question

Transduction

answer

the energy of thermal, chemical, or mechanical stimuli is converted to electrical energy

question

nociceptor

answer

sensory peripheral pain nerve fiber

question

substance P

answer

cause vasodilation and edema

question

Serotonin

answer

inhibits pain transmission

question

prostaglandins

answer

increases sensitivity to pain

question

bradykinin

answer

binds to receptors on peripheral nerves, increasing pain stimuli

question

neuromodulators

answer

body natural supply of morphinelike substances

question

Perception

answer

the point at which a person is aware of pain

question

modulation

answer

inhibition of the pain impulse of the nociceptive process

question

Pain threshold

answer

the point at which a person feels pain

question

Pain tolerance

answer

level of pain a person is willing to put up with

question

acute pain

answer

is protective, has a cause, is of short duration, and has limited tissue damage and emotional response

question

chronic pain

answer

is chronic in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition

question

Nociceptive pain

answer

Normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged; usually responsive to nonopioids and/or opioids.

question

Somatic

answer

comes from bone, joint, muscle, skin, or connective tissue. It is usually aching or throbbing in quality and is well-localized.

question

Visceral pain

answer

Arises from visceral organs, such as the gastrointestinal tract and pancreas.

question

Neuropathic pain

answer

Abnormal processing of sensory input by the peripheral or central nervous system; treatment usually includes adjuvant analgesics.

question

Deafferentation pain

answer

Injury to either the peripheral or central nervous system. Examples: Phantom pain reflects injury to the peripheral nervous system; burning pain below the level of a spinal cord lesion reflects injury to the central nervous system.

question

Sympathetically maintained pain

answer

Associated with dysregulation of the autonomic nervous system. Examples: pain associated with reflex sympathetic dystrophy/causalgia (complex regional pain syndrome, type I, type II).

question

Polyneuropathies

answer

Client feels pain along the distribution of many peripheral nerves. Examples: diabetic neuropathy, alcohol-nutritional neuropathy, and Guillain-Barré syndrome.

question

Mononeuropathies

answer

Usually associated with a known peripheral nerve injury, and pain is felt at least partly along the distribution of the damaged nerve. Examples: nerve root compression, nerve entrapment, trigeminal neuralgia.

question

Identify the physiological factors that influences pain

answer

a. age b. fatigue c. genes d. neurological function

question

Identify the social factors that can influence pain

answer

a. attention b. previous experience c. family and social support.

question

Identify the spiritual factors that can influence pain

answer

Active searching for meaning, concerns of loss of independence and becoming a burden to the family

question

Identify the psychological factors that can influence pain

answer

a. anxiety b. coping styles

question

Identify the cultural factors that can influence pain

answer

a. meaning of the pain b. ethnicity

question

Nursing process: Assessment Identify the ABCDE clinical approach to pain assessment and management A

answer

A: Ask about pain regularly. Assess pain systematically.

question

Nursing process: Assessment Identify the ABCDE clinical approach to pain assessment and management B

answer

B: Believe the client and family in their report of pain and what relieves it.

question

Nursing process: Assessment Identify the ABCDE clinical approach to pain assessment and management C

answer

C: Choose pain-control options appropriate for the client, family, and setting.

question

Nursing process: Assessment Identify the ABCDE clinical approach to pain assessment and management D

answer

D: Deliver interventions in a timely, logical, and coordinated fashion.

question

Nursing process: Assessment Identify the ABCDE clinical approach to pain assessment and management E

answer

E: Empower clients and their families. Enable them to control their course to the greatest extent possible.

question

Identify the common characteristics of pain that the nurse would assess.

answer

a. onset and duration b. location c. intensity d. quality e. pain pattern f. relief measures g. contributing symptoms h. effects of pain on the client i. behavioral effects j. influence on activities of daily living

question

Nursing Diagnosis List potential or actual nursing diagnosis related to a client in pain

answer

-anxiety -fatigue -hopelessness -impaired physical mobility -imbalanced nutrition: less than -powerlessness -chronic low self-esteem -disturbed sleep pattern -impaired social interaction -spiritual distress

question

Planning List the client outcomes appropriate for the client experiencing pain.

answer

-Reports that pain is a 3 or less on a scale of 0-10, does not interfere with ADLs, or personal pain intensity goal attained -Identifies factors that intensify pain and modifies behavior accordingly -Uses pain-relief measures safely

question

Implementation 35. The agency for healthcare research and quality (AHRQ) guidelines for acute pain management cite non pharmacological interventions appropriate for clients who meet certain criteria. List those criteria.

