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62 Cards in this Set

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What are the most common types of pain
Low back pain and cancer pain are the most common types of pain.
What are the basic principles of pain management
A. Know that the person with the pain experience - not the health care provider, family, or friend - is the authority on the pain. [Definition of Pain]
B. Describe the complexity of the pain experience, including the sensory and emotional components of pain. [Definition of Pain, Neurophysiology modules]
C. Describe the differences (definition, characteristics, sources) between acute, chronic non-cancer pain and cancer-related pain [Categories of Pain; Acute and Chronic Pain, Cancer Pain]
D. Describe the major types of pain: nociceptive (somatic and visceral) and neuropathic, and the differences in their quality and presentation. [Nocipective and Neuropathic Pain]
E. Acknowledge and follow with patient/family education, the major patient-related barriers (myths) to adequate pain management: [Pain Myths}
What do you document when a person is having pain, using the pain assessment tool?
Document location, intensity, quality, pattern (e.g. radiating, intermittent or constant), alleviating and aggravating factors, medication history, responses to past treatments, and other relevant factors such as the patients’ lifestyle, impact of the pain on the patient’s life (ADL’s, sleep)
Provide accurate, objective and timely documentation of the pain assessment in the medical record.
Perform regular, ongoing reassessment of pain
Non-Pharmacological interventions for managing pain
A. Cognitive-Behavioral
i. distraction
ii. guided imagery
iii. biofeedback
iv. music
v. humor
vi. cognitive reframing
vii. relaxation
viii. meditation
B. Physical (Physical interventions)
i. massage
ii. positioning
iii. heat and cold
iv. yoga
Pharmacological interventions for treating pain
i. non-opioids
ii. opioids
iii. Adjuvants
Define chronic pain
Chronic pain is defined as persistent pain, which can be either continuous or recurrent and of sufficient duration and intensity to adversely affect a patient's well-being, level of function, and quality of life. It is pain that lasts longer than typical healing time and is now thought to be pain longer than 6 weeks.
What are the types of chronic pain
Inflammatory Pain
Mechanical/Compressive Pain
Neuropathic Pain
Muscle Pain
Define/Describe Inflammatory Pain
Give examples
What are the physical findings of inflammatory pain
Also known as nociceptive pain because the inflammatory chemicals like prostaglandins directly stimulate primary sensory nerves that carry pain information to the spinal cord

Examples
a. Arthritis
b. Infection
c. Tissue injury
d. Postoperative pain
3. Physical findings: heat, redness, and swelling at the pain site and a history of injury or known inflammation
Define/Describe Mechanical/Compressive Pain
Give Examples of this type of pain
Mechanical/Compressive Pain
1. A type of nociceptive pain
because mechanical pressure or stretching directly stimulates the pain sensitive neurons
2. Aggravated by activity and
temporarily relieved by rest
3. Examples
a. Neck and back pain related to muscle/ligament strain sprain, degeneration of disks or facets, or osteoporosis with compression fractures
b. Fracture
c. Obstruction
d. Dislocation or compression of tissue by tumor, cyst or boney structure
Define/Describe
Neuropathic pain
Give examples of this type of pain
Character of this type of pain
And
Physical findings
Neuropathic pain
1. Definition: Pain produced by damage or dysfunction of the nervous system
2. Examples
a. Sciatica from nerve root compression
b. Diabetic peripheral neuropathy
c. Trigeminal neuralgia
d. Postherapeutic neuralgia (a complication of herpes zoster (shingles) that typically produces a constant, burning pain persisting after the herpes lesions have healed)
e. Post stroke neuropathic pain
3. Character a. Burning, Shooting, Stabbing
b. May follow a nerve distribution (e.g. median nerve for carpal tunnel syndrome)
c. Stocking-glove distribution (peripheral neuropathy)
d. Trigeminal distribution (trigeminal neuralgia)
e. Dermatomal distribution (postherpetic neuralgia)
4. Physical findings
a. Numbness in pain territory
b. Sensitivity to a non-noxious stimulus like
light touch or rubbing ( allodynia)
Coolness of skin in pain territory
Define/Describe Muscle Pain and give examples, character, and physical findings
Muscle pain is pain produced by skeletal muscles (etiology unknown)

Examples
a. Fibromyalgia Syndrome
b. Myofascial Pain Syndrome
3. Character
a. Sore, stiff, aching, painful muscles and soft tissues
b. Also fatigue, poor sleep, depression, headaches, irritable bowel syndrome

Physical Findings
a. Fibromyalgia: criteria for classification
i. Widespread pain (trunk and
upper/lower extremities)
ii. Pain in 11/18 tender spots
iii. Pain present for at least 3 months
iv. Other symptoms are chronic put not
diagnostic including insomnia, depression, stress, fatigue, irritable bowel syndrome
b. Myofascial pain: Regional muscle soft tissue pain involving the neck, shoulders, arms, low back, hips, and lower extremities
What is the Chronic Pain assessment in regards to the Joint commission pain requirements
i. Joint Commission Pain Requirements
1. Each agency usually develops their own policy. Joint Commission requires that all patients have the right to an adequate pain assessment including documentation of pain location, intensity, quality,
Onset/duration/variations/rhythms, manner of expressing pain, pain relief, what makes it worse, effects of pain and a pain plan.
