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Pain is a privately experienced, unpleasant sensation usually associated with

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disease or injury

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Emotional component of pain is

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suffering

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Types of pain

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nocieptive or neuropathic

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Onset intensity, and duration determine if pain is

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acute or chronic

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Nociceptive pain is

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noxious stimuli that are transmitted form the pint of cellular injury over peripheral sensory nerves to pathways between the spinal cord and thalmaus and from the thalmus to the cerebral cortex of the brain

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Somatic pain is caused by

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mechanical, chemical, thermal, or electrical injuries or disorders affecting bones, joints, muscles, skin. or other structures composed of connective tissue

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Superficial somatic pain?cutaneous pain is

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such as from an insect bite or paper cut, perceived as sharp or burning discomfort

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Mechanical pain would be

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stubbing toe, chemical burn or thermal

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cutaneous

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skin deep

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noxious

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unpleasant

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deeper somatic pain is caused by

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trauma

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deeper somatic pain produces sensations that are

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sharp, throbbing and intense

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Dull, aching, diffuse discomfort with long term disorders such as

answer

arthritis

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Visceral pain arises from internal organs such as the heart, kidneys, and intestines that are

answer

diseased or injured

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Causes of visceral pain

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ischemia (death of tissue due to blood loss), compression of an organ (tumor) intestinal distention (gas pain), contraction (spasm) of an organ (kidney stones, gallstones or uterine contractions)

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visceral pain is usually accompanied by Autonomic Nervous System Symptoms such as

answer

nausea, vomiting, pallor, hypotension and sweating

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Referred pain is

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discomfort in a general area of the body bu not in the exact site where an organ in located (like arm pain during a heart attack)

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Neuropathic Pain is

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pain processed abnormally by the nervous system

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Neuropathic pain results from damage to either the

answer

pain pathways in peripheral nerves or pain processing centers in the brain

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Neuropathic pain is intense, shooting ,burning or described as

answer

pins and needles or hot poker

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Examples of neuropathic pain would be

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phantom limb pain, spinal cord injuries, strokes, diabetes, and herpes zoster (shingles)

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Cancer pain is

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nociceptive and neuropathic

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Radiation drugs can cause

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nerve damage

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adjuvant drugs are

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made for one thing but used for something else (lyrica, neurotin)

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Acute pain is

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less than 6 months

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Acute pain is protective and has a purpose T or F

answer

true

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Acute pain is associated with tissue trauma and eases with

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healing (surgery, pain will lessen when healing begins)

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Acute pain will manifest as SNS/F/F causing what symptoms

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elevated blood pressure, elevated heart and respiratory rates, diaphoresis and dilated pupils, grimacing, moaning, flinching and guarding

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Acute pain will lessen if you

answer

treat the underlying problem

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Chronic pain lasts

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longer than 6 months, ongoing and reoccurs frequently

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Chronic pain affects quality of life; others begin to show

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negative reactions to the sufferer

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Chronic Pain has no purpose and is not protective T / F

answer

true

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Chronic pain may have periods of acute pain called

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breakthrough pain

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Manifestations of chronic pain are similar to

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depression, including hopelessness, weight loss, fatigue, or physical immobility. Often the opposite of acute pain

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Qualities of life activities affected by chronic pain

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exercising, working around the house, sleeping, socializing, walking, sex

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Four phases of pain transmission

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Transduction, Transmission, Perception and Modulation

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Transduction

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conversion of chemical information in the cellular environment to electrical impulses that move toward the spinal cord. (like touching a hot iron)

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Transduction is initiated by

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cellular disruption

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Nociceptors are

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specialized pain receptors located in the free nerve endings of peripheral sensory nerves

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A delta Fibers

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can carry pain impulses rapidly;get sharp, acute initial pain

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C Fibers are

answer

throbbing, aching or burning after initial pain

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Transmission is

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peripheral never fibers form synapses with neurons in the spinal cord

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Transmission impulses move

answer

from the spinal cord to the brain

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Transmission chemicals increase

answer

pain transmission

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4 chemicals that increase pain transmission

answer

Substance P, Prostaglandins, Bradykinin, Histamine

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Chemicals that decrease pain transmission

answer

Seratonine and endorphines

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Perception

answer

brain experiences pain at a conscious level;locates pain, its intensity, and what it means

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Perception gives pain an

answer

emotional response

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Pain threshold is

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point at which the pain transmitting neurochemicals reach the brain, causing conscious awareness

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Hyperalgesia

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decreased pain threshold

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Pain tolerance is

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the amount of pain a person endures once the threshold has been reached

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Variables in pain tolerance

answer

age, older adults may not complain, gender, men complain less, fatigue, tiredness decreases pain tolerance, culture, anticipatory fear

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Modulation

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brain transmits a response down the spinal nerves to the point where the pain transmission originated to alter the pain experience. (pull hand back from hot stove)

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Modulation causes

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muscles to contract reflexively, moving the body away from painful stimuli

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Endogenous opiods - neurochemicals like serotonin reduce

answer

painful sensations

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Patients have the right to adequate assessment and management of pain. T /F

answer

true

question

Nurses are accountable for the assessment of pain T/F

answer

true

question

The nurse's role is that of an

answer

advocate and educator for effective pain management

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What is pain:

