Pain COPY Flashcards
What are some things that can cause people to be reluctant to report pain
fear of being viewed as weak or complainer
dont want to be bothersome
fear of administration methods for pain relievers
viewing pain as normal
What does a pain assessment consist of
history of the pain
observation of behaviors, injuries, and secondary physiological responses to it
What are some things the nurse needs to be aware of when assessing pain
previous treatments and their effectiveness
when and what analgesics were lsat taken
other meds being taken
allergies to meds
What data should be collected during an interview assessing pain
location quality intensity pattern onset precipitating factors alleviating factors effect on ADL's associated symptoms meaning
What is a question to ask for location
where is your discomfort
What is a question to ask for quality
tell me what it feels like
What is a question to ask for intensity
0-10 scale
What is a question to ask for pattern
do you have pain free periods, if so how long do they last
What is a question to ask for onset
when did it start
What is a question to ask for alleviating factors
have you found anything that helps with the pain
What is a question to ask for precipitating factors
Does anything trigger the pain
What is a question to ask for associated symptoms
Do you have any other symptoms before during or after the pain
What is a question to ask for effect on ADL’s
How does the pain affect your daily activities
What can the nurse do to ass pain for clients who cannot use a numerical scale
assess the level of pain based on the degree of interference with functioning
What is the scale for pain based on functioning interference
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
What are good pain tests for patients who cannot use a numerical scale for pain
wong-baker faces rating scale
What are some good pain tests for patients with chronic pain
Brief pain inventory (BPI)
short form McGill Pain Questionaire (SF-MPQ)
What is a good pain test for children 2mo to 7yrs
FLACC
What are some physiological responses to acute pain
increased BP, HR, RR, pallor, diaphoresis, and pupil dilation
Are you more or less likely to see physiological reponses in people with chronic pain
no, bx of adaptation to the pain
What is the framework for determinign pain in nonverbal patients
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
What can be given to someone with chronic pain to help identify pain patterns and factors that mediate/exacerbate pain
a daily pain diary
What are some things that need to be recorded in a pain diary
onset time activity or situation quality intensity emotions any interventions intensity after interventions
What are some nursing diagnoses for pain
acute and chronic pain
What should the nurse include in the diagnostic statement for pain
the location and related factors (when available)
What else can pain be in the diagnosis
the etiology
What are some examples of pain as the etiology
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
Before discharge, what data needs to be assessed
client knowledge and self care abilities for pain management
Family/caregiver availability, skills, and willingness to help
the degree of family role changes and coping
resources available to the client
What are some things that should be taught for client teachign
skills for administrating meds
non-pharmacologic techniques to reduce pain
how to access community resources
Poor pain management can cause problem with
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
What are patient influences that can affect pain management
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
What are some nurse influences that can affect pain management
Knowledge- of different types of meds and their properties
Attitude- like biases
Skill- judgement, observation/assessment skills, communication skills
During intervention, what is used to determine whether nonpharm or pharm pain management is needed
the WHO 3 step analgesic ladder
What is the first step in the 3 step ladder
For mild pain (1-3 on a 0-10 scale)
use nonopioid analgesics
When do you move to step two of the 3 step ladder
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
What is done in the step two of the step ladder
use of an opioid like codeine or tramadol by themselves or in combination with a nonpharm intervention as well like oxycodone with acetaminophen
When do you use the 3 step of the 3 step ladder
pain of 4-6 doesnt go away with full dose or pain reported 7-10 on a 0-10 scale
What are some opioids that are used for step 3 on the 3 stap ladder
morphine
hydromorphone
fentanyl
What is a scale that can be used to assess the sedation level of a client receiving opioids
the pasero opioid-induced sedation scale
What are the rackings of the pasero opioid induced sedation scale
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
What are the common sideeffects of opioids
constipation sedation N/V Respiratory depression pruritus urinary retention
What are the three types of non-pharm pain management areas
physical
cognitive-behavioral
lifestyle
What are the physical non-pharm pain management modalities
heat/cold
TENS
acupuncture
cutaneous stimulation (massage)
What are the cognitive-behavioral non-pharm pain management modalities
distraction
relaxation techniques
hypnosis
emotional counceling
What are the lifestyle non-pharm pain management modalities
stress management
exercise
nutrition
symptom monitoring
What is nociceptive pain
Pain directly from tissue damage
Patients with visceral pain often have more problems with
N/V
What is neuropathic pain
Pain that is related to damaged or malfunctioning nervous tissue in the peripheral and /or CNS
What is intractable pain
Pain for which there is no cure - cancer
What are some descriptor words for nociceptive pain
cramping crushing sharp throbbing tender pressing
What are some descriptor words for neuropathic pain
drilling numb burning shooting stabbing tingling
What are behavioral indicators of pain
Guarding Impaired thought processes Social withdrawal Introspection Altered time perception Moaning Crying Pacing, restlessness Mask of pain Diaphoresis, change in vital signs
What is visceral pain?
Pain arising from organs or hollow viscera and is often perceived in an area remote from the organ causing the pain
What are some sympathetic nervous system responses to acute pain?
Increased pulse rate Increased Respiratory rate Elevated blood pressure Diaphoresis- sweating Dilated pupils
What are some parasympathetic nervous system responses to chronic pain?
Dry, warm skin
Pupils normal or dilated
Vital Signs are Normal
What does Hyperalgesia/Hyperpathia mean? What’s one example?
Heightened responses to a painful stimuli.
Extreme pain response to paper cut
What does allodynia mean? What’s one example?
Non-painful stimuli that produces pain.
Wind blowing on face produces pain.
What is dysesthesia?
An unpleasant abnormal sensation.
How is pain perceived through nociception?
Nociceptors are activated when signals are transduced and transmitted to the spine and brain where the signals are modified before they are processed and “felt.”
African Americans: Beliefs about Pain and How They React to It?
Pain and Suffering is part of life and must be endured
Some may deny or avoid dealing with pain
Some believe prayer will free a person from pain
Hispanic/Latino: Beliefs about Pain and How They React to It?
Enduring pain is a sign of strength
Asian Americans: Beliefs about Pain and How They React to It?
Chinese culture values silence and may be quiet when in pain
Japanese may be stoic and may even refuse pain medication
Filipino clients may believe that pain must be endured and not expressed
Buddhist view pain as bringing oneself to a higher state of being
Arab Americans: Beliefs about Pain and How They React to It?
Pain is regarded as unpleasant and they anticipate immediate relief
Expressive, Emotional and Vocal responses to pain
What are some painful disorders that women get that we should consider?
HA, Fibromyalgia, Lupus, and Menstrual related disorders
What are some painful disorders that men get that we should consider?
Pain related to occupation, burns, post trauma pain
What groups are frequently under treated for pain compared to adult males?
Very young, very old, women, and ethnic minorities
