Chapter 20 - Pain Management

Front 1

Who defined pain as "an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage?"

Back 1

International Association for the Study of Pain (IASP)

Front 2

How is pain protective?

Back 2

It warns us of potential injury to the body.

Front 3

Who defined pain as "whatever the person says it is, and existing whenever the person says it does"

Back 3

Margo McCaffrey

Front 4

Arises in the skin or subcutaneous tissue.

Back 4

Cutaneous or superficial pain.

Front 5

Example of cutaneous pain

Back 5

-paper cut
-touching hot object

Front 6

Caused by the stimulation of deep internal pain receptors.

Back 6

visceral pain

Front 7

Examples of visceral pain

Back 7

menstrual cramps, labor pain, GI infections, organ cancers

Front 8

Where is visceral pain most often experienced?

Back 8

abdominal cavity, cranium, or thorax

Front 9

Originates in the ligaments, tendons, nerves, blood vessels, and bones.

Back 9

deep somatic pain

Front 10

Examples of deep somatic pain

Back 10

sprain, arthritis, fracture, bone cancer

Front 11

occurs in an area distant from the original site

Back 11

referred pain

Front 12

example of referred pain

Back 12

feeling the pain of an MI not in the arm or jaw rather than the chest

Front 13

Name three ways to classify pain.

Back 13

1. site of pain
2. cause of pain
3. duration of pain

Front 14

What are the two causes of physical pain?

Back 14

-nociceptive pain
-neuropathic pain

Front 15

What is the most common type of pain experienced

Back 15

nociceptive pain

Front 16

Nociceptive pain occurs when these pain receptors respond to stimuli that are potentially damaging.

Back 16

nociceptors

Front 17

Name the causes of nociceptive pain

Back 17

trauma, inflammation, surgery

Front 18

Complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli

Back 18

neuropathic pain

Front 19

Example of causes of neuropathic pain

Back 19

diabetic neuropathy, tumor, stroke, viral infection

Front 20

What is a type of medication that can trigger neuropathic pain

Back 20

chemotherapy

Front 21

Name three ways to classify the duration of pain

Back 21

acute, chronic, intractable

Front 22

Type of pain that has a short duration and is generrally rapid in onset.

Back 22

Acute pain

Front 23

Acute pain ________ in intensity and may last up to ________ months

Back 23

-varies
-6

Front 24

Acute pain is most often associated with what (2 answers)

Back 24

-trauma
-surgery

Front 25

How is acute pain protective

Back 25

It indicates potential or actual tissue damage

Front 26

What is helpful for the patient to know regarding acute pain

Back 26

that it will disappear as the tissues heal

Front 27

pain that has lasted 6 months or longer and interferes with daily activities is called

Back 27

chronic pain

Front 28

patients with chronic pain may experience periods of ____________ or __________

Back 28

-remission
-exacerbation (worsening)

Front 29

examples of words used to describe pain

Back 29

dull, sharp, aching, burning, stabbing, throbbing, tingling, episodic, intermittent, constant, mild, distracting, moderate, severe, or intolerable

Front 30

What has the highest density of nociceptors?

Back 30

the skin

Front 31

what has the least density of nociceptors

Back 31

internal organs

Front 32

what is the procedure in which nociceptors become activated?

Back 32

transduction

Front 33

external forces that result in pressure or friction against the body

Back 33

mechanical stimuli

Front 34

involve strecthing of tissue in joints and body cavities related to bleeding and swelling, and compression of body tissues caused by the force of the accident

Back 34

mechanical stimuli

Front 35

surgical incisions, friction, skin shearing, or pressure from a mechanical device are examples of

Back 35

mechanical stimuli

Front 36

result from exposure to extreme heat or cold

Back 36

thermal stimuli

Front 37

can be internal or external. external would be lemon juice on a cut; internal would be chest pain experienced during a heart attack

Back 37

chemical stimuli

Front 38

What is the single greatest cause of pain

Back 38

inflammation

Front 39

the process in which peripheral nerves carry the pain message to the dorsal horn of the spinal cord

