pain management

Question 1

a subjective and individual phenomenon that warns us of potential injury and alerts us when tissue damage has occurred.

Answer 1

pain

Question 2

involves the normal processing of painful stimuli and is described in terms of a 4 step process that occurs when pain becomes a conscience event.

Answer 2

nociception

Question 3

extends from the periphery through the spinal cord, brain stem, and thalamus to the cerebral cortex, where the sensation is perceived.

Answer 3

the nociceptive system

Question 4

Occurs when energy is converted from one form to another and injured cells release substances that activate nearby nociceptors. Substance P, bradykinins, prostaglandins are released.

Answer 4

transduction

Question 5

a peripheral nervous system receptor that is sensitive to harmful stimuli

Answer 5

nociceptor

Question 6

the bright, sharp, well localized pain that is immediately associated with the injury

Answer 6

A-delta fibers

Question 7

cause second pain sensation that is dull, poorly localized and persistent after injury

Answer 7

C-fibers

Question 8

where complex processing of messages occurs. It is one of the most important areas for pain transmission

Answer 8

the spinal dorsal horn

Question 9

the result of potential or actual injury and includes activation of nociceptive fibers at the site of localized injury. It is time limited and occurs after trauma, surgery, or disease process. May have observable signs such as increased heart rate, respirations and elevated blood pressure.

Answer 9

acute pain

Question 10

an abnormal pain signaling process with origins that can occur both peripherally and centrally. It is cyclical and irreversible and generally persists longer than 3-6 months. These patients may appear flat.

Answer 10

persistant (chronic) pain

Question 11

A mechanism that can lead to chronic pain. It occurs when nociceptors bombard the CNS from the periphery, which leads to long term changes in the CNS.

Answer 11

central sensitization

Question 12

an exaggerated réponse to normal painful stimuli. Results in a lower pain threshold. Common in patients with postherpetic neuralgia

Answer 12

hyperalgesia

Question 13

occurs due to abnormal pain signaling that results in perceived pain with mild, non painful stimuli. Example- diabetic neuropathy

Answer 13

allodynia

Question 14

originates in bone, skin, and soft tissue and is often well localized

Answer 14

somatic pain

Question 15

originates internally as the result of stretching, distention and inflammation or damage to the hollow and solid organs. usually described as aching, throbbing, pressure, cramping, deep, or radiating.

Answer 15

visceral pain

Question 16

arises from damage of the peripheral nerves or the CNS and unlike nociceptive pain is the result of abnormal sensory input

Answer 16

neuropathic pain

Question 17

pain that can be observed by objective signs in the face, lower extremity positioning, activity level, crying and level of consolation

Answer 17

newborn and infant pain

Question 18

they have the ability to describe but may also be associated with lethargy, fatigue, anorexia, and regression

Answer 18

toddler and preschooler pain

Question 19

are able to describe, identify and rationalize pain. Regression is possible.

Answer 19

school aged children

Question 20

pain puts them at greater risk for depression, social isolation, and cognitive dysfunction. They most likely have decreased opioid receptors and increased inflammatory activity and are at risk for poor pain management.

Answer 20

older adults

Question 21

an emotional response associated with increased pain. It is associated with events that threatens a person’s intactness.

Answer 21

suffering

Question 22

occurs when a patient receives a drug such as an opioid continuously over an extended period of time

Answer 22

tolerance

Question 23

a physiologic adaptation that is characterized by the development of withdrawal symptoms such as diaphoresis, anxiety,tachycardia, or nausea when the drug is stopped abruptly

Answer 23

physical dependance

Question 24

patients who take medication for euphoria rather than for it’s intended pain relieving properties

Answer 24

addiction

Question 25

• must be controlled only by the PATIENT
• decreases the likeliness of over sedation events
• documentation is important to monitor for safeness and effectiveness.

Answer 25

PCA (patient controlled analgesia)

Question 26

a catheter is placed in the epidural space to deliver analgesia

• hypotension is a common side effect
• patient should sit upright on bedside before getting up
• calf pump exercises can increase blood flow prior to ambulation

Answer 26

epidural infusion therapy

Question 27

a band of skin innervated by the sensory root of a single spinal nerve

Answer 27

dermatome

Question 28

maintaining body alignment, regular scheduled turning, and limb elevation to decrease edema, maintaining a therapeutic environment, good hygiene

Answer 28

basic comfort measures

Question 29

decreases the sensitivity to pain and increases blood flow through vasodilatation of blood vessels. 40-45 degrees C and 5-30 minutes as tolerated.

Answer 29

heat application

Question 30

decreases sensitivity to pain and is useful for muscle spasms, back pain, arthritis, headache trauma, and surgical incisional pain.

• acts faster than heat
• 15 degrees C
• no longer than 20 mins

Answer 30

cold application

Question 31

used as an adjunct in the overall management of acute and chronic pain. It is a palm-sized light weight, simulator that generates a mild electrical impulse.
- contraindication for patient with pacemaker and implanted devices

Answer 31

TENS ( transcutaneous electrical nerve stimulation) unit

Question 32

the patient learns voluntary control over autonomic functions such as heart rate, hand temperature and muscle tension

Answer 32

biofeedback

Question 33

• Pain receptors
• pain impulse
• A delta fibers
• C fibers

Answer 33

transmission

Question 34

Cortical structures of brain (emotions, physiological)

Therapies- relaxation, imagery

Answer 34

perception

Question 35

Either pain signal transmission or pain receptor
Occurs in “descending system 
Endorphins released
Medications
Heat,cold,pressure
Gate Control Theory

Answer 35

modulation

Question 36

hastens death
potential decrease immune system
decrease mobility
risk for pneumonia/embolism
increase work heart/lung
impairs quality of life

Answer 36

inadequate pain relief