Nur 111 Exam 2

Front 1

Pain

Back 1

"Pain is whatever the person experiencing pain says it is, existing wheneer he/she says it does."
It is one of the body's defense mechanisms that indicates the person is experiencing a problem.

Front 2

Acute Pain

Back 2

Generally rapid in onset, varies in intensity from mild to severe. It warns the individual of tissue damage or organic disease. (causes include pricked finder, sore throat, surgery)

Front 3

Chronic pain

Back 3

May be limited, intermittent, or persistent but that lasts beyond the normal healing period.

Front 4

Remission

Back 4

When the disease is present but the person does not experience symptoms

Front 5

Exacerbation

Back 5

The symptoms reappear.

Front 6

Intractable Pain

Back 6

Does not go away. It is resistant to therapy and persists despite a variety of interventions.

Front 7

Cutaneous Pain

Back 7

Superficial cut (Paper cut)

Front 8

Deep Somatic Pain

Back 8

Diffuse or scattered and originates in tendons, ligaments, bones, blood vessels and nerves.

Front 9

Visceral Pain

Back 9

Poorly localized and originates in body organs in the thorax, cranium, and abdomen.

Front 10

Referred Pain

Back 10

Can originate in one part of the body but be perceived in an area distant from its point of origin

Front 11

Radiating Pain

Back 11

Pain that radiates down a direct path.

Front 12

Phantom pain

Back 12

The pain that is often referred to an amputated leg where receptors and nerves are clearly absent is a real experience.

Front 13

Psychogenic pain

Back 13

Physical cause for the pain cannot be identified.

Front 14

Transduction

Back 14

The activation of pain receptors. It involves conversion of painful stimuli into electrical impulses that travel from the periphery to the spinal cord at the dorsal horn.

Front 15

Nociceptors

Back 15

The peripheral nerve fibers that transmit pain.

Front 16

Neurotransmitters

Back 16

Substances that either excite or inhibit target nerve cells

Front 17

Mechanical stimulants

Back 17

Friction from bed linens and pressure from a cast

Front 18

Thermal stimulants

Back 18

Sunburn and cold water on a tooth

Front 19

Chemical stimulant

Back 19

An acid burn

Front 20

Electrical stimulant

Back 20

The jolt of a static charge

Front 21

Transmission

Back 21

Pain sensations from the site of an injury or inflammation are conducted along pathways to the spinal cord and then on to high centers.

Front 22

Protective Pain reflex

Back 22

Responsible for withdrawal of an endangered tissue from a damaging stimulus.

Front 23

Perception

Back 23

Involves the sensory process that occurs when a stimulus for pain is present.

Front 24

Pain Threshold

Back 24

The lowest intensity of a stimulus that causes a subject to recognize pain. Studies show that women have lower ones than men.

Front 25

Modulation

Back 25

The process by which the sensation of pain is inhibited or modified.

Front 26

Neuromodulators

Back 26

The sensation of pain appears to be regulated or modified by these substances, which are endogenous oploid compounds, meaning they are naturally present, mophine-like chemical regulators in the spinal cord and brain.

Front 27

Endorphins

Back 27

Are produced at neural synapses at various points along the CNS pathway. They are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria..

Front 28

Gate Control Theory

Back 28

Recognizes the relationship btwn pain and emotions. Explains that excitatory pain stimuli carried by small-diameter nerve fibers can be blocked by inhibiting signals carried by large-diameter nerve fibers. The exciting and inhibiting signals at the gate in the spinal cord determine the impulses that eventually reach the brain, when too much information is sent through, certain cells in the spinal column interrupt the signal as if closing the gate.

Front 29

Behavior Responses to pain

Back 29

Moving away from pain stimuli, grimacing, moaning, and crying. Restlessness & protecting the painful area & refusing to move

Front 30

Physiologic Responses -sympathetic

Back 30

Increased BP, Increased pulse & respiratory rate, pupil dilation,"", muscle tension and rigidity, pallor, increased adrenaline output, increased blood glucose. (Increased vital signs only occur briefly in acute pain, may not be present in chronic pain.)

Front 31

Physiologic responses-parasympathetic

Back 31

nausea & vomiting, fainting or unconsciousness, decreased BP, decreases pulse rate,"", Prostration, rapid and irregular breathing.

Front 32

Psychological/Affective responses

Back 32

Exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness.

Front 33

Factors influencing pain

Back 33

Culture & ethnic
Family, gender, and age
Religious beliefs
Environment & support people
Anxiety
Past pain experience
Fatigue
Misconceptions

Front 34

Culture and ethnic

Back 34

Be knowledgeable about cultural variations and develop an understanding of cultural influences on pain tolerance, expressions of pain, and alternative practices used to manage pain. Do not stereotype

Front 35

African-Americans

Back 35

Pain viewed as a sign of illness or disease. Believe pain and suffering are inevitable, spiritual and religious beliefs contribute to a high tolerance for pain, some believe that praying and laying on hands may aid from pain and suffering.

Front 36

Arab-Americans

Back 36

View pain as unpleasant & something that should be controlled, express pain openly w/family members but more restrained in from of health professionals. Usually expect positive response from medical interventions to control pain.

Front 37

Chinese Americans

Back 37

Expressions off pain are usually similar to americans. Believe pain is related to imbalances of yin and yang. Cope w/pain with oils and massages, as well as warmth, sleeping on the area of pain, relaxation, and aspirin.

Front 38

Greek Americans

Back 38

Pain (ponos) viewed as an evil that needs to be eradicated. Shared w/family. Family is considered a resource for pain relief because they act as advocates and provide emotional support.

Front 39

Mexican Americans

Back 39

Delay seeking medical pain and hope instead that it will go away. consider it a necessary part of life. Seem to experience more pain than other ethnic groups but report it less frequently, often see a relationship btwn pain & suffering and immoral behavior.

Front 40

Navajo Indians

Back 40

Do not usually openly express their pain or request pain medication. They mask actual intensity of pain, may prefer herbal medicines and use them w/o the knowledge of healthcare provider.

Front 41

Family, Gender, and Age Variables

Back 41

An individuals response to pain may be affected or influence by the response of family members. Women are more comfortable communicating pain, but this ability may cause some to view the pain as emotionally or psychologically based. Infants and small children are sensitive to and experience pain. Among Older people, pain is often viewed as a natural component of the aging process, being ignored or under treated by HC providers.

Front 42

Religious beliefs

Back 42

Can be a powerful influence on the indvs experience of pain. In some, pain & suffering can be viewed as a "lack of goodness" in themselves. Patients may refuse relief measures. In others it can be viewed as punishment from a vengeful God. Anger, resentment and depression may compound the pain pain experience.

Front 43

Environment and support People

Back 43

People in a critical care unity compounds the experience of pain. Depersonalization from a fave pillow, pet or other source may further decrease the person's sense of comfort. For some the presence of a loved one is essential to their sense of well-being, while others prefer to be alone.

Front 44

Anxiety

Back 44

Is almost always present when pain is anticipated or being experienced, tends to increase the perceived intensity of pain.

Front 45

Fatigue

Back 45

Pain may be aggravated with fatigue. The rested and relaxed person can often cope with more discomfort than someone who is suffering from fatigue.

Front 46

Past Pain Experience

Back 46

Some who have never known severe pain and have no fear of pain don't realize how intense the sensation can be. In general, people who have experienced more pain than usual tend to anticipate more pain and exhibit increased sensitivity to pain. Some who have experience severe pain and unable to secure relief can have acute feelings of fear, despair, and hopelessness to the thought of new pain.

Front 47

Misconceptions

Back 47

If i ask for something for pain, i may become addicted to it.. Sometimes it is better to put up with pain than to deal w/side effects; It is immature to talk about pain; I should wait until the pain gets really bad before I ask for help; It is natural to have pain after surgery.

Front 48

Assessment: Focused assessment

Back 48

When? On admission, and continued ongoing
How? Physiologic responses, behavior responses. LDQQCA

Front 49

OLD AIR QRST

Back 49

Tools
O: onset
L: location
D: duration
A: aggravating/alleviating factors
I: intensity
R: relief measuresP: what precipitated the pain or pattern
Q: what is the quality?
R: what is its region? Radiates?
S: what is the severity
T: what it its timing. When does it begin, how
long does it last, and how is it related to other
events in your life?

Front 50

ABCDE “Clinical Approach”

Back 50

Ask~about pain regularly.~Assess pain systematically.
~Believe~the client and family in their report of pain and what relieves it.
Choose~pain control options appropriate for the client, family, and setting.
Deliver~interventions in a timely, logical, and coordinated fashion.
Empower~clients and their families. Enable them to control their course to the greatest extent possible.

Front 51

Nursing Diagnosis

Back 51

Is it Acute or Chronic?
What type of pain?
What are the etiologic factors?
What type of response?
What other factors are affecting pain process?

Front 52

Nursing Planning/Intervention

Back 52

Developing a plan of care that, when implemented, demonstrates nursing's commitment to assist the patient to develop effective main management strategies.
Ex. of Patient Outcome: The patient will describe a gradual reduction of pain, using a scale ranging from 0-10.

Front 53

Implementation

Back 53

The nurse implements the nursing strategies that are most likely to assist the patient to achieve pain relief outcomes.

Front 54

Mind-Body Intervention: using the powers of the mind to produce changes in the body.

Back 54

Help with chronic pain by reducing stressful emotions such as panic and fear, and by refocusing attention on subjects other than pain. (meditation, guided imagery, biofeedback, relaxation)

Front 55

Nutritional and herbal remedies

Back 55

For chronic pain especially abdominal, headaches and inflammatory conditions (RA) Helps by boosting the body's natural immunity, reducing pain-causing inflammation, soothing pain, and decreasing insomnia.
(anti-inflammatory diet, omega-3 fatty acids, ginger, turmeric, MSM)

Front 56

Energy Healing: Manipulating the electric energy

Back 56

Helps pain that lingers after an injury heals, as well as pain complicated by trauma, anxiety, or depression by relaxing the body & mind, distracting the nervous system, producing natural painkillers, activating natural pleasure centers, and manipulating. (Acupuncture, Acupressure, Chi gong, Reiki)

Front 57

Physical Manipulation: Cutaneous stimulation

Back 57

Hands on massage or movement of painful areas Helps muskoskeletal pain and pain from adhesions or scars by restoring mobility, improving circulation, decreasing BP, and relieving stress. (Massage, Chiropractic, Osteopathy)

Front 58

Pain tolerance

Back 58

The point beyond which a person is no longer willing to endure pain.

Front 59

Analgesic

Back 59

is a pharmaceutical agent that relieves pain.. Function to reduce the person's perception of pain and to alter the person's responses to discomfort.

Front 60

Nonopoid analgesics

Back 60

Acetaminophens (Tylenol) & NSAIDs ( (ibuprofen (Motrin); ketorolac (Toradol); naproxen (Naprosyn); celecoxib (Celebrex) )

Side Effects: Gastric side effects

Front 61

Opoid

Back 61

all controlled substances morphine,"", codeine,"", meperidine, hydromorphone, methadone.
((Morphine sulfate; Hydrocodone (Vicodin; Lortab); Hydromorphone (Dilaudid); Fentanyl (Duragesic);
Oxycodone (OxyContin) )

Side Effects: Sedation, nausea, and constipation.

Front 62

Adjuvant drugs

Back 62

Enhance the effects of oploids: lessen side effects (anticonvulsants, antidepressants, multipurpose drugs)

Front 63

Administration

Back 63

PRN-as needed
Patient-Controlled Analgesia (PCA)
Epidural analgesia

Front 64

PRN

Back 64

As needed drug regimen has not been proven effective for people experiencing acute pain.

Front 65

PCA

Back 65

Patient controlled analgesia provides effective individualized analgesia and comfort. Used to manage chronic pain in a HC facility or home. Relieve pain associated with operative procedures such as labor & delivery, trauma, and cancer. (morphine, fentanyl, hydromorphone)

Front 66

Epidural analgesia

Back 66

Used to provide pain relief during the immediate postoperative phase particlarly after thoracic, abdominal,"", orthopedic, and vascular surgery) Morphine or Fentanyl

Front 67

Physical dependence

Back 67

A state of adaptation manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. (American Pain Society)

Front 68

Tolerance

Back 68

A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.( American Pain Society)

Front 69

Addiction

Back 69

A primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It’s characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continues use despite harm, and craving. (American Pain Society)

Front 70

Evaluation

Back 70

Becomes ongoing. Its directed towards the changing nature of the pain experience, the treatment modalities,"", and family's response to the plan of care.