Back 39

transmission

Front 40

what are the two types of fibers that conduct pain along the the spinal cord

Back 40

-A-delta fibers
-C fibers

Front 41

large diameter mylenated fibers that transmit fast pain

Back 41

A-delta fibers

Front 42

A-delta fibers transmit pain from which stimuli

Back 42

acute, mechanical, thermal

Front 43

two examples of A-delta fiber pain

Back 43

bumping your knee, pleasurable stimuli such as massage

Front 44

smaller unmylenated fibers that transmit slow pain

Back 44

C fibers

Front 45

Which type of stimuli do C fibers conduct

Back 45

mechanical, thermal, and chemical

Front 46

example of C fiber pain

Back 46

the lingering ache that occurs after you bump your knee

Front 47

most pain impulses are transmitted to which area of the brain

Back 47

the thalamus

Front 48

involves the recognition and definition of pain

Back 48

perception

Front 49

where in the brain does perception occur

Back 49

frontal cortex

Front 50

the point at which the brain recognizes and defines a stimulus as pain

Back 50

painn threshold

Front 51

repeated experience with pain can __________ a person's threshold

Back 51

reduce

Front 52

the duration or intensity of pain that a person is willing to endure

Back 52

pain tolerance

Front 53

tolerance varies from person to person, but for the ______ person in different situations

Back 53

same

Front 54

give an example in which pain tolerance would vary WITHIN the same individual

Back 54

Someone with post-op pain from kidney removal might complain of pain less if it was donated to a loved one rather than if it were removed due to cancer

Front 55

extreme sensitivity to pain is called

Back 55

hyperalgesia

Front 56

Explain how the gate control theory works

Back 56

-normal (unmodulated pain) travels down the SLOW C fibers
-when you experience pain and provide a nonpainful stimulus (rubbing your finger after hitting it with a hammer), the stimulus travels on the faster A-delta fibers
-the non painful stimulus gets there faster, and can block the transmission of some of the pain travelling on the slow C fibers

Front 57

Name four factors that influence pain

Back 57

-emotions
-developmental stage
-sociocultural factors
-cognitive and communication factors

Front 58

Name five common emotions associated with pain

Back 58

fear, guilt, anger, helplessness, and loneliness

Front 59

some people feel that if they accept pain medication they will become __________

Back 59

addicted

Front 60

depression is most commpnly link with ___________ pain, especially intractable pain

Back 60

chronic

Front 61

Name two interventions that may aid in pain relief

Back 61

reflective listening
gentle touch

Front 62

What three words seem to be used across many cultures to describe pain?

Back 62

-pain
-hurt
-ache

Front 63

Why are patients with impaired cognitive and communication abilities at risk for underassessment of pain and inadequate pain relief?

Back 63

they are unable to express their needs verbally

Front 64

What do you use as a form of self-reporting of pain from individuals with cognitive and communicative impairments

Back 64

nonverbal cues (facial expressions, vocalizations, changes in physical activity, changes in routines, mental status changes)

Front 65

At the onset of acute pain, the body automatically activates what, triggering the fight or flight response.

Back 65

the sympathetic nervous system

Front 66

If chronic pain persists, the body adapts, and this takes over

Back 66

the parasympathetic nervous system

Front 67

Ongoing pain triggers the release of excessive amounts of hormones. Name 6 of them.

Back 67

1. ACTH
2. Growth Hormone
3. Cortisol
4. ADH
5. catchecholamines
6. glucagon

Front 68

In ongoing pain, do insulin and testosterone levels increase or decrease

Back 68

decrease

Front 69

Pain causes _______, the involuntary limiting of thoracic and abdominal movement in an effort to reduce pain

Back 69

splinting

Front 70

You should assess for pain __________ implementing a pain management intervention (eg, administering an analgesic) and ____minutes after the intervention

Back 70

-before
-30

Front 71

List two NANDA nursing diagnoses used when pain is the primary focus of the problem

Back 71

-Acute pain (anticipated duration of less than six months)
-chronic pain (more than months)

Front 72

Pain assessments should be made how long after administering an oral administration

Back 72

30 to 60 minutes

Front 73

Why will you have to assess pain for an injection differently than for an oral medication

Back 73

the injection works more quickly

Front 74

Cutaneous stimulation is based on which method of pain relief

Back 74

gate control theory

Front 75

A battery-powered device about the size of a pager that is worn externally

Back 75

TENS (or a strap-on vibrator :))

Front 76

Similar to a TENS, but uses a needle proble to stimulate peripheral sensory nerves

Back 76

PENS

Front 77

The use of long, slow, guiding strokes in massage. It is used during labor and as back rubs for postsurgical patients

Back 77

effleurage

Front 78

If you are using heat or cold therapy and see extreme redness, blistering, cyanosis, or blanching , you should do what

Back 78

1. discontinue the treatment immediately
2. notify the physician
(IN THAT ORDER)`

Front 79

Involves stimulating the skin in an area opposite to the painful site. Helpful in patients who have a cast, bandages, an area painful to the touch or phantom pain.

Back 79

-contralateral stimulation

Front 80

When using splints, you must remember to remove the splints at __________ intervals so that the patient can exercise the area to prevent further injury

Back 80

regular

Front 81

True or False: It is okay to use distraction in place of analgesics in certain patients

Back 81

FALSE: You should never use distraction in place of analgesics

Front 82

Guided imagery can be used for acute, chronic, physical, or psychological pain, but for which type is it more effective?

