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Med/Surg 1 Exam 2 > Sensory/Perception: Pain > Flashcards

Sensory/Perception: Pain Flashcards

1
Q

What is part of external stimuli?

A 
Visual 
Auditory 
Olfactory 
Tactile 
Gustatory
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2
Q

What is part of internal stimuli?

A

Gustatory
Visceral
Kinesthetic

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3
Q

What are the components of pain?

A

Reception (receiving of stimuli or data)
Perception (translation of the stimuli/data into meaningful information)
Reaction (response of the stimuli)

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4
Q

S/S of sensory deprivation

A 
Yawning 
Drowsy, sleepy
Decreased attention span
Disorientation 
Nocturnal confusion (sun downing)
Apathy 
Hallucinations, delusions
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5
Q

What is sensory deprivation?

A

Decrease or lack of meaningful stimuli

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6
Q

What happens with patients with sensory deprivation?

A

Become more aware of remaining stimuli

Alters perception, cognition, and emotion

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7
Q

What is sensory overload?

A

Inability to process or manage the amount or intensity of sensory stimuli

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8
Q

What are the three factors of sensory overload?

A

Internal
External
Inability to disregard stimuli selectively

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9
Q

S/S of sensory overload

A 
Irritability 
Disorientation 
Fatigue, sleeplessness
Reduced problem solving ability 
Scattered attention 
Increased muscle tension
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10
Q

Who are more at risk for sensory deprivation?

A

Patients who:

  • are in confinement in nonstimulating environment (home or facility)
  • have impaired vision or hearing
  • have mobility restrictions
  • have communicable diseases (AIDS)
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11
Q

Who are more at risk for sensory overload?

A

Patients:

  • with pain/discomfort
  • in ICU with IV’s, tubes, and machines
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12
Q

What factors influence sensory function?

A 
Developmental (age)
Medications 
Cultural 
Stress
 Preexisting illnesses 
Lifestyle and personality 
Smoking
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13
Q

What are some consequences of untreated pain?

A 
Unnecessary suffering 
Physical and psychosocial dysfunction 
Increased respiratory and cardiac workload
Impaired recovery 
Immunosuppression 
Sleep disturbances 
Decreased GI motility 
Increased catabolism 
Increased morbidity
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14
Q

What are nociceptors?

A

Primary neurons

Detect tissue injury and damage

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15
Q

What sensations does nociceptors evoke?

A 
Touch
Heat 
Cold
Pain
Pressure
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16
Q

What does the process of nociception consist of ?

A

Transduction (conversion of stimulus into neural action potential)
Transmission (movement of impulse to brain (substance P))
Perception (pain recognized, defined, and responded)
Modulation (“descending system”)

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17
Q

What are the type of nerve fibers?

A

‘A’

‘C’

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18
Q

What are ‘A’ fibers?

And what type of pain do they sense?

A

Myelinated

  • Fatty covering
  • Sharp, prickling, localized pain
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19
Q

What are ‘C’ fibers?

And what type of pain do they sense?

A

Unmyelinated

  • No fatty sheath
  • Dull, burning, diffuse pain, aching
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20
Q

What are some interactional responses to pain?

A

Physiologic (transmission)
Sensory (recognition, patten, area, intensity)
Affective (motivational, fear, anger, depression)
Behavioral (observable: facial expressions)
Cognitive (beliefs, attitudes, memories)

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21
Q

What are some sources of pain?

A

Mechanical (tearing, pressure, muscle spasm, infection)
Thermal (electrical current, sunburn, lightning)
Chemical (histamines, enzymes, caustic agents)

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22
Q

What are some physiological effects of pain?

A 
Dilation of bronchi
Increase RR and HR
Peripheral vasoconstriction
Elevated glucose
Diaphoresis
Increased muscle tension 
Decreased GI motility
23
Q

Environmental variable: Night vs Day?

A

Night increases pain perception

Daytime decreases pain perception

24
Q

What are some sociocultural variables?

