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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
Q

How does each of these affect pain?

  1. Culture
  2. Attitude&Value
  3. Sex
  4. Birth order
A
  1. Affects attitude and beliefs
  2. Gives meaning to pain
  3. Females are more expressive
  4. First born usually less tolerant of pain
26
Q

What are endorphins?

A

Natural supply of opium like substances
“morphine within”
Produces analgesia

27
Q

Where are endorphins located?

A

Brain
Spinal cord
GI tract

28
Q

Endorphins are activated by what?

A

Pain and stress

29
Q

What is the gate control theory ?

A

Peripheral nerve fibers can be altered at the spinal cord level

30
Q

Gate Control Theory: What can be used to “close” the gates?

A

Backrubs
Warm compresses
TENS
Distraction

31
Q

What are some common biases and misconceptions?

A
  • 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
Q

What is pain threshold?

A

Point at which a person first perceives the pain

33
Q

Who is at risk for pain?

A

Pre-op patients
Clients preparing for childbirth
Clients with altered internal or external integrity
Clients with localized area of inflammation

34
Q

What is the most important part of nursing assessment?

A

Client interview

35
Q

What do you want the client to answer about pain?

A

Full description of characteristics of pain
Pain trajectory
Clients response to pain
Variables affecting pain
Assessment of previous records regarding pain

36
Q

What should be included in the physical assessment when dealing with pain?

A 
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
Q

What different scales can be used to measure pain intensity?

A

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
Q

What are the different types of chronic pain?

A

Intractable (having no relief)
Benign (no known disease or injury)
Persistent (does not subside after injury heals)

39
Q

What can be part of chronic pain management?

A

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
Q

What is TENS?

A

Stimulates endorphin production

Battery transmitter, wires, electrodes attached to skin at pain point
Produces buzzing/tingling sensation
Nerve function not damaged

41
Q

What is the best indicator for evaluation of a client’s pain?

A

Client’s verbal report of pain

42
Q

What are some techniques for pain control?

A
  • 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
Q

The Analgesic Ladder:
What is included in Step 1?
For what pain intensity ?

A

ASA (acetylsalicylic acid)
Acetaminophen
NSAID’s

1-3/10

“Ceiling effect”
OTC
Do not produce tolerance/dependence

44
Q

The Analgesic Ladder:
What is included in Step 2?
For what pain intensity ?

A

Codeine
Oxycodone
Hydrocodone

4-6/10

Common opioids combined with nonopioid
Persistent pain despite nonopioid therapy

45
Q

The Analgesic Ladder:
What is included in Step 3?
For what pain intensity ?

A 
Morphine 
Fentanyl 
Hydromorphone 
Methadone
Oxycodone

7-10/10

No “ceiling effect”

46
Q

What is adjuvant therapy used for?

A

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
Q

What are some drugs used with adjuvant therapy?

A 
Antidepressants 
Anti-seizure 
a2 Adrenergic agonists 
Corticosteroids
Local anesthetics
48
Q

What is the route of choice?

A

Oral

49
Q

What is the most effective route of administration for pain medication?

A

IV

50
Q

What are the routes of administration?

A 
Oral 
SL/Buccal 
Intranasal 
Rectal 
Transdermal 
Parenteral 
Intraspinal
51
Q

What are some intraspinal complications?

A

Catheter dislodgment/migration
Neurtoxicity
Infection

52
Q

Advantages of PCA

A

Fewer post op complication
Less total analgesic
Great sense of control for patient
Earlier ambulation

53
Q

What is a basal rate?

A

PCA run as a continuous infusion

Med/Surg 1 Exam 2 (6 decks)

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