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CHPN Exam > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Visceral pain: associated with

A

internal organs

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2
Q

Visceral pain: sensitivity

A

can be different depending on organ

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3
Q

Visceral pain: internal organs: not sensitive to pain

A

lack nociceptors may withstand great deal of damage without causing pain spleen kidney pancreas

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4
Q

Visceral pain: internal organs: sensitive to pain

A

significant pain from even slightest damage stomach bladder ureters

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5
Q

Visceral pain: area

A

poorly defined area

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6
Q

Visceral pain: capable of

A

referring pain to other remote locations away from area of injury

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7
Q

Visceral pain: description

A

squeezing cramping deep ache within the internal organs

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8
Q

Visceral pain: pt c/o

A

generalized “sick” feeling nausea and vomiting

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9
Q

Visceral pain: treatment

A

opioids

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10
Q

Neuropathic pain: results from

A

injury to nervous system

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11
Q

Neuropathic pain:injury to nervous system from

A

cancer cells compressing nerves or spinal cord actual cancerous invasion into the nerves or spinal cord chemical damage to nerves caused by chemo and radiation diabetes alcohol trauma nerualgias illness affecting neural path: centrally or peripherally

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12
Q

Neuropathic pain: damaged nerves

A

unable to carry information

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13
Q

Neuropathic pain: damaged nerves: pain

A

severe distinct pain messages

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14
Q

Neuropathic pain: damaged nerves: relay pain

A

long after the original cause of the pain is resolved

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15
Q

Neuropathic pain: description

A

sharp shooting burning shocking tingling electrical in nature

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16
Q

Neuropathic pain: travel

A

length of nerve path from spine to distal body part such as hand, or down buttocks to foot

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17
Q

Neuropathic pain: ineffective treatement

A

NSAIDs opioids

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18
Q

Neuropathic pain: opioids: adjuvants

A

adjutants may enhance the therapeutic effect of opioids

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19
Q

Neuropathic pain: treatment

A

nerve blocks

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20
Q

Pain assessment: sources

A

gathered from a variety observations interviews with patient and family medical records

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21
Q

Pain: remember

A

subjective and personal

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22
Q

Pain level: definition

A

whatever the patient says it is

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23
Q

Pain assessment

A

location duration or length onset or when it begins intensity per pain scales

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24
Q

Pain: influeneces

A

psychological social spiritual

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25
Q

Pain: helpful in defining pain

A

behavioral assessments psychological assessments subjective assessments physical demeanor vital signs

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26
Q

Pain: best assesment

A

patient’s own report all other information is assessed as supporting this report

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27
Q

Pain: physical s/s: vital signs

A

systolic blood pressure heart rate respiration

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28
Q

Pain: physical s/s

A

vital signs muscle groups posturing verbalization facial expressions

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29
Q

Pain: physical s/s: muscle groups

A

tightness or tension may be felt in major muscle groups Posturing can also occur: guard areas of body, curl around themselves in a “fetal” position, hold only certain body portions rigid

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30
Q

Pain: physical s/s: verbalization

A

calling out increased volume in speech moaning

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31
Q

Pain: physical s/s: facial expression

A

flat affect grimacing distraction from surroundings

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32
Q

Somatic pain: definition

A

refers to messages from pain receptors located in the cutaneous of musculoskeletal tissues

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33
Q

Deep somatic pain

A

occurs withing the musculoskeletal tissue

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34
Q

Deep somatic pain: origin

A

metastasizing cancers

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35
Q

Surface somatic pain

A

concentrated in dermis and cutaneous layers

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36
Q

Surface somatic pain: origin

A

surgical incision

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37
Q

Deep somatic pain: description

A

dull throbbing ache well focused on area of trauma

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38
Q

Deep somatic pain: treatment

A

responds well to opioids

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39
Q

Surface somatic pain:description

A

sharper than deep somatic pain burning or pricking sensation directly focused on injury

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40
Q

Classification of pain

A

nociceptive pain neuropathic pain

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41
Q

Nociceptive pain: two types

A

visceral somatic

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42
Q

Nociceptive pain: definition

A

umbrella term for pain caused by stimulation of neuroreceptor

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43
Q

Nociceptive pain: stmiulation

A

direct result of tissue injury

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44
Q

Nociceptive pain: 4 stages

A

transduction transmission modulation perception

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45
Q

Nociceptive pain: 4 stages: transduction

A

a change occurs

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46
Q

Nociceptive pain: 4 stages: transmission

A

impulse transferred along the neural path

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47
Q

Nociceptive pain: 4 stages: modulation/translation

A

of the signal

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48
Q

Nociceptive pain: 4 stages: perception

A

by patient

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49
Q

Nociceptive pain: severity of pain

A

is proportionate to extent of injury

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50
Q

Nociceptive pain: somatic: location

A

cutaneous tissues bone joints muscle tissue

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51
Q

Nociceptive pain: visceral: location

A

internal organs protected by a layer of viscera respiratory gastrointestinal genitourinary

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52
Q

Nociceptive pain: visceral, somatic: treatment

A

both types are treatable with opioids

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53
Q

Addiction: definition

A

primary and constant, neuro-biologic disease with genetic, psycho-social and environment factors that create an obsessive and irrational need or preoccupation with a substance