answer

a. find such interventions appealing b. express anxiety or fear c. will possibly benefit from avoiding or reducing drug therapy d. are likely to experience and need to cope with a prolonged interval of postoperative pain e. have incomplete pain relief after use of pharmacological interventions

question

Relaxation for Pain

answer

is mental and physical freedom from tension or stress that provides individuals with a sense of self-control

question

Distraction for Pain

answer

directs a client's attention to something other than pain and thus reduces the awareness of pain

question

Music for Pain

answer

diverts the person's attention away from the pain and creates a relaxation response

question

Cutaneous Stimulation for Pain

answer

a massage, warm bath, ice bag, and TENS stimulates the skin to reduce pain perception by the release of endorphins, which block the transmission of painful stimuli

question

Herbals for Pain

answer

not sufficiently studied; however, many use herbals such as echinacea, ginseng, gingko biloba, and garlic supplements

question

Reducing pain perception

answer

One simple way to promote comfort is by removing or preventing painful stimuli; also distraction, prayer, relaxation, guided imagery, music, and biofeedback

question

Three types of analgesics used for pain relief

answer

a. nonopioids b. opioids c. adjuvants/coanalgesics

question

adjuvants/coanalgesics

answer

variety of medications that enhance analgesics or have analgesic properties that were originally unknown

question

Benefits of patient-controlled analgesia (PCA):

answer

• allows clients to self-administer opioids with minimal risk of overdose • the goal is to maintain a constant plasma level of analgesic to avoid the problems of prn dosing

question

Explain the purpose of perineural local anesthetic infusion

answer

manage pain from a variety of surgical procedures with a pump that is set as a demand or continuous mode and left in place for 48 hours

question

explain the purpose of topical analgesics

answer

EMLA via a disc or thick cream to the skin for 30 to 60 minutes before minor procedures

question

Local anesthesia

answer

local infiltration of an anesthetic medication to induce loss of sensation to a body part

question

Regional anesthesia

answer

is the injection of a local anesthetic to block a group of sensory nerve fibers

question

epidural anesthesia

answer

permits control or reduction of severe pain and reduces the client's overall opioid requirement; can be short- or long-term

question

Complications of opioid analgesia are:

answer

• nausea and vomiting • urinary retention • Constipation • respiratory depression • pruritus

question

List the goals for the care of a client with epidural infusions. Describe one action for each goal.

answer

a. Prevent catheter displacement: Secure catheter (if not connected to implanted reservoir) carefully to outside skin. b. Maintain catheter function: Check external dressing around catheter site for dampness or discharge. (Leak of cerebrospinal fluid may develop.) c. Prevent infection: Use strict aseptic technique when caring for catheter (see Chapter 33). d. Monitor for respiratory depression: Monitor vital signs, especially respirations, per policy. e. Prevent undesirable complications: Assess for pruritus (itching) and nausea and vomiting. f. Maintain urinary and bowel function: Monitor intake and output.

question

transdermal fentanyl

answer

100 times more potent than morphine in predetermined doses that provide analgesic for 48-72 hours; useful when unable to take oral medications

question

transmucosal fentanyl

answer

to treat breakthrough pain in opioid-tolerant clients, the unit is placed in the mouth and dissolved, not chewed

question

Incident pain

answer

Pain that is predictable and elicited by specific behaviors such as physical therapy or wound-dressing changes

question

End-of-dose failure pain

answer

Pain that occurs toward the end of the usual dosing interval of a regularly scheduled analgesic

question

Spontaneous pain

answer

Pain that is unpredictable and not associated with any activity or event

question

examples of barriers to effective pain management Client

answer

Fear of addiction, Worry about side effects, Fear of tolerance (won't be there when I need it), Take too many pills already, Fear of injections, Concern about not being a "good" client, Don't want to worry family and friends, May need more tests, Need to suffer to be cured, Pain is for past indiscretions, Inadequate education, Reluctance to discuss pain, Pain is inevitable, Pain is part of aging, Fear of disease progression, Primary health care providers and nurses are doing all that they can, Just forget to take analgesics, Fear of distracting primary health care providers from treating illness, Primary health care providers have more important or ill clients to see, Suffering in silence is noble and expected

question

examples of barriers to effective pain management Health Care Provider

answer

Inadequate pain assessment, Concern with addiction, Opiophobia (fear of opioids), Fear of legal repercussions, No visible cause of pain, Clients must learn to live with pain, Reluctance to deal with side effects of analgesics, Fear of giving a dose that will kill the client, Not believing the client's report of pain, Primary health care provider time constraints, Inadequate reimbursement, Belief that opioids "mask" symptoms, Belief that pain is part of aging, Overestimation of rates of respiratory depression

question

examples of barriers to effective pain management Health care system barriers

answer

Concern with creating "addicts,", Ability to fill prescriptions, Absolute dollar restriction on amount reimbursed for prescriptions, Mail order pharmacy restrictions, Nurse practitioners and physician assistants not used efficiently, Extensive documentation requirements, Poor pain policies and procedures regarding pain management, Lack of money, Inadequate access to pain clinics, Poor understanding of economic impact of unrelieved pain

question

Type of dependence: physical dependence

answer

A state of adaptation that is manifested by a drug class-specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

question

Type of dependence: drug tolerance

answer

A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

question

Type of dependence: Addiction

answer

A primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addictive behaviors include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

question

Type of dependence: Pseudoaddiction

answer

Client behaviors (drug seeking) that occur when pain is undertreated.

question

Type of dependence: Pseudotolerance

answer

Need to increase opioid dose for reasons other than opioid tolerance: progression of disease, onset of new disorder, increased physical activity, lack of adherence, change in opioid formulation, drug-drug interaction, drug-food interaction.

question

Define placebo

answer

a medication or procedure that produces positive or negative effects in clients that are not related to the placebo's specific physical or chemical properties

question

Pain clinics

answer

treat persons on an inpatient or outpatient basis; multidisciplinary approach to find the most effective pain-relief measures

question

Palliative care

answer

the goal is to live life fully with an incurable condition

question

Hospice

answer

care of clients at the end of life, this emphasizes quality of life over quantity

question

Evaluation identify some principles to evaluate related to pain management.

answer

-evaluate the client for the effectiveness of the pain management after an appropriate period of time -entertain new approaches if no relief -evaluate the client's perception of pain

question

Review questions Pain is a protective mechanism warning of tissue injury and largely a (an): 1. Objective experience 2. Subjective experience 3. Acute symptom of short duration 4. Symptom of a severe illness or disease

answer

Answer is: 2. Rationale: Only the client knows whether pain is present and what the experience is like.

question

Review questions A substance that can cause analgesia when it attaches to opiate receptors in the brain is: 1. Endorphin 2. Bradykinin 3. Substance P 4. Prostaglandin

answer

Answer is: 1. Rationale: Once the brain perceives pain, there is a release of inhibitory neurotransmitters such as endogenous opioids (e.g., endorphins) which hinder the transmission of pain and help produce an analgesic effect.

question

Review questions To adequately assess the quality of a client's pain, which question would be appropriate? 1. "Is it a sharp or a dull pain?" 2. "Tell me what your pain feels like." 3. "Is your pain a crushing sensation?" 4. "How long have you had this pain?"

answer

Answer is: 2. Rationale: A client's self-report of pain is the single most reliable indicator of the existence and intensity of pain.

question

Review questions The use of client distraction in pain control is based on the principle that: 1. Small C fibers transmit impulses via the spinothalamic tract 2. The reticular formation can send inhibitory signals to gating mechanisms 3. large A fibers compete with pain impulses to close gates to painful stimuli 4. Transmission of pain impulses from the spinal cord to the cerebral cortex can inhibited

answer

Answer is: 2. Rationale: The reticular activating system inhibits painful stimuli if a person receives sufficient or excessive sensory input; with sufficient sensory stimulation a person is able to ignore or become unaware of pain.

question

Review questions Teaching a child about painful procedures is best achieved by: 1. Early warnings of the anticipated pain 2. Storytelling about the upcoming procedure 3. Relevant play directed toward procedure activities 4. Avoiding explanations until the pain is experienced

answer

Answer is: 3. Rationale: Developmental differences are found between age groups; therefore, the nurse needs to adapt approaches for assessing a child's pain and how to prepare a child for a painful procedure.

question

Activity tolerance

answer

The type or exercise or work that a person is able to perform w/o undue exertion or possible injury

question

when A person begins to walk monitor for

answer

dyspnea,chest pain or fatigue

question

serotonin

answer

released from the brain stem and dorsal horn to inhibit pain transmission

question

Diaphoresis Physiological reactions to pain

answer

controls body temp during stress

question

Pallor Parasympathetic stimulation

answer

cause blood supply to shift away from periphery

question

Respiratory depression is an adverse effect of ?

answer

opioids

question

When a patient with chronic pain seeks pain medication from multiple primary health care providers, the patient is called a drug seeker but not an illicit drug abuser.this called of addiction is called ?

answer

pseudoaddiction.

Potter Perry Chapter 44 – Pain Management – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards