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147 Cards in this Set
- Front
- Back
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What is pain?
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1. The 5th Vital Sign
2. Pain is purely subjective 3. No two individuals experience pain to the same degree 4. Each client has physiological, sociocultural, spiritual, and psychological factors that influence reactions to discomfort and pain |
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What factors influence reactions to discomfort and pain?
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1. Physiological
2. Sociocultural 3. Spiritual 4. Psychological |
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What is Margo McCaffery's definition of pain?
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"Whatever the experiencing person says it is, existing whenever and wherever the person say it does"
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Who is Margo McCaffery?
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A registered nurse and pioneer of the field of pain management nursing
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What is the nature of pain?
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1. Involves physical, emotional, and cognitive components
2. Physical and/or mental stimulus 3. Is exhausting and demands energy 4. Interferes with relationships 5. Only the client knows whether pain is present and what the experience is like 6. It is not the responsibility of clients to prove that they are in pain, it is the nurse's responsibility to accept clients' report of pain (American Pain Society) |
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What is important to remember about pain?
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1. Always remember that the client is the one who is experiencing pain
2. Therefore, pain is whatever the client states it is 3. If clients are having difficulty expressing pain, it does not mean that they are not in pain |
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What is the fifth vital sign?
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Pain
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What is the Joint Commission pain standard?
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Requires health care providers to assess all clients for pain on a regular basis
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Do clients have to prove that they are in pain?
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NO
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What is the purpose of pain management?
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Helps the client:
1. Improve their quality of life 2. Reduces their physical discomfort 3. Promotes early mobilization 4. Returns them to normal activities of life |
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What are the causes of pain?
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1. Thermal, chemical, or mechanical stimuli usually cause pain
2. Energy of these stimuli are converted to electrical energy |
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What are the conductors of electrical energy?
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Nerves
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What are the phases of pain?
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1. Transduction
2. Transmission 3. Perception 4. Modulation |
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Can a client who is experiencing pain discriminate between these four phases of pain?
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NO
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What is transduction?
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Conversion of thermal, chemical, or mechanical stimuli into electrical energy
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What is transmission?
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An impulse sent across a sensory peripheral pain nerve fiber (nociceptor)
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What is perception?
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The point at which the client experiences pain
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What is modulation?
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The inhibition of the pain impulse
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What happens during the transduction phase?
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The pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor) beginning the transmission of pain
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What is a nociceptor?
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Pain nerve fiber
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True or False:
One single pain center exists |
FALSE
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What are neurotransmitters?
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Chemical substances that enhance or inhibit nerve impulse transmission
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What stimulates release of neurotransmitters?
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When cellular damage occurs by thermal, mechanical, or chemical stimuli
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What are some examples of neurotransmitters?
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1. Prostaglandin
2. Bradykinin 3. Potassium 4. Histamine 5. Substance P 6. Serotonin |
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What is substance P?
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1. Neurotransmitters that are found in the pain neurons of the dorsal horn (excitatory peptide)
2. Needed to transmit pain impulses from the periphery to higher brain centers 3. Causes vasodilation and edema |
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Neurotransmitters that are found in the pain neurons of the dorsal horn (excitatory peptide)
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Substance P
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What neurotransmitter is needed to transmit pain impulses from the periphery to higher brain centers?
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Substance P
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Where are neurotransmitters?
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Surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response
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What is serotonin?
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Neurotransmitter that is released from the brain stem and dorsal horn to inhibit pain transmission
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Neurotransmitter that is released from the brain stem and dorsal horn to inhibit pain transmission
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Serotonin
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What are prostaglandins?
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1. Neurotransmitters that are generated from the breakdown of phospholipids in cell membranes
2. Neurotransmitters that are thought to increase sensitivity to pain |
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Neurotransmitters that are thought to increase sensitivity to pain
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Prostaglandins
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Neurotransmitters that are generated from the breakdown of phospholipids in cell membranes
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Prostaglandins
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What are bradykinins?
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1. Neurotransmitters that are released from plasma that leaks from surrounding blood vessels at the site of tissue injury
2. Binds to receptors on peripheral nerves, increasing pain stimuli 3. Binds to cells that cause the chain reaction producing prostaglandins |
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Neurotransmitters that are released from plasma that leaks from surrounding blood vessels at the site of tissue injury
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Bradykinins
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Neurotrasmitters that bind to receptors on peripheral nerves, increasing pain stimuli
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Bradykinins
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Neurotrasmitters that bind to cells that cause the chain reaction producing prostaglandins
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Bradykinins
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What are the types of pain theories?
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1. Physiological Response
2. The Gate-Control Theory 3. Behavioral responses to pain will vary |
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What is the Physiological Response?