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54
Q

Addiction: behaviors

A

unrestricted, continued cravings compulsive and persistent use of a drug despite harmful experiences and S/E

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55
Q

Pseudo-addiction: definition

A

assumption patient is addicted to a substance when in actuality patient is not experiencing relief from medication

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56
Q

Pseudo-addiction: pain

A

prolonged, unrelieved pain maybe result of under-treatment

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57
Q

Pseudo-addiction: under-treatment

A

lead patient to become more aggressive in seeking medicated relief resulting in “drug seeker” label

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58
Q

Pain: experience

A

90% or all advanced disease patient will experience some level of pain

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59
Q

Pain: hospice philiosophy

A

relief of pain provision for comfort measures for all patients who desire to improve quality of life

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60
Q

Pain: patient’s right

A

to accept or refuse treatment for pain

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61
Q

Pain: communication

A

assume patient was experiencing pain, will continue to even in an unconscious state

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62
Q

Pain: non-verbal patient: assessment data

A

changes in assessment data provide supporting information for continued pain assessments in non-verbal patients

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63
Q

Pain: unidimensional tools for pain assessment

A

Numeric rating scale (NRS) Visual analog scale (VAS) Categorical scales

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64
Q

Pain: numeric scale

A

most widely known rate pain 0-10; 0-5 0= no pain; highest number = worst

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65
Q

Pain: visual analog scale

A

line marked on one end for no pain, other end for most severe patient indicates where he feels pain is line then measured to indicated point and scored

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66
Q

Pain: categorical scales

A

verbal response visual response

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67
Q

Pain: categorical scales: verbal

A

mild discomforting distressing horrible excruciating

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68
Q

Pain: categorical scales: visual

A

Faces Pain Scale, Wong-Baker Faces various facial expressions to choose from

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69
Q

Pain: contolling pain with meds

A

does not shorten or extend life span

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70
Q

Pain: most common med for severe pain

A

opioids

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71
Q

Pain: common opioid choice

A

methadone safe inexpensive

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72
Q

Pain: meds: concerns of family

A

addiction S/E tolerance to pain-reducing effects

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73
Q

Pain: opioids: concern

A

addiction is rare respiratory depression concern when patient first introduced

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74
Q

Pain: opioids: respiratory depression

A

problem when first introduced overcome as body becomes use to opioid

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75
Q

Pain: opioids: tolerance

A

can occur

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76
Q

Pain: opioids: assessments

A

made to avoid under-dosing, which can cause pain to become out of control and unmanageable

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77
Q

oxycodone

A

synthetic formulation long-acting opioid moderate to severe pain

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78
Q

oxycodone: S/E

A

lightheadedness dizziness sedation nausea constipation pruritus

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79
Q

oxycodone: pain relief ratio

A

similar to morphine possibility of less nausea

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80
Q

oxycodone: extended-release

A

cannot be cut or crushed for administration

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81
Q

oxycodone: use cautiously

A

hypothyroidism Addison disease urethral stricture prostatic hypertrophy lung or liver disease

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82
Q

hydromorphone: route

A

tablets liquid suppository parenteral formulations

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83
Q

hydromorphone: advantage

A

synthetic used for patients with morphine allergy

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84
Q

hydromorphone: helpful

A

when significant S/E have occured in past or pain has been inadquately controlled with other medications

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85
Q

hydromorphone: useful for controling

A

cough

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86
Q

hydromorphone: serious S/E

A

neurotoxicity may occur myoclonus: brief, involuntary twitching of a muscle hyperalgesia: increased sensitivity to pain seizures

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87
Q

hydromorphone: use cautiously

A

kidney disease prostatic hypertrophy urinary problems

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88
Q

hydromorphone: common side effects

A

dizziness lightheadedness drowsiness upset stomach if taken without food vomiting

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89
Q

Breakthrough pain: 3 types

A

Incident Pain Spontaneous Pain End-of-Dose Failure

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90
Q

Breakthrough pain: incident pain

A

tied to a specific event, such as dressing change or physical therapy

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91
Q

Breakthrough pain: incident pain: treatment

A

rapid-onset, short-acting analgesic just prior to painful event

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92
Q

Breakthrough pain: spontaneous pain

A

unpredictable and can’t be pinpointed to a relationship with any certain time or event no way to anticipate spontaneous pain

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93
Q

Breakthrough pain: spontaneous pain: neuropathic pain

A

adjuvant therapy may be useful

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94
Q

Breakthrough pain: spontaneous pain: treatment

A

rapid-onset, short acting analgesic is used

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95
Q

Breakthrough pain: end-of-dose failure

A

pain that specifically occurs at the end of a routine analgesic dosing cycle when medication blood levels begin to taper off

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96
Q

Breakthrough pain: end-of-dose failure: treatment

A

may indicate an increased dose tolerance and need for medication dose alterations

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97
Q

QUESTT pediatric pain assessment tool

A

Q = question U = use assessment tools E = evaluate S = secure T = take cause of pain into consideration T = take action to treat pain

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98
Q

QUESTT pediatric pain assessment tool: Q

A

question both the child an parent about the pain experience

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99
Q

QUESTT pediatric pain assessment tool: U

A

use assessment tools and rating scales that are appropriate to the developmental stage and situation and understanding of the child

