Unit Two: The Concept Of Comfort

Question 1

Katharine Kolcaba’s Comfort theory

Answer 1

The immediate state of being strengthened by having the needs of relief, ease, and transcendence addressed in the four contexts of holistic human experience: physical, psycho spiritual, sociocultural, and environmental.

Question 2

Domains of comfort

Answer 2

Physical, sociocultural, psychospirital, enviormental

Question 3

Physical comfort

Answer 3

Homeostasis

Question 4

Sociocultural

Answer 4

Culture, family, finances

Question 5

Psychospiritual comfort

Answer 5

Sexuality, spirituality

Question 6

Environmental comfort

Answer 6

Room temp, back ground noise

Question 7

Comfort is _____________.

Answer 7

Subjective

Question 8

A client indicates an intensity for 8 on the 0-10 pain scale. The best action for the nurse to take is which of the following?
A. Check back in 30 mins to see wether the pain has changed
B. Give pain medication
C. Further assess pain to determine the best intervention
D. Do nothing because pain is at a tolerable level

Answer 8

C

Question 9

When describing pain, the client states the pain is a dull aching pain. The nurse determines that this description tends to indicate that the client’s pain is most likely:
A. Neuropathic pain
B. Visceral Pain
C. Referred pain
D. Phantom Pain

Answer 9

B.

Question 10

Neuropathic pain

Answer 10

Stabbing, burning; usually from fibromyalgia. Chronic pain. Sending incorrect pain signals. Tissue injury.

Question 11

Visceral pain

Answer 11

Deep pain from organs

Question 12

Referred pain

Answer 12

Coming from a site other than its point of origin

Question 13

Phantom Pain

Answer 13

Usually coming from a site of amputation. Shooting, burning, stabbing pain.

Question 14

The nurse is evaluating a client’s pain. The client states that the pain is at level 2. The client is indicating which of the following about the pain?
A. Duration
B. Quality
C. Intensity 
D. Onset

Answer 14

C

Question 15

Pain management is important because:
A. Determines whether the pt and family give good evaluations to the hospital and caregivers
B. It determines when the patient can be discharged from the hospital
C. It is defined as a pt right by the Joint Commission on the Accreditation of Healthcare Organization
D. It is the fifth vital sign

Answer 15

C.

Question 16

Risk factors effecting comfort

Answer 16

Poor nutrition
Smoking
Excessive alcohol intake
Illicit drug use
Poor hygiene
Occupational hazards including heavy lifting, long hours, or repetitive movements
Participation in team or extreme sports

Question 17

________ is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Answer 17

Pain

Question 18

Pain is always ______________.

Answer 18

Subjective

Question 19

Pain is the ______________.

Answer 19

Fifth vital sign

Question 20

_________ is the most common reason for seeking healthcare.

Answer 20

Pain

Question 21

Pain experiences

Answer 21

Pain perception, Pain threshold, pain tolerance

Question 22

Acute pain is:

Answer 22

Temporary(Less than 6 months)
Protective
Sudden onset
Identifiable cause

Question 23

Examples of Acute pain:

Answer 23

Muscle spasms, toothaches

Question 24

Three types of acute pain:

Answer 24

Somatic, visceral, referred

Question 25

Chronic pain is:

Answer 25

Prolonged (longer than 6 months) Non protective May not be identifiable cause Can be malignant or non-malignant

Question 26

Examples of chronic pain:

Answer 26

Back pain, arthritis, Crohn’s disease

Question 27

Factors that effect clients response to pain:

Answer 27

``` Age Developmental stage Sociocultural Factors Emotional Status Past experiences Meaning of pain Knowledge deficit ```

Question 28

Somatic pain

Answer 28

Acute; comes from skin or surface of body. Like an overstretched muscle.

Question 29

Physical response to Acute pain

Answer 29

Increased HR, Increased pulse, Increased BP, Increased muscle tension, dry mouth, Nausea, and vomiting. (fight or flight)

Question 30

Physical response to chronic pain

Answer 30

No autonomic nervous system response, usually because their body has gotten used to the pain.

Question 31

Breakthrough pain

Answer 31

Pain caused by some kind of trigger. Can be Incident pain or Ideopathic pain

Question 32

Breakthrough, Incident pain

Answer 32

Pain caused by doing something i.e. wound care or walking after surgery

Question 33

Breakthrough, Idiopathic pain

Answer 33

Has an unsure cause

Question 34

End of dose medication failure

Answer 34

Pain that happens right before it is time to give them their next dose of medication. Can be fixed by recommending to provider to change med schedule.

Question 35

Questions you need to ask when assessing pain:

Answer 35