How does culture affect someone’s perception or verbalization of pain
Culture and pain
1. Description of behaviors observed concerning patients' responses to the subjective feeling of pain
2. Pain is a culture, bond bound, phenomenon, how pain and discomfort are presented varies among cultures. One culture may allow free and open expression of feelings, whereas another culture may teach that true feelings must never be revealed.
3. Same operation on the same day; it would not be unusual to see these differences.
4. Should also be appropriate to race, creed, socioeconomic status.
iv. Parameters to assess and document the pain
LMNOPQRST
Location
Manner, Medications, Musculoskeletal
Number, Neurological
Origin
Provoking, precipitating
Psycho-social assessment
Quality
Radiation
Severity, Suffering
Timing
L: stands for
(Documenting Pain)
Location of pain
M: Stands for
(Documenting Pain)
Manner of expressing pain
b. Have you tried medications, what worked, what did not?
c. Musculoskeletal System
i. For obvious deformity or atrophy
ii. Color for cyanosis or pallor of an extremity
iii. Skin temperature
iv. Posture, gait, ROM
v. Palpation for tenderness and trigger points
N stands for
(Documenting Pain)
Number of pains; many
patients have more than one pain, these should be evaluated individually
b. System
i. Mental status
ii. Peripheral nervous system: muscle
strength, sensation
iii. Check for allodynia and
hyperalgesia useful in suspected complex regional pain syndrome
iv. S&S of upper motor neuron
dysfunction painful conditions such as multiple sclerosis or myelopathy due to cervical spinal stenosis
v. Hemiplegia or hemiparesis may exhibit central type pain syndromes.
O stands For
(Documenting Pain)
0rigin of pain (biological
mechanisms of pain as above); Understanding the cause of the pain may help you to remove the underlying cause or help with consideration of specific therapeutic options
P stands for
(Documenting Pain)
Provoking, or Precipitating factors: What makes the pain worse or better? Do certain activities or positions alleviate or worsen the pain?
b. Psycho-social assessment
i. Hx of depression, anxiety that may affect the perception of pain
ii. Past or current physical, sexual,
emotional abuse also important
c. Hx chemical dependency
iv. Sleep disorders
v. Personality disorders
vi. Coping patterns and resources
1. Passive and avoidant behavioral patterns or lack of active engagement in self management activities can contribute to diminished activity and perpetuation of chronic pain syndrome
2. Social support resources
a. Quality and nature of supportive relationships will influence pain-related adjustment
3. Meaning of pain to the person, distress caused by the pain
4. Spirituality A medical patient with chronic pain who identifies him or herself as a spiritual being will report the link to divine help as empowering them to use strategies to heal themselves. "Is spirituality an important part of your life?"
5. Person's preferences and expectations/beliefs/myths about pain management methods
6. Person's preferences and response to receiving information related to his/her condition and pain

vii. Work and Disability issues
1 . "Are you working and where?
2. If no, why not?
3. If yes, do you enjoy your job?
Do you get along with your supervisor? (highly correlated with adverse outcomes (chronic pain and impairment)
Q stands for
Quality - _
a. What words does the person use to describe pain?
b. Nociceptive pain may be sharp, dull, stabbing, or pressure like
c. Neuropathic pain descriptions often have an electrical quality such as burning, lancinating, tingling, lightning-like
R stands for
Radiation -Does the pain extend from the site?
a. Both nociceptive and neuropathic pain may radiate
b. Neuropathic pain tends to radiate in a distribution that follows nerves
c. Nociceptive pain radiates in less obvious ways
S stands for
8. Severity/Suffering
a. Use a pain scale 7-10 is severe
b. What impact is the pain having on the patient and families' lifestyle
c. associative factors (nausea, vomiting, constipation, sedation, confusion, depression)
ii. effects of pain (sleep and rest,
appetite, socialization and relationship, sexual activity, physical needs - ADL's, work, hobbies)
T stands for
9. Timing _
a. Pain is rarely the same all the time; find the pattern
i. Occasional. intermittent, constant
ii. Acute pain comes on rapidly and
dissipates rapidly
iii. Chronic pain has a base and
occasional spikes of incident pain
Describe the baseline functional ability assessment
1. Baseline functional ability assessment can provide objectively verifiable information about a patient's quality of life and ability to participate in normal life activities.
2. Information can then be used for
a. Identifying significant areas of impairment or disability
b. Establishing specific functional outcome goals within a care plan
c. Measuring the effectiveness of the care plan or treatment interventions
3. Standardized tools available, but personalized goal setting, such as regaining
ability to perform a specific job task, hobby or family activity, can also be used
4. Contributing factors to pain
d. Diagnostic Testing
i. PET Scan
ii. Plain radiography
iii. MRI and CT
e. Describe the impact of inadequately treated pain on physiological function, psychological status and quality of life.
f. Physiological function
1. Suppresses the immune response: suppresses the natural killer cells that defend the body against certain tumor cells and virus-infected cells
ii. Psychological status
iii. Quality of life
List some Nursing Diagnoses that
Analyze assessment data to determine pain diagnoses or problems
a. Pain, Chronic related to
b. Activity Intolerance related to
c. Risk for Ineffective Coping related
d. Risk for Powerlessness related to
e. Risk for Anxiety related to
f. Risk for Disturbed Sleep Pattern related to
g. Deficient Knowledge related to
h. Risk for Fear related to
Identify expected pain management outcomes for a plan individualized to the patient with pain
a. Determined as a team: client, physician, nurses,
family
b. Comfort Level
c. Depression Control
d. Depression Level
e. Pain Control
f. Pain: Disruptive Effects
g. Pain Level
h. Pain: Psychological Response
i. Goals need to be SMART
i. Specific
ii. Measurable
iii. Achievable
iv. Realistic
v. Time based
Planning
Develop a pain management plan that prescribes strategies and alternatives to attain expected outcomes
i. Again determined as a team including the person. "People who take an active role in their treatment tend to have better quality of life, reduce their sense of suffering, and feel more empowered." Penny Cowen, American Chronic Pain Association
ii. Teamwork and empathetic listening in the
development of a treatment plan is critical
c. Give individual and the family a copy of the
treatment plan
iv. 5 major elements of a treatment plan
1. Set personal goals
2. Improve sleep
3. Increase physical activity
4. Manage stress
5. Decrease Pain
Intervention: Implement the identified pain management plan
a. Attitudes toward pain and its treatment
b. What are some common misconceptions and myths about pain
Pain perception can accurately be correlated with vital sign changes and evidence of injury
ii. Patients in pain readily express their pain to
healthcare providers
iii. There is no physiological basis for the
moderating effects of emotions on pain perception
iv. Patients of certain cultural, ethnic, or
socioeconomic backgrounds consistently under-report or over-report pain
v. Opioids are addictive and a treatment of last resort because of unmanageable side effects
w. Patients experiencing chronic pain over-report
pain because they are addicted to opioids
vii. Children, older patients, and cognitively impaired
patients do not perceive pain as intensely as other patients
c. Common barriers to treatment
Biological
Comorbid
disease
Multiple allergies
Conflicting
therapies

Knowledge
Deficit
Lack of diagnosis
Misinformation -
e.g., from the
internet
Patient
expectations


Health Care
Provider/System
Health care
provider knowledge,
training,
inexperience in
chronic illness
Disease focus
rather than patient
focus
Time constraints

Behavioral
Passive patient
Low motivation
Unrealistic
expectations
Poor compliance
Chemical
dependency
Poor
communication

Social
Language barrier
Cultural barrier
Health system
obstacles
Time constraints
Lack of social
support
Regulatory fears
Financial

Insurance
Systems
Formulary
restrictions
Coverage
restrictions
Behavioral health
care-out systems
Health care
provider
reimbursement
List 6 Nursing Intervention Classifications that are used when a patient is in Chronic pain
i. Pain Management
ii. Mood Management
iii. Patient Contracting
iv. Medication Management
v. Behavior Modification
vi. Coping Enhancement
Describe the WHO analgesic ladder
If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used. To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand” This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective.
Risks associated with use of NSAIDS
1. Major risks associated with the use of NSAID's
a. gastric irritation and bleeding
b. renal failure
c. diminished platelet function
2. Acetaminophen may cause liver toxicity at high doses
Describe Breakthrough pain and what are the 3 causes of breakthrough pain
It is a brief, moderate to severe flare-up that occurs even when the patient is taking around the clock medication for persistent pain.
i. Incident pain is caused by movement or activity (Walking, standing, sitting, coughing, having a BM
ii. Spontaneous or Idiopathic pain
cannot be linked to a specific activity or associated with the timing of the A TC dose. It just happens.
iii. End of dose failure pain occurs
when serum drug levels of pain medication fall below the analgesic threshold at the end of a dosing interval. Some don't consider this a type of breakthrough pain because the dose of A TC medication should be adjusted and then it will no longer be a problem. (Need to increase ATC med) (around the clock)
Potential side effects of opioids such are
1. Sedation
2. Constipation
3. Nausea and vomiting
4. Itching
5. Respiratory depression - Safely administer naloxone (Narcan) as an antidote to opioids
What is the medication not recommended for chronic pain
1. Meperidine
2. Contraindicated in impaired renal function
Define: Tolerance, physical dependence, addiction and
pseudo-addiction; and clearly describe the differences between them.
1. Tolerance - Disease progression or a new pain syndrome is usually the reason an increased dosage is required.
2. Physical dependence - A physiological state in which the abrupt withdrawal or reduction of a drug causes withdrawal symptoms. Withdrawal symptoms can be prevented or minimized by withdrawing drugs slowly over a period of several days.
3. Psychological dependence - Also known as addiction, is a psychological condition characterized by a compulsive craving for excessive doses of a drug. Psychological dependence on opioids that are correctly prescribed for pain is extremely rare, even among patients who have taken opioids for years.
4. Pseudo-addiction - Is often mistaken for addiction by healthcare providers. A pattern of drug-seeking behavior in an attempt to gain pain relief is often a result of uncontrolled pain due to inadequate treatment. This pseudo-addictive behavior stops when pain relief is achieved
Anesthetic procedures used in the management
of chronic pain, indications and nursing implications
1. Local anesthetic infusions: On-Q
2. Nerve blocks
a. Trigger point
b. Joint and bursa injections
c. Extra-articular (bursa) injections
d. Intercostal blocks
3. Epidural catheters/intraspinal infusions
4. What is intrathecal drug delivery?
Medtronic's intrathecal drug delivery systems are composed of two implantable components: an infusion pump and an intraspinal catheter. The pump is placed abdominally in a subcutaneous pocket, while the catheter is inserted into the intrathecal space of the spine, tunneled under the skin and connected to the pump. Medication can be delivered at constant or variable flow rates.
What are the General principles that enhance optimal chronic pain management
1. Matching the choice of analgesic to the intensity and type of pain
2. Matching the frequency of administration to the duration of the medication's effect
3. The importance of around the clock dosing for constant pain
4. The use of breakthrough medications
5. Desirability of simplicity of modality and dosage schedule.
Non-pharmacologic physical interventions: Describe the role of the following in the management of chronic pain, their indications and nursing implications
Exercise fitness program [not for chronic malignant pain]
1. Cognitive behavioral approach with functional restoration can reduce pain and improve function
ii. Acupuncture
iii. TENS
iv. Surgical interventions
How should a nurse act when they are around someone who is in pain—How should the nurse present himself/herself
Presence as a nursing intervention
i. Demonstrate accepting attitude
ii. Verbally communicate empathy or
understanding of the patient's experience
iii. Be sensitive to the patient's traditions and
beliefs
iv. Establish trust and a positive regard
v. Listen to the patient's concerns
vi. Use silence, as appropriate
vii. Touch patient to express concern, as
appropriate
viii. Be physically available as a helper
ix. Remain physically present without expecting
interactional responses
x. Provide distance for the patient and family, as needed
xi. Offer to remain with patient during initial
interactions with others on the unit
xii. Help patient to realize that you are available, but
do not reinforce dependent behaviors
xiii. Stay with patient to promote safety and reduce
fear
xiv. Reassure and assist parents in their supportive
role with their child
xv. Stay with the patient and provide assurance of
safety and security during periods of anxiety
xvi. Offer to contact other support persons (e.g.
