Chapter 30 - Pain Management - Billy

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

starts at the source but extends to other locations

Back 11

radiating oain

Front 12

example of radiating pain

Back 12

sore throat spreading to ears, GERD

Front 13

occurs in an area distant from the original site

Back 13

referred pain

Front 14

example of referred pain

Back 14

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

Front 15

Pain that is perceived to originate from an area that has been surgically removed

Back 15

phantom pain (the lotion did not work, by the way :))

Front 16

Example of phantom pain

Back 16

Billy's missing testicle

Front 17

believed to originate from the mind

Back 17

psychogenic pain

Front 18

In psychogenic pain, the patient perceives the pain despite the fact that no ___________ can be found

Back 18

physical

Front 19

True or False: Psychogenic pain is never as severe as pain from a physical cause

Back 19

FALSE: It can be just as severe as physical pain

Front 20

Name three ways to classify pain.

Back 20

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

Front 21

What are the two causes of physical pain?

Back 21

-nociceptive pain
-neuropathic pain

Front 22

What is the most common type of pain experienced

Back 22

nociceptive pain

Front 23

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

Back 23

nociceptors

Front 24

Name the causes of nociceptive pain

Back 24

trauma, inflammation, surgery

Front 25

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 25

neuropathic pain

Front 26

Example of causes of neuropathic pain

Back 26

diabetic neuropathy, tumor, stroke, viral infection

Front 27

What is a type of medication that can trigger neuropathic pain

Back 27

chemotherapy

Front 28

True or False: Neuropathic pain caused by medication can last even after the medication is discontinued

Back 28

TRUE

Front 29

What percentage of patients in pain clinics suffer from neuropathic pain

Back 29

20-40%

Front 30

Name three ways to classify the duration of pain

Back 30

acute, chronic, intractable

Front 31

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

Back 31

Acute pain

Front 32

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

Back 32

-varies
-6

Front 33

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

Back 33

-trauma
-surgery

Front 34

How is acute pain protective

Back 34

It indicates potential or actual tissue damage

Front 35

What is helpful for the patient to know regarding acute pain

Back 35

that it will disappear as the tissues heal

Front 36

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

Back 36

chronic pain

Front 37

True or False: Chronic pain can be related to a progressive disorder, or it can occur when there is no current tissue injury, such as in neuropathic pain

Back 37

TRUE

Front 38

patients with chronic pain may experience periods of ____________ or __________

Back 38

-remission
-exacerbation (worsening)

Front 39

Chronic pain is often viewed as _____________ and may lead to depression, anger, frustration, and dependence

Back 39

meaningless

Front 40

Next to incurability, this is the most feared aspect of contracting cancer or another progressive disease

Back 40

chronic pain

Front 41

Both chronic and highly resistant to relief

Back 41

intractable pain

Front 42

intractable pain should be approached with ________ methods of pain relief

Back 42

multiple

Front 43

The ________ patients use to describe the quality of their pain help care providers to determine the probable cause and most effective treatment

Back 43

words

Front 44

examples of words used to describe pain

Back 44

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

Front 45

What has the highest density of nociceptors?

Back 45

the skin

Front 46

what has the least density of nociceptors

Back 46

internal organs

Front 47

what is the procedure in which nociceptors become activated?

Back 47

transduction

Front 48

nociceptors become __________ by the perception of potentially damaging mechanical, thermal, and chemical stimuli

Back 48

activated

Front 49

external forces that result in pressure or friction against the body

Back 49

mechanical stimuli

Front 50

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 50

mechanical stimuli

Front 51

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

Back 51

mechanical stimuli

Front 52

result from exposure to extreme heat or cold

Back 52

thermal stimuli

Front 53

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

Back 53

chemical stimuli

Front 54

tissue damage promotes the release of bradykinin, histamine, and prostaglandins, which continue the activation of ___________ in the surrounding tissues

Back 54

nociceptors

Front 55

A powerful vasodialator that triggers a release of inflammatory chemicals that cause the injured area to become red, swollen, and tender

Back 55

bradykinin

Front 56

What is the single greatest cause of pain

Back 56

inflammation

Front 57

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

Back 57

transmission

Front 58

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

Back 58

-A-delta fibers
-C fibers

Front 59

large diameter mylenated fibers that transmit fast pain

Back 59

A-delta fibers

Front 60

A-delta fibers transmit pain from which stimuli

Back 60

acute, mechanical, thermal

Front 61

two examples of A-delta fiber pain

Back 61

bumping your knee, pleasurable stimuli such as massage

Front 62

smaller unmylenated fibers that transmit slow pain

Back 62

C fibers

Front 63

Which type of stimuli do C fibers conduct

Back 63

mechanical, thermal, and chemical

Front 64

example of C fiber pain

Back 64

the lingering ache that occurs after you bump your knee

Front 65

One of the most important neurotransmitters that communicate pain is called what?