A 
Demographics 
Support systems 
Social roles 
Culture 
 - Pain expression  
 - Drug use
 - Pain related beliefs 
 - Coping
25
How does each of these affect pain? 1. Culture 2. Attitude&Value 3. Sex 4. Birth order
1. Affects attitude and beliefs 2. Gives meaning to pain 3. Females are more expressive 4. First born usually less tolerant of pain
26
What are endorphins?
Natural supply of opium like substances "morphine within" Produces analgesia
27
Where are endorphins located?
Brain Spinal cord GI tract
28
Endorphins are activated by what?
Pain and stress
29
What is the gate control theory ?
Peripheral nerve fibers can be altered at the spinal cord level
30
Gate Control Theory: What can be used to "close" the gates?
Backrubs Warm compresses TENS Distraction
31
What are some common biases and misconceptions?
- Pts with minor illnesses have less pain than those with severe illnesses - Giving analgesics regularly will lead to drug addiction - Amount of tissue damage in an injury accurately indicates the amount of pain - Psychogenic pain is not real - Drug abusers and alcoholics over react to pain - Health care personnel are the best authorities on the nature of the client's health
32
What is pain threshold?
Point at which a person first perceives the pain
33
Who is at risk for pain?
Pre-op patients Clients preparing for childbirth Clients with altered internal or external integrity Clients with localized area of inflammation
34
What is the most important part of nursing assessment?
Client interview
35
What do you want the client to answer about pain?
Full description of characteristics of pain Pain trajectory Clients response to pain Variables affecting pain Assessment of previous records regarding pain
36
What should be included in the physical assessment when dealing with pain?
``` Location Type Intensity (0-10) Quality Duration (how long?) Control (what can client do to minimize pain) Nonverbal and physiological expressions Verbalization of fears and expectations ```
37
What different scales can be used to measure pain intensity?
0-10 Scale Wong-Baker Faces rating scale (children) Adult Non-Verbal Pain Scale (ANVPS) (18+ who cant communicate) Defense and Veterans Pain Rating Scale (DVPRS) Richmond Agitation Sedation Scale (RASS) (ICU)
38
What are the different types of chronic pain?
Intractable (having no relief) Benign (no known disease or injury) Persistent (does not subside after injury heals)
39
What can be part of chronic pain management?
Nerve blocks (epidurals) Acupuncture Biofeedback (alteration of body function through mental concentration) TENS (Transcutaneous Electrical Nerve Stimulation) Hypnosis Neurosurgery - Neurectomy (removal of nerve) - Rhizotomy (removal of root nerve) - Chordotomy (cut pathway at spinal column) Operant conditioning
40
What is TENS?
Stimulates endorphin production Battery transmitter, wires, electrodes attached to skin at pain point Produces buzzing/tingling sensation Nerve function not damaged
41
What is the best indicator for evaluation of a client's pain?
Client's verbal report of pain
42
What are some techniques for pain control?
- Distraction - Progressive relaxation techniques (contraction and relaxation of muscle groups) - Promote rest (cluster care, mild sedation) - Cutaneous stimulation (lightly rubbing affected area) - Guided imagery - Therapeutic touch
43
The Analgesic Ladder: What is included in Step 1? For what pain intensity ?
ASA (acetylsalicylic acid) Acetaminophen NSAID's 1-3/10 "Ceiling effect" OTC Do not produce tolerance/dependence
44
The Analgesic Ladder: What is included in Step 2? For what pain intensity ?
Codeine Oxycodone Hydrocodone 4-6/10 Common opioids combined with nonopioid Persistent pain despite nonopioid therapy
45
The Analgesic Ladder: What is included in Step 3? For what pain intensity ?
``` Morphine Fentanyl Hydromorphone Methadone Oxycodone ``` 7-10/10 No "ceiling effect"
46
What is adjuvant therapy used for?
Enhance pain therapy - Enhance effects of opioid and non-opioids - Possess analgesic properties - Counteracts side effects of analgesics Used at all steps of the analgesia ladder
47
What are some drugs used with adjuvant therapy?
``` Antidepressants Anti-seizure a2 Adrenergic agonists Corticosteroids Local anesthetics ```
48
What is the route of choice?
Oral
49
What is the most effective route of administration for pain medication?
IV
50
What are the routes of administration?
``` Oral SL/Buccal Intranasal Rectal Transdermal Parenteral Intraspinal ```
51
What are some intraspinal complications?
Catheter dislodgment/migration Neurtoxicity Infection
52
Advantages of PCA
Fewer post op complication Less total analgesic Great sense of control for patient Earlier ambulation
53
What is a basal rate?
PCA run as a continuous infusion

Med/Surg 1 Exam 2 (6 decks)

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