priest/rabbi), as appropriate
How is the pain management plan coordinated?
a. Communicate the pain assessment findings
to members of the interdisciplinary team b. Advocate on behalf of the person for changes to the treatment plan if pain is not being relieved. Support recommendations with appropriate evidence, providing a clear rationale for the need for change, including
i. Intensity of pain using a validated scale
ii. Change in severity pain scores in lasts 24 hours
iii. Change in severity and quality of pain following
administration of analgesic and length of time analgesic is effective
iv. Amount of regular and breakthrough pain
medication taken in last 24 hours
v. Person's goals for pain relief
vi. Effect of unrelieved pain on the person
vii. Absence/presence of side effects or toxicity
viii. Suggestions for specific changes to the
treatment plan that are supported by evidence
c. Instruct individual to
i. use a pain log or diary (provide a tool)
ii. Communicate unrelieved pain to their physician
d. Refer persons with chronic pain whose pain is not relieved after following standard principles of pain management to
i. A specialist skilled in "dealing with the particular type of pain
ii. A multidisciplinary team to address the complex
emotional, psycho/social, spiritual and concomitant medical factors involved.
What strategies can promote, maintain, and restore pain-relieving behaviors
a. Include patient and family in all aspects of pain management, especially through ongoing education about pain, assessment, treatment, and the common barriers to adequate management.
What are the outcomes of pain management and how is progress measured?
Reassess pain on a regular basis, according to the type and intensity of pain and the treatment plan
i. At each new report of pain and new procedure, when intensity increases, and when pain is not relieved by previously effective strategies
ii. After the intervention has reached peak effect
1. 15-30 minutes after parenteral drug therapy
2. 1 hour after immediate release analgesic
3. 4 hours after sustained release analgesic or transdermal patch
4. 30 minutes after non-pharmacological intervention
iii. With unexpected intense pain, particularly if sudden or associated with altered vital signs such as ypotension, tachycardia, fever
What are the 9 standards of professional performance, and describe these briefly.
a. Quality of Practice Systematically evaluate the quality and effectiveness of pain management practice.
b. Education Attain knowledge and competency that reflects current pain management nursing practice.
c. Professional Practice Evaluation Systematically evaluate their own nursing practice in relation to professional pain practice standards and guidelines, relevant statutes, rules and regulations.
d. Collegiality Interact with, and contribute to the professional development of peers and colleagues.
e. Collaboration Collaborate with patient, family, and others in the conduct of pain management nursing practice.
f. Ethics Integrate ethical provisions to guide pain management practices.
g. Report situations of unrelieved pain as an ethical responsibility using all appropriate channels of communication in the organization, including individual/care provider documentation
h. Research Integrate pain research findings into clinical practice.
i. Resource Utilization Consider factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of pain management.
j. Leadership Provide leadership in professional pain management.
k. Maintain awareness of policy initiatives related to pain management at the local, state, national and international levels
Family members are encouraging your client to "tough it out" rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the family's wishes. Priority nursing interven¬tions for this client should target which dimension of pain?
1. Sensory
2. Affective
3. Sociocultural
4. Behavioral
6. Cognitive
3.
The family is part of the sociocultural dimension of pain. they are influencing the client and should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand the overall treatment plan and pain medication
A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain?
1. amitriptyline (Elavil)
2. corticosteroids
3. methylphenidate (Ritalin)
4. lorazepam (Ativan)
Answer 1
Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic
Which client is most likely to receive opioids for extended periods of time?
1. A client with tibromyalgia
2. A client with phantom limb pain
3. A client with progressive pancreatic cancer
4. A client with trigeminal neuralgia
3
Cancer pain generally worsens with the disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and aduvant medications. trigeminal neuralgia is treated with anti-seizure meds such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins
In caring for a young child with pain, which assessment tool is the most useful?
1. Simple description pain intensity scale
2. 0-10 numeric pain scale
3. Faces pain-rating scale
4. McGill-Melzack pain questionnaire
3
The faces pain rating scale (depicting smiling, neutral, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal desecriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary
In applying the principles of pain treatment, what is the first consideration?
1. Treatment is based on client goals.
2. A multidisciplinary approach is needed.
3. The client must be believed about perceptions of own pain.
4. Drug side effects must be prevented and managed.
3
the client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to the other options in developing the treatment plan.