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100
Q

QUESTT pediatric pain assessment tool: E

A

evaluate the patient for both behavioral and physiological changes

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101
Q

QUESTT pediatric pain assessment tool: S

A

secrue the parent’s participatoin in all stages of the pain evaluation and treatment process

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102
Q

QUESTT pediatric pain assessment tool: T

A

take the cause of the pain into consideration during the evaluation and choice of treatment methods

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103
Q

QUESTT pediatric pain assessment tool: T

A

take action to treat the pain appropriately, and then evaluate the results on a regular basis

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104
Q

ABCDE pain assessment

A

A = ask regularly B = believe patient C = choose appropriate pain control D = deliver pain relief E = empower patient

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105
Q

ABCDE pain assessment: A

A

ask regularly and consistently use same systematic approach every time pain is assessed

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106
Q

ABCDE pain assessment: B

A

believe patient’s report of pain and how it is best relieved

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107
Q

ABCDE pain assessment: C

A

Choose appropriate pain control options according to the needs of the patient, family and setting

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108
Q

ABCDE pain assessment: D

A

deliver pain relief in a timely, consistent and coordinated manner

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109
Q

ABCDE pain assessment: E

A

empower patient and family with information and an active voice in their care Care and pain relief should always be patient driven

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110
Q

Myoclonus: definition

A

presents as sudden, uncontrollable, nonrhythmic jerking of the extremities

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111
Q

Mycolonus: jerking

A

can be induced by tapping on the affected muscle group

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112
Q

Myoclonus: critical

A

early identification and rapid treatment

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113
Q

Myoclonus: for patient

A

can be exhausting

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114
Q

Myoclonus: can progress towards

A

severe neurological dysfunction seizures

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115
Q

Myoclonus: main cause

A

result of opioids given in high doses, particularly in patients with renal failure

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116
Q

Myoclonus: other causes

A

brain surgery intrathecal catheter placement AIDS dementia hypoxia

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117
Q

Nocturnal myoclonus: definition

A

nonrhythmic jerking of the extremities just prior to sleep

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118
Q

Nocturnal myoclonus: preceds

A

common preceds opioid-induced myoclonus

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119
Q

Myoclonus: treatment

A

opioid rotation use of adjuvants to reduce amount of opioid needed

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120
Q

Physical dependence: defiinition

A

condition of bodily adaptation to the presence of a specific drug or chemical

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121
Q

Physical dependence: removal of drug

A

or rapid reduction in dosage will result in withdrawal symptoms

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122
Q

Physical dependence: s/s

A

does not present with psychological and environmental dependence

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123
Q

Addiction: s/s

A

psychological and environmental dependence obsessive and irrational need or preoccupation with a substance unrestricted continued cravings compulsive and persistent use of a drug despite harmful experiences and S/E

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124
Q

Tolerance: defintion

A

adaptation of the body to continued exposure to a drug or chemical

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125
Q

Tolerance: effects of drug

A

at the same level of exposure are minimized over time

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126
Q

Tolerance: dosing

A

additional dosing is required to maintain the same outcomes

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127
Q

Pseudo-tolerance

A

misguided perception of health care provider that a patient’s need for increasing doses of a drug is due to the development of tolerance when in reality disease progression or other factors are responsible

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128
Q

Multidimensional tools for pain

A

Initial Pain Assessment Tool Brief Pain Inventory McGill Pain Questionnaire

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129
Q

Initial Pain Assessment Tool

A

specific to initial patient evaluation assesses characteristic of pain, patient’s manner of expressing pain, and effects of pain on quality of life

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130
Q

Initial Pain Assessment Tool: diagram

A

used to indicate pain locations and a scale rates pain intensity

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131
Q

Brief Pain Inventory

A

meant to quickly identify pain intensity and related restrictions series of questions about pain over 24 hours location, intensity, quality of life, type and patient’s response to treatments

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132
Q

McGill Pain Questionnaire

A

assesses pain on three levels identifying words selected by patient to describe their pain can be used with other tools both long and shotr forms

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133
Q

McGill Pain Questionnaire: three levels of assessment

A

sensory affective evaluative

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134
Q

nociceptors: definition

A

primary neurons, or sensory receptors,responding to stimulus in skin, muscle and joints, as well as stomach bladder and uterus.

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135
Q

nociceptors: neurons

A

specialized responses for: mechanical stimuli thermal stimuli chemical stimuli

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136
Q

nociceptors: neuron stimulation

A

result of direct tissue injury

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137
Q

nociceptors: 4 stages

A

transduction transmission modulation perceptoin

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138
Q

nociceptors: 4 stages: transduction

A

where a change occurs

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139
Q

nociceptors: 4 stages: transmission

A

where impulse is transferred along the neural path

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140
Q

nociceptors: 4 stages: modulation

A

or translation of signal

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141
Q

nociceptors: 4 stages:perception

A

perception of pain by patient

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142
Q

nociceptors: injury

A

nociceptors initiate process that begins depolarization of peripheral nerve

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143
Q

nociceptors: axons

A

A or C A carry pain messages faster thatn C mesage fast

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144
Q

nociceptors: message

A

passes along the neural pathway and creates a perception of pain

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145
Q

Schedule II drugs: disposal law

A

should be discarded by nurse or medical professional who is responsible for medication management at the time of death of a patient i

