question

What is Pain?

answer

Subjective, whatever the patient says it is.

question

Pain Should Be?

answer

At an acceptable, tolerable level for the patient. Ask the patient what is the patients acceptable pain level. When they reach that the goal has been met.

question

Patients May...

answer

Complain all the time or be reluctant to complain.

question

Nurses Need To...

answer

Educate patients beforehand about medications, when they can take them, how they are going to effect the patient, how long it will take to take effect.

question

Offer...

answer

Alternative methods of pain control.

question

What to do 15 min - 1 hr Before Having Patient do Anything Strenuous.

answer

Medicate them

question

Nature of Pain

answer

- Involves physiccal, emotional, and cognitive components - Results from physical and/or mental stimulus - Reduces quality of life - Not measurable objectively - Subjective and highly individualized component

question

How To Explain Why They Cannot Have Any More Medication

answer

Because we don't want to over medicate them. If we give them too much it can slow down their heart rate and stop breathing all together.

question

Physiology of Pain

answer

Cellular damage by thermal, mechanical, or chemical stimuli causes release of neurotransmitters.

question

If Pain Does Not Go To Brain...

answer

Patient feels no pain

question

Good grad school research

answer

Phantom limb pain

question

Types of Sensory Nerve Fibers

answer

A-delta Fibers and C-Fibers

question

A-delta Fibers:

answer

Fast, myelinated, send sharp, localized, distinct sensations Close Gates (Stops Pain)

question

Idiopathic

answer

Pain that cannot be located

question

C Fibers:

answer

Slow, small, unmyelinated, send poorly localized, burning, persistent pain Open Gates (Pain)

question

Non-Pharm ways to Help with Pain

answer

Messages, compresses, music, distract them, tea, herbs

question

Sources of Pain

answer

- Nociceptive Pain: mechanical stimuli, themal stimuli, chemical stimuli, electrical stimuli - Neuropathic Pain

question

Thermal Stimuli

answer

Hypothermia, Hyperthermia

question

Chemical Stimuli

answer

Tissue eschemia

question

Electrical Stimuli

answer

Electrical pulses (not AED)

question

Neuropathic Pain

answer

Nerve pain - generally cannot directly pinpoint location

question

Types of Pain

answer

Acute/Transient, Chronic/Persistent, Chronic Episodic, Cancer, Inferred Pathological, Idiopathic

question

Acute/Transient Pain

answer

Protective, identifiable, short duration; limited emotional response

question

Chronic/Persistent Pain

answer

Is not protective, has no purpose, may or may not have an identifiable cause

question

Chronic Episodic Pain

answer

Occurs sporadically over an extended duration

question

Cancer Pain

answer

Can be acute or chronic

question

Inferred Pathological Pain

answer

Musculoskeletal, visceral, or neuropathic

question

Idiopathic Pain

answer

Chronic pain without identifiable physical or psychological cause

question

Other Types of Pain

answer

Deep somatic, visceral, lancinating, referred, phantom

question

Acute Pain

answer

- Short duration - Cause usually well defined - Act as a warning sign - Activates SNS - Decrease with healing - Reversible - Mild to severe - May be accompanied by anxiety

question

Chronic Pain

answer

- Lasts more than several months (usually 5-6) - Cause may or may not be well-defined - Begins gradually and persists - Poorly localized (hard to pinpoint) - Mild to severe - May be accompanied by depression ; fatigue

question

Endorphins

answer

- Opiate-like substances - Bind with opioid receptors in CNS - Inhibit release of neurotransmitters such as Substance P

question

Management of Pain

answer

Get patient involved, needs to be systemic, consider patients quality of life.

question

Assessment

answer

Expressions of pain Characteristics of pain Is baseline

question

Characteristics of Pain

answer

Onset and duration Location (have them point to exactly where) Intensity Quality Pattern Relief measures (What would you do at home) Contributing symptoms Effects of pain on the patient

question

Assess Pain

answer

At least every 4hrs, PRN, With pain meds, with vitals

question

PQRSTU Pain Assessment Tool

answer

P: Precipitating or palliative Q: Quality or quantity R: Region or radiation S: Severity scale T: Timing U: other

question

Comatose Patients in Pain

answer

Assess vitals, facial expressions

question

Pains Scales

answer

Numeric, color, faces, behavioral

question

PRN Pain Meds

answer

IV - immediate PO - hours later Good idea to give both so that they continue to have relief

question

1. When a smiling and cooperative patient complains of discomfort, nurses caring for this patient often harbor misconceptions about the patient's pain. Which of the following is true? A. Chronic pain is psychological in nature. B. Patients are the best judges of their pain. C. Regular use of narcotic analgesics leads to drug addiction. D. Amount of pain is reflective of actual tissue damage.

answer

B

question

VERY IMPORTANT TO KNOW DRUGS - WILL BE SENT HOME IF DO NOT KNOW

answer

KNOW ALL OF PATIENTS DRUGS WHETHER THEY ARE RECEIVING THEM OR NOT

question

Acute Pain Management Medications

answer

PRN, ATC, PCA

question

PRN

answer

As needed

question

ATC

answer

Around the clock

question

PCA

answer

Patient controlled analgesic (they get the button and give themselves the medication)

question

PRN Meds: How to Evaluate Which to Give

answer

- Set goals with patient - Check previous dose and response - What is patient about? (What is going on with your patient, talk to them, have they always had that pain) - Anticipate rather than react to pain - Watch for adverse effects - Can combine different meds if pain does not change (Class example)

question

If Patient Wants Only 1 out of 2 Tablets

answer

Can downgrade but not upgrade

question

Analgesic Types

answer

Nonopioids Opioids Adjuvants/co-analgesics

question

Delivery Systems (Routes)

answer

Patient-controlled analgesia (PCA) Local/regional anesthesia Topical agents

question

Analgesic Classification and Action Sites

answer

Nonopioids - NSAIDS (Acetaminophen) - PNS (Peripheral Nervous System) Opioids - Narcotics - CNS (Central Nervous System) Adjuvant Analgesics - Antidepressants, Anticonvulsants - Neuropathic, chronic pain

question

Opioid AnalgesicSide Effects

answer

Depresses cough center Respiratory depression Miosis Nausea & vomiting Constipation Sedation Vasolidation / hypotension/ Increased ICP

question

Synthetic Opioids

answer

Fentanyl Methadone Demerol

question

Semi-Synthetic Opioids

answer

Hydromorphone Oxymorphone Hydrocodone Oxycodone Heroin

question

Opioid Withdrawl

answer

Sign and Symptoms: Agitation Insomnia Diarrhea Diaphoresis Tachycardia

question

If patient has cerosis

answer

do not give tylenol

question

If having chest pain

answer

Chew on a baby aspirin ( chewing has a different affect)

question

Tylenol is best to give if

answer

they are on Warfrin (Cumaden)

question

No whether it is an

answer

allergic reaction or a side effect

question

Best to give BP before

answer

giving opioid

question

The patient is receiving his first dose of an opioid analgesic for pain. The nurse expects that another medication that will probably be ordered concurrently for this patient will be a(n): A) Antacid agent B) Laxative or stool softener C) Anti-anxiety agent D) Breakthrough pain reliever

answer

B

question

KNOW WHY WE WOULD GIVE ONE TYPE OF MEDICATION OVER ANOTHER

answer

WHEN THEY DO THE SAME THING

question

Transmucosal

answer

Under tongue, in the cheek

question

If taking drug test do not eat anything with poppy seeds

answer

because the drug test will be positive for opioids

question

Start low and go slow

answer

for opioids, especially in older adults

question

Stopping opioids cold turkey

answer

will go through withdrawal Will have to ween them off, to give them a little something in the meantime

question

Hydromorphone

answer

Dilauded

question

Patient-Controlled Analgesia (PCA)

answer

Goals: is to maintain a constant plasma level of analgesic Give patient control with low risk of overdose Meds used: Morphine Sulfate Hydromorphone Settings: PCA dose Lockout time Basal rate

question

Narcotic Opioid Reversal Agent

answer

Narcan

question

Mixed Agonist/Antagonist

answer

Will prevent from overdoing it on the opioids

question

Morphine

answer

Slows down the breathing

question

Adjuvant Drugs

answer

Antidepressants Anticonvulsants Steroids Benzodiazepines

question

Evaluation

answer

Is goal met

question

WHO Analgesic Ladderfor Cancer Patients

answer

Three Step Ladder: 1. By the Mouth 2. By the Clock 3. By the Ladder

question

2. A patient has just undergone an appendectomy. When discussing with the patient several pain relief interventions, the most appropriate recommendation would be A. Adjunctive therapy. B. Nonopioids. C. NSAIDs. D. PCA pain management.

answer

D

question

Assess to see if the patient needs their medication

answer

a little before you would actually give it

question

True or False: A patient who has a history of chronic pain is in danger of experiencing respiratory depression when taking opioids as long-term therapy.

answer

False

question

EQUIANALGESIC CHARTS

answer

WILL BE ON TEST

question

""

answer

WILL HAVE A CHART

question

""

answer

DOSES: EVERYTHING ON THE CHART IS EQUAL

question

""

answer

USE PROPORTIONS TO ANSWER

question

Ms

answer

Morphine

question

The patient is recovering from exploratory abdominal surgery for pancreatic cancer. Her pain has been well controlled with morphine sulfate 10 mg IV every 4 hours. When she began to take liquids, her surgeon prescribed morphine elixir 30 mg PO q 4h. Based on the change in orders, what is the nurse's best action? A) Administer the new drug as ordered. B) Question the new order because the patient will be receiving too little medication C) Question the new order because the patient will be receiving too much medication. D) Try non-pharmacological measures to relieve pain.

answer

A

question

The patient has been from bony lesions as a result of multiple myeloma. His pain has been well controlled at home on Morphine elixir 40 mg p.o. q 3h. While in the hospital he is NPO in preparation for an x-ray. The physician prescribes Hydromorphone 4 mg IV q 3h until the diagnostic test is completed. Based on the change in orders, what is the nurse's best action? A) Administer the new order because the patient will be receiving too little medication. B) Question the new order because the patient will be receiving too little medication. C) Question the new order because the patient will be receiving too much medication. D) Use anticipatory guidance instead of p.o. morphine to relieve pain

answer

C

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