Back 65

substance P

Front 66

most pain impulses are transmitted to which area of the brain

Back 66

the thalamus

Front 67

involves the recognition and definition of pain

Back 67

perception

Front 68

where in the brain does perception occur

Back 68

frontal cortex

Front 69

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

Back 69

painn threshold

Front 70

True or False: The number and intensity of stimuli necessary to produce pain, as well as the duration and characteristics of the pain produced are the same for every person

Back 70

FALSE: they vary from person to person

Front 71

repeated experience with pain can __________ a person's threshold

Back 71

reduce

Front 72

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

Back 72

pain tolerance

Front 73

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

Back 73

same

Front 74

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

Back 74

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 75

extreme sensitivity to pain is called

Back 75

hyperalgesia

Front 76

in this process, pain signals can be either facilitated (allowed, made easier) or inhibited (not allowed, stopped)

Back 76

modulation

Front 77

what two mechanisms are associated with modulation

Back 77

-the endogenous analgesia system
-gate control theory of pain modulation

Front 78

modulation mechanism which involves triggering natural opioids found in the body

Back 78

endogenous analgesia system

Front 79

how do endogenous opioids work

Back 79

they inhibit the transmission of substance P

Front 80

what are the three neurotransmitters that make up the endogenous opioids

Back 80

enkaphalins, dynorphins, and beta endorphins

Front 81

states that the somatic signals from nonpainful sources can inhibit signals of pain

Back 81

gate-control theory of pain modulation

Front 82

Explain how the gate control theory works

Back 82

-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 83

True or False: Because mood and emotion are also believed to open or close the gate, chronic pain is often treated with anti-depression medication, meditation, relaxation, etc.

Back 83

TRUE

Front 84

Name four factors that influence pain

Back 84

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

Front 85

Name five common emotions associated with pain

Back 85

fear, guilt, anger, helplessness, and loneliness

Front 86

Many patients fear that if they ask for pain medication they will be considered what?

Back 86

weak

Front 87

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

Back 87

addicted

Front 88

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

Back 88

chronic

Front 89

True or False: often patients who have had numerous painful experiences with pain are more anxious about pain and more sensitive to pain

Back 89

TRUE (remember the study about the boys who were circumcised without anesthesia)

Front 90

Name two interventions that may aid in pain relief

Back 90

reflective listening
gentle touch

Front 91

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

Back 91

-pain
-hurt
-ache

Front 92

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

Back 92

they are unable to express their needs verbally

Front 93

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

Back 93

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

Front 94

True or False: The absence of physiological cues (increased BP and pulse) in patients with cognitive and communication impairments means that they are not experiencing pain

Back 94

FALSE: they could still have pain

Front 95

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

Back 95

the sympathetic nervous system

Front 96

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

Back 96

the parasympathetic nervous system

Front 97

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

Back 97

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

Front 98

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

Back 98

decrease

Front 99

True or false: In unrelieved pain, inflammation, combined with endocrine and metabolic changes can result in weight loss, tachycardia, fever, increased respiratory rate, and death

Back 99

TRUE

Front 100

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

Back 100

splinting

Front 101

True or False: In unrelieved pain, the resulting hormonal upset lead to decreased urinary output, urinary retention, fluid overload, hypokalemia, hypertension, and increased cardiac output

Back 101

True

Front 102

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

Back 102

-before
-30

Front 103

What are the ABCDEEs of assessing pain?

Back 103

-Ask bout pain regularly
-Believe the paitient and family
-Choose pain control options appropriate for the patient
-deliver interventions in a timely, logical, coordinated, fashion
-Enpower patients and families
-Enable patients to control their course to the greatest extent possible

Front 104

True or False: Changes in vital signs associated with pain only last a short time

Back 104

TRUE

Front 105

True or False: Normal vital signs do not mean that a patient is free of pain

Back 105

true

Front 106

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

Back 106

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

Front 107

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

Back 107

30 to 60 minutes

Front 108

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

Back 108

the injection works more quickly

Front 109

Cutaneous stimulation is based on which method of pain relief

Back 109

gate control theory

Front 110

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

Back 110

TENS (or a strap-on vibrator :))

Front 111

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

Back 111

PENS

Front 112

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

Back 112

effleurage

Front 113

Apply heat and cold _________, or for no more than ________ minutes at a time

Back 113

-intermittently

Front 114

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

Back 114

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

Front 115

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 115

-contralateral stimulation

Front 116

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 116

regular

Front 117

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

Back 117

FALSE: You should never use distraction in place of analgesics

Front 118

What is one disadvantage of using distraction

Back 118

Some patients may experience an increase in pain or become fatigued and irritable when no longer distracted

Front 119

True or False: Distraction works best with severe pain.

