Pain Exam 1

Question 1

What type of patient is least likely to receive standardized pain assessment and to receive pain meds

Answer 1

Physiologically unstable patients

Question 2

Pain can present with non pain diagnoses such as

Answer 2

LE pain- can be vascular, spinal cord, or if bilateral most likely DM.

Depression can also present as pain.

Question 3

For unstable pt what is one barrier for pain administration

Answer 3

Hypotension

Question 4

What pain med can be given for unstable pt and at what dose

Answer 4

Ketamine 0.2-0.3 mg/kg
This is below the dissociative dose. Induction dose of ketamine 0.5-2mg/kg

Question 5

How do studies skew pain reported in African Americans

Answer 5

The studies may not take into account sickle cell anemia which can be extremely painful. This may be why the pain reported in this population is higher.

Question 6

How does culture play a part in pain management

Answer 6

Patient may need to go thru there ministry to get approval for certain treatment options.
Strong cultural ties may lead to stronger support system.

Question 7

How does living in rural areas and having lower socioeconomic status affect reported pain

Answer 7

Lower socioeconomic status and living in rural areas has seen an increased reporting of chronic pain, pain related disability, and depression.

Question 8

How can previous pain experiences lead to persistent pain

Answer 8

Previous pain can alter activity within certain brain regions resposible for pain processing resulting in persistent pain .

Question 9

What disorders have been linked to chronic pain

Answer 9

mood disorders and other psychiatric disorders.

Question 10

An exaggerated cognitive response to an anticipated or actual painful stimulus

Answer 10

pain catastrophizing

Question 11

What is magnification component of catastrophizing

Answer 11

Magnification response that symptoms can or are greater than expected

Question 12

What is Rumination component of catastrophizing

Answer 12

Individual focuses repeatedly on attributes of an event that evokes negative response
Ex. “I can’t stop thinking about how much it hurts”

Question 13

Describe the helplessness component of catastrophizing

Answer 13

The belief that there is nothing that anyone can do to improve a bad situation.

Question 14

What medicines can be given to help with pain catastrophizing

Answer 14

Versed, possibly more than the 1-2 mg dose.
Precedex may be a good option.

Question 15

What non medicine it perfections help with catastrophizing

Answer 15

Talk to patient/have family/chaplain talk to them

Question 16

What are two things that were worry about in regards to pain and genetics

Answer 16

Worry about ultra rapid metabolizers. E.g. codeine metabolized rapidly and converted to morphine more quickly. Supra-therapeutic doses.

Slow metabolizers.
E.g. codeine not efficiently metabolized and never reach therapeutic doses.

Question 17

What patient info can help determine their drug metabolism

Answer 17

Medication list, family history, talk about previous anesthetic.
Did they wake up with pain? Were they easy to wake up after surgery?

Question 18

What are the different factors used to classify pain

Answer 18

Underlying etiology (source of pain), anatomical location (site of pain), temporal nature (duration),
intensity (degree or level of pain)

Question 19

Basics of pain assessment

Answer 19

Question 20

Functionality assessment of pain

Answer 20

Question 21

Describe OPQRST

Answer 21

Onset of pain, Provocation and palliation of symptoms, Quality, Region and radiation, Severity, Timing

Question 22

Why may PO opioids be beneficial to IV

Answer 22

The PO may take longer to take effect but the effects last longer. The PO opioids help achieve a steady state of the drug.

IV is fast on but fast off.

Question 23

Pediatric Tylenol dosages

Answer 23

15 mg/kg PO q 4-6 hours
MAX: 90 mg/kg/day

Question 24

Pediatric IV Tylenol dose

Answer 24

15mg/kg IV q6h or
12.5 mg/kg q4h
Max 75 mg/kg/day

Question 25

What side effects can be seen with Toradol

Answer 25

Increased risk for bleeding d/t alteration in platelet function.
Renal impairment.

Question 26

What is Toradol dose and duration

Answer 26

Toradol adult dose is 15-30mg IV/IM q6h
Max: 120 mg/day x5 days

Question 27

What is the benefit of nebulized ketamine

Answer 27

Ketamine has topical effects in addition to its systemic effects. This may help localize the airway in addition to getting sedation.

Question 28

What are the effects of ketamine

Answer 28

Disassociate, analgesia, bronchodilation, hallucinate later, increased salivation

Question 29

What is one of the most common mistakes made in pain management

Answer 29

Failure to reassess pain

Question 30

What percent of decrease in pain is clinically meaningful from a patients perspective

Answer 30

A decrease in 33-50% decrease in pain intensity. This represents a reasonable standard of intervention for acute and chronic pain.