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146
Q

Schedule II drugs: time of medication waste

A

needs to occur as soon after the death as reasonable and needs to be witnessed and verified by a second qualified individual

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147
Q

Schedule II drugs: disposal: belong to

A

drugs have been paid for as part of patient’s care, so they do not belong to hospice of palliative care program

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148
Q

Schedule II drugs: disposal: pharmacy stock

A

can’t be returned to pharmacy stock because there is no guarantee medications have not been altered

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149
Q

: benefits

A

anti-inflammatory analgesic antipyretic

150
Q

NSAIDS use: first line defense against

A

pain caused by inflammatory conditions

151
Q

NSAIDS use: opioids adjuvuncts

A

used in conjunction with opioid therapy to reduce amount of opioid needed

152
Q

NSAIDS use: disadvantage

A

GI bleeding or ulceration decreased renal function impaired platelet aggregation

153
Q

NSAIDS use: therapeutic effects

A

may not extend beyond 6-12 months of use

154
Q

NSAIDS use: increased risk

A

short-term memory loss may occur in older patients increased cardiovascular risk with prolonged use

155
Q

NSAIDS use: allergy

A

patients allergic to sulfa drugs can also experience a cross-sensitivity to some types of NSAIDS

156
Q

Pain assessment: JACHO: core principle

A

All patients have right to appropriate assessment and management of pain

157
Q

Pain assessment: JACHO: caregivers

A

should encourage all patients to report pain and follow through with pain-relieving treatments

158
Q

Pain assessment: JACHO: assessment

A

must be appropriate for patient and address all aspects of pain

159
Q

Pain assessment: JACHO: family

A

should be included in assessment process

160
Q

Pain assessment: JACHO: most accurate indicator

A

patient’s own description always subjective clinician should accept and respect patient’s report

161
Q

Pain assessment: JACHO: individual pain

A

unique dependent on many contributing factors: heredity energy level coping skills prior experiences

162
Q

Pain assessment: JACHO: physiological and behavioral observatins

A

should not replace information obtained directly from patient when it can be communicated Pain can be present w/o physiological evidence or cause

163
Q

Pain assessment: JACHO: chronic pain

A

can create an overall lower threshold of tolerance for pain and other stimuli

164
Q

Pain assessment: JACHO: unrelieved pain

A

has adverse effects on all aspects of patient’s life

165
Q

Perception: importance

A

to assess and treat all aspects of patient’s pain

166
Q

Unrelieved pain

A

has adverse effects on all aspects of patient’s life

167
Q

Pain does not occur in

A

isolation

168
Q

Pain intensity

A

individual perception based on physical, psychological, social and spiritual factofs

169
Q

Pain can be present

A

without a known or visible cause

170
Q

Patient’s total pain: contributing factors

A

heredity energy level coping skills support systems prior experiences tissue damage other physical influences

171
Q

Pain: other symptoms and concerns

A

experience by patient compounds the suffering associated with pain

172
Q

Pain: chronic

A

can create an overall lower threshold of tolerance for pain and other stimnuli

173
Q

Non drug therapies

A

cognitive-behavioral techniques physical measures

174
Q

Cognitive-behavioral therapies: used to

A

improve coping and relaxation techniques

175
Q

Cognitive-behavioral therapies: examples

A

guided imagery hypnosis biofeedback distraction with music or humor prayer or other spiritual routines simple exercises rest breathing exercises meditation patient education about nature and causes

176
Q

Patient education about nature and causes of pain

A

can help patients feel more in control and less anxious in dealing with pain

177
Q

Physical measures of pain relief: examples

A

heat and cold massage reflexology acupuncture chiropractic transcutaneous electrical nerve stimulation (TENS)

178
Q

Physical measures of pain relief: refractory pain

A

nerve blocks cordotomy (surgical option)

179
Q

Substandard pain assessment: causes

A

nurses fail to recognize importance of full pain assessment interpersonal factors failure in healthcare system

180
Q

Substandard pain assessment: failure to recognize importance

A

result of inadequate knowledge perceived lack of time necessary therefore given low prioirty

181
Q

Substandard pain assessment: interpersonal factors

A

inability to establish rapport or empathize with patient personal prejudice and bias

182
Q

Substandard pain assessment: failure in healthcare system

A

lack of provider accountability policies criteria availability of pain assessment tools

183
Q

Last hours of life

A

assessment of pain continues in last hours of life medication adjusted accordingly

184
Q

Last hours of life: pain level

A

pain does not necessarily increase as death approaches

185
Q

Last hours of life: unconscious state

A

it can be assumed if pain was present prior to loss of consciousness it will continue in patient’s unconscious state should be assessed and treated

186
Q

Last hours of life: research

A

has confirmed administering opioids at end of life does not hasten nor prolong dying process patient’s prior medication regimen should be continued

187
Q

Last hours of life: medication regimen: adjustments

A

made in consideration of reduced renal or hepatic clearance

188
Q

Last hours of life: route

A

needs to be assessed for appropriateness and adjusted as needed loss of consciousness inability to swallow

