Pain Objectives Flashcards
considered the 5th vital sign
Pain
Origin:Arises in skin/Sub-q tissue (paper cut/hot stove)
Cutaneous/superficial
Origin:Originates in the ligaments, tendons, nerves, blood vessels, and bones (fracture/bone cancer)
Somatic
Origin:Deep internal pain; often experienced in the abdominal cavity, cranium, or thorax
Not well localized; tight/pressure/crampy
Menstrual/labor pain; GI infections; bowel disorders; organ cancers
Visceral
Origin:Starts at the origin but extends to other locations.
Example - sore throat extends to ears/head
Radiating
Origin:Occurs in an area that is distant from the original site.
Example -the pain from a heart attack may be experienced down the left arm, through the back, or into the jaw.
Referred
Origin:Perceived to originate from an area that has been surgically removed. Patients with amputated limbs may still perceive that the limb exists and experience burning, itching, and deep pain in that area.
Phantom
Origin:Believed to arise from the mind. The patient perceives the pain despite the fact that no physical cause can be identified. Psychogenic pain can be just as severe as pain from a physical cause.
Psychogenic
Most common type of pain
Nociceptive pain (acute)
Occurs when pain receptors respond to thermal, chemical, or mechanical stimuli
Nociceptive pain
Type of pain that may occur as a result of trauma, surgery, or inflammation.
Often described as “achy” pain
Nociceptive pain
a complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli.
Neuropathic pain (Often chronic)
Short duration/rapid onset (up to 6 months)
Varies in intensity
Protective in nature
Associated with injury/surgery
Generally lessens/disappears with healing
Activates the sympathetic nervous system
acute pain
Lasts more than 6 months
Interferes with ADL’s
Periods of remissions/exacerbations
Not protective in nature; may lead to W/D; depression; anger; frustration; dependence
Chronic pain
Chronic
Highly resistant to relief
Frustrating to the client
Treat with multiple methods to ensure pain relief
Intractable pain
may be described as sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling.
Pain quality
may be referred to as episodic, intermittent, or constant.
Pain periodicity
is described with a variety of terms, such as mild, distracting, moderate, severe, or intolerable.
Pain intensity
In a process called ________, nociceptors become activated by the perception of mechanical, thermal, and chemical stimuli.
transduction
Peripheral nerves carry the pain message to the dorsal horn of the spinal cord in a process known as _____
transmission
A-delta and C-delta fibers
involves the recognition and interpretation of pain in the frontal cortex
Pain Perception
is the duration or intensity of pain that a person can endure. This varies not only from person to person but also for the same person in different situations
Pain tolerance
A process called ___________changes the perception of pain by either facilitating or inhibiting pain signals through the endogenous analgesia system and the gate-control mechanism.
modulation
It is most important for the nurse to understand the various ways in which pain is classified so that he or she can
Document the client’s pain using accurate terms.
Be clear in communication with the physician.
Develop an effective pain management plan.
Educate the client thoroughly.
Develop an effective pain management plan
Different modalities are used in the treatment/management of pain and are often based on how the pain is classified (e.g., acute versus chronic).
These fibers: are large and fast myelinated and transmit pain that is sharp, fast, well localized, “1st pain”
A” delta
These fibers: are smaller and unmyelinated and transmit slow, diffuse, aching pain, “2nd pain”
C” fibers
lowest intensity of a stimulus that is recognized as pain
Varies from client to client
Pain threshold
The onset of acute pain activates the ________ nervous system
sympathetic
this fight-or-flight (stress) response is protective. It minimizes blood loss, maintains perfusion to vital organs, prevents and fights infections, and promotes healing.
If the pain continues, the body adapts, and the________ nervous system takes over
parasympathetic
Unrelieved pain - Effects on endocrine system - triggers_____
Insulin and testosterone _____
Carbohydrates, proteins, and fat breakdown leading to _______
All which can result in :
excessive release of hormones
decrease
hyperglycemia
Weight loss, tachycardia, fever, increased respiratory rate
Cardiovascular System Unrelieved pain leads to
__________ clotting, also called____________
___________ heart rate, blood pressure, cardiac workload and O2 demand
All of which can lead to: _____
increased , hyper coagulation
increased
Chest pain, intracoronary thrombosis, Myocardial Infarction
Musculoskeletal system - unrelieved pain effects
Fatigue, impaired muscle function, immobility
alters ability to perform ADL’s
Respiratory system - unrelieved pain effects:
Breaths become ________
Tidal volume ______
Resulting in:_______
shallow
reduced
Pneumonia, retained carbon dioxide (Hypercarbia), respiratory acidosis
Unrelieved pain - Genitourinary system : ___________amounts of catecholamines, aldosterone, ADH, cortisol, angiotensin II, and prostaglandins
_________ urinary output, urinary retention, fluid _______, ____kalemia, ______tension, increased cardiac output
excessive
decreased
overload
hypo
hyper
unrelieved pain - Gastrointestinal system:
Intestinal secretions and smooth muscle tone ______
Gastric emptying, and motility __________
increase
decrease
The first step in the treatment of pain is an appropriate and thorough
pain assessment.