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
1. Intraspinal
2. Patient-controlled analgesia (peA)
3. Intravenous (IV)
4. Sublingual
3
The IV route is preferred as the fastest and most amenable to titration. A PCA bolus can be delivered; however, the pump will limit the dosage that can be delivered unless the paramaters are changed. Intraspinal administration requires special catheter placement and there are more potential complications with this route. Sublingual is reasonably fast, but not a good route for titration, and the medication variety in this form is limited
When titrating an analgesic to manage pain, what is the priority goal?
1. Administer smallest dose that provides relief with the fewest side effects.
2. Titrate upward until the client is pain free.
3. Titrate downwards to prevent toxicity.
4. Ensure that the drug is adequate to meet the client's subjective needs.
1
The goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated upward until the pain is controlled. Downward titration occurs when the pain begins to subside. Adequate dosing is important however, the concept of controlled dosing applies more to potent vasoactive drugs
Place the examples of drugs in the order of usage according to the World Health Organization (WH 0) analgesic ladder.
1. morphine, hydromorphone, acetaminophen, and lorazepam
2. NSAIDs and corticosteroids
3. codeine, oxycodone, and diphenhydramine
Answer: 2,3,1
Step 1 includes nonopioids and adjuvant drugs
Step 2 includes opioids for mild pain plus step 1 drugs and adjuvant drugs as needed
Step 3 includes opioids for severe pain (replacing step 2 opioids) and continuing step 1 drugs and adjuvant drugs as needed
Which client is at greatest risk for respiratory depression while receiving opioids for analgesia?
1. An elderly chronic pain client with a hip fracture
2. A client with a heroin addiction and back pain
3. A young female client with advanced multiple myeloma
4. A child with an arm fracture and cystic fibrosis
4
the greatest risk are elderly clients, opiate naive clients, and those with underlying pulmonary disease. The child has two of the three risk factors.
23. A client appears upset and tearful, but denies pain and refuses pain medication, because "my sib¬ling is a drug addict and has ruined our lives." What is the priority intervention for this client?
1. Encourage expression of fears and past experiences.
2. Provide accurate information about use of pain medication.
3. Explain that addiction is unlikely among acute care clients.
4. Seek family assistance in resolving this problem.
1
This client has strong beliefs and emotions related to the issue of the sibling's addiction. First, encourage expression. This indicates to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Fiving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.
A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
1. Fever
2. Nausea
3. Diaphoresis
4. Abdominal cramps
3
Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours
The physician has ordered a placebo for a chronic pain client. You are a newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?
1. Prepare the medication and hand it to the physician.
2. Check the hospital policy regarding use of the placebo.
3. Follow a personal code of ethics and refuse to give it.
4. Contact the charge nurse for advice.
4
The charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delayng the administration does not endanger the health or safety of the client. While following ones own ethical code is correct, you must ensure that the client is not abandoned and that care continues
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
1. Closely assess for nonverbal signs such as grimacing or rocking.
2. Obtain baseline behavioral indicators from family members.
3. Look at the MAR and chart, to note the time of the last dose and response.
4. Give the maximum PRN dose within the minimum time frame for relief.
2 Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
1. Oral
2. Transdermal
3. PCA
4. IV
5. IM or subcutaneous
1. oral
If the gastrointestinal system is functional, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower an the medication availability is limited compared to oral forms
A first day post-operative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
1. Deliver the bolus dose per standing order.
2. Contact the physician to increase the dose.
3. Try non-pharmacological comfort measures.
4. Assess the pain for location, quality, and intensity.
4 Assess the pain for location, quality and intensity
Also assess changes in response to medication. this assessment will guide the next steps.
What is the best way to schedule medication for a client with constant pain?
1. PRN at the client's request
2. Prior to painful procedures
3. IV bolus after pain assessment
4. Around-the-clock
4.
If the pain is constant, the best schedule is around the clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
For a client who is taking aspirin, which laboratory value should be reported to the physician?
1. Potassium 3.6 mEq/L
2. Hematocrit 41 %
3. PT 14 seconds
4. BUN 20 mg/dL
3
When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds or 85-100%). Also monitor for possible decreases in potassium (normal range 3.5-5 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42-52%, female 37-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).
A family member asks you, "Why can't you give more pain medicine? He is still having a lot of pain." What is your best response?
1. "The doctor ordered the medicine to be given every 4 hours."
2. "If the medication is given too frequently he could suffer ill effects."
3. "Please tell him that I will be right there to check on him. "
4. "Let's wait about 30-40 minutes. If there is no relief I'll call the doctor."
3
Directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.