Fundamentals of Nursing-Pain Management Exam 89 Questions with Verified Answers
Pain definition - CORRECT ANSWER unpleasant sensation usually
... [Show More] associated with diesase or injury.
-Causes physical discomfort and is accompanied by suffering.
Suffering is? - CORRECT ANSWER the emotional component of pain.
How is pain defined by McCaffrey - CORRECT ANSWER whatever the person SAYS it is, and existing whenever the person says it DOES.
Process of Pain-4 - CORRECT ANSWER Process by which people experience pain occurs in 4 phases.
1. Transduction
2. Transmission
3. Perception
4. MOdulation
Transduction - CORRECT ANSWER conversion of chemical info at a cellular level into electrical impulses that move toward the spoinal cord.
-begins when injured cells release chems. like Substance P, Prostaglandins, bradykinin, histamine, and glutamate.
-these chemicals excite Nocireceptors located in the skin, bones, joints, muscles, and internal organs.
Transduction-Nocireceptor - CORRECT ANSWER Type of sensory nerve recptors activated by noxious stimuli located in the skin, bones, joints, muscles, and internal organs.
Transmission - CORRECT ANSWER stimuli move from the peripheral nervous system toward the brain.
-Trans. occurs when peripheral nociceptors from synapses with neurons within the spinal cord that carry pain impulses and other sensory info such as pressure.
Trasmission-A-delta fibers/Fast Pain Pathway - CORRECT ANSWER large myelinated fibers, carry impulses rapidly at a rate of approximately 5-30 meters per second.
Transmission-C-fibers - CORRECT ANSWER carry impulses at a slower rate of .5 to 2 m/sec. cary impulses more slowly.
-responsible for THROBBING, ACHING, BURNING SENSATION that persists after the initial discomfort.
What 2 things happen when the pain impulses reach the Thalamus? - CORRECT ANSWER 1. thalamus transmits the message to the CORTEX, where the location and severity of the injury are identified.
2. Notifies the nociceptors that the message has been received and that continued trasmission is no longer necessary.
Perception - CORRECT ANSWER conscious experience of discomfort.
-occurs when the pain threshold is reached.
-ONce perceived brain determines it's intesity, meaninfulness, and provokes emotional responses.
Pain Threshold - CORRECT ANSWER point at which sufficient pain trasmitting stimuli reach the brain.
Pain Tolerance - CORRECT ANSWER amount of pain a person endures.
Influenced by:
-genetics, learned behaviors specific to gender, age, and culture.
Modulation - CORRECT ANSWER LAST PHASE of pain impulse transmission.
-when the brain interacts with the spinal nerves in a downward fashion to alter the pain experience.
-Releases pain inhibiting chemicals that will reduce the painful sesnsation.
Endogenous Opioids - CORRECT ANSWER naturally produced morphine like chemicals.
-Include:
-endorphins
-dynophins
enkephalins.
All reduce pain.
What stimulated Endogenous Opioids? - CORRECT ANSWER two neurotransmitters.
-Serotonin
-norepinphrine stimulate their relase.
Types of Pain - CORRECT ANSWER 1. Cutaneous Pain
2. Visceral Pain
3. Neuropathic Pain
4. Acute Pain
5. Chronic Pain
Cutaneous Pain - CORRECT ANSWER discomfort that originates at the skin level.
-generally results from some sort of trauma.
stubbed toe.
Visceral Pain - CORRECT ANSWER discomfort arising from internal organs.
-Associated with disease or injury.
Sometimes referred or poorly localized.
Ex. Nausea, vomiting, pallor, hypotension, sweating may accompany.
Neuropathic Pain - CORRECT ANSWER Pain with atypical characteristics. Also called Functional Pain.
Experienced days, weeks, or even months after the source of the pain has been treated and resolved.
-PHANTOM LIMB SYNDROME!
-Fibromyalgia
Referred Pain - CORRECT ANSWER Discomfort perceived in a general area of the body usually away from the site of stimulation.
-NOT experienced in the exact site where an organ is located.
Acute Pain - CORRECT ANSWER Discomfot that has a short duration.
-last for a few seconds to less than 6 months.
-Associated with Tissue trauma, including surgery . Usually eases with healing and eventually disappears.
Chronic Pain - CORRECT ANSWER Discomfort that lasts longer than 6 moths.
Pain Assessment Standards - CORRECT ANSWER American Pain Society proposed that pain is the fifth vital sign.
-Nurse checks and documents patients pain every time they come in.
Joint Commission Pain Assessment and Management Standards - CORRECT ANSWER -Everyone has right to assessment and management of pain.
-Pain is assessed using the proper tools
-Pain is assessed regularly
-Pain is treated at the office or referred somewhere else.