189
Q

Ketamine: pain crisis: treatment

A

initial bolus: 0.1 mg/kg IV if no improvement 5 minutes later, second bolus: double dosage may be repeated as needed

190
Q

Ketamine: pain crisis: boluses

A

should be followed by decrease in patient’s current opioid use by 50% and infusion of ketamine

191
Q

Ketamine: pain crisis: infusion dose

A

0.015 mg/kg/min or 1 mg/min for a 70 kg person

192
Q

Ketamine: pain crisis: no IV access

A

subcutaneous 0.3 - 0.5 mg/kg

193
Q

Ketamine: pain crisis: concurrent treatment

A

benzodiazepines: prevent hallucinations or frightful dreams

194
Q

Ketamine: pain crisis: observe for

A

increased secretions

195
Q

Ketamine: pain crisis: secretions treatment

A

glycopyrrolate scopolamine atropine

196
Q

Subjective nature of pain

A

patient my inadvertently sabotage attempts at a full pain assessment and subsequent treatment

197
Q

Lack or rapport with nurse might create

A

patient unwilling to communicate extent of pain fear he will be seen as a “bother” or drug seeker

198
Q

If patient’s attitude is fatalistic

A

might feel pain is inevitable and must be tolerated may feel treatments will be ineffective may lack understanding about effective treatment methods

199
Q

Barriers for effective pain assessment

A

cultural religious age-related effective communication skills unfounded beliefs about pain and treatment

200
Q

Opioid analgesic therapy

A

widely used method of chronic pain control

201
Q

Opioid analgesic therapy: IM

A

last resort except in presence of a “pain emergency” rare since it can be given SubQ

202
Q

Opioid analgesic therapy: trans-dermal and transmucosal

A

by pass eternal route optimal for continuous pain control effective for eliminating breakthrough pain

203
Q

Opioid analgesic therapy: changing from one opioid to another, or alternating delivery method

A

may be necessary because of incomplete cross-tolerance among opioids occurs

204
Q

Opioid analgesic therapy: changing analgesics or method of delivery

A

may result in a decreased ddrug requirement

205
Q

Opioid analgesic therapy: morphine equivalents

A

use morphine equivalents as common factor for all dose conversionsn

206
Q

Opioid analgesic therapy: morphine equivalents

A

reduce medication errors

207
Q

Opioid analgesic therapy: S/E

A

sedation constipation nausea myoclonus

208
Q

Effective pain control begins with

A

initial evaluation

209
Q

Goal of palliative care

A

bring pain that is not well controlled withing patient’s own comfort level within the first 48 hours

210
Q

Pain after 48 hours of initial assessment

A

should be maintained within patient’s own comfort level with provisions for breakthrough pain episodes and changes in overall pain llevels

211
Q

Pain out of control

A

should be managed by active intervention within a predetermined time limit

212
Q

Mission of palliative care

A

to improve overall quality of patient’s life

213
Q

No patient should

A

face death or die in presence of uncontrolled pain

214
Q

Adverse effects

A

should be treated in timely manner

215
Q

Should be taken into account with every prescription

A

individual patient’s needs costs practicality convenience

216
Q

Guideline to improve quality pain managemnt

A

prescription monitor patient status frequently and adjust analgesics around-the-clock- pain relief immediate-release options avoid mixing agonist-antagonist opioids monitor for drug-drug and drug disease interactions manage S/E be familiar with pain experts in care community

217
Q

Adjust analgesics based on

A

patient’s goals results of full pain assessments including needs for supplemental analgesics, sleep, emotions and quality-of-life factors

218
Q

Around the clock pain relief

A

provided in form of sustained-release options consistent dosing schedules

219
Q

Immediate release options

A

provided for breakthrough pain

220
Q

Avoid mixing

A

agonist-antagonist opiioids

221
Q

Monitor and manage

A

drug-drug interactions drug-disease interactions manage known S/E

222
Q

Be familiar with

A

additional resources of pain management experts in care community make referrals as needed when pain cannot be adequately controlled

223
Q

Pain documentation

A

initial assessment patient’s goals and expectations current analgesic routine bodily functions interdisciplinary progress notes pain treatments related pain factors patient teaching interventions adverse effects

224
Q

Pain documentation: initial comprehensive pain assessment

A

current pain management regimen patient’s past experience with pain and its control

225
Q

Pain documentation: patient goals and expectations

A

should be addressed

226
Q

Pain documentation: current analgesic routine

A

should be addressed with any concerns regarding drugs in use

227
Q

Pain documentation: bodily fucntions

A

affected by medications are to be reviewed, including bowels, balance and other quality of life issues

228
Q

Pain documentation: interdisciplinary progress notes

A

recurrent pain assessments with baseline pain scores breakthrough pain episodes timing severity related causes treatments

