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52 Cards in this Set

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What is the definition of pain?
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
When do you know that the pain exists?
Pain exists whenever the person says it does!
What is the function of pain?
Protective mechanism
What is important about the subjective experience of pain?
Tissue damage may not be proportional to extent of pain experienced
What is important to know about pain thresholds and pain tolerance?
Pain thresholds are similar for all people BUT pain tolerance & perception greatly differ
What is threshold?
level of intensity that triggers neuropathways resulting in pain sensation

level of intensity needed to cause an action potential and neuron firing
What is tolerance?
amount of pain a person perceives as tolerable
Compare/contrast acute and chronic pain
Acute
Sudden onset
Short duration: <3 months
Cause: usually can identify
Course: pain decreases over time

Chronic
Gradual or sudden onset
Duration: >3 months
Cause: may not know
Course: does not go away; pariods of waxing/waning
What is the 3rd largest problem in the united states?
Chronic pain
What % of persons seeking medical care do so because of pain?
50% or 1/2 of the people
What are the 3 types of nocioceptive pain? describe them.
Cutaneous (superficial)- caused by stimulation of nerve fibers in skin (burning/sharp)

Somatic (deep)- non-localized, originates in support structures strong pressure on tendons, bones, ligaments (aching/throbbing)

Visceral- arises from internal organs, difficult to localize (stomach, intestines)
What causes neuropathic pain?
damage to nerves
How is neuropathic pain described?
shooting, burning, pins & needles, intense
What are 2 types of neuropathic pain?
Phantom- sensation perceived when body limb or part is missing

Diabetic neuropathy- damage to nerves in the body that occurs due to high blood sugar levels from diabetes
What is radiating pain?
perceived at the source and extends to nearby tissue
What is idiopathic pain?
chronic pain in the absence of any identifiable cause
What is referred pain?
pain felt in different body area of body than actual tissue damage
What is psychogenic pain?
pain from a mental event, no physical cause identified
What is intractable pain?
pain highly resistant to relief (ie: bone ca)
When does pain begin?
when there is enough tissue injury to reach a pain threshold
What happens in the pain process of transduction after the threshold has been reached?
Neurotransmitters (excitatory) are released which spread pain message and also stimulate the inflammatory response
(examples of these neurotransmitters are histamine, lactic acid, prostaglandins, bradykinin, Substance-P
Describe the pain process of transmission.
Impulses travel along primary afferent neurons to the dorsal horn of spinal comuln-Substance-P released- pain sensation transmitted via spinothalamic tract

Acute pain runs up large A fibers (myelinated)
Fast transmission-Sharp pain

Diffuse pain runs up smaller C fibers (unmyelinated)
Slower transmission- throbbing pain
What is perception?
Stimulus received by thalamus; transmitted to cortex where pain is consciously perceived
What is modulation?
Activation of endogenous opoids/neuromodulation system. Body releases pain blocking substances: endorphins, enkephalins, serotonin.
Efferent message sent to muscles to withdraw from pain stimulus.
What is the sensory center for heat, cold, pain, and touch?
Thalamus
Where is the intensity and location of pain perceived?
Cortex
What controls the behavioral and emotional response to pain?
Hypothalamus/Limbic system
Describe the gate control theory.
Theory that describes how external stimulation and cognitive techniques can affect pain transmission

Impulses traveling on small diameter C fibers act to "open the gate" to pain

Impulses traveling on large diameter A fibers act to "close the gate" to pain

External stimulation such as massage/heat/cold/TENS/acupuncture on large A fibers "close the gate" to small C fibers and pain

Also, cognitive techniques such as biofeedback, distraction, guided imagery can "close the gate"

Gate located @ dorsal root or spinal cord
What are some factors that affect pain?
Previous experience with pain
Fatigue
Anxiety/stress
Support systems
Attention
Coping style: locus of control
Neurological function
Age
Cultural factors
What aging considerations should be made related to pain?
Meaning of pain may be exacerbated
Interference with functional status has greater impact on body systems
Not a normal sign of aging or inevitable

Additional RISKS:
-under-reporting of pain
-analgesic toxicity
What are some diversity considerations you should make related to pain?
Meaning of pain
Spiritual factors
Cultural beliefs and values
-acceptable expression of pain
-need for nurse self-assessment
Communication obstacles
Variation in acetylator rates of meds
Describe an assessment of patient pain.
Beging with acceptance of client report

Includes:
Subjective description-
Client statement
Use of a pain-rating scale

Objective assessment-
physical examination
Describe the clinical approach to pain assessment & management
(hint: ABCDE)
A- ask about pain regularly
assess pain symmetrically