-Nurses are educated on pain managment, and pain assessment.
-pts. and families are educated about effective pain management
-Pt. choices are respected as far as pain management.
When does the Nurse Assess Pain? - CORRECT ANSWER 1. When the pt. is admitted
2. when the nurse takes vital signs
3. at least once per shift when pain is actual or potential problem.
Intensity - CORRECT ANSWER rating for present pain, worst pain, and least pain using a consistent scale.
Location - CORRECT ANSWER site of pain on diagram.
Quality - CORRECT ANSWER Description of pt. pain in own words.
Onset - CORRECT ANSWER time pain began
Duration - CORRECT ANSWER Period that pain has existed
Variations - CORRECT ANSWER pain characteristics that change
Patterns - CORRECT ANSWER Repetitveness or not.
Alleviating factors - CORRECT ANSWER what makes pt feel better
Aggravating factors - CORRECT ANSWER what makes it worse.
Present pain management regimen - CORRECT ANSWER Approaches used to control the pain and results and effectiveness
Pain Management history - CORRECT ANSWER past medications, interventions, response, personal, spiritual, religious, cultural beliefs that effect pain management.
Effects of Pain - CORRECT ANSWER alterations in self care, sleep , dietaryu intake, thinking, lifestyle relationships.
Phsyical examination of pain - CORRECT ANSWER assessment of structures that relate to the site of pain.
Pain Assessment Data - CORRECT ANSWER Pt. Description of Onset, quality, intesity, location, and duration of the pain.
When is the WONG BAKER FACES scale used? - CORRECT ANSWER Children or mentally impaired patients.
Pain Mangement - CORRECT ANSWER techiniques for preventing, reducing, or relieving pain.
Drug Therapy - CORRECT ANSWER Either alone or with other therapeutic measures is the cornerstone of pain management.
Nonopioids - CORRECT ANSWER nonnarcotic drugs
Have an analgesic ceiling.
APAP: May cause liver toxicity; do not go beyond 4 g in 24 hours.
NSAIDs: Inhibits prostaglandin production, which protects the stomach and kidneys. Also inhibits platelet aggregation.
Side effects include gastrointestinal irritation, renal toxicity, and bleeding. Use with caution in patients with gastrointestinal disorders, kidney disease, and patients with bleeding risk
Opioids - CORRECT ANSWER narcotic drugs
No analgesic ceiling.
Work peripherally and centrally along the pain pathway.
Constipation is the most common side effect. Other side effects are dose related and include sedation, nausea, vomiting, pruritus, respiratory depression, and delirium
Adjuvants - CORRECT ANSWER drugs that assist in accomplishing the desired effect of primary drug.
Interrupting Pain Transmittion at the Site of Injury - CORRECT ANSWER Local anesthetics, anti-inflammatory drugs
Altering transmission at the spinal cord - CORRECT ANSWER intraspinal aneshesia and analgesia
Substituting Sensory stimuli for pain producing stimuli - CORRECT ANSWER cutaneous stimuli
Blocking brain perception - CORRECT ANSWER narcotics, nondrug techniques.
Controlled Substances - CORRECT ANSWER drugs whose prescription and dispensing are regulated by federal law because they have the potential for being abused.
Patient Controlled Analgesia - CORRECT ANSWER PCA. Intervention that allows pts. to self administer narcotic pain medication through use of an infusion device.
-used mainly to relive acute pain after surgery.
Bolus or Loading Dose - CORRECT ANSWER larger dose of drug administered initially or when pain is intense.
Intraspinal Analgesia - CORRECT ANSWER method of relieving pain by instilling a narcotic or local anesthetic thorugh a CATHETER into the subarachnoid or epidural space of the spional cord.
Adjuvant Drugs - CORRECT ANSWER Antidepressants, Prozac, Pazil, Cymbalta, Neurontin,
-Often combined with analgesic drugs.
Alternative Medical Therapy - CORRECT ANSWER treatment outside the mainstream of traditional medicine.
Botulinum Toxin Therapy - CORRECT ANSWER made from the bacterium clostridium botulinum, found in soi8l and water..
-Type A has been approved to treat painful musculoskeletal conditions and various types of headaches.
-injected into the muscle.
Intractable Pain - CORRECT ANSWER pain unresponsive to other methods of pain management.
-can be relieved with surgery.
-Rhizotomy and cordotomy are neurosurgical procedures that provide pain relief.
Rhizotomy - CORRECT ANSWER surgical sectioning of a nerve root close to the spinal cord.
-prevents sensory impulses from entering the spinal cord and traveling to the brain.
-
Cordotomy - CORRECT ANSWER surgical interruption of pain pathways in the spinal cord.
-cutting bundles of nerves.