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Pain theory that:
1. Occurs when pain impulses ascend the spinal cord toward the brain stem and thalamus 2. Occurs when the ANS becomes stimulated 3. Pain thus triggers the fight-or-flight reaction of the GAS 4. Stimulation of the sympathetic branch of the ANS results in physiological response (see Table 43-1) 5. A client in pain will not always experience a change in vital signs! |
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What s the Gate-Control Theory?
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Pain theory that:
1. Suggests that pain impulses pass through when a gate is open and are blocked when the gate is closed 2. The gates can be physiological, emotional, or cognitive processes. |
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How do behavioral responses to pain vary?
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1. If pain is untreated, the client’s life will be altered
2. Pain threatens a client’s physiological and psychological well-being |
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What are the types of pain?
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1. Acute/transient pain
2. Chronic/persistent 3. Chronic episodic 4. Cancer 5. Inferred physiological 6. Idiopathic |
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What is acute/transient pain?
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Pain that is protective, identifiable, and has a short duration
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What is chronic/persistent pain?
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Pain that is not productive and has no purpose or may not have an identifiable cause
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What is chronic episodic pain?
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Pain that occurs sporadically over an extended duration
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What is cancer pain?
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Pain related to cancer that can be acute or chronic
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What is inferred physiological
pain? |
Pain that is musculoskeletal, visceral, or neuropathic
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What is idiopathic pain?
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Chronic pain without an identifiable physical or psychological cause
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Pain that is protective, identifiable, and short in duration
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Acute/transient pain
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Pain that is not productive and has no purpose or may not have identifiable cause
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Chronic/persistent pain
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Pain that occurs sporadically over an extended duration
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Chronic episodic pain
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Pain related to cancer that can be acute or chronic
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Cancer pain
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Pain that is musculoskeletal, visceral, or neuropathic
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Inferred physiological
pain |
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Chronic pain without an identifiable physical or psychological cause
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Idiopathic pain
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How can pain be categorized?
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1. Duration (chronic or acute)
2. Pathology (cancer or neuropathic) |
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What is important to remember about acute pain?
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Acute pain can threaten a client’s recovery by resulting in prolonged hospitalization, complications from immobility, or delayed rehabilitation
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What is important to remember about chronic pain?
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1. Chronic pain lasts longer than anticipated pain and can be cancerous or noncancerous
2. Chronic noncancerous pain may include arthritis, headache, low back pain, or peripheral neuropathy. This type of pain is non–life threatening |
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Is chronic noncanceros pain life-threatening?
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NO
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What is important to remember about cancer pain?
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In cancer, pain is usually a late clinical manifestation
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What are the sources of pain?
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1. Visceral
2. Referred 3. Acute 4. Intractable 5. Chronic 6. Phantom 7. Radiating 8. Superficial |
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What is visceral pain?
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Pain that originates in large organs
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What is referred pain?
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Pain that is felt at a site different from the site of injury
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What is intractable pain?
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Severe, pain that is unrelieved
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What is phantom pain?
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Pain felt at a site after amputation
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What is radiating pain?
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Pain that radiates from site of origin
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What is superficial pain?
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Pain that derives from the subcutanous/skin
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What is significant when a patient makes a fist and states “ It feels like an elephant is sitting on my chest!”?
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This is an indicator that a patient just experienced a heart attack. As a nurse, sit the patient upright, administer O2 therapy, and start an IV.
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What is a placebo?
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A "medication" that has no active ingredient, but produces a positive response
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A "medication" that has no active ingredient, but produces a positive response
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Placebo
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What is a pain threshold?
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The point at which a person feels pain
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The point at which a person feels pain
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Pain threshold
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What is pain tolerance?
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Level of pain a person is willing to put up with
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Level of pain a person is willing to put up with
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Pain tolerance
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What is addiction?
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A primary, chronic, neurobiologic need of medications
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A primary, chronic, neurobiologic need of medications
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Addiction
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What is physical dependency?
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State of adaptation to a drug class, that is produced after the drug is stopped
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State of adaptation to a drug class, that is produced after the drug is stopped
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Physical dependency
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What is psychological dependency?
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When a drug is used to obtain relief from tension or discomfort
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When a drug is used to obtain relief from tension or discomfort
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Psychological dependency
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What is drug tolerance?
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A drug induces changes that result in decreased relief and need for increased dosing
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A drug induces changes that result in decreased relief and need for increased dosing
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Drug Tolerance
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What are some misconceptions about pain?
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1. Attitude of health care providers: Patients are malingerers or complainers
2. Assumptions about clients in pain: Biases based on culture, education, experiences |
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What is the “medical model” of pain?
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The belief that indicates that pain is only due to an organ dysfunction
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What causes some health care providers to not believe the client is experiencing pain if clients do not have objective signs of pain?
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The “medical model” of pain
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What is important to remember regarding pain?