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Whatever the patient tells you it is

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Pain is private and the patient is the only reliable source of quantifying pain T/F

answer

true

question

Clients description of subjective pain

answer

onset, quality, intensity, location and duration

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What makes the pain better or worse

answer

ask the client

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Clients objective nonverbal behaviors for pain

answer

clenched jaw, frowning, crying, rocking or fidgeting

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Allondynia

answer

exaggerated pain response

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Acute pain will temporarily increase BP, Pulse, respiration will eventually levelize so they are not an accurate indicator of pain

answer

TRUE

question

Assessments biases with pain

answer

client's pain is misunderstood

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Pain assessment tools that are objective

answer

numeric scale, word scale, linear scale, faces scale (Wong Baker)

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Assessment Standards of the Joint Commission for Accredited healthcare facilities

answer

Right to assessment and pain management, Assessment for appropriate age, developmental level, condition and culture, Pain is reassessed regularly, client's choices of pain management are respected and healthcare workers are educated

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Joint Commission components of pain assessment

answer

intensity, location, quality, onset, duration, variations, patterns,alleviating factors, aggravating factors, present pain management regimen, pain management history, effects of pain, person's goal for pain control, physical examination of pain

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Pain management techniques

answer

blocking brain perception, interrupting pain transmitting chemicals with NSAIDS, combining analgesics(opioids and nonopioids), substituting sensory stimuli, altering pain transmission

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WHO recommends the 3 tier approach for pain management

answer

1. non-opiod +/- adjuvant 2. Opiod for mild/moderate pain +/- non opiod +/- adjuvant 3. Opiod for moderate/severe pain +/- non-opiod +/- adjuvant

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Pain management Opioids -Narcotics

answer

interfere with pain perceptions centrally at the brain

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Use narcotics for

answer

moderate to severe pain (post op, mi, cancer)

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Narcotic drugs

answer

oxycodone, norphine sulfate, fentanyl and codeine

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Narcotic side effects

answer

sedation, n/v, constipation, paralytic ileus, respiratory depression, urinary rentention, hypotension, and physical dependancy

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Contraindications

answer

pregnancy/lacatation/head injury/cns depression, copd, liver/kidney disease, caution with the elderly/ children/ suicidal patients and those with addiction issues

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atelectasis is

answer

lung collapse

question

nalozone

answer

reversal agent for narcotics

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When patients are taking narcotics, encourage them to

answer

t, c, db to prevent atelectasis (turn, cough and deep breathe)

question

Maintain safety

answer

bed in low position, call light in preach, instruct the patient to call for assistance ambulating

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duragesic patches need to be changed every

answer

72 hours

question

meperidine (demerol)

answer

restrict to 48 hours and not recomended in older adults

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non opiod algesics -not narcotics alter

answer

neurotransmission at the peripheral level or site of injury

question

Administer NSAIDS with

answer

food to prevent GI upset

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N-acetyleysteine (Mucomyst) is

answer

reversal agent for acetaminophen overdose

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acetaminophen should not be given more than

answer

4g/per day

question

Adjuvant analgesics enhance the effects of nonopiods, help alleviate other symptoms that aggreavate pain such as

answer

depression, seizures, inflammation and are useful in neuropathic pain

question

Anticonvulsant

answer

carbamazepine (Tegretol)

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Antianxiety

answer

diazepam (Valium)

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Tricyclic antidepressants

answer

amitriptyline (Elavil)

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Antihistamine

answer

hyroxyzine (Vistaril)

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Glucocortidcoids

answer

desamethasone (Decadron)

question

Antiementics

answer

ondanestron(Zofran)

question

Nutritional supplemnts

answer

glinko biloba (anti inflammatory) glucosamine

question

Equinalagesic dose

answer

oral dosage that provides the same level of relief as a parenteral dose

question

Palliative sedation

answer

relieving intractable pain experienced by a dying patient

question

Transcutaneous Electrical Stimulation

answer

TENS delivers bursts of electricity to the skin and underlying nerves

question

Percutaneous Electrical Nerve Stimulation

answer

PENS TENS plus acupuncture

question

other non pharmaceutical approaches to pain

answer

imagery, hypnosis, physical/occupation therapy and counseling

question

Administration of analgesics every

answer

3 hours rather than PRN often provides uniform relief of pain

question

Acknowledge a pts pain and respond

answer

quickly

question

When caring for a client with pain, which of the following is an essential action by the nurse

answer

giving assurance that pain management is a nursing and agency priority

question

Oral dose will be higher than the parenteral dose

answer

true

question

take nsaid with food

answer

true

question

perform pain assessment when vital signs are taken

answer

true

question

The nurse is correct in identifying that the client is at greater risk for an adverse effect of opiate analgesic if they are treating for

answer

copd

question

non verbal behaviors for pain

answer

eating poorly, moans frequently, client is emotionally irritable, client resists repositioning

question

It is speculated that some nondrug methods relieve pain by releasing

answer

endogenous opiates

question

Conscious experience of discomfort is

answer

perception

question

Point at which pain trasmitting neurochemicals reach the brain causing awareness

answer

pain threshold

question

the amount of pain a person endures after the threshold has been met

answer

pain tolerance

Pain Management Chapter 11 ATI chapter 4 – Flashcards

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