some cultures may frown upon expressing pain, while others may consider it desirable
-> Avoid stereotyping responses to pain
Religion:
- Some view pain and suffering as a lack of goodness, a means of purification, or making up for sins, providing strength to cope with pain.
-> Patients with such beliefs may refuse analgesics, feeling it lessens their suffering. - Illness and pain may be viewed as punishment from a vengeful God
- Persistent pain, disability, and suffering can enhance spiritual awareness/lead to anger and frustration
Network
- Support system
Past pain experience
- previous pain experience can affect how you feel/interpret pain now
What is the most common complication after surgery?
RT infection
What is viselike pain?
pressure pain (usually felt in people with myocardial infarction)
T/F: Women and elderly pain are undertreated
True
T/F: Narcotic addiction typically starts immediately
False, narcotic addiction does not start immediately
If a person reports having pain, what “outline” should you follow when assessing pain
(Hint: its the mnemonic)
PQRST
- P – Provoking factors
- Q – Quality (stabbing, burning, aching)
- R – Region/Radiation
- S – Severity (pain scale)
- T – Timing
OTHER
- Nonverbal cues: grimacing/curled up (abdominal pain)
What is the Wong-Baker Scale? (What is it?, who is it used on?)
Wong-Baker Scale:
- A scale used to identify severity of pain using a visual model
Who its used on: ‘
- Used for children OVER 3
- Adults with cognitive/communication impairment.
What is the FLACC Scale? (What is it? What does it stand for, who is it used on?)
FLACC Scale
- pain assessment tool that doctors used to assess pain
- Faces (F), Legs (L), Activity (A), Cry (C), Consolability (C)
- Higher score = higher the pain
Who is it used on:
- Infant/children (2 months - 7 years)
T/F: A nursing diagnosis does not include etiological factors
False, a nursing diagnosis can include etiological factors
When assessing a patients pain, it is important to ask about their pain history. Include what should be noted when taking a patients pain history
- Previous tx and effectiveness (When and what drugs were last taken)
- Other medications taken
- Allergies to medication
When diagnosing a patient with pain, you would diagnose the pain as _______ or ________ pain
Acute pain or Chronic pain
Identify the etiological factor in this nursing diagnosis:
Ineffective airway clearance r/t weak cough secondary to post-op abdominal pain
Ineffective airway clearance r/t weak cough secondary to post-op abdominal pain
Which statement best represents the planning stage of the nursing process in pain management?
A) Patient will have a reduction/elimination of pain AEB decreased rating on pain scale.
B) Nurse administers prescribed analgesic and repositions patient for comfort.
C) Patient reports pain level of 8/10 and describes it as sharp and radiating.
D) Nurse assesses patient’s vital signs and observes facial grimacing.
A
(Explanation: The planning stage of the nursing process involves setting measurable and achievable goals to address the patient’s problem. Option A presents a clear and measurable outcome for pain management.)
PLANNING = SETTING MEASUREABLE, RELALISTIC GOALS FOR PT
What is the FIRST nursing action you should take when a patient is complaining about pain?
Reposition the patient
What nursing implementations should be used when a patient complains about pain
Interventions
- Repositioning (for prop alignment/support) first nursing action if pt complains of pain
- Acknowledge pain
- Plan care around pain relief
-> Wound dressing changes/Physical therapy after pt has been adequatley medicated - Teach distraction techniques
- Relaxation exercise (yoga), Massage, Medication, Music
- Education (regarding need for medication)
- Emotional support to reduce fear/anxiety
-> Fear/anxiety = amplify pain - Guided Imagery: pain visualized then overcome by a more powerful image
What are Adjuvants? What are some examples of them?
