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54 Cards in this Set

  • Front
  • Back
Comfort is?
1. subjective in nature
2. concept central to the art of nursing
3.ultimate goal of pain interventions
When was comfort/pain relief declared a legal right?
by the American Bar Assoc. in 2000
Pain is?
1. subjective in nature
2. can only be quantified by the client
3. pain scale used to evaluate effectiveness of interventions
Physiology of Pain
a. transduction
b. transmission of impulse
c. perception
d. modulation
e. release of:
Physiology of Pain: Transduction
conversion of pain stimuli energy into electrical energy
Physiology of Pain: Perception
awareness of pain-psychological and cognitive factors act here
Physiology of Pain: Modulation
inhibition of pain impulse
Physiology of Pain: Release
of inhibitory neurotransmitters, endogenous opioids, serotonin, norepinephrine, gamma aminobutyric acid (GABA), producing an analgesic effect
Physiology of Pain: Neurotransmitters
1.Substance P
Substance P is?
found in pain neurons, needed to transmit pain impulses, causes vasodilation
Serotonin is?
released from brain stem & dorsal horn
Prostaglandins are?
generated from the breakdown of phospholipids; believed to increase sensitivity to pain-inflammatory, alert response
Physiology of Pain: Neuromodulators
1. Endorphins & dynorphins
2. Bradykinin
Endorphins & dynorphins are?
body's natural supply of morphinelike substances; activated by stress & pain; located within the brain, spinal cord & GI tract; cause analgesia when attaching to opiate receptors; present in higher levels in people who have less pain (higher pain tolerance)
Bradykinin is?
released from plasma at site of tissue injury; binds to receptors on peripheral nerves; binds to cells that cause the chain reaction production prostaglandins
Wall & Malzack's Gate-Control Theory of Pain
1. 1965
2. no specific pain center in nervous system
3. pain has obligatory physical, emotional & cognitive components
4. gating mechanisms along the CNS
5. pain passes through open gate
6. pain relief measure to close the gate
a. Pain threshold
Pain relief measures
when you control and close the gate then you have found the right med or method
Pain Threshold
the point at which a person feels pain
Client Responses: Physiological responses
1. low-moderate & superficial pain elicit fight or flight
2. The brain & body eventually adapt
Client Responses: Behavioral Responses
1. Pain threatens physical & psychological well-being
2. Is under reported, anticipated in chronic conditions, tolerated differently by each individual
Types of Pain
1. Acute pain
2. Chronic pain
3. Cancer pain
4. pain by inferred pathology
5. idiopathic pain
Factors that Influence Pain
1. Physiological factors
2. Social Factors
3. Spiritual Factors
4. Psychological Factors
5. Cultural Factors
(see notes for each)
Nursing Process: Assessment of Comfort Level: characteristics of pain
a. onset and duration
b. location
c. intensity-scale
d. quality
e. pattern
f. relief measures
g. contributing symptoms
h. behavioral effects on the client
i. influences on ADLs
Nursing Process: Nursing Diagnosis
1. Anxiety
2. Ineffective coping
3. Fatigue
4. Acute pain
5. Chronic pain
6. Ineffective role performance
7. Disturbed sleep pattern
Nursing Process: Planning
A. Goals & outcomes
1. pain relief measures are effective
2. client is using pain relief measures safely
3. client understands how to rate pain to evaluate continued relief
B. Setting priorities
C. Continuity of care
Nursing Process: Implementation
A. Health promotion
B. Client Education
C. nonpharmacological Pain Relief
D. Controlling Painful Stimuli
E. Comfort Measures
F. Other Comfort measure considerations
G. Barriers to effective pain management
H. Restorative Care
Nursing Process: Implementation: Health Promotion
1. nonpharmacological pain-relief interventions:
a. relaxation & guided imagery
b. distraction
c. biofeedback
d. cutaneous stimulation
2. Acute care- analgesics; NSAIDs, Opioids, adjuvants, PCA pumps, Local, regional & topical analgesics
Nursing Process: Implementation: Client Education
understanding intervention use; evaluation of effectiveness; safety
a. Holistic care- may be more than physical pain; all possibilities should be explored and addressed
Nursing Process: Implementation: Nonpharmacological Pain Relief
a. Relaxation & guided imagery
b. distraction
c. biofeedback
d. cutaneous stimulation-massage, application of hot/cold, TENS
e. herbals
f. reducing painful stimuli & perception
Nursing Process: Implementation: Controlling Painful Stimuli
a. managing the client's environment-bed, linens, temp.