``` Location Intensity Quality Duration Aggravating and Relieving Factors Signs and Symptoms ```

Question 36

Pain Assessment tools

Answer 36

``` Visual analog scale 0-10 Numeric Pain Intensity Scale Simple descriptive Pain Intensity Scale FACES pain Scale CNPI Scale FLACC ```

Question 37

FLACC pain scale

Answer 37

``` Face Legs Activity Cry Consolability Used fo infants ```

Question 38

CNPI

Answer 38

Checklist of Nonverbal Pain Indicators | ICU patients, unconscious patients

Question 39

Nonpharmacologic Nursing interventions for pain

Answer 39

``` Relaxation Guided Imagery Distraction Massage Heat/cold Therapy Therapeutic touch TENS Unit ```

Question 40

Pharmacological Therapies for pain

Answer 40

``` Non-opioid analgesics/NSAIDS Weak/partial opioid analgesics Mixed opioid analgesics Strong opioid analgesics Co-analgesics ```

Question 41

Nonopioids

Answer 41

Used to treat mild to moderate pain. Many are over the Counter and have a ceiling effect narrow therapeutic index

Question 42

Examples of nonopioids used to treat pain

Answer 42

NSAIDS Acetaminophen Aspirin

Question 43

Nonopioids Salicylates—ASA

Answer 43

``` Used to treat mild to moderate pain Used as: -Analgesic (reduces plain) -Anti-inflammatory -Antipyresis -Antiplatelet ```

Question 44

Nonopioid Acetaminophen

Answer 44

Similar properties as ASA. More people are allergic to this ASA than to Acetaminophen. TYLENOL when used in high doses or long term use may cause liver damage. Do not take on empty stomach Antidote is Acetylcystine.

Question 45

Nonopioid NSAIDs

Answer 45

Nonsteroidal Anti-Inflammatory Drugs. Ibuprofen, Aspirin, Naproxen. Common S/E: gastric ulcers, increased bleeding Take with full glass of water DO NOT give with antacids; reduces absorption of drug.

Question 46

Opioids

Answer 46

Formerly called narcotic analgesics Controlled substances Capable of controlling any type of pain Most common S/E: sedation, nausea, and constipation AND RESPIRATORY DEPRESSION

Question 47

POSS

Answer 47

Palermo Opioid-induced Sedation Scale S-sleep; easy to arouse 1. Awake and Alert 2. Slightly drowsy, easily aroused 3. Frequently drowsy, arousable, drifts off to sleep during conversation 4. Somnolent, minimal or no response to verbal of physical stimulation INCLUDE RESPIRATORY RATE AND QUALITY INITAL AND 30 MINS AFTER

Question 48

Narcan

Answer 48

Opioid antagonist; reverses the respiratory depressant effect of an opioid. Typically .4mg

Question 49

S/E: of opioids

Answer 49

``` Respiratory depression Nausea and Vomiting Urinary retention Constipation Pinpoint pain Light-headedness/dizziness Confusion and disorientation Orthostatic Hypotension ```

Question 50

Adjuvant or Co-analgesics

Answer 50

Used to enhance the effects of opioids but also have other purposes. Can help reduce S/E of the opioid or lessen anxiety about pain

Question 51

Commonly used adjuvant drugs:

Answer 51

Corticosteroids, anticonvulsants, and antidepressants

Question 52

Methods to distribute Pain Meds

Answer 52

``` PCA pumps Local Nerve block Oral IM IV Pain Pump Spinal Chord Stimulator Epidural/spinal block Transdermal Transmuscousa ```

Question 53

When assessing pain while using pain meds

Answer 53

Evaluate continually; 30-90 mins after admin Assess for increased drug tolerance Identify need for route of admin change, dosage change, or S/E Ongoing assessment is imperative as long as pain persists Timing is important PRN drug regimen has not been proven effective for acute pain

Question 54

Opioid use with children

Answer 54

- Assessment is crucial (use appropriate scale; face scale) - Good communication with family - Children need a routine postoperative analgesics or by continuous infusion b/c they do not speak up

Question 55

Opioid use with the elderly

Answer 55

- Chronic pain is most common in the elderly | - Pain is not a natural occurrence in the elderly so pain is sometimes underrated

Question 56

With the elderly avoid the use of ______________, _____________, ___________, and _______________ due to increased risk of toxicity.

Answer 56

Demerol, Davonte products, Talwin, Indocin

Question 57

Avoid ________________ whenever possible for the elderly because of diminished muscle, fat stores, and circulation.

Answer 57

IM injections