Nursing Interventions Pain Management Exam 37 Questions with Verified Answers
Pain - CORRECT ANSWER -Exists whenever the person says it does
-Serves
... [Show More] as an injury prevention mechanism
-Highly individual
Pain is influenced by various factors - CORRECT ANSWER -Affective
--Fatigue
-Behavioral
--Age
-Cognitive
-Physiological sensory
--Neurological function
--Genes
Pain Process - CORRECT ANSWER -Nociception -processing of painful stimuli
-Transduction- conversion of painful stimuli to electrical impulses that travel along afferent(to the CNS) (sensory) nerve fibers to dorsal horn
-All cellular damage results in release of neurotransmitters (hormones):
--Prostaglandins
--Substance P
--Serotonin
-Produce a pain-sensitizing inflammatory response
Types of Pain - CORRECT ANSWER -Acute - follows nociceptive pain process
-Persistent (chronic)- no useful purpose
-Nociceptive - somatic, visceral
-Neuropathic- nerve damage
Pain-Acute - CORRECT ANSWER -Occurs abruptly with injury or disease
-Once underlying cause resolved, pain disappears
-May be associated with anxiety and fear
-Typically increases with
--Wound care
--Ambulation
--Coughing
--Deep breathing
Pain-Chronic - CORRECT ANSWER -Lasts for a prolonged period of time
-Experience remission and exacerbations
-Associated with prolonged tissue pathology
-May be associated with depression, frustration, or fear
-Cause may be unidentifiable
--Idiopathic (unexplainable pain)
Pain-Malignant - CORRECT ANSWER -Progressive pattern of
--Recurrent, acute pain
--Persistent chronic pain
-Resistant to treatment or cure
-Intractable
-Interferes with quality of life
-May be described as all-consuming
Lifespan Considerations - CORRECT ANSWER -Newborn/ Infant - under treatment of pain
-Toddler/ Preschooler- cannot ID pain
-School age/Adolescent- can rationalize pain
-Adult/ Older adult- MS pain
-Cultural- communication /devalued
Affective factors - CORRECT ANSWER -Verbal
--Subjective
--Still the most dependable indicators of pain
--Suffering
-Non-verbal
--Gives clues to location of pain
---Rubbing
---Frowning
---Grimacing
---Guarding
---Immobilization
---↑ muscle tension
Behavioral & Cognitive Factors - CORRECT ANSWER -Usual activities
-Anxiety
-Fear
-Aggression
-Physical withdrawal from activities
-Meaning associated with disease
-Cultural beliefs
Manifestations of Pain - CORRECT ANSWER -↑ blood pressure
-↑ heart rate
-↑ respiratory rate
-Metabolic changes → catabolic state
--↑ metabolism
--↑ O2 consumption
--↑ blood glucose
--↑ free fatty acids
--↑ blood lactate
--↑ ketones
Pain Assessment - CORRECT ANSWER -at regular intervals throughout treatment
-with each report of pain
-before and after non-pharmacologic treatment and medication administration
Pain Onset - CORRECT ANSWER -Day and time that pain began
-Any precipitating factors associated with pain onset
Pain Duration - CORRECT ANSWER -Temporal patterns
--Brief
--Momentary
--Transient
--Rhythmic
--Periodic
--Intermittent
--Continuous
--Steady
--Constant
--Breakthrough-between doses
Pain Location - CORRECT ANSWER -May be measured objectively
--Use drawing of the body
--Ask a client to mark areas of pain
---Different symbols may indicate various types of pain and intensity
--Ask client to point directly at area of pain
-May be referred pain from another area
Pain Intensity - CORRECT ANSWER -Typically measured on a scale 0-10
-Varies depending on
--Personal experience
--Personal expectations
--Ability to be distracted
--Level of consciousness
--Activity level
Pain Threshold - CORRECT ANSWER Amount of pain stimulation a person requires before feeling it
Pain Tolerance - CORRECT ANSWER Highest intensity of pain that the person is willing to tolerate