-Both procedures interrupt the sensation of pain, they also inhibit the perception of pressure and temp. in the area supplied by the nerves.
Nondrug and Nonsurgical Interventions - CORRECT ANSWER 1. Education
2. Imagery,
3. Distraction
4. relaxation
applications of heat or cold.
5. TENS, acupunture, acupressure, hypnosis, etc.
Education - CORRECT ANSWER educating patients about pain, pain methods and pain management.
Imagery - CORRECT ANSWER using the mind to visualize an experience , intentional daydreaming.
-takes the patient out of that pain state for a brief period of time.
Meditation - CORRECT ANSWER concentrating on a word or idea that promotes tranquility and is similar to imagery except the subject matter is more spiritual.D
Distraction - CORRECT ANSWER intentional diversion of attention to switch the persons focus on something pleasant.
Relaxation - CORRECT ANSWER releaseing muscle tension and quieting the mind, which helps reduce pain, relieve anxiety and promote a sense of well being.
Heat and Cold - CORRECT ANSWER thermal therapy.
-must obtain permission from physician.
-Pain is best treated with cold first.
-Heat packs are placed after 24-48 hours after the injury.
NEVER USED longer than 20 minutes at any one time.
Transcutaneous Electrical Nerve Stimulation - CORRECT ANSWER TENS. Electrical stimulation.
Acupuncture - CORRECT ANSWER long thin needles are inserted intot he skin at specific points.
Acupressure - CORRECT ANSWER involves tissue compression . Like massage?
`Percutaneous Electrical Nerve Stimulations - CORRECT ANSWER Combo of acupuncture and TENS.
Biofeedback - CORRECT ANSWER client learns to control or alter a physiological phenomenon (pain, blood pressure) .
Hyponosis - CORRECT ANSWER person enters a trance like state resulting in an alteration in perception and memory.
Placebos - CORRECT ANSWER inactive substance or treatment used as a substitute for an analgesic drug. Can relieve pain.
-DOn't assume because placebos worked pt. is a malinger.
Malinger - CORRECT ANSWER someone who pretends to be sick or in pain.
World Health Organization Pain Relief Ladder - CORRECT ANSWER three levels:
1. Nonopioid + adjuvent
2. Opioid for fild to moderate pain + nonopioid + adjuvent
3. Opioid for moderate to severe pain + nonopioid + adjuvant.
WHO Standards for the Relief of Acute Pain and Cancer Pain-Standard I - CORRECT ANSWER Acute and cancer pain are recognized and effectively treated
WHO Standards for the Relief of Acute Pain and Cancer Pain-Standard 2 - CORRECT ANSWER Information about analgesics is readily available
Who standards for the Relief of Acute Pain and Cancer Pain-Standard 3 - CORRECT ANSWER Patients are informed on admission, both orally and in writing that effective pain relief is an important part of their treatment. that their communication of unrelieved pain is essential, and that health professionals will respond quickly to their reports of pain.
Who Standards for the Relief of Acute Pain And Cancer Pain Standard 4. - CORRECT ANSWER Explicit policies for use of advanced analgesic technologies are defined.
WHO standard for the relief of Acute Pain and Cancer Pain Standard 5 - CORRECT ANSWER Adherence to standards in monitored by an interdisciplinary committee.
FLACC Scale - CORRECT ANSWER pain scale ages of 2 months and 7 years
Face, Legs, Activity, Cry, Consolability scale
0 TO 2 0 BEING NO PAIN AND 2 BEING PAIN
Critical Domains for Successful Pain Management - CORRECT ANSWER A: Ask regularly, assess systematically
B: Believe patient's self-report
C: Choose treatment options based on comprehensive assessment
D: Deliver interventions in a coordinated way
E: Evaluate treatment effectiveness by reassessment
gate control theory - CORRECT ANSWER pain asserts that non-painful input closes the "gates" to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain.
Adverse Effects of Analgesics - CORRECT ANSWER Gastrointestinal and renal side effects
Sedation
Respiratory depression (most serious)
Evaluation for Adverse Effects of Opioid Administration - CORRECT ANSWER Oxygen saturation monitoring
Used during intravenous opioid delivery to monitor patients for opioid induced respiratory depression.
Ventilation monitoring
End tidal CO2 monitoring (capnography) is a highly reliable measure of the quality of ventilation and an early indicator of impending respiratory depression
allodynia - CORRECT ANSWER Enhanced sensation of pain produced by an innocuous stimulus, such as a light touch
central sensitization - CORRECT ANSWER Nociceptive nerve signals triggered by inflammation or nerve injury bombard the central nervous system from the periphery
dermatome: - CORRECT ANSWER The band of skin innervated by the sensory root of a single spinal nerve [Show Less]