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the activation of pain receptors, involves conversion of painful stimuli into electrical impulses that travel from the periphery to the spinal cord at the dorsal horn

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transduction

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peripheral receptors, respond selectively to specific noxious stimuli,

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nocioceptors

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a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vacoconstriction, substances that either excite or inhibit target nerve cells

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neurotransmitters

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conduction of pain sensations from the site of an injury or inflammation along clear and unclear pathways to the spinal cord and then on to higher centers

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transmission

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involves the sensory process that occurs when stimulus for pain is present, includes the persons ___ of pain,

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perception

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the threshold of perception, is the lowest intensity of a stimulus that causes the subject to recognize the pain, remarkably similar for everyone

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pain threshold

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the process by which the sensation of pain is inhibited or modified

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modulation

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the sensation of pain appears to be regulated or modified by substances called _______ they are naturally present morphine like chemical regulators in the spinal cord and brain

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neuromodulators

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endorphins and enkephalins are opioid

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neuromodulators

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produced at neural synapses at various points along the CNS pathway, they are powerful pain blocking chemicals that have prolonged analgesic effects and produce euphoria

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endorphins

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what endorphin has the most powerful effect

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dynorphin

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less potent than endorphins, are thought to reduce pain sensation by inhibiting the release of substance P from the terminals of afferent neurons

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enkephalins

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the most practical model regrading the concept of pain, theory that excitatory pain stimuli carried by small diameter nerve fibers can be blocked by inhibiting signals carried by large diameter nerve fibers

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gate control theory

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what does gate control theory describe?

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it describes the transmission of painful stimuli and recognizes a relation between pain and emotions,

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what explains why different people interpret similar painful stimuli differently?

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gate control theory, explains why mechanical and electrical interventions or heat and pressure may provide effective pain relief,

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rapid in onset and varies in intensity from mild to severe, protective in nature, warns the person of tissue damage or organic disease

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acute pain

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pain that may be limited, intermittent, or persistent, but lasts beyond the normal healing period, 3-6 month duration

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chronic pain

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people with chronic pain experience _____ when the disease is present but the person does not experience symptoms

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remission

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the symptoms reappear after remission

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exacerbation

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superficial pain, usually involves the skin or subcutaneous tissue,

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cutaneous pain

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diffuse or scattered, and originates in tendons, ligaments, bones, blood vessels and nerves

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somatic pain

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poorly localized and originates in body organs in the thorax, cranium, and abdomen

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visceral pain

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pain can originate in one part of the body but be percieved in an area distant from its point of origin

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referred pain

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normal process that results in noxious stimuli being perceived as painful

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nociceptive pain

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peripheral nerve fibers that transmit pain from somatic and visceral sites

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nociceptors

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results as a direct consequence of a lesion or disease affecting abnormal functioning of the PNS or the CNS, can originate peripherally (phantom leg) or centrally (pain from spinal cord injury)

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neuropathic pain

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when pain is resistant to therapy and persists despite a variety of interventions

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intractable

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pain that is often referred to an amputated leg where receptors and nerves are clearly absent

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phantom pain

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when pain has a psychogenic origin, meaning that a physical cause for pain cannot be justified

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psychogenic pain

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refers to the tendency to believe that ones norms are correct and are the standard used to evaluate others beliefs

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ethnocentrism

question

the point beyond which a person is no longer willing to endure pain

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pain tolerance

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phenomenon in which the body physiologically becomes accustomed to long-term opioid therapy and suffers withdrawal symptoms if the opioid is suddenly removed or the dose is rapidly decreased

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physical dependence

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occurs when the body becomes accustomed to the opioid and needs a larger dose each time for pain relief, the side effects diminish along with the pain relief

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tolerance

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a pattern of compulsive opioid use for means other than pain control

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addiction

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drugs are typically used for other purposes but are also used to enhance the effect of opioids by providing additional pain relief, may also reduce side effect

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adjuvant

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temporary flare up moderate to severe pain that occurs even when the patient is taking ATC medication for persistant pain, can be classified by incident pain, idiopathic, or end of dose pain

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breakthrough pain

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any medication or procedure including surgery, that produce an effect in a patient because of its implicit or explicit intent and not because of it specific physical or chemical properties

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placebo

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pain is whatever the experiencing person says it is, existing whenever he or she says it does

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defining of pain that is greatest benefit to nurses

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what are the 4 specific physiologic processes involved in nocioception (ability to feel pain)?

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transduction, transmission, perception, modulation of pain

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Transduction-->transmission-->perception-->modulation of pain

answer

pain receptors are activated, conversion of painful stimuli into electrical impulses nociceptors respond selectively to specific noxious stimuli- > pain sensations from the site of injury or inflammation are conducted along pathways to the spinal cord then on to higher centers, these pathways are clearly defined in certain areas, but are still somewhat unclear in other areas--> involves the sensory process that occurs when a stimulus for pain is present includes the persons interpretation of pain, includes threshold--> the pain is inhibited or modified

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what are factors that may affect a person's pain experience?

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cultural and ethnic variables, family, gender, age variables, religious beliefs, environment and support people, anxiety and other stressors, past pain experience

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What are characteristics of pain that you should assess?

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location, duration, quantity, quality, chronology, aggravating factors, alleviating factors, associated phenomena "Where is your pain" "How long have you been experiencing pain" Ask the patient to rate pain on pain scale "What words would you use to describe your pain?" "How does the pain develop and progress?" "What makes the pain occur or increase in intensity" "What makes the pain go away or lessen?" "Are there any other factors that relate consistently to your pain?"

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What are some physiologic responses to pain that you should assess?

answer

Vital signs, skin color, perspiration, pupil size, nausea, muscle tension, anxiety,

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What are some behavioral responses to pain that you should assess?

answer

posture, gross motor activities, facial features, verbal expressions,

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What are some affective responses to assess for a pain assessment?

answer

anxiety, depression, interactions, degree to which pain interferes with patient's life, perception of pain and meaning to patient, adaptive mechanisms used to cope with pain, outcomes "Do you feel anxious? Are you afraid? If so how bad are these feelings?" "Do you feel depressed, down or low, If so how bad are these feelings?" "Does the pain interfere with sleep?" "Are you worried about your illness?" "What do you usually do to relieve stress?" "What would you like to be doing if pain were better controlled?"

question

Diagnosis of pain involves a

answer

multidisciplinary collaboration

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when a nursing diagnosis of acute or chronic pain is developed, the diagnostic statement and plan of care should identify what?

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type of pain, etiologic factors to the extent that they are known and understood, patients behavior, physiologic and affective responses, other factors affecting pain stimulus, transmission, perception and response

question

Because the experience of pain affects so many other aspects of human flourishing pain may be the

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etiology of numerous other nursing diagnosis statements "related to pain"

question

pain: acute postoperative = nursing diagnosis

answer

related to fear of taking prescribed analgesics

question

pain = nursing diagnosis

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related to prolonged labor and commitment to natural childbirth

question

chronic pain: headaches = nursing diagnosis

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related to inadequate pain management secondary to belief that somehow patient "deserves this pain"

question

chronic pain= nursing diagnosis

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related to inadequate pain management of metastatic cancer involving bone

question

what are some nonpharmacologic pain relief measures ?

answer

using distraction, employing humor, listening to music, using imagery, employing relaxation, using cutaneous stimulation, using acupuncture, using hypnosis, employing biofeedback, providing healing/therapeutic touch, providing animal-facilitated therapy,

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what must the nurse assess before giving analgesic pain medication?

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the patients pain and understand the patient's goal for pain relief,

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knowledge of common analgesics enables the nurse to tailor the patient's regime and communicate professionally with the physicians about a patient who is being under medicated or who needs a different drug or a different route of admission, nurses should not refrain from using analgesics or reduce their doses because of

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unrealistic fear of their potency and side effects

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major class of analgesics used in the management of moderate to severe pain because of their effectiveness, considered capable of relieving pain of virtually every nature in the sufficient dose

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opioid analgesics

question

what is a commonly feared side effect of opioid use?

answer

respiratory depression

question

what can you do to determine those patients at risk for respiratory depression more so than assessing the respiratory rate?

answer

nursing assessment using the numeric sedation scale

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what are important factors to consider when administering opioid analgesic?

answer

patient's pain rating, sedation level, patient's comfort-function goal

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what are non opioid analgesics?

answer

acetaminophen, NSAIDS,

question

what is viewed as one of the safest and best tolerated analgesics?

answer

acetaminophen

question

the recommendation for NSAIDS is what?

answer

safest to take in low doses

question

what are some guidelines recommended for effective, individualized pain management in any setting?

answer

review the pain scale of choice thoroughly, discuss the benefits of using a pain scale, try various pain control measures, use pain control measures before severity of pain increases, ask the patient what has proved effective for pain relief in the past, select and modify pain control measures based on patients response, encourage the patient to try the pain treatment several times before labeling it ineffective, be open minded about alt. pain relief strategies, be persistent, be a safe practitioner

question

collaborate with the members of health disciplines using different

answer

treatment modalities to promote pain relief

question

what does teaching include when teaching patient and family members about pain management?

answer

the patient and family need info about the nature and causes of pain, explanation about a pain scale that can be used easily, practice with this assessment tool, and assistance to set goals for comfort and either optimal function or recovery , teaching includes specific suggestions related to safety concerns about pain control in the home setting, provide the patient and family with information about available resources,

question

unintended drug overdose is the

answer

second leading cause of accidental death

question

timing is an important consideration when administering analgesics know the average duration of action for the drug and time administration so that

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the peak analgesic effect occurs when the patient's pain is expected to be most intense

question

the ___ protocol is totally inadequate for patients experiencing chronic pain

answer

PRN

question

preventing pain is easier then

answer

treating it once it has occurred

question

what is a nursing responsibility when it comes to PCA pumps?

answer

setting up the PCA pump and ensuring that it is functioning properly

question

a nurse instructor is teaching a class of student nurses about the nature of pain. which statements accurately describe this phenomenon?

answer

pain exists whenever the person experiencing it says it does, pain is an emotional and sensory reaction to tissue damage, pain is classified by duration, location, source, transmission and etiology

question

one of the most common distinctions of pain is whether it is acute or chronic what describes chronic pain?

answer

a patient is receiving chemotherapy for bladder cancer, a patient who has firbromyalgia requests pain medication, a patient has back pain related to an accident that occurred last year

question

a patient complains about abdominal pain that is difficult to localize. The nurse documents this as which type of pain?

answer

visceral-poorly localized pain and can originate in body organs in the abdomen

question

a female patient who is having a myocardial infarction complains of pain that is situated in her jaw. The nurse documents this as what type of pain?

answer

referred pain

question

the three types of responses to pain are physiologic, behavioral and affective. Which are examples of behavioral responses to pain?

answer

a patient cradles a wrist that is injured from a car accident, a child is moaning and crying due to a stomach ache, a child pulls away from a nurse trying to give him an injection

question

an elderly patient is confined to bedrest following cervical spine surgery to treat nerve pinching, the nurse is vigilant about turning the patient and assessing the patient regularly to prevent the formation of pressure ulcers, what type of agent is the stimulus for pressure ulcers?

answer

mechanical- receptors in the skin and superficial organs may be stimulated by mechanical, thermal, chemical and electrical agents

question

a nurse uses a whirlpool to relax a patient following intense physical therapy to restore movement in her legs. what is a potent pain blocking neuromodulator released through relaxation techniques?

answer

endorphins- released through pain relief measures, powerful pain blocking chemicals with prolonged analgesic effects

question

a patient is postoperative following an emergency cesarean section birth, the patient asks the nurse about the use of pain medications following surgery, what would be a correct response by the nurse?

answer

Your doctor has ordered pain medications for you which you should not be afraid to request any time you are having pain

question

applying the gate control theory of pain what would be an effective nursing intervention for a patient with lower back pain?

answer

applying a moist heating pad to the area at prescribed intervals

question

the nurse is assessing the pain of a neonate who is admitted to NICU with a heart defect. which pain assessment scale would be best used for this patient?

answer

CRIES scale

question

Mr. Wright is recovering from abdominal surgery, when the nurse assists him to walk she observes that he grimaces moves stiffly and becomes pale, she is aware that he has consistently refused pain medications, what would be a priority nursing diagnosis for this patient?

answer

acute pain related to fear of taking pain prescribed post operative medications

question

when developing the plain of care for a patient with chronic pain the nurse plans interventions based on the knowledge that chronic pain is most effectively relieved when analgesics are administered in what matter?

answer

around the clock (ATC)

question

when assessing pain in a child the nurse needs to be aware of what considerations?

answer

inadequate or inconsistent relief of pain is widespread

question

a pregnant women is receiving an epidural analgesic prior to delivery the nurse provides vigilant monitoring of this patient to prevent the occurrence of

answer

respiratory depression

question

when assessing a patient receiving a continuous opioid infusion the nurse immediately notifies the patient when the patient has

answer

a sedation level of 4

Exam 3 Chapter 34 Comfort and Pain Management Reading – Flashcards

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