229
Q

Pain documentation: pain treatments

A

non-pharmacological timing results

230
Q

Pain documentation: related pain factors

A

sleep activity levels social interaction mood

231
Q

Pain documentation: patient teaching interventions

A

described and evaluated for effectiveness

232
Q

Pain documentation: adverse effects

A

changes in bowel functions sedation nausea vomiting

233
Q

Pain crisis: assess for

A

change in mechanism or location of pain

234
Q

Pain crisis: differentiate between

A

terminal anxiety or agitation and physical causes of pain

235
Q

Pain crisis: begin with

A

a rapid increase in opioid treatment

236
Q

Pain crisis: unresponsive to opioid titration

A

switching to benzodiazepines may produce response

237
Q

Pain crisis: benzodiazepines

A

diazepam lorazepam

238
Q

Pain crisis: unresponsive to benzodiazepines

A

assess for drug absorption

239
Q

Pain crisis: invasive routes

A

generally avoided unless necessary only guaranteed route of drug delivery is IV

240
Q

Pain crisis: any question about absorption

A

appropriate to establish parenteral access

241
Q

Pain crisis: IM

A

last resort

242
Q

Pain crisis: resources exhausted

A

seek pain management consultation as quickly as possible

243
Q

Pain crisis: alternative methods of terminal pain control

A

radiotherapy anesthetic or neuroabliatve procedures

244
Q

Addiction challenges: important

A

to choose a long-acting opioid that can facilitate around the clock dosing and minimize need for short-term medications used for “breakthrough” doses

245
Q

Addiction challenges: short-term medication

A

should be very limited or eliminated entirely i possible

246
Q

Addiction challenges: non-drug adjuvants

A

use whenever possible: relaxation techniques distraction biofeedback TNS therapeutic communication

247
Q

Addiction challenges: short term medication

A

non-opioid is best

248
Q

Addiction challenges: limit

A

amount of medication available to patient at any given time

249
Q

Addiction challenges: monitor

A

for compliance with pill counts urine toxicology screens referral to addictions specialist

250
Q

Neuropathic Pain Scale

A

way to assess and provide information about specific types and degrees of sensations experience by patients living with neuropathic pain

251
Q

Neuropathic Pain Scale: 8 common qualities of neuropathic pain

A

sharp dull hot cold sensitive itchy deep surface

252
Q

Neuropathic Pain Scale: rate each sensation

A

on a number scale from 0 to 10 10 is worst imaginable sensation

253
Q

Adjuvant: definition

A

complimentary treatment used in an effort to reduce and supplement current pharmacological responses

254
Q

Adjuvant: pain control use

A

reduce amount of medication enhance overall analgesic effects

255
Q

Adjuvant: pharmacological choices

A

antidepressants anticonvulsants corticosteroids

256
Q

Adjuvant: nonpharmacologic

A

meditation hot or cold application acupuncture

257
Q

meperidine

A

opioid analgesic

258
Q

meperidine: use

A

American Pain Society strongly discourage use of, especially in long-term palliative care setting

259
Q

meperidine: analgesic effect

A

does not have a long-lasting analgesic effect only last 2-3 hours

260
Q

meperidine: repeated doses

A

may lead to CNS toxicity result of ineffective metabolite clearance

261
Q

meperidine: renal insufficiency

A

patients with are unable to excrete byproduct of meperidine from system

262
Q

meperidine: accumulation of by product

A

called normeperidine results in chronic muscle twitching or new-onset seizures

263
Q

meperidine: metabolities

A

linked to increase in pain perception and intensity

264
Q

Normeperidine: toxicity

A

not easily reversed does not respond to naloxone

265
Q

Morphine: advantage

A

no ceiling dose different forms of administration used as equivalency standard for other opioids

266
Q

Morphine: no ceiling dose

A

as tolerance incrases or disease progresses dose can be graually incrased to an infintie level

267
Q

Morphine: different forms of administration

A

IV, IM, immediate release, sustained release, long-acting, liquid oral preparations, and suppositories

268
Q

Morphine: S/E

A

sedation respiratory depression itching nausea chronic spasms or twitching of muscle groups constipation

269
Q

Morphine: constipation

A

experienced by all patients receiving opioids should be planned for and treated aggressively

270
Q

Morphine: hallucinations

A

common when morphine is initiated

271
Q

Morphine: after first few days

A

most patients will overcome respiratory depression, nausea, itching and extreme sedation

272
Q

Conscious sedation: definition

A

a minimally depressed state of awareness in which patient maintains ability to respond appropriately to verbal and physical stimulus and commands

273
Q

Conscious sedation: patients capable of

A

maintaining their own airways, as well as continuing to protect themselves with reflexive responses

274
Q

Conscious sedation: maintained with

A

analgesics and sedatives in order to perform various medical and surgical procedures

275
Q

Conscious sedation: procedure

A

must be used with precaution in order to prevent loss of consciousness

276
Q

Conscious sedation:equipment for emergency

A

airway management resuscitation medications for sedation reversal

277
Q

Conscious sedation: medications for sedation reversal

A

naloxone benzodiazepines

278
Q

ketorolac: classification

A

NSAID

279
Q

ketorolac: use

A

analgesic antipyretic anti-inflammatory

280
Q

ketorolac: action

A

inhibits synthesis of prostaglandins within body

281
Q

ketorolac: therapeutic use time frame

A

short-term therapy of 5 days of less

282
Q

ketorolac: route

A

oral IM ophthalmic solutions

283
Q

ketorolac: ophthalmic solution

A

effective in treating: general eye pain irritation r/t seasonal allergies

284
Q

ketorolac: contraindictated

A

renal disease

285
Q

ketorolac: S/E

A

edema hypertension rash nausea constipation diarrhea vomiting drowsiness dizziness headache

