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59 Cards in this Set

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K.T.

Cutaneous pain
pain that originates in the skin or subcutaneous tissue
K.T.

Deep somatic pain
pain that arises from ligaments, tendons, bones, blood vessels and nerves
K.T.

Hyperalgesia
extreme sensitivity to pain
K.T.

Intractable pain
pain that is resistant to cure or relief
K.T.

Neuropathic pain
the result of a disturbance of the peripheral or central nervous system that results in pain that may or may not be associated with an ongoing tissue damaging process
K.T.

Pain reaction
the autonomic nervous system and behavioral responses to pain
K.T.

Pain threshold (AKA pain sensation)
the amount of pain stimulation a person requires before feeling pain. People’s pain threshold is generally uniform; however it can change. For example the same stimuli that once produced mild pain can at another time produce intense pain. When an individual perceives pain from injured tissue, the pain threshold is reached.
K.T.

Pain tolerance
the maximum amount and duration of pain that an individual is willing to endure
K.T.

Phantom Pain
pain that remains after the perceived location has been removed, such as pain perceived in a foot after the leg has been amputated
K.T.

Radiating pain
pain perceived at the source and in the surrounding or nearby tissues
K.T.

Referred pain
pain perceived to be in one area but whose source is another area
K.T.

Somatic pain
pain that arises from ligaments, tendons, bones, blood vessels, and nerves
K.T.

