Pain Management

Question 1

What is pain?

Answer 1

Unpleasant sensory, emotional experience with actual or potential tissue damage

Question 2

What is acute pain?

Answer 2

Typically, rapid onset and intensity ranges from mild to severe

It disappears after the underlying cause is resolved

Result of tissue damage or organic disease

Question 3

What are examples of acute pain?

Answer 3

Surgery, sore throat, pricked finger

Question 4

What is chronic pain?

Answer 4

Last beyond “normal” healing period

Can be time limited, or last a lifetime

Varies: severe, consistent, or have periods of remission and exacerbation
(Break through pain)

Can lead to depression, frustration, and anger

Question 5

What are examples of chronic pain?

Answer 5

Cancer: peripheral neuropathy

Back pain

Osteoarthritis

Question 6

What is nociceptive pain?

Answer 6

Physiologic
-tissue damage

Question 7

What is neuropathic pain?

Answer 7

Pathophysiologic
-damage to the peripheral or central nervous system

Question 8

Examples of neuropathic pain

Answer 8

Phantom limb syndrome

Diabetic neuropathy

Complex regional pain syndrome

Question 9

What are behavioral responses (voluntary movements) to pain?

Answer 9

Moving away

Clenching

Guarding painful area or limb

Bent posture

Grimace

Crying

Moaning

Restlessness

Question 10

What are psychological responses to pain?

Answer 10

Fear

Exaggerated weeping and restlessness

Powerlessness

Withdrawal

Anorexia

Depression

Anger

Hopelessness

Question 11

What are physiological responses to pain? (involuntary responses)

Answer 11

Sympathetic responses
- Tachycardia, hypertension
-Pupil dilation
-Pallor
-Tachypnea

Parasympathetic responses
-Tachypnea (irregular)
-N/V
-Syncope, hypotension, bradycardia

Question 12

What are we going to assess for regarding pain?

Answer 12

Physiological

Emotional factors

Sociocultural

Physiological factors

Question 13

What are the assessment tools for pain?

Answer 13

Numeric ratings scale

Verbal descriptive pain scale

Wong - Baker FACES pain rating scale

Pain assessment in advanced dementia scale

Question 14

What is special population when assessing pain?

Answer 14

Children

Patience with dementia

Critically ill

Developmentally delayed

Cognitive impairment

Language barriers

Question 15

What are some basic comfort measures?

Answer 15

Tighten and smooth wrinkled bed linens

Position tubing on which client is lying

Loosen constricting bandages

Change wet dressings and linens

Lift client up in bed

Position correctly on bed pan

Prevent urinary retention

Prevent constipation with fluids, diet and exercise

Clear clutter away from patients

Question 16

What are some nonpharmacological ways to ease pain?

Answer 16

Ice

Heat

Elevation

Compression

Physical therapy/exercise

Cutaneous (TENS) stimulation

Question 17

What are pharmacological ways to ease pain

Answer 17

Analgesics
-opioids
-non-opioid like acetaminophen and NSAIDs
-anti-depressants, anti-convulsants like gabapentin

Question 18

What are some pharmacological interventions?

Answer 18

Know previous response to analgesics

Select proper medication when more than one is ordered
-use pain scale for assessment

Assess the right time, route, and interval for administration

No accurate dosage

Question 19

What scale do you use after you give a narcotic?

Answer 19

The Pasero opioid induced sedation scale

Question 20

How do you use the pasero opioid sedation scale

Answer 20

S- sleep, easy to arouse

1- awake and alert

2- occasionally drowsy, but easy to arouse

3- frequently drowsy and drift off to sleep during conversation

4- somnolent with minimal or no response to stimuli

Question 21

What are the levels of consciousness?

Answer 21

Normal

Confusion/delirium

Lethargy

Obtundation

Stupor

Coma

Question 22

How can distraction help with pain?

Answer 22

It is believed that conscious attention may be necessary to experience pain

Most effective for mild pain at the beginning of pain symptoms

Question 23

What are some distraction techniques?

Answer 23

Counting

Listening to music

Playing with a toy

Rubbing a pet

Drawing

Watching TV

Question 24

How can humor ease pain?

Answer 24

It can be used in combination with analgesics, but should never replace pharmacological intervention

May have a positive effect on the immune system

Question 25

How can music ease pain?

Answer 25

Relaxing, soothing, provides distraction, and decreased pain

Affects neurotransmitters like epinephrine, and norepinephrine

Hormones like lowering cortisol

Immune and autonomic nervous system

Physiological responses

Question 26

What is guided imagery?

Answer 26

Focus on replacing those negative and stressful feelings with pleasant images

Involves all five senses

Typically use after a relaxation technique

Question 27

Ways we can assist with guided imagery

Answer 27

Recorded material and scripts

Using a picture or photo

Asking the patient to “go to their favorite place” and imagine being there

Question 28

What is the goal of relaxation?

Answer 28

Promote parasympathetic nervous activity- to reduce sympathetic activity and restore balance

Question 29

What are some benefits of relaxation?

Answer 29

Reduced anxiety

Reduced muscle tension and pain

Enhanced sleep and rest