286
Q

ketorolac: serious risk factors

A

stomach ulceration bleeding perforation renal damage hemorhage

287
Q

Pediatric patient: pain assessment:

A

consider chronological and developmental age of child parameters identify underlying cause of pain any non-pharmacological measures methods for pharmacological interventions is child able to speak

288
Q

Pediatric patient: chronological and developmental age of child

A

help determine which measure the child might use to express pain, as well as treatments

289
Q

Pediatric pain: parameters

A

presence of and parameters surrounding chronic illness, as well as neurologicla impariment

290
Q

Pediatric pain: pharmacological interventions

A

weight of child in kilograms determines appropriate dosages of medications

291
Q

Pediatric pain: is child able to speak?

A

speak same language ? any barriers to communication or pain relief measures?

292
Q

Medications: neuropathic pain

A

anticonvulsants anesthetics antidepressants

293
Q

Medications: neuropathic pain: dosing

A

as needed, but most require consistent dosing with 24-hour symptom control

294
Q

Medications: neuropathic pain: examples

A

amitriptyline nortriptyline duloxetine gabapentin topical lidocaine opioids pregabalin

295
Q

Medications: neuropathic pain: choice

A

type and progression of disorder associated physical and emotional problems

296
Q

Medications: neuropathic pain: physical and emotional problems

A

nerve injury muscle weakness or spasms anxiety depression sleep disturbances

297
Q

Medications: neuropathic pain: depression

A

amitriptyline nortriptyline duloxetine

298
Q

Medications: neuropathic pain: anticonvulsants

A

gabapentin pregabapentin

299
Q

Morphine: enteral: dose

A

30 mg (available as continuous and sustained-release fomulations to last 12-24 hours

300
Q

Morphine:parenteral dosage

A

10 mg

301
Q

Codeine: enteral: dose

A

200 mg (not generally recommended)

302
Q

Codeine: parenteral dose

A

130 mg

303
Q

Hydromorphone: enteral: dose

A

7.5 mg (available as a continuous-release formula lasting 24 hours)

304
Q

Hydromorphone: parenteral: dose

A

1.5 mg

305
Q

Levorphanol: acute pain episodes: enteral dose

A

4 mg

306
Q

Levorphanol: acute pain episodes: parenteral dose

A

2 mg

307
Q

Levorphanol: chronic pain: enteral dose

A

1 mg

308
Q

Levorphanol: chronic pain: parenteral dose

A

1 mg

309
Q

Bone pain: treatment options

A

may depend on causative agent r/t pain: primary cancer site severely weakened bones fractures

310
Q

Bone pain: systemic treatments choices

A

chemotherapy radiation hormone therapy bisphosphonates surgery opioids NSAIDS COX2 inhibitors

311
Q

Bone pain: hormone therapy: used

A

in presence of estrogen and androgen receptors within cancer cells

312
Q

Bone pain: bisphosphonates: action

A

strengthen bone slow damage prevent fractures reduce pain

313
Q

Bone pain: bisphosphonates: medications

A

ibandronate zoledronate alendronate

314
Q

Bone pain: bisphonsphonates: S/E

A

fatigue fever N/V anemia

315
Q

Bone pain: surgery

A

may be considered to remove cancerous cells or reinforce weakened areas of bone

316
Q

Bone pain: opioids, NSAIDS/COX2 inhibitors

A

used most often for pain relief and need to be provided on consistent basis

317
Q

Bone pain: morphine combined with ?

A

ibuprofen

318
Q

Bone pain: morphine + ibuprofen

A

benefit of a centrally acting opioid with a peripherally acting NSAIDS

319
Q

Bone pain: ibuprofen

A

acts as an effective adjuvant analgesic agent to enhance relief provided by opioid without increasing opioid S/E

320
Q

Addiction: definition

A

primary and constant, neuro biologic disease with genetic, psycho-social, and environmental factors that create an obsessive and irrational need or preoccupation with a substance

321
Q

Addictive behaviors:

A

unrestricted, continued cravings and compulsive and persistent use of a drug despite harmful experiences and S/E

322
Q

Pseudo-addiction: definition

A

assumption the patient is addicted to a substance when in reality the patient is not experiencing relief from the medication

323
Q

Pseudo-addiction: pain

A

prolonged, unrelieved pain that may be result of under-treatment

324
Q

Pseudo-addiction: sistuation

A

may lead patient to become more aggressive in seeking medicated relief, resulting in inappropriate “drug seeker” label

325
Q

Pain management: American and Alaskan natives

A

unwilling to show pain or request medications pain is a difficulty that must be endured rather than treated

326
Q

Pain management: Asian and Pacific Islanders

A

do not vocalize pain may have an interest in pursuing nontraditional and non-pharmacological treatments, such as acupuncture, to help relive pain

327
Q

Pain management: Black and African American

A

openly express pain, but still believe it is to be endured may avoid medication because of personal fears of addiction or cultural stigmattism

328
Q

Pain management: Hispanic cultures

A

value ability to endure pain and suffering as a personal quality of strength expression of pain, especially for a male, is considered a sign of weakness pain is a form of godly punishment or trial