Visceral pain
results from stimulation of pain receptors in the abdominal cavity, cranium, and thorax
2.) Name 3 ways that pain may be described:
(Kozier p1133)
Pain may be described in terms of duration, location, or etiology
2.) Differentiate between acute and chronic pain:
(Kozier p1133)
Acute pain lasts only through the expected recovery period, whether is has sudden or slow onset and regardless on the intensity.
Chronic pain is prolonged, usually recurring or persisting over
6 months or longer, and interferes with function.
2. Ways that chronic pain may be classified:
Chronic pain can be further classified as "chronic malignant pain", when associated with cancer or other life-threatening conditions, or as
"chronic nonmalignant pain" when the etiology is a nonprogressive disorder.
2. A side by side comparison of acute and chronic pain relative to SEVERITY, physiologic systems and reactions, resolutions and client behaviour:
ACUTE: Mild to severe
CHRONIC: Mild to severe
2. A side by side comparison of acute and chronic pain relative to severity, PHYSIOLOGIC SYSTEMS AND REACTIONS, resolutions and client behaviour:
ACUTE: Sympathetic nervous system; Increases pulse rate; increased respiratory rate; elevated blood pressure; diaphoresis (sweating); dilated pupils
CHRONIC: Parasympathetic nervous system response; Vital signs normal; dry, warm skin; Pupils normal or dilated
2. A side by side comparison of acute and chronic pain relative to severity, physiologic systems and reactions, RESOLUTIONS and client behaviour:
ACUTE: Related to tissue injury, resolves with healing
CHRONIC: Continues beyond healing
2. A side by side comparison of acute and chronic pain relative to severity, physiologic systems and reactions, resolutions and CLIENT BEHAVIOR:
ACUTE: Client appears restless and anxious; Client reports pain; Client exhibits behavior indicative of pain-crying, rubbing area, holding area
CHRONIC: Client appears depressed and withdrawn; Client often doesn’t mention pain unless asked; Pain behavior often absent
3.) Discuss concepts associated with pain, e.g. pain reaction's two components:
(Kozier p.1134)
The autonomic nervous system response is the autonomic reaction of the body that often protects the individual from further harm, for example, the automatic withdrawal of the hand from a hot stove.
The behavioral response is a learned response used as a method of coping with the pain.
3. Are there variations from person to person regarding pain tolerance?
Some clients are unable to tolerate even the slightest pain, whereas others are willing to endure severe pain rather than be treated for it. Thus pain tolerance varies greatly among people and is widely influenced by psychologic and sociocultural factors
4.) Identify common pain syndromes: 2 examples of Peripheral Pain Syndromes:
(Kozier p.1135 Box 44-1)
Postherpetic neuralgia syndrome, severe pain persists for months or years with lightning-like pain in the area of the original eruption.
Phantom limb pain. Can occur in anyone who has had a body part amputated. The pain may be severe and is often described as a burning, crushing, or cramping sensation.
4.) Identify common pain syndromes: 1 example of Central Pain Syndromes:
(Kozier p.1135 Box 44-1)
Trigeminal neuralgia. This is an intense stablike pain that is distributed by one or more branches of the trigeminal nerve (5th cranial). The pain is usually experienced on parts of the face and head; for example, gums, eye, cheek and surface of the head.
4.) Identify common pain syndromes:
Pain with underlying pathology syndromes (1st example)
- Headache. This common somatic pain can be caused by either intra cranial or extra cranial problems. To establish a plan to prevent or trat headache, the nurse needs to assess the quality, location, onset, duration and frequency of the pain, as well as any signs and symptoms that precede the headache
4.) Identify common pain syndromes:
Pain with underlying pathology syndromes (2nd example)
Cancer pain syndrome. These syndromes can result from the progression of the disease or from efforts to cure or control the disease
4.) Identify common pain syndromes:
Pain with underlying pathology syndromes (3rd example)
Myofascial pain syndrome. This pain occurs in the muscles and fascia. It is characterized by muscle spasm, tenderness, stiffness, limitation of movement, and weakness. The pain is often described as dull or aching, and the intensity varies from severe and disabling to mild
5. What is Nociception?
(Kozier p 1135-1136)
The receptors that transmit pain sensation are called nociceptors.
(The peripheral nervous system includes primary sensory neurons socialized to detect tissue damage and to evoke the sensation of touch, heat, cold, pain and pressure.)
5. How might nociceptors be stimulated?
Nociceptors can be excited by mechanical, thermal or chemical stimuli.
5. What are the four processes involved in nociception?
transduction
transmission
perception and
modulation
5. What happens during the transduction phase?
Noxious stimuli (tissue injury) trigger the release of biochemical mediators (bradykinin, serotonin) that sensitize nociceptors
Noxious or painful stimulation also causes movement of ions across cell-membranes, which excites nociceptors
5. What are the three segments of transmission?
1. the pain impulse travels from the peripheral nerve fibers to the spinal cord
2. transmission from the spinal cord and ascension, via spinothalamic tracts, to the brain stem and thalamus.
3. Involves transmission of signals between the thalamus to the somatic sensory cortex where pain perception occurs.
5. What are the two types of nociceptor fibers and what do they transmit?
1. C fibers transmit dull aching pain
2.A-delta fiber transmit sharp localized pain
5. What happens during the third process, perception?
Client becomes conscious of the pain. (It is believed that pain perception occurs in the cortical structures, which allows for different cognitive behavioral strategies to be applied to reduce the sensory and affective components of pain. Such as distraction)
5. What happens during the fourth process, modulation?
neurons in the brain stem send signals, back down to the dorsal horn of the spinal cord; descending fibers release substances such as endogenous opioids, serotonin, and norepinephrine, which can inhibit the ascending noxious (painful) impulses.
5. When would the pain reliever ibuprofin work in these processes?
Pain medications can work during the Transduction phase by blocking the production of prostaglandin (ibuprofen) or by decreasing the movement of ions across the cell membrane
6.) Identify types of pain stimuli (Kozier p 1135 tables 44-2)
Mechanical
Thermal
Chemical
6. What might mechanical stimulus be caused by?
1. Trauma to body tissues (surgery)(irritation of the pain Receptors)
2. Alterations in body tissue (edema)/Pressure on pain receptors
3. Blockage of body duct (Distention of the lumen of the duct)
4. Tumor (Pressure on the pain receptors)
5. Muscle spasm (Stimulation of pain receptors )
6. What might thermal stimulus be caused by?
Extreme heat or cold (burns): Tissue destruction; stimulation of thermosenstive pain receptors
6. What might chemical stimulus be caused by?
Stimulation of pain receptors because of accumulated lactic acid (and other chemicals, such as bradykinin and enzymes) in tissues
Muscle spasm: (Tissue ischemia secondary to mechanical stimulation (see above)
7. Who arrived at the "gate control theory" re: pain?
Melzack and Wall’s gate control theory (1965)
7. What is the gate control theory. (Kozier p.1137)
peripheral nerve fibers carrying pain to the spinal cord can have their input modified at the spinal cord level before transmission to the brain. Synapses in the dorsal horns act as gates that close to keep impulses from reaching the brain or open to permit impulses to ascend to the brain.
7. What else might influence the 'gate' of pain being open or closed?
The brain. For example, previous experiences with pain are known to affect the way an individual responds to pain. The involvement of the brain helps explain why painful stimuli are interpreted differently by people
8.) Discuss the body’s response to pain (kozier p. 1137)
A complex process rather than a specific action with both physiologic and psychosocial aspects.
1st, sympathetic nervous system responds, resulting in the fight-or-flight response. As pain combines, parasympathetic nervous system takes over, reversing many of the initial physiologic responses; may occur after several hours or days of pain. The actual pain receptors adapt very little and continue to transmit the pain message.
8.) Briefly, how might an individual cope with pain?
(kozier p. 1137)
Through cognitive and behavioral activities, such as diversions, imagery, and excessive sleeping. The individual may respond to pain by seeking out physical interventions to manage the pain, such as analgesics, massage and exercise
9.) Identify factors that affect the pain experience (x6):
(Kozier p.1137-1140)
1Ethnic and cultural values
2Developmental stage
3Environment and support people
4Past pain experiences
5Meaning of pain
6Anxiety and stress
10.) Identify two major areas to be included in a pain assessment:

(Kozier p. 1140)
(a) a pain history to obtain facts from the client
(b) direct observation of behavioral and physiologic responses of the client.
11.) Identify data that should be obtained in a comprehensive pain history:

(Kozier p. 1141)
pain location, intensity, quality, patterns, precipitating factors, alleviating factors, associated symptoms, effect on ADL’s, past pain experiences, meaning of the pain of the person, coping resources and affective responses
11. Description of data categories for pain history: location, intensity and quality:
Location: Where is your pain
Intensity: scale of 1 to 10 (1 lowest pain/10 highest pain
Quality: What does pain feel like
11. Description of data categories for pain history: Pattern
Onset; when did pain start?
Duration: how long have you had pain.
How long does it usually last?
Constancy: do you have pain free period/when/how long
12.) Identify NANDA diagnostic labels for client experiencing pain or discomfort:

(Kozier p. 1146)
- Acute pain
- Chronic pain
(When writing the diagnostic statement, the nurse should specify the location (right ankle pain). Related factors, when known, must also be a part of the diagnostic statement and can include both physiologic and psychologic factors)
13.) Identify five key factors in pain management:

(Kozier p1150)
1. Acknowledging and accepting client’s pain
2. Assisting support persons
3. Reducing misconceptions about pain
4. Reducing fear and anxiety
5. Preventing pain
14.) Discuss nonpharmacologic, non invasive pain management

(Kozier P 1160-1162)
Nonpharmacologic pain management consists of a variety of physical and cognitive-behavioral pain management strategies. These are broken down into Physical and Mid-body Interventions.
14.) Discuss physical interventions of pain management (x4)

(Kozier P 1160-1162)
Physical Interventions - goals are to provide comfort, altering physiologic responses and reducing fears associated with pain-related immobility or activity restriction. 4 interventions are:
cutaneous stimulation,
immobilization,
transcutaneous electrical nerve simulation and
acupuncture
14.) Describe Cutaneous Stimulation:
For temporary pain relief. Distracts client and focuses attention on tactile stimuli, away from the painful sensations, thus reducing pain perception. Includes: Massage, application of heat or cold, acupressure and contra lateral stimulation. (Cutaneous stimulation is contraindicated in areas of skin breakdown)
14.) Describe Immobilization:
Restricting the movement of a painful body part may help to manage episodes of acute pain. (Prolonged immobilization can result in joint contracture, muscle atrophy and cardiovascular problems)
14.) Describe Transcutaneous Electrical Nerve Stimulation:
Applying low voltage electrical stimulation directly over identified pain areas, at acupressure point, along the peripheral nerve areas that inner-vate the pain area or along th spinal column. (Contraindicated for clients with pacemakers, arrhythmia or in areas of skin breakdown.)
14.) Describe Distraction:
Draws the person’s attention away from the pain and lessens the perception of pain. Examples: Visual: reading or tv, auditory: humor or listening to music, tactile: Slow breathing, massage, petting and animal
15.) Discuss barriers to pain management:

(Kozier p. 1148)
Misconceptions and biases can affect pain management.
Fear of becoming addicted, especially when long-term opioid use is prescribed.