Adjuvants: not used for pain, but given with pain meds to control pain; may reduce side effects from prescribed opiods/lessen anxiety about pain experiences
- Anticonvulsants (Gabapentin)
- Antidepressants (Prozac)
- Anti-anxiety meds
- Corticosteroids
What is the WHO Analgesic Ladder?
three-step analgesic ladder that outlines the appropriate progression of drugs and dosages to manage cancer-related pain effectively
Describe the steps to the WHO Analgesic Ladder
(What drugs to use for Mild Pain, Moderate Pain, and Severe Pain. Include examples of drugs)
1. Mild pain
- Non-opioid analgesics
-> Non-narcotics Analgesics: ASA (asprin), Tylenol
-> NSAIDS - ibuprofen, naproxen
2. Moderate pain
- Non-opiod analgesics + Opioids
-> Opioids/Narcotic Analgesics: Morphine (best), Dilaudid, Fentanyl patch (good delivery), Vicodin, Demerol
3. Severe pain
- Non-opiod analgesics + opioids + adjuncts
-> Adjuvants: Co-analgesics agents, antidepressants - Prozac, anticovulsant - gabapentin, corticosteroids
T/F: If a post-op patient presents with a decreased respiratory rate, it is still okay to give them medication
False, hold medication if a patient has a decrease RR
What are effective nursing interventions for administering a post-op patient with opiods?
- Regular administration of pain med ATC (around the clock)
- PCA pump (pt controlled analgesia)
- Fentaly 24 hour patch
- MS Contin
T/F: The most effective optiod order is PRN and the least effect opiod order is ATC
False, most effective is ATC, while least effective is PRN
Describe what a PCA pump is (How does it work? Dose? Important info)
- PT administers narcotic dose via IV route IV = best/fastest route
- Dose given in small amounts (as pt needs it)
- ONLY THE PATINET MAY ADMINISTER, NOT NURSE/FAMILY
T/F: Medications can be administered with others, for example Tylenol with coedine, for an additive effect
True
Post op patients should be informed about what three things regarding pain?
- Uncontrolled pain delays healing
- Pain interferes with mobility, causing constipation
- Pain interferes with deep breathing and coughing causing pneumonia
What is TENS (Transcutaneous Electrical Nerve Stimulation)?
(What is it, How does it work, Use?, Order requirements)
TENS: is a non-pharmacolgical intervention for pain
How it Works
- Stimulate the large nerve fibers (Gate Theory, Peripheral Nerve Stimulation)
Used for:
- Localized pain relief
- Good for back pain
Order
- MD ORDER NEEDED
The following are all non-pharmacological modalities that can be used to help a pt when they are in pain. Organize the following into modalities that would require a order and modalities that would not require an order
Categories
- No order needed
- Order needed
Non-Pharmacological Modalities
- Repositioning
- Neurosurgical Treatment
- Progressive Relaxation
- Guided Imagery
- Cold
- Behavioral Modification
- TENS unit (Peripheral Nerve Stimulation)
- Music
- Pain clinics
- Distraction (TV Show)
- Heat
NO ORDER NEEDED
- Progressive Relaxation
- Repositioning
- Guided Imagery
- Music
- Distraction (TV Show)
ORDER NEEDED
- Heat
- Cold
- TENS unit (Peripheral Nerve Stimulation)
- Behavioral Modification
- Pain clinics
- Neurosurgical Treatment
T/F: Sedation levels do not predict respiratory depression
False, sedation levels predict respiratory depression. Monitor the respiratory rate and HOLD medication if below normal range
During the evaluation stage of the nursing process, you will want to evaluate pain relief ______ hours after _____. Use the pain scale and compare - at least _____% ______ in pain
1/2 hour (30 minutes)
intervention
50% reduction
During the evaluation stage, you will want to monitor for sedation using the Inova Sedation Scale (ISS). Know the scale and what the numbers mean (Which is good/problem). Know what to do if patient is at a problematic scale
GOOD
- 1: Alert
- 2: Occasionally drowsy, easy to rouse
- 3: Dozing Intermittently
- 4: Asleep, easy to waken
PROBLEM
- 5: Diffcult to awake
- 6: Unresponsive
- Notify MD if pt is at a 5 level
- Dose reduction if at level 6 - naloxone (reverses the respiratory-depressant effect of an opioid)
Length of effectiveness duration of sedation is _______ hours max
4 hours max
(idk what she was talking about for this LOL)
T/F: Negative evaluation in the HCAHPS Survery will affect Medicare payment
True