B- believe the client and family

C- choose appropriate pain control options

D- deliver interventions in timely fashion

E- empower the client and family
What should you ask a patient about for a subjective pain assessment?
Where is your pain?
When did your pain start?
What does your pain feel like?
How much pain do you have now?
What makes the pain better or worse?
How does pain limit your function/activities?
Why do you think you are having pain?
What are your expectations regarding pain and pain relief?
What are the 4 subjective assessment tools?
Descriptive:
No pain-mild-severe

Numerical:
0-10

Visual analog:
Wong Baker

Behavioral:
Peyen PBS
What should you do to obtain objective information related to the pain of a patient?
Inspect the site of pain

Take vital signs

Note behavioral and affective signs
Describe the physiological response to pain.
Involuntary
Sympathetic response (fight or flight):
Increased BP, HR, R, Pallor, Diaphoresis

If prolonged, deep, severe leads to parasympathetic response:
Decreased BP, HR, N & V, fainting
Describe the behavioral response to pain.
Guarding, Rubbing, Grimacing, Moaning, Immobilization, restlessness
Describe the affective (psychosocial) response to pain.
Anxiety, fear, fatigue, anger, depression, withdrawal-isolation, decreased attention
What are some nursing diagnoses related to pain?
Acute pain r/t tissue damage (mechanical, thermal, chemical) AEN.......

Chronic pain r/t tumor progression AEB.......

Related:
Self care deficit r/t pain
Ineffective airway clearance r/t pain
What should the RN be planning in regards to pain management for their patients?
Client will...

Utilize a pain rating scale to identify pain and determine comfort level

Report that pain management regimen relieves pain to satisfactory level

Describe how unrelieved pain will be managed
How should the RN implement her plans to manage pain?
Establish trusting nurse-client relationship

Comfort measures:
-administering analgesics
-modifying environment
-non-pharmacologic relief measures

Client teaching is an important part of a pain management plan

Explore strategies that have been effective for the client in the past
Who should the RN collaborate with in order to properply implement pain management to the fullest?
Physician
Pharmacist
Physical therapist
Occupational therapist
Pain specialist
What are some non-pharmacologic interventions for pain?
Used with pharmacologic
-Distraction
-Guided imagery
-Relaxation
-Music
-Cutaneous stimulation: TENS, massage, heat, cold, acupressure
How can the RN implement pain relief by modifying the environment?
Removing or altering cause of pain:
-Loosening of a tight binder
-Emptying a distended bladder

Altering factors affecting pain tolerance:
-Environmental control
-Quiet, dim lighting
-Allow client to rest
-Position for comfort
What are the types of pain relieving medications?
Non-opoid
acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) such as ASA, ibuprofen

Opoids (narcotics)
Ex:morphine,codeine

Adjuvants/co-analgesics
drug developed for use other than analgesic but enhances effect of opoids by providing added relief
What are some non-opoid nursing considerations?
Decreases inflammatory response

Works on peripheral nervous system

Blocks release of excitatory neurotransmitters (ie:histamine)

Slower onset-longer peak action

Side effects: stomach irritation, liver and renal damage, bleeding, ASA toxicity-tinnitus, hearing loss

Acetaminophen- N & V, low BS and pH. Max dose= no more than 4g daily. Watch for combo medications.
What are some adjuvants nursing considerations?
Provide synergistic additive effect

Antidepressants- Elavil
Muscle Relaxants- Flexeril
Corticosteroids- Decadron
Anti anxiety- Valium
Anticonvulsants- Neurontin
Antihistamines- Vistaril
What are some nursing considerations for opoids?
Decreases cognitive perception of pain

Works on Central Nervous System

Blocks (locks into) pain receptors

Faster onset- shorter duration

Side effects- orthostatic hypotension, dizziness, sedation, nausea, constipation, urinary retention, respiratory depression

Emergency Rx for overdose= Narcan
narcan= narcotic antagonist
What are the major principles of analgesic administration?
Give regularly instead of PRN, ATC, or PCA

Recognize side effects and treat appropriately

Use combinations that enhance analgesics

Individualize dosing specific to patient

Monitor for tolerance and treat appropriately

Monitor for physical dependence- body physically adapts to opoids and withdrawal symptoms can occur upon sudden stoppage. THIS IS NOT AN ADDICTION

Addiction (psychological dependence)- compulsive drug use; craving for opoid for effects other than pain relief
What client teaching/health promotion should take place related to pain?
Function/cause of pain
When pain can be anticipated
How to use pain scale
What pain control measures will be used
Other measures to control pain
Methods for pain relief after discharge
How should the RN evaluate pain after implementing pain relief measures?
Goals met?
Pain controlled?
Comfort level acceptable to patient?
Quality improvement considerations