Pain Exam 3 Flashcards
What is pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
How is pain defined according to the person experiencing it?
Pain is whatever the person says it is, and it exists whenever the person says it does.
Why is pain different from vital signs like pulse or blood pressure?
Pain cannot be measured objectively like pulse or blood pressure.
What is one role of pain in the body?
Pain can be a warning of potential injury to the body.
How is pain classified?
Pain is classified and assessed by origin, duration, pattern of occurrence, quality, intensity, and time since onset.
What is cutaneous/superficial pain?
Cutaneous/Superficial Pain usually occurs due to a skin or subcutaneous injury and is usually short in duration.
What characterizes deep somatic pain?
Deep somatic pain originates in ligaments, tendons, nerves, blood vessels, and bones, and can be longer in duration.
What is visceral pain?
Visceral pain is caused by stimulation of deep internal pain receptors, often in the abdominal cavity, cranium, or thorax.
What is radiating pain?
Radiating pain starts at the origin but extends to other locations.
What is referred pain?
Referred pain starts at the origin but extends to more distant locations.
What is phantom pain?
Phantom pain is pain perceived to originate from an area that has been surgically removed.
What is psychogenic pain?
Psychogenic pain is believed to arise from the mind, with the patient perceiving pain without an identifiable physical cause.
Define acute pain.
Acute pain is usually short in duration, has a rapid onset, and may last up to 6 months.
Define chronic pain.
Chronic pain lasts 3-6 months or longer and interferes with daily activities.
What is transduction in the context of pain?
Transduction is the process when nerve cells (nociceptors) become activated by mechanical, thermal, or chemical stimuli.
What is transmission in pain processing?
Transmission is when peripheral nerves carry the pain message to the dorsal horn of the spinal cord and then to the brain.
What role do neurotransmitters play in pain perception?
Neurotransmitters are endogenous chemicals that aid in pain transmission, sending messages to the thalamus of the brain.
What is pain perception?
Perception involves the recognition and interpretation of pain in the frontal cortex.
What is modulation in pain processing?
Modulation changes the perception of pain by facilitating or inhibiting pain signals through the analgesia system.
What are some effects of unrelieved pain on the endocrine system?
Unrelieved pain can trigger hormones that decrease insulin release and increase glucose release.
How does pain affect the cardiovascular system?
Pain leads to hypercoagulation, increased heart rate, blood pressure, cardiac workload, and oxygen demand.
What impact does pain have on the musculoskeletal system?
Unrelieved pain can lead to impaired muscle function, fatigue, and immobility.
What is the Fifth Vital Sign in pain assessment?
Pain is assessed every time vital signs are checked, but its classification as the fifth vital sign has been debated.
What is the most common method to assess pain?
The numerical rating scale from 0 to 10 is the most common method.
What are nonpharmacological pain relief measures?
Nonpharmacological measures include TENS units, massage, spinal cord stimulators, acupuncture, and heat/cold applications.
What is TENS?
TENS (transcutaneous electrical nerve stimulation) uses electrode pads to relieve pain.
What is the purpose of moisture heat therapy?
Moist heat therapy helps relax muscles and promote healing.
What are some cognitive behavioral interventions for pain management?
Cognitive behavioral interventions include distraction, relaxation techniques, guided imagery, and therapy animals.
What temperature range should moist heat therapy be applied?
Moist heat should be applied at temperatures between 40°C to 46°C (105°F to 115°F).
What is the primary goal of pain treatment strategies?
Pain treatment strategies should be patient-centered, considering risks and benefits.
What is the recommended duration for applying heat or cold therapy?
Heat or cold should be applied for no longer than 15 minutes at a time.
What is the purpose of cognitive behavioral interventions in pain management?
They aim to alter negative thoughts and encourage more adaptive thoughts and emotions.
What are cognitive behavioral interventions that can help alter negative thoughts?
- Distraction
- Relaxation techniques
- Guided imagery
- Diaphragmatic breathing
- Hypnosis
- Humor
- Expressive writing
These interventions encourage more adaptive thoughts and emotions.
What is the purpose of therapy animals in a therapeutic setting?
To decrease stress, anxiety, and depression, and provide benefits for those with chronic pain, including cancer patients.
Animal assisted therapy has been used for many years.
What is therapeutic touch?
A practice developed by nurses to direct positive energy and help patients relax, derived from the ancient practice of ‘laying on of hands’.
It is often used to promote relaxation.
What are analgesics?
Pain relieving medications that should not be confused with anesthetics.
Analgesics work best if given before pain becomes too severe.
What is the recommended approach for administering analgesics?
Always start with the least amount possible and maintain around-the-clock dosing to control pain better.
Keeping ahead of the pain helps patients function optimally.
What are non-opioid analgesics?
- A variety of medications that relieve mild to moderate pain
- Available over the counter
- Reduce inflammation and fever
They can be taken in rotation or combined with opioid pain medications.
What are the common side effects of nonsteroidal anti-inflammatory drugs (NSAIDs)?
- Gastric bleeding
- Irritation
- Increased blood pressure
- Harmful to kidneys
NSAIDs are the largest group of nonopioid analgesics.
What unique effect does aspirin have compared to other NSAIDs?
Inhibits platelet aggregation, affecting bleeding.
Regular use can prolong clotting time, increasing bruising and bleeding risk.
What is acetaminophen (Tylenol)?
A non-NSAID that reduces fever and pain but has very little anti-inflammatory effect.
It can cause liver toxicity and should be limited to 4,000 mg per day.
What are opioids used for?
Relief of pain by activating opioid receptors in the brain, spinal cord, and central nervous system.
They require careful monitoring due to the risk of addiction.
What are the possible side effects of opioids?
- Sedation
- Respiratory depression
- Orthostatic hypotension
- Nausea and vomiting
- Constipation
- Itching, rashes, and flushing
Clients must be frequently assessed to avoid oversedation.
What are the three classes of opioids?
- Natural
- Semisynthetic
- Synthetic
Natural opioids come from the opium poppy, semisynthetic are derived from natural opiates, and synthetic are manufactured.
What are adjuvant analgesics?
Medications that assist with pain relief by addressing underlying pain generators.
Examples include corticosteroids, antidepressants, anticonvulsants, cannabis, and botulinum toxin.
What is Patient Controlled Analgesia (PCA)?
Self-administered medication for pain relief, frequently used postoperatively.
It allows clients to administer small amounts of pain medication as needed.
What are nursing considerations when using PCA?
- Only trained nurses should set up the pump
- Two nurses should initiate setup
- Monitor CO2 and O2 levels
- Educate patient and family
PCA pumps are programmed with lock-out times.
What is the purpose of KASPER?
A controlled substance prescription monitoring system in Kentucky to assist practitioners and law enforcement with controlled substances.
KASPER is not intended to prevent patients from receiving needed medications.
What is the difference between drug misuse, abuse, and diversion?
- Misuse: Taking for non-medical reasons
- Abuse: Repeated non-medical use
- Diversion: Acquiring medication not prescribed
All terms relate to improper use of controlled substances.
What should be documented regarding pain management?
- Expected outcomes
- Present pain level
- Response to interventions
- Adverse reactions
- Planned interventions
Pain documentation should occur every 4 hours and after interventions.
What should patients and families be taught about pain management?
- Cause of pain
- Overall pain management plan
- Normal duration of pain
- Nonpharmacological treatment options
- Side effects of medications
Teach how to contact the healthcare team and safely dispose of narcotics.
What is the significance of swearing in relation to pain?
Swearing raises pain threshold and tolerance but new ‘swear’ words do not have similar effects.
Swearing may affect pain alleviation through emotion arousal.
What nursing interventions are important for managing a client’s pain?
- Assess pain frequently
- Support patient and family
- Provide analgesics timely
- Manage side effects
- Educate the patient
Evaluation is critical to ensure pain management effectiveness.
What are SMART goals related to pain management?
- Report pain less than 3
- Participate in ADLs by shift end
- List 3 ways to manage pain
Goals should be specific, measurable, achievable, relevant, and time-bound.
How does the body react to pain via respiratory?
Patients in pain tend to breathe more shallow limiting thoracic and abdominal movement. This is called splinting. Splinting reduces tidal volume and increases inspiratory and expiratory pressures. These changes can lead to pneumonia, ateclectasis, and underventilation resulting in respiratory acidosis.
How does the body react to pain via genitourinary?
Pain can cause release of excessive amounts of catecholamines, aldosterone, ADH, cortisol, and prostaglandins. These hormones hold onto fluid and cause decreased urinary output, hypertension, fluid overload, and increased cardiac output.
How does the body react to pain via gastrointestinal?
In response to pain, intestinal muscle tone increases and gastric emptying decreases.
Factors influencing pain
- emotions
- previous pain experience
- life stages
- socialcultural factors
-communication and cognitive impairments
Pain assessment
Pain location, quality, onset, duration, and intensity should be included in the assessment.
Pain free is not always an option
scales for pain level
faces called wong baker scale , 0-10, non verbal scale
Culturally competent assessment
use an interpreter for pain rating and questions
non- opioid analgesics
NSAIDS most side effect is gastric bleeding and ittitation. Can cause BP to raise—>harmful to kidneys
ASPRIN
nsaid
reducing inflammation, fever, and pain, it can inhibit platelet aggregation, the first step of clot formation
no children—>Aspirin in children is associated with Reye’s syndrome
Tylenol (acetaminophen)
not an NSAID
no anti-inflammatory.
does do fever and pain
liver toxicity
max of 4000mcg per day
Opioids
Opioids can cause both sedation and depression of the respiratory system
- check VS
Managing Pain for Older Adults
PCA PUMP
PCA pumps are contraindicated in patients who have limited ability to operate or understand use.
Family should be taught to NEVER operate the PCA pump.
The patient is the ONLY person who should be instructed to depress the button for administration.
Nerve block
Nerve blocks or epidural injections are types of regional anesthesia.
Nerve blocks may be used for short term pain relief for/after surgical procedures or for long term management of chronic pain.
addiction
A chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.
Chemical/Physical Dependence
Develops over time due to long term use of a drug. For example, a 20-year tennis player with chronic elbow pain may be prescribed hydrocodone for pain, as needed. After 10 years, he may be dependent on hydrocodone (meaning he could go in withdrawal without it) but he isn’t necessarily addicted.
Why should a client be honest with a nurse during assessment regarding their use of drug?
Treat for withdrawal symptoms
Intervention for possible drug abuse or addiction
Nursing intervention: Remember to remain nonjudgmental when providing care. It is the duty of the nurse to maintain balance of pain control and protect against inappropriate drug use.
KASPER
KASPER is a controlled substance prescription monitoring system
When is pain documented?
Pain should be documented q4h and for response to intervention in one hour
Client X is a 65 year old, female admitted to a telemetry unit after a left above knee amputation. She has a history of high blood pressure, diabetes, and non healing wounds. Client X rates her pain as a 5 out of 10. She has a patient-controlled analgesia pump (PCA) with 2 mg of morphine available every 30 minutes. She states she pushed the button 5 minutes ago. She states her goal for pain is a 3. Client X has orders for 5mg of oxycodone PO every 12 hours as needed. Her wife is at the bedside.
What will the nurse do next?
-anxiety
-risk for falls
-risk for opiod abuse
-not ready to learn
-educate
-give pain meds
-walk
pain goals 3/10
lower pain rating
report VS, grimmacing
Goal met: yes
Eval of pain
Evaluation is critical to pain management. Compare your findings with expected outcomes of the patient.
Are the patient’s pain scores consistently at or better than the desired level? Are they improving?
Is the patient’s behavior, range of motion, and mood consistent with pain relief?
Can the patient participate in ADLs, pulmonary toilet, physical therapy, etc.?
Is the pain tolerable during procedures, dressing changes, and therapies?