Back 82

chronis

Front 83

type of touch in which the nurse gives energy to the patient

Back 83

therapeutic touch

Front 84

does therapeutic touch require physical contact

Back 84

no

Front 85

What two things are important to consider when using humor?

Back 85

that it is in good taste an age appropriate

Front 86

650 mg of aspirin or aceteminophen may relieve as much pain as _______ mg of oral meperidine or ___ to ___ mg of oxycodone

Back 86

-50
-3 to 5

Front 87

combining 2 ________ is not recommended because it increases the risks of side effects and may not be more effective

Back 87

NSAIDs

Front 88

taking a small daily dose of _________ to prevent MIs does not seem to be a risk for patients taking other NSAIDs

Back 88

aspirin

Front 89

One of the most common side effects of taking NSAIDs is what?

Back 89

gastric irritation

Front 90

How can gastric irritation from taking NSAIDs be helped

Back 90

-taking it with food
-taking enteric coated tablets

Front 91

__________, even in recommended doses, can cause severe hepatotoxicity in patients who consume alcohol and in patients with liver disease

Back 91

acetaminopohen

Front 92

psychological dependence, or addiction, occurs in less than _______% even after long-term prescriobed use of opioids for pain

Back 92

1%

Front 93

you should monitor postoperative patients who receive opioids for sedation and respiratory depression every ___ to ______ hours during the first 12 to 24 hours after surgery.

Back 93

1 to 2 hours

Front 94

These stimulate Mu receptors and are used for acute, chronic, and cancer pain.

Back 94

Mu agonists

Front 95

codeine, morphine, hydromorphine(Dilaudid), fentanyl, methadone, and oxycodone are examples of

Back 95

Mu agonists

Front 96

When assessing respiratory depression and drowsiness, reduce the opioid _____% if analgesia if adequate

Back 96

25%

Front 97

to prevent drowsiness when using opioids, offer stimulants such as ____ during the daytime

Back 97

caffeine

Front 98

to increase peak concentration of opioids offer a ________ dose more frequently

Back 98

lower

Front 99

this route of opoid administration is preferred unless rapid onset of analgesia is required

Back 99

oral

Front 100

the transdermal route of opioid administration delivers a continuous release of the drug for up to how many hours

Back 100

72

Front 101

This opioid is commonly given as a transdermal pouch

Back 101

Fentanyl (Duragesic)

Front 102

Transdermal patches should be used carefully in _______ patients, because their increased temperature will increase absorption of the drug

Back 102

febrile (high fever)

Front 103

When is rectal administtration of opioids useful

Back 103

when the patient is vomiting, has a GI obstruction, or is at rosk for aspiration with oral meds

Front 104

The SubQ route of administering opioids may be used when

Back 104

intermittently and continuous administration

Front 105

what are the most commonly used SubQ opioids

Back 105

hydromorphine and morphine

Front 106

why are IM opioids used less frequently

Back 106

they are painful, the onset of action is slow, and the absprption is unreliable

Front 107

why should IM opioids be avoided in children

Back 107

because they are painful and children will often refuse pain meds to avoid the pain of the injection

Front 108

this route of administering opioids provides immediate pain relief and is desirable for acute or escalating pain

Back 108

IV

Front 109

IV opioids are commonly used for _______ ________ use and for hospitalized patients who can be closely monitored

Back 109

short-term

Front 110

PCA pumps are helpful because they give the patients a sense of _______ over pain

Back 110

control

Front 111

most PCA pumps can be programmed with ______ or _____ hour medication limits

Back 111

1 or 4 hours

Front 112

In intraspinal analgesics, which space is preferred because it poses less risk of complications

Back 112

the epidural space

Front 113

drugs in this category include anticonvulsants, antidepressants, local anasthetics, topical agents, etc; they can be used as primary therapy or in conjunctio with opioids

Back 113

adjuvant analgesics

Front 114

a type of regional anasthesia in which an anaesthetic agent is injected into or around the nerve that supplies sensation to a particular part of the body

Back 114

nerve blocks

Front 115

the injection of local anasthetics and long acting agents

Back 115

local anasthesia

Front 116

involves applying an agent that contains cocaine, lidocaine, or benzocaine directly to the skin, mucous membrannes, wounds, or burns

Back 116

topical anasthesia

Front 117

why should you include the family when teaching about pain

Back 117

pain is a barrier to learning (the family may be able to take in information that the patient can due to his/her pain)

Front 118

why should you document the pain management plan and the patient's responses

Back 118

because if you don't document it, it's the same as if you didn't do it.