Pain Management

Question 1

Transduction

Answer 1

nociceptors are activated when exposed to noxious stimuli

-mechanical, chemical, or thermal

Question 2

Transmission

Answer 2

stimuli are converted to electrical impulses and relayed to spinal cord and brain by afferent nerve fibers and unmyelinated C fibers
-neurotransmitters facilitated transmission process to the brain

Question 3

Pain

Answer 3

• an unpleasant sensory and emotional experience that is associated w/ actual or potential tissue damage
• whatever the person says it is

Question 4

What is the 5th vital sign?

Answer 4

Pain

Question 5

A-delta Fibers

Answer 5

lead to sharp stabbing local pain

Question 6

C Fibers

Answer 6

lead to diffuse, dull burning or aching pain

Question 7

Perception of Pain

Answer 7

• nerve fibers divide in dorsal horn of spinal cord, cross to opposite side, rise upward to thalamus
• thalamus sends message to somatosensory cortex of brain where impulse is interpreted as pain

Question 8

Pain Threshold

Answer 8

point where person feels lowest intensity of painful stimulus

Question 9

Modulation

Answer 9

neuromodulators modulate pain sensation

can be modified peripherally or centrally

Question 10

Examples of Neuromodulators

Answer 10

Serotonin
Endorphins
Enkephalins
Dynorphins

Question 11

Classifications of Pain

Answer 11

• duration
• etiology
• source/location

Question 12

Types of Duration

Answer 12

Acute or Chronic

Question 13

Acute Duration

Answer 13

rapid onset of varying intensity, sore throat, appendicitis, surgery, invasive procedure

Question 14

Chronic Duration

Answer 14

pain that continues past the expected point of healing for injured tissue, abdominal pain, headache, sickle cell disease, or migraines

Question 15

Types of Etiology

Answer 15

Nociceptive

Neuropathic

Question 16

Nociceptive

Answer 16

due to noxious stimuli that damages normal tissue or has the potential to, chemical burn, sun burn, appendicitis

Question 17

Neuropathic

Answer 17

pain due to malfunctioning or the peripheral or central nervous system, spinal cord injury, phantom limb pain

Question 18

Types of Source/Location Pain

Answer 18

Somatic

Visceral

Question 19

Somatic

Answer 19

pain that develops in the tissues; superficial or deep

Question 20

Visceral

Answer 20

pain that develops w/in organs such as heart, lungs, GI tract, bladder, etc.

Question 21

Factors Influencing Pain

Answer 21

Age 
Gender
Cognitive level
Temperament 
Previous experiences 
Family and Cultural background

Question 22

Situational Factors Influencing Pain

Answer 22

behavioral
cognitive
emotional

Question 23

Behavioral Factor

Answer 23

how the child and family react and what they do about the pain experience

Question 24

Cognitive Factor

Answer 24

what the child understands and believes about the pain experience

Question 25

Emotional Factor

Answer 25

how the child and family feels about the pain experience

Question 26

Indicators of Pain in Infants

Answer 26

- facial expressions - body movements - crying - changes in HR, RR, BP, oxygen sat, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels

Question 27

Toddlers and Pain

Answer 27

- encourage to verbalize pain - may hit, bite, scream, or kick - use words they understand

Question 28

Preschoolers and Pain

Answer 28

- may not verbally report pain - thinking pain is expected - think adults are aware of pain - "I need to go to the bathroom" - difficulty describing pain

Question 29

School Age Children and Pain

Answer 29

- type, location, and severity - use descriptions based on things they know - try to be brave - might be embarrassed about acting out - withdraw - muscular rigidity

Question 30

Adolescents and Pain

Answer 30

- concerned primarily w/ body language - concerned w/ fear of losing control of behavior - can deny or refuse meds - mood affects response to pain - don't want to look like child - look for subtle changes

Question 31

What subtle changes should you look for in response to pain for adolescents?

Answer 31

rapid breathing, clenched teeth, clenched fists

Question 32

Factors Affecting Child's response to Pain

Answer 32

type of pain extent of pain age/developmental

Question 33

Key Principles of Pain Assessment

Answer 33

- question the child - use reliable and valid pain scale - evaluate child's behavior and physiologic changes to establish baseline - secure parents involvement - take cause of pain into account - take action

Question 34

Health History Data Related to Pain Assessment

Answer 34

- location, quality, severity, and onset of pain - conditions that preceded the onset of pain and conditions that followed - any associated symptoms such as weight loss, fever, vomiting, diarrhea, that may indicate illness - any recent trauma including interventions used

Question 35

Pain Management Guide For Children

Answer 35

- individualized interventions - use nonpharmacologic and pharmacologic approaches to ease/eliminate pain - teach child and fam about pain relief interventions and techniques

Question 36

What should you base your individualized interventions on when managing pain?

Answer 36

Amount of pain experienced, the child's characteristics such as developmental level, temperament, previous pain experience and coping strategies

Question 37

Nonpharmacologic Techniques

Answer 37

relaxation distraction guided imagery

Question 38

Behavioral-Cognitive Pain Management Strategies

Answer 38

- relaxation - distraction - imagery - biofeedback - thought stopping - positive self talk

Question 39

Biophysical Interventions for Pain Management

Answer 39

- sucking and sucrose - heat and cold applications - massage and pressure