Pain Management

Question 1

describe PAIN

Answer 1

• is completely SUBJECTIVE
• no two people experience it the same way
• the most common reason why people seek healthcare

Question 2

describe PAIN MANAGEMENT

Answer 2

• practicing PATIENT ADVOCACY
• must be PATIENT-CENTERED
• nurses are legally responsible for ASSESSING & MANAGING PAIN

Question 3

describe the NATURE OF PAIN

Answer 3

• can be PHYSICAL, EMOTIONAL, & COGNITIVE
• type of PHYSIOLOGICAL MECHANISM that protects an individual from a harmful stimulus

Question 4

describe the PHYSIOLOGY OF PAIN

Answer 4

has the processes of;
TRANSDUCTION
TRANSMISSION
PERCEPTION
MODULATION

these are all aspects of NOCICEPTION

Question 5

nociception

Answer 5

• an observable activity in the nervous system that allows people to detect pain
• the PROTECTIVE PHYSIOLOGICAL SERIES OF EVENTS that brings awareness of actual or potential tissue damage

Question 6

transduction

Answer 6

conversion of specific THERMAL, MECHANICAL, or CHEMICAL STIMULI (energy) into ELECTRICAL IMPULSES

Question 7

transmission

Answer 7

1. sending and transmission of the NOCICEPTIVE IMPULSE
2. usage of MYELINATED (A-DELTA FIBERS) + UNMYELINATED FIBERS (C-FIBERS)
3. transmission into MULTIPLE AREAS OF THE BRAIN

Question 8

perception

Answer 8

1. interpretation of the QUALITY OF PAIN & processing of information from other experiences, knowledge etc…
2. point of AWARENESS of NOCICEPTIVE IMPULSES

Question 9

modulation

Answer 9

activation of ENDOGENOUS DESCENDING INHIBITORY MEDIATORS
endorphins, GABA, norepinephrine, serotonin
production of an ANALGESIC EFFECT
helps to HINDER TRANSMISSION OF NOCICEPTIVE IMPULSES

Question 10

gate-control theory of pain

Answer 10

• consists of PHYSIOLOGICAL or BEHAVIORAL RESPONSES

Question 11

physiological response

Answer 11

• AUTONOMIC NERVOUS SYSTEM:
  
  • stimulated in the SYMPATHETIC BRANCH
  • results in PHYSIOLOGICAL RESPONSES;
    
    • increased heart rate, dilation of bronchial tubes, peripheral vasoconstriction, increased blood glucose, increased cortisol levels, diaphoresis

Question 12

behavioral responses

Answer 12

• affected by CULTURE, PAIN PERCEPTION, STRESS MANAGEMENT, & EXP. WITH PAIN

Question 13

acute pain

Answer 13

• protective and typically of SHORT DURATION
• common from ACUTE INJURY, DISEASE, or SURGERY
• often have FRIGHTENED, ANXIOUS PATIENTS

Question 14

CHRONIC/PERSISTENT NONCANCER PAIN

Answer 14

• is NOT protective
• prolonged + varies in intensity; usually lasts longer than 3 - 6 months
• does NOT ALWAYS have an IDENTIFIABLE CAUSE
  
  • low back pain, arthritis, fibromyalgia etc…
• can sometimes FRUSTRATE a PATIENT

Question 15

CHRONIC EPISODIC PAIN

Answer 15

• pain that happens SPORADICALLY & over extended period of time
• ex. sickle cell crisis or migraines

Question 16

CANCER PAIN

Answer 16

• often caused of TUMOR PROGRESSION - related to PATHOLOGICAL PROCESSES + INVASIVE PROCEDURES + TOXICITIES of CHEMOTHERAPY, INFECTION, or PHYSICAL LIMITATIONS

Question 17

IDIOPATHIC PAIN

Answer 17

• type of CHRONIC PAIN that either does NOT HAVE an IDENTIFIABLE PHYSICAL or PSYCHOLOGICAL CAUSE
• ex. COMPLEX REGIONAL PAIN SYNDROME

Question 18

what are some preconceptions nurses have about pain?

Answer 18

• don’t believe the patient is in pain
• thinks patient is just difficult, complaining
• only reporting and observing through objective data
• fear of medication addiction

Question 19

what are the factors that influence PAIN?

Answer 19

• PHYSIOLOGICAL
• SOCIAL
• PSYCHOLGICAL
• CULTURAL

Question 20

what are the PHYSIOLOGICAL FACTORS that influence pain?

Answer 20

• AGE
  infants - they DO FEEL PAIN; cannot express or understand
  adolescents - development changes
  elders - pain is NOT a normal thing as we age/polypharmacy/decreased app.
• FATIGUE
  more tired = more pain
• GENES
• NEUROLOGICAL FXN.
  neuropathy - diabetic patients/SCI

Question 21

what are the SOCIAL FACTORS that influence pain?

Answer 21

• PREVIOUS EXPERIENCE
• FAMILY & SOCIAL NETWORK
• SPIRITUAL FACTORS

Question 22

what are the PSYCHOLOGICAL FACTORS that influence pain?

Answer 22

• ATTENTION
• ANXIETY & FEAR
• COPING STYLE

Question 23

what are the CULTURAL FACTORS that influence pain?

Answer 23

• MEANING OF PAIN
• ETHICITY

Question 24

what are the FACTORS THAT ARE IMPACTED BY PAIN ITSELF?

Answer 24

• person’s quality of life
• way of self-care
• how one works
• proper social support

Question 25

what factors to consider during PAIN ASSESSMENT?

Answer 25

• pain level scale; the SUBJECTIVITY OF PAIN
• pain expression
• physical exam
• pain characteristics;
  timing (onset, duration & pattern)

Question 26

what are our types of PAIN SCALES?

Answer 26

• NUMERICAL RATING SCALE (older adults - cog. active)
• VERBAL DESCRIPTIVE SCALE (use of descriptors or words)
• VISUAL ANALOG SCALE
• WONG-BAKER FACES PAIN RATING SCALE (often used in pediatric settings)

Question 27

what are the PAIN CHARACTERISTICS?

Answer 27

• the quality
• aggravating/precipitating factors (what makes it better or worse)
• relief measures

Question 28

what are the PAIN EFFECTS?

Answer 28

• effects on behavior
• effects on ADLs

Question 29

concomitant symptoms

Answer 29

symptoms that come with pain; increases severity
ex. headaches, or nausea

Question 30

how to promote health - pain

Answer 30

be OPEN MINDED
use measures that the patient believes
- IMPROVEMENT IS THE GOAL; being completely free of pain is not always realistic

Question 31

what are our NONPHARMACOLOGICAL PAIN-RELIEF INTERVENTIONS?

Answer 31

• relaxation/guided imagery
• distractions
• music
• cutaneous stimuli; massages/hot/cold
• herbals
• reducing pain perception

Question 32

what are our PHARMACOLOGICAL PAIN THERAPIES?

Answer 32

• PCA; PATIENT-CONTROLLED ANALGESIA
• topical/transdermal
• local anesthesia / injection
• epidural
• perineural local anesthetic infusions

Question 33

what type of ANALGESICS CAN WE TAKE FOR PAIN?

Answer 33

• NONOPIOIDS; tylenol
• OPIOIDS; narcotics/oxycodone (mod-severe)
• ADJUVANTS/CO-ANALGESICS; not directly meant for pain; but helps

Question 34

how are PCAs controlled?

Answer 34

• the PATIENT IS THE ONLY PERSON who should press button
• look for signs of oversedation/resp. depression
• only certain amts are administered