Pain - NRSG Fun Ch 30

Question 1

Name some of the non-verbal cues for pain

Answer 1

decreased activity
grimacing
sad or frightened expression
rapid blinking
frowning
crying
moaning
irritability
fidgeting
increased pacing/ rocking
disruptive behavior
increased confusion
noising breathing
profanity or verbally abusive behavior
refusing food
difficulty sleeping

Question 2

What are the changes to VS r/t acute (sympathetic) pain?

Answer 2

increased systolic blood pressure
increased heart rate and force of contraction
increased respiratory rate

dilated blood vessels to the brain
dilated pupils
rapid speech

Question 3

What are the changes to VS r/t Deep or Prolonged (parasympathetic) Pain?

Answer 3

Decreased systolic blood pressure, possible syncope
Decreased pulse rate
Changeable breathing patterns

Withdrawal
Constricted pupils
Slow, monotonous speech

Question 4

What are some psychological (Affective) Responses to pain?

Answer 4

anxiety
depression
anger
fear
exhaustion
hopelessness
irritability

Question 5

What are things to consider when assessing for pain?

Answer 5

Take a pain history
Observe for nonverbal indicators of pain
Use a pain scale

Question 6

What questions could you ask as part of a pain history?

Answer 6

Do you have pain now?
When did the pain begin?
Where is the pain located?
Rate your pain?
How would you describe your pain? Sharp, aching etc.
How often do you have pain?
Is there a pattern to your pain?
What makes the pain better/worse?
How does the pain affect your ADL?
Have you experienced this pain before?
Have you used any medications/ alternative therapies?
Cultural influences?

Question 7

Assessing pain in children?

Answer 7

Use art or play to assess pain
Child may deny pain if they think they will have to get a shot
Can use Wong-Baker face pain scale

Question 8

What pain management tasks can be delegated to a UAP?

Answer 8

re-positioning
back rub or massage
providing darkness and quiet in the room for sleep
straightening sheets
mouth care
soft music of the patients preference
using distraction (talking or setting up a game, giving a book to read etc.)

Question 9

What are some nonpharmacological measures to treat pain?

Answer 9

-TENS (transcutaneous electrical nerve stimulator)
-PENS (percutaneous electrical stimulation)
-Acupuncture
-Acupressure
-Massage
-Application of heat or cold
-Contralateral stimulation
-Immobilization
-Distraction
-sequential muscle relaxation (SMR)
-Guided imagery
-Hypnosis
-Theraputic touch
-Humor
-

Question 10

What is TENS?

Answer 10

transcutaneous electrical nerve stimulator

electrical device connected to pads that are placed over the painful area. The unit stimulates A-delta sensory fibers. Can be worn intermittently or over long periods.

Question 11

What is PENS?

Answer 11

percutaneous electrical stimulation

Combines a TENS with a percutaneously placed (through the skin) needle probes to stimulate peripheral sensory nerves.
Effective in short term management of acute or chronic pain

Question 12

What is acupuncture?

Answer 12

application of extremely fine needles to specific sites.
Believed to stimulate the endogenous analgesia system.
Well documented to help with dental pain, after surgery and chemotherapy to treat nausea.
Can cause lightheadedness - so consider risk for falls carefully

Question 13

What is acupressure?

Answer 13

The use of fingertips to provide firm, gentle pressure to pressure points.
May have a calming affect through the release of endorphins.
Can be self-administered.

Question 14

What is massage?

Answer 14

Pain relief through cutaneous stimulation and relaxing the muscles.
May improve sleep
May increase flow of body fluids and toxins - increases workload of kidneys and liver.

Question 15

How does application of heat or cold affect pain?

Answer 15

Cold - causes vasoconstriction and can help prevent swelling and bleeding. Especially effective in reducing pain during procedures.

Heat - promotes circulation, which speeds healing

Question 16

What is contralateral stimulation?

Answer 16

stimulation of the skin in an area opposite to the painful site.
stimulation = scratching, rubbing, applying heat or cold
Good for sites that cannot be accessed.
encased in cast
phantom limb

Question 17

What are the categories of analgesics?

Answer 17

nonopioids
opioids
adjuvants

Question 18

In what order should analgesics be given for pain (according to category)?

Answer 18

For mild pain: 
     nonopiods +/- adjuvants
For mild to moderate pain: 
     Opioid + Nonopioid +/- adjuvant
For moderate to severe pain:
     Opioid +/- Nonopioid +/- adjuvant

Question 19

Characterisks of Nonopioid analgesics

Answer 19

mild to moderate pain
May reduce inflammation and fever
for both acute and chronic pain
includes NSAIDs and Acetaminophen
can be compounded with opioids

Question 20

NSAIDs

Answer 20

nonsteroidal anti-inflammatory drugs
aspirin and ibuprofen etc
act primarily in the peripheral tissues by interfering with the production of prostaglandins
causes gastric irritation
aspirin also reduces aggregation in blood

Question 21

acetaminophen

Answer 21

analgesic and anti-fever affects

can cause liver toxicity in those who consume alcohol or liver disease

Question 22

Opioid analgesics

Answer 22

General side effects are:
nausea, vomiting, constipation and drowsiness
large doses can cause respiratory depression and hypotension

Question 23

Mu Agonists

Answer 23

stimulate Mu receptors
includes morphine
acute, chronic and cancer pain … breakthrough pain
no maximum level of analgesia

Question 24

Agonist-Antagonists

Answer 24

stimulate some opioid receptors and block others
for acute moderate to severe pain
not for severe escalating pain or as first-line drug
not to be used with mu agonists (can counteract them)
Has a limit to analgesic effects

Question 25

Opioids may be administered via

Answer 25

oral
nasal
transdermal
subcutaneous
rectal
Intramuscular
intravenous
patient-controlled analgesia (PCA pump)
Intraspinal analgesic

Question 26

Equianalgesia

Answer 26

refers to the approximately equal analgesia that a variety of opioids will provide

Question 27

Adjuvant analgesics

Answer 27

primary therapy for mild to moderate pain
in conjunction with opioids for moderate to severe pain
Include
anticonvulsants
antidepressants
local anesthetics
topical agents
psychostimulants
muscle relaxants
neuroleptics
corticosteroids
etc

Question 28

What are nerve blocks?

Answer 28

a type of regional anesthesia

for short-term pain relief or long-term management of pain

Question 29

What is Local anesthesia?

Answer 29

injection of local anesthetics into body tissues

Long or short-term use

Question 30

What is topical anesthesia?

Answer 30

application to the skin

quickly absorbed providing pain relief for mild to moderate pain

Question 31

What are the types of surgical interruption of pain?

Answer 31

Pain relief by permanent destruction of the nerve pathways. Types include:
cordotomy
rhizotomy
neurectomy
sympathectomy

Question 32

What is a cordotomy?

Answer 32

interrupts pain and temperature sensation below the tract that is severed.
Usually for leg and trunk pain

Question 33

What is a Rhizotomy?

Answer 33

interrupts the anterior or posterior nerve rout that is located between the ganglion and the cord
Anterior interruption generally used to stop spastic movements accompanying paraplegia
Posterior interruption generally used to eliminate pain in the innervated area
Usually used for head and neck pain produced by cancer

Question 34

What is a neurectomy?

Answer 34

used to eliminate intractable localized pain

Question 35

What is sympathectomy?

Answer 35

severs the paths to the sympathetic division of the autonomic nervous system