Pain (Comfort)

Question 1

What are the three types of responses to pain? Give an example of each.

Answer 1

1) Behavioral (Voluntary) - Moving away from painful stimuli, grimacing, moaning and crying.
2) Physiologic (Involuntary) - Increased BP, HR & pulse, nausea and vomitting.
3) Affective (Psychological) - Withdrawal, anxiety, depression, fear, anger, fatigue, anorexia, powerlessness and hopelessness.

Question 2

Describe cutaneous pain vs.
somatic pain vs.
visceral pain

Answer 2

1) Cutaneous Pain - Superficial pain in the skin or subcutaneous tissue.
2) Somatic Pain - Pain originating from bones, tendons, ligaments, blood vessels and nerves.
3) Visceral Pain - Pain originating from body organs in the thorax, cranium and abdomen.

Question 3

Define neuropathic pain.

Answer 3

Pain resulting from an injury to a nerve. It is often described as stabbing or burning.

Question 4

Define intractable pain.

Answer 4

Pain that is resistant to therapy and persists despite a variety of interventions.

Question 5

Define psychogenic pain.

Answer 5

Pain for which no physical cause can be identified.

Question 6

Women who have had a hysterectomy can have a dropped bladder which could cause referred pain where?

Answer 6

Down the thighs

Question 7

What is the single most reliable indicator of the existence and intensity of acute pain and resultant affective discomfort or distress?

Answer 7

The patient’s self report

Question 8

What specific areas of the body does not have much referred pain?

Answer 8

The extremities, if you get a paper cut or a knee scrape, there usually isnt any referred pain.

Question 9

What is PAINAD?

Answer 9

The Pain Assessment in Advanced Dementia scale - developed to assess pain in cognitively impaired individuals. It relies on the observation of 5 things: breathing, vocalization, facial expression, body language, and consolability.

Question 10

What is the best scale to use to assess patients with dementia and other cognitively impaired patients?

Answer 10

Wong-Baker Faces scale

Question 11

Define Pain Tolerance.

Answer 11

The point beyond which a person is no longer willing to endure pain.

Question 12

(T/F) Fatigue tends to increase pain, therefore, promoting rest is helpful in treating pain?

Answer 12

True

Question 13

Name the 10 Non-Pharmacologic methods mentioned in Taylor, used to relieve pain?

Answer 13

1) Using Distraction 2) Employing Humor
3) Listening to Music 4) Using Imagery
5) Employing Relaxation 6) Using Cutaneous Stimulation
7) Using Acupuncture 8) Using Hypnosis
9) Employing Biofeedback 10) Providing Therapeutic Touch

Question 14

Name four forms of Cutaneous Stimulation used as a nonpharmacologic means of relieving pain?

Answer 14

1) Massage
2) Application of heat or cold
3) Acupressure
4) Transcutaneous Electrical Nerve Stimulation (TENS) - Requires a physician’s order.

Question 15

Describe what each number in the numeric sedation scale signifies?

Answer 15

1 = Awake and alert; no action necessary
2 = Occasionally drowsy but easy to arouse; requires no action
3 = Frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose.
4 = Somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

Question 16

What is the difference between physical dependence and addiction?

Answer 16

1) Physical dependence - When the body becomes physiologically accustomed to the opioid and suffers withdrawal symptoms if the opioid is suddenly removed or or the dose is rapidly decreased.
2) Addiction - A pattern of compulsive opioid use for means other pain control.

Question 17

What are the four characteristics that define addiction?

Answer 17

1) Craving for the substance
2) Compulsive use
3) Lack of control over the drug
4) Continued use despite harm

Question 18

Name three reasons why adjuvant meds may be used in conjunction with opioids?

Answer 18

1) Used to enhance the effect of opioids by providing additional pain relief.
2) Used to reduce side effects.
3) Used to lessen anxiety about the pain experience.

Question 19

What kind of patients are indicated for the use of a PCA? What kind of patients are not recommended for this type of pain relief?

Answer 19

1) Indicated for PTs who are alert and capable of controlling the unit.
2) Not recommended for confused elderly PTs, children, cognitively impaired PTs, and PTs who are sedated.

Question 20

Name 6 nursing strategies a nurse can implement that will most likely assist the patient to achieve pain relief outcomes?

Answer 20

1) Establish a trusting nurse-patient relationship
2) Manipulate factors affecting the pain experience
3) Use nonpharmacologic methods
4) Use Pharmacologic methods
5) Teach patient and family about pain
6) Ensure ethical and legal responsibility to relieve pain

Question 21

Name 2 physical pain relief techniques?

Answer 21

1) Positioning and hygiene

2) Cutaneous stimulation

Question 22

Name 4 cognitive pain relief techniques

Answer 22

1) Anticipatory guidance
2) Distraction
3) guided imagery
4) Hypnosis

Question 23

Name 3 behavioral pain relief techniques

Answer 23

1) relaxation
2) meditation
3) biofeedback

Question 24

Opioid-induced respiratory depression is usually preceded by what?

Answer 24

Sedation

Question 25

Describe the steps of the 3-step ladder for cancer pain relief and palliative care.

Answer 25

1) Step 1 - nonopioid +/- adjuvant
2) Step 2 - opioid for mild to moderate pain relief + nonopioid +/-
adjuvant
3) Step 3 - opioid for moderate to severe pain relief + nonopioid +/-
adjuvant