b. positioning
c. changing wet clothes and dressings
d. monitoring equipment, bandages, hot and cold applications
e. preventing urinary retention & constipation
Nursing Process: Implementation: Comfort Measures
Pharmacological pain relief:
a. analgesics: NSAIDs & non-opioids, opioids, adjuvants
b. patient-controlled analgesia (PCA)
c. local analgesic infusion pump
d. topical analgesics & anesthetics
e. local and regional anesthetics
Nursing Process: Implementation: Other Comfort Measure Considerations
a. Surgical ingterventions- may be used to correct or repair source of pain; can cause pain stimulus
b. Procedural pain mgmt-prophylactic intervention, if possible; as soon after a procedure, if needed
c. Chronic & cancer pain mgmt-various agents; different principles from acute care
Nursing Process: Implementation: Barriers to Effective Pain Mgmt
Lesser understanding of physical dependence & addiction
a. fear of addiction
b. can lead to under use of meds & ineffective relief
c. misconceptions by health care providers & clients
d. separate physical dependency from addiction
e. drug tolerence does not constitute addiction
Nursing Process: Implementation: Restorative Care
a. Pain clinics
1. bad reputations-holy trinity-Soma, Lortab, Xanax
2. some are reputable & effective
3. caution & client teaching
b. Palliative care- teams that help clients & families manage pain of incurable conditions
c. Hospices-programs of care for clients at end of life regardless of disease or condition
Nursing Process: Evaluation
A. Client care
1. behavioral responses not always obvious
2. nurse must be an intent observer
3. physiological & psychological responses must be evaluated
B. Client expectations
1. effective communication
2. safe relief
This organization declared pain relief a basic legal right?
American Bar Association-
Pain is viewed as a?
separate disease
This type of pain lasts longer than anticipated, may not have a identifiable cause, and leads to great personal suffering?
Chronic pain
One of the reasons many nurses avoid acknowledging a client's pain is?
fear that the intervention may cause addiction- a common biase and misconception
Cognitively this age-group is unable to recall explanations about pain or associate pain with exsperiences that can occur in various situations?
Preschoolers-unable to recall explanations about pain or associate pain with experiences that can occur in various situations
An 82-yr old man with Alzheimer's disease is restless and moaning. The client's daughter states the client did not sleep well most of the night. The nurses first response would be to?
assess and document physical and behavioral data-by assessing the client's withdrawal from communication, grimacing and moaning, as well as verbalization of discomfort
The client requested meds for her abd. incision pain, which she rates a 5. 1 hr after admin. of pain meds, she was able to walk in the hall for 10 min. & rated her pain as a 7. This indicated that the dosage of pain meds. was?
insufficient- descriptive pain scales are useful not only in assessing the severity of pain, but also in evaluating changes in a client's condition. A rating of 7 or mor on a 0-10 scale requres immediate attention
Approx. 30 min, after admin. a complementary trtmt such as heat therapy or back massage, the nurse should?
evaluate the effectiveness of the treatment-
A preventive approach for acute pain relief means that analgesic meds are given?
before the pain becomes severe
One of the reasons that pt-controlled analgesia (PCA) pumps are frequently used for postoperative pain mgmt is to?
encourage the use of pain meds before the client experiences severe pain
Because of the high discomfort level during the transition phase of labor, nursing care should be directed toward:
1. admin.meds
2. helping the clt maintain control
3. decreasing the rate of IV
4. having the clt breathe in uniform patterns
A clt in active labor is rushed from the emergency svc to the labor and birth suite screaming "knock me out". examination reveals that her cervix is 9 cm dilated. while trying to calm her, the nurse should respond?
1. I'll rub your back which will help ease your pain
2. you will get a shot when you reach the birthing room
3. i'm sure you're in pain, but try to bear with it for the baby's sake
4. medication may interfere with the baby's 1st breaths, try to bear the pain
When a client who had an above-the knee amputation complains of phantom limb sensations, the nursing staff should?
1. reassure the client that these sensations will pass
2. encourage the client to get involved in diversional activities
3. explain the psychological component involved to the client
4. describe the neurological mechanisma in language the client understands
A client with multiple sclerosis is informed that it is a chronic progressive neurologic condition. The client asks the nurse, "Will I experience pain?" The nurses best response would be?
1. tell me about your fears regarding pain
2. analgesics will be ordered to control the pain
3. let's make a list of the things you need to ask the physician
4. pain is not a characteristic symptom of this disease process
Which of the following definitions best describes dysuria?
--Urine containing pus
--Voiding during normal sleeping hours
--Painful voiding usually associated with UTI
--Formation and excretion of decreased amounts of urine
The nurse should advise the patient which of the following when the patient is complaining of early morning stiffness associated with rheumatoid arthritis?
--Take aspirin before bedtime
--Take a hot bath or shower in the morning
--Use Icy Hot liberally
--Sleep with legs elevated
the primary reason for administering morphine to a client with a myocardial infarction?
1. for sedation
2. to decrease pain
3. to decrease anxiety
4. to decrease oxygen demand on the heart
1. A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client. The client is complaining of severe pain in his feet and hands. The pulse oximetry is 92. Which of the following interventions would be implemented first? Assume that there are orders for each intervention.
A. Adjust the room temperature
B. Give a bolus of IV fluids
C. Start O2
D. Administer meperidine (Demerol) 75mg IV push
2. The client with suspected meningitis is admitted to the unit. The doctor is performing an assessment to determine meningeal irritation and spinal nerve root inflammation. A positive Kernig's sign is charted if the nurse notes
A. Pain on flexion of the hip and knee