Back 119

FALSE: it works best with mild to moderate pain, but it can be used in sever pain

Front 120

In this cognitive-behavioral technique. the person sits and tenses a group of muscles for 15 seconds and then relaxes the muscle while breathing out. The process is repeated with another set of muscles

Back 120

sequential muscle relaxatio (SMR)

Front 121

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

Back 121

chronis

Front 122

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

Back 122

therapeutic touch

Front 123

does therapeutic touch require physical contact

Back 123

no

Front 124

What two things are important to consider when using humor?

Back 124

that it is in good taste an age appropriate

Front 125

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

Back 125

-50
-3 to 5

Front 126

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

Back 126

NSAIDs

Front 127

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

Back 127

aspirin

Front 128

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

Back 128

gastric irritation

Front 129

How can gastric irritation from taking NSAIDs be helped

Back 129

-taking it with food
-taking enteric coated tablets

Front 130

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

Back 130

acetaminopohen

Front 131

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

Back 131

1%

Front 132

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 132

1 to 2 hours

Front 133

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

Back 133

Mu agonists

Front 134

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

Back 134

Mu agonists

Front 135

Mu agonists are excellent for this type of pain, which refers to a rescue or extra dose

Back 135

breakthrough pain

Front 136

drugs used for breakthrough pain should have a ____onset and ____duration

Back 136

-rapid
-short

Front 137

when using a drug for breakthrough pain, use the ___ drug as that given for ongoing pain relief

Back 137

-same

Front 138

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

Back 138

25%

Front 139

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

Back 139

caffeine

Front 140

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

Back 140

lower

Front 141

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

Back 141

oral

Front 142

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

Back 142

72

Front 143

This opioid is commonly given as a transdermal pouch

Back 143

Fentanyl (Duragesic)

Front 144

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

Back 144

febrile (high fever)

Front 145

When is rectal administtration of opioids useful

Back 145

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

Front 146

The SubQ route of administering opioids may be used when

Back 146

intermittently and continuous administration

Front 147

what are the most commonly used SubQ opioids

Back 147

hydromorphine and morphine

Front 148

why are IM opioids used less frequently

Back 148

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

Front 149

why should IM opioids be avoided in children

Back 149

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

Front 150

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

Back 150

IV

Front 151

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

Back 151

short-term

Front 152

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

Back 152

control

Front 153

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

Back 153

1 or 4 hours

Front 154

these require placement of a catheter in the subarachnoid space or the epidural space by an anesthesiologist or CRNA

Back 154

intraspinal analgesics

Front 155

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

Back 155

the epidural space

Front 156

refers to approximately equal analgesia that a variety of opioids will provide

Back 156

eqianalgesia

Front 157

these calculations provide a starting point when changing from one opioid to another or from one route to another

Back 157

eqianalgesia

Front 158

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 158

adjuvant analgesics

Front 159

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 159

nerve blocks

Front 160

the injection of local anasthetics and long acting agents

Back 160

local anasthesia

Front 161

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

Back 161

topical anasthesia

Front 162

interrupts pain and temperature sensation below the tract that is severed (cut)

Back 162

cordotomy

Front 163

interrupts the anterior or posterior nerve route that is located between the ganglion and the cord

Back 163

rhizotomy

Front 164

used to eliminate intracable localized pain

Back 164

neurectomy

Front 165

severs the paths to the sympathetic division of the autonomic nervous system

Back 165

sympathectomy

Front 166

sympathectomy is used to treat the pain from vascular disorders such as what?

Back 166

Raynaud's Disease

Front 167

-most people don't have pain from that illness or procedure
-there is no obvious, physical cause for the pain
-concerns about drug seeking behavior and addiction

these are reasons why nurses often _______ patients' reports of pain

Back 167

doubt

Front 168

on average, a 70 year old takes how many different medications

Back 168

7

Front 169

adding analgesics to an already complex medication regimen (eg older adults) increases the likelyhood of what

Back 169

drug interactions

Front 170

name three behaviors that may indicate substance abuse or addiction

Back 170

-repeated requests for injections of an opois even though the surgery was several days ago
-refusal to try oral meds
-continued high opioid dose, even though surgery or acute illness has passed

Front 171

any medication or procedure, including surgery, that produces an effect in a patient because of it's implicit or explicit intent, not because of its specific physical or chemical properties (hint: sugar pill)

Back 171

placebo

Front 172

what is the ethical reason for not using placebos

Back 172

it involves deceit

Front 173

why should you include the family when teaching about pain

Back 173

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 174

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

Back 174

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