The nurse is caring for a client who was involved in a motor vehicle accident. As a result of the accident, the client required multiple surgeries and is currently intubated.
What are the common responses to acute pain - Select all that apply A Constricted pupils B Increased heart rate C Decreased respiratory rate D Increased respiratory rate E Tearful
B, D, E
constricted pupils are a sign of deep or prolonged pain not acute. A change in breathing pattern can be seen with prolonged pain, but it is not a typical sign of acute pain. In acute pain, the client is likely to be tearful with tachycardia and tachypnea.
When we use pain scales, we are measuring
the_________ of the client’s pain
INTENSITY
_______vital signs do not mean that the patient is free of pain.
normal
What is PQRST in pain assessment
Precipitating factor: What provokes or causes the pain, makes it worse, or better?
Quality: What it like - sharp? dull? burning? Stabbing? Crushing? Changing?
Radiate: Does pain travel from one area to another?
Severity: Does the patient think the pain is mild, moderate, or severe? (On a scale of 1-10) does it vary – what does the variation depend on?
Timing: Constant or intermittent? Occurred before? Started? Change in severity- get better, then worse? When did it start? How long has it been going on?
Non pharmacological pain relief:
_______consists of electrode pads, connecting wire, and the stimulator. The pads are applied directly to the painful area, which is most often muscle and soft tissue. Once activated, the unit stimulates A-delta sensory fibers.
transcutaneous electrical nerve stimulator (TENS)
Non pharmacological pain relief:
_______combines a TENS unit with needle probes percutaneously placed (through the skin) to stimulate peripheral sensory nerves.
Percutaneous electrical stimulation (PENS)
Analgesics are classified into three groups:
nonopioids, adjuvants, and opioids.
Which analgesic act on peripheral nerve ending at the injury site
Nonopioid analgesics include a variety of medications that relieve mild to moderate pain, and chronic and acute pain. Many are available over the counter (e.g., acetaminophen, aspirin, ibuprofen, and naproxen). Most also reduce inflammation and fever.
Unlike most nonopioid analgesics, _________ has very little anti-inflammatory effect.
acetaminophen
this analgesic reduces the amount of opioid the patient requires. They include
Adjuvants/Co-analgesics
anticonvulsants, antidepressants, local anesthetics, topical agents, psychostimulants, muscle relaxants, neuroleptics, corticosteroids, and others. It is used:
As a primary therapy for mild pain
In conjunction with opioids, for moderate to severe pain
Especially by patients experiencing significant side effects from increased doses of opioids
To manage neuropathic pain
These analgesic are natural and synthetic compounds that relieve pain, although they vary in potency. They act on
Opioids –
Act on the CNS
Name some opioids
Morphine, Codeine, Demerol; also synthetic opioids like Dilaudid)
Analgesics work best if given
before pain becomes too severe. “Keeping ahead of the pain” helps to maintain pain at an acceptable level allow patients to function optimally.
Most common side effects of opioids
drowsiness, nausea, vomiting, and constipation. Some, such as drowsiness and nausea, improve after a few doses.
Opioid antagonist
Narcan also called naloxone
What is a PCA
Patient Controlled Analgesia
Application of extremely fine needles to specific sites in the body to relieve pain is called
Acupuncture
This type of non pharm pain relief is documented to provide relief from joint pain and dental discomfort. It is also used after surgery and chemotherapy to treat nausea
Acupuncture
the use of slow, long, guiding strokes, is used for obstetrical patients during labor and as back rubs for postsurgical patients.
Effleurage
Similar to acupuncture, from which it evolved,_________ stimulates specific sites in the body. However, instead of needles, fingertips provide firm, gentle pressure over the various pressure points.
acupressure