Pain Quality - CORRECT ANSWER -How the pain is felt by a client
--Stabbing
--Crushing
--Burning
--Sharp
--Shooting
--Throbbing
Opioid Concerns - CORRECT ANSWER Addiction
Dependence
Tolerance
Addiction - CORRECT ANSWER A psychological state in which an individual seeks medications for purposes other than the prescribed purpose
Dependence - CORRECT ANSWER -A physiologic response of clients who take opioids regularly for greater than 10 days
-Abrupt discontinuation elicits withdrawal symptoms
-Anxiety
-Nervousness
-Irritability
-↑ salivation
-↑ perspiration
-Diarrhea
- Chills
− Hot flashes
− Nausea and Vomiting
− Abdominal cramps
Tolerance - CORRECT ANSWER -Develops when a dose of opioid becomes less effective on repeated administration
-Tolerance is not addiction
-Involves physiologic changes related to
--drug metabolism
--nervous system's adaptation to the medication
-Need for increasing drug dosage may also indicate
--Disease progression
--New pathology
Tolerance Treatment - CORRECT ANSWER -Titration
--Adjusting drug dosage to clients response
--Balance of desired and adverse effects to maintain client comfort
-Change to a different drug in the same classification
-Add an adjuvant analgesic: Modifies the drug given
-May require increased doses of medication
Pain Relief - CORRECT ANSWER -Non-Pharmacologic
--Relaxation
--Guided imagery
--Deep breathing
--Distraction
--Biofeedback
--Meditation
--Transcutaneous Electrical Nerve Stimulation
---Tens
--Positioning
--Hygiene
--Cutaneous stimulation
---Massage
---Heat
---Cold
---Acupressure
---Contralateral stimulation
Non-opioids - CORRECT ANSWER Acetylsalicylic acid (ASA)
-Analgesic
-Antipyretic
-Antiinflammatory
-↓ platelet aggregation
NSAIDs - CORRECT ANSWER Analgesic
Antipyretic antifever
Antiinflammatory
Acetaminophen - CORRECT ANSWER Analgesic
Antipyretic
Corticosteroids - CORRECT ANSWER Anti-inflammatory
Adjuvant Analgesics - CORRECT ANSWER -Tricyclic antidepressants
-Antihistamines
-Caffeine
-Muscle relaxants
-Anticonvulsants
-Antiemetic -vomit reduction
Opioid Analgesia - CORRECT ANSWER -Morphine
-Codeine
-Hydromorphone
-Oxycodone
-Meperidine(don't give to elderly)
-Fentanyl
-Methadone
Opioid antagonist - CORRECT ANSWER Narcan (antidote)
Opioid Agonist Side Effects - CORRECT ANSWER -Common
--Constipation
---↓ peristalsis
---↓ intestinal secretions
--Nausea & Vomiting
--Vomiting
--Sedation
--Dizziness
--Pruritus
--Headache
--Dry Mouth
-Serious(antidote Narcan)
--Respiratory Depression
--Apnea
--Respiratory Arrest
--Circulatory Depression
--Hypotension
--Shock
Numeric Sedation Scale - CORRECT ANSWER S: sleep, easy to arouse: no action necessary
1: awake and alert; no action necessary
2: occasionally drowsy, but easy to arouse; no action necessary
3: frequently drowsy, drifts off to sleep during conversation; reduce dosage
4: somnolent with minimal or no response to stimuli; discontinue opioid, consider use of naloxone
Invasive Pain Management - CORRECT ANSWER Intraspinal - Epidural/Intrathecal
-Used to control
--Post-op pain
--Chronic non-malignant pain
--Severe cancer pain
-May be placed in the cervical, thoracic, lumbar, or caudal spinal regions
Patient Controlled Anesthesia-PCA
Non-pharmacologic Pain Management - CORRECT ANSWER -Basic comfort measures - environment
-Cutaneous stimulation- interrupts pain signal
-Heat- vasodilatation
-Cold- vasoconstriction
-Massage- tactile stimulation
Pain Evaluation/Documentation - CORRECT ANSWER Ongoing assessment
-Character of client's pain
-Client's response to interventions
--Non-pharmacologic
--Pharmacologic
-Client's perception of pain relief measure effectiveness [Show Less]