329
Q

Pain: gender can affect

A

pain sensitivity tolerance distress exaggeration of pain patient’s willingness to report pain displayed nonverbal cues concerning pain experience

330
Q

Pain: Women

A

lower pain thresholds and less tolerance for noxious stimuli or pain factors that hinder them from doing things they enjoy

331
Q

Pain: women: seek help

A

for pain related problems sooner than men and respond better to herapy

332
Q

Pain:women:visceral pain

A

women experience more visceral pain than men

333
Q

Pain:men:somatic pain

A

more prone to experience somatic pain

334
Q

Pain:men: emotion

A

more stoicism regarding pain than women

335
Q

Pain:neuropathic: genders

A

experienced equally between men and women

336
Q

Pain experiences

A

individual differ between sexes

337
Q

Acetaminophen (APAP)

A

safest analgesics for long-term use

338
Q

Acetaminophen (APAP): used for

A

mild pain adjuvant with other analgesics for more severe pain nonspecific musculoskeletal pain osteoarthritis limited anti-inflammatory nature

339
Q

Acetaminophen (APAP): use cautiously

A

in persons with altered liver or kidney function history of alcohol use

340
Q

Acetaminophen (APAP): dosed

A

dosed separately from any opioid analgesic, which should be given separately as well

341
Q

Acetaminophen (APAP): separate dosing

A

allows for individual titration of each drug to assess individual needs and S/E separately

342
Q

Methadone: useful for

A

treating severe or chronic pain helpful in presence of neuropathic pain

343
Q

Methadone: long acting relief

A

long acting pain relief factor for a lower cost than many comparable medications

344
Q

Methadone: dosing ratios

A

exact dosing ratios with morphine remain unclear

345
Q

Methadone: metabolism

A

can be increased or decreased by many other medications

346
Q

Methadone: opioid addiction

A

used to treat opioid addiction

347
Q

Methadone: US law

A

prescription of methadone for addiction in detoxification or maintenance programs requires a special license and patient enrollment

348
Q

Methadone: prescription

A

words “for pain” needs to be clearly stated

349
Q

Methadone: S/E

A

drowsiness weakness headache N/V constipation sweating flushing sedation decreased respiration irregular herat rate

350
Q

Oral transmucosal fentanyl citrate: consists of

A

fentanyl on an oral applicator

351
Q

Oral transmucosal fentanyl citrate: dosage

A

starting at 200 mcg

352
Q

Oral transmucosal fentanyl citrate: route

A

patient applies dosage to the buccal mucosa between the cheek and gum for rapid absorption and subsequent pain relief

353
Q

Oral transmucosal fentanyl citrate: useful for

A

managing breakthrough pain

354
Q

Oral transmucosal fentanyl citrate: pain relief

A

begins within 5 minutes

355
Q

Oral transmucosal fentanyl citrate: second dose

A

wait 15 minutes

356
Q

Oral transmucosal fentanyl citrate: swallowing

A

can affect timing of pain relief onset

357
Q

Oral transmucosal fentanyl citrate: peak

A

20 - 40 minutes

358
Q

Oral transmucosal fentanyl citrate: duration

A

2-3 hours

359
Q

Oral transmucosal fentanyl citrate: S/E

A

somnolence nausea dizziness

360
Q

Oral transmucosal fentanyl citrate: drinks

A

alter oral secretion of pH and absorption rate coffee tea juices

361
Q

Pain: HIV/AIDS patient: sources

A

aphthous ulcer and oral candidiasis arthralgia hepatotoxicity herpes simplex virus 2 (HSV-2) isosporiasis myalgia neuralgia and peripheral neuropathy Stevens-Johnson syndrome (SJS) cryptococcal meningitis

362
Q

Pain: HIV/AIDS patient: aphthous ulcer and oral candidiasis

A

produce painful sores within the oral cavity dysphagia may be experienced

363
Q

Pain: HIV/AIDS patient: arthralgia

A

joint pain with heat, redness, tenderness, loss of motion, and swelling

364
Q

Pain: HIV/AIDS patient: cryptococcal meningities

A

life-threatening fungal infection resulting in headache, dizziness and stiff neck coma and death can occur

365
Q

Pain: HIV/AIDS patient: hepatotoxicity

A

liver damage resulting in N/V, abdominal pain, loss of appetite, diarrhea, fatigue and weakness, jaundice, swelling and weight gain

366
Q

Pain: HIV/AIDS patient: herpes simplex virus 2 (HSV-2)

A

produces painful sores around the anus or genitals

367
Q

Pain: HIV/AIDS patient: isosporiasis

A

gastrointestinal infection diarrhea, fever, headache, abdominal pain, vomiting, and weight loss

368
Q

Pain: HIV/AIDS patient: myalgia

A

condition of muscle pain and tenderness, general discomfort and weakness throughout enite body

369
Q

Pain: HIV/AIDS patient: neuralgia and peripheral neuropathy

A

sources of chronic nerve pain

370
Q

Pain: HIV/AIDS patient: Stevens-Johnson syndrome (SJS)

A

reaction to medications and creates a severe to fatal skin rash with red, blistered and painful spots on skin, mouth, eyes, genital, and moist area of the body or internal organs

CHPN Exam (6 decks)

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