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1. It will be important that the nurse’s and client’s perception of the client’s pain are congruent so the client can experience pain relief
2. Often, nurses will allow their misconceptions about pain and pain management to interfere with their ability to treat their clients |
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What factors influence pain?
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1. Physiological
2. Social 3. Spiritual 4. Psychological 5. Cultural |
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What are the physiological factors that influence pain?
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Age, fatigue, genes, neurological function
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What are the social factors that influence pain?
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Attention, previous experiences, family and support groups
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What are the psychological factors that influence pain?
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Anxiety, coping style
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What are the cultural factors that influence pain?
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Meaning of pain, ethnicity
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This is complex and may require a holistic approach to help meet the needs of your client
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Pain
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How does age influence the pain experience?
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The young and very old may not be able to adequately express their needs
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What can increase the perception of pain and can cause problems with sleep and rest?
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Fatigue
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What may possibly affect a person’s pain threshold or pain tolerance?
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Genetic makeup
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What can affect the client’s response to pain?
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Any factor that interrupts or influences the normal pain reception or perception (spinal cord injury, peripheral neuropathy, neurological disease)
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What will affect pain experiences?
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A client’s attention to pain, previous experiences, and social support systems
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What is important to remember about repeated pain?
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1. Repeated pain experiences may help the client to deal with the present pain experience
2. When in pain a client may rely heavily on others for assistance |
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What is crucial to remember about spirituality?
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Spirituality stretches beyond religion. When experiencing pain, a client may ask “Why am I suffering?” or “Why has God done this to me?”
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What is related to the meaning of pain?
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The degree and quality of pain a client experiences are related to the meaning of pain. It is difficult to separate pain and anxiety sensations.
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What influences a client's ability to handle pain?
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Coping styles influence a client’s ability to handle pain. For example, allowing the client to self-medicate using a PCA can help the client control the pain experience.
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How does pain affect the critically ill and injured patients?
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They often perceive a lack of control over their environment and experience anxiety
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What needs to be assessed for pain?
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1. Client’s expression of pain
2. Characteristics of pain 3. Location 4. Quality 5. Relief measures 6. Effect of pain 7. Influence on ADLs |
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What are the characteristics of pain?
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1. Onset and duration
2. Intensity (pain scale) 3. Pattern 4. Contributing symptoms 5. Behavioral effect |
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What does the American Nurses Association believe about pain?
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Pain assessment and management is within the scope of every nurse’s practice. This is why pain is now known as the fifth vital sign
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What is the nurse's responsibility regarding a client's pain?
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1. It will be of paramount importance to ascertain the level of pain the client is experiencing
2. It will also be important to encourage the client to express pain or discomfort 3. It is also the nurse’s duty to constantly assess the client’s pain |
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What are the mneumonics for pain?
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1. PQRST
2. COLDERRA |
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What does PQRST stand for?
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P-provoking factors
Q-quality R-radiation/region S-severity on a scale of 1 to 10 T-time/onset |
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What does COLDERRA stand for?
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C-characteristics: Dull, achy, sharp, etc?
O-onset: When did it start? L-location: Where does it hurt? D-duration: How long does it last? Frequency? E-exacerbation: What makes it worse? R-radiation: Does it travel to another part of the body? R-relief: What provides relief? A-associated s/sx: Nausea, anxiety, autonomic responses |
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What analgesics are used for pain relief?
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1. Nonopioids
2. Opioids 3. Adjuvants/coanalgesics 4. PCA 5. Local/regional anesthesia 6. Topical agents |
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What are some nonopioid/non-narcotic analgesics?
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1. Tylenol
2. NSAIDS: Asprin & Ibuprofen |
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What is the action of Tylenol?
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1. Inhibits prostaglandin synthesis at the PNS, but its exact mechanisms of action are not known
2. No parenteral available 3. No antinflammatory or antiplatelet properties 4. COMBINED W/OTHER MEDICATIONS OTC (Colds, flu, analgesics) 5. Great medication for elderly—good relief with it! 6. Hepatotoxic: Liver function tests 7. MAX DOSE IS 4G DAILY!! |
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What is important to remember regarding Tylenol?
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MAX DOSE IS 4G DAILY!!
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What is important to remember about NSAIDS: Asprin & Ibuprofen?
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1. INCREASES GI BLEEDING!!
2. Decreases transmission of pain 3. Increases renal insufficiency |
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When are opioids prescribed?
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Prescribed for moderate to severe pain
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What are opioids associated with?
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1. Respiratory depression
2. Adverse effects of nausea, vomiting, constipation, itching, urinary retention, and altered mental processes |
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What are some examples of opioids?
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1. Morphine sulfate
2. Dilaudid 3. Fentanyl 4. Codeine 5. Demerol |
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What are the characteristics of morphine sulfate?
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1. Binds to opioid recepters in the CNS
2. All routes available 3. Varying dosages based on route 4. Constipation 5. n&v, itching, urinary retention, altered mental processes |
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What are the adverse effects of morphine sulfate?
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1. Constipation
2. N/V 3. Itching 4. Urinary retention 5. Altered mental processes |
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What is important to remember about opioids?
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RESPIRATORY DEPRESSION caused by oversedation
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What does Vicodin 25/500 mean?
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25 = dosage of Codeine
500 = dosage of Tylenol |
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What are some combination analgesics?
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1. Hydrocodone & Tylenol (vicodin types)
2. Opioids and tylenol: Varying dosages BE AWARE!!! 3. Percodan (oxycontin w/aspirin) LOTS OF COMBOS—LOOK UP BOTH!! |
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What are some adjuvants?
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1. NSAIDS (ibuprofen, celebrex)
2. Anticonvulsant (Neurontin) 3. Antidepressants (Doxepin - decrease dose) 4. Muscles relaxants (valium, soma) |
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What do NSAIDS do?
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Decrease inflammation
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What do anticonvulsants do?
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Relieve nerve pain
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What do muscle relaxants do?
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Decrease muscle spasms
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What are adjuvants?
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Drugs used to treat other conditions but they also have analgesic qualities
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Drugs used to treat other conditions but they also have analgesic qualities
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Anjuvants and coanalgesics
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Examples of Local & Regional Anesthesia
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1. Lidocaine, Morphine, Epidural
2. Nerve blocks 3. Spinal Blocks 4. Regional blocks |
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Examples of Topical Anesthesia
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1. Lidocaine patches
2. EMLA cream (lidocaine & prilocaine) 3. Tiger balm 4. Aspercreme |
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What are the uses of local & regional anesthesia?
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Used in a variety of conditions including labor and delivery, chronic cancer pain, and selected postoperative procedures
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These produce anesthesia to soft tissue
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Topical anesthesia (i.e. EMLA and lidocaine that are administered via patches or disks)
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What are the characteristics of Patient Controlled Analgesia (PCA)?
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1. Allows clients to help manage their pain
2. Client must be able to participate |
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What are the most common PCAs?
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1. Morphine
2. Hydromorphone (Dilaudid) 3. Fentanyl |
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What are the advantages of PCAs?
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1. PCA prevents overdose
2. No one but the patient administers the pain meds 3. The machine has safety mechanisms that prevent overdosage 4. Nurses need to monitor a patient’s PCA at least 3 times during a shift |
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What are some non-pharmacological interventions of pain management?
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1. TENS (transcutaneous electrical nerve stimulation)
2. Heat/cold (thermacare) 3. Massage, etc. 4. Cognitive Behavior |
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What are some cognitive behaviors for pain management?
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1. Imagery
2. Relaxation 3. Meditation 4. Humor 5. Distraction |
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How is pain evaluated?
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1. Evaluation of pain is considered a major responsibility of nurses
2. The client’s response to pain may not be obvious 3. Evaluating the appropriateness of pain medication will require nurses to evaluate clients 15 to 30 minutes after administration, as well as with the VS 4. It is important to evaluate if nursing interventions have helped the client meet their outcomes and goals 5. It will be important to evaluate the client’s perception of the effectiveness of nursing interventions |
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What are the estimates for addiction to pain medications?
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Range from 1% to 24%
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What is the management of cancer pain?
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Follow AHPR guidelines, which treat cancer pain very comprehensively and aggressively
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How is chronic pain managed?
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1. Clients with chronic pain need to be given medications on a regular basis
2. The WHO recommends a three-step approach to the management of cancer pain 3. Treatment begins with NSAIDs and/or adjuvants and progresses to opioids |
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What opioids are available for chronic pain?
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1. Transdermal fentanyl is 100 times more potent than morphine and provides analgesia for 48 to 72 hours. This route is used when clients are unable to take oral medications.
2. Transmucosal fentanyl exists for breakthrough pain. The fentanyl is swabbed into the mouth. |
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How much more potent is trandermal fentanyl than morphine?
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Transdermal fentanyl is 100 times more potent than morphine
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How long does transdermal fentanyl provide pain relief for?
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Provides analgesia for 48 to 72 hours
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When is transdermal fentanyl used?
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This route is used when clients are unable to take oral medications
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When is transmucosal fentanyl used?
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Transmucosal fentanyl exists for breakthrough pain
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How is transmucosal fentanyl administered?
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The fentanyl is swabbed into the mouth
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What is breakthrough pain?
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Pain that comes on suddenly for short periods of time and is not alleviated by the patients' normal pain suppression management. It is common in cancer patients who commonly have a background level of pain controlled by medications, but the pain periodically "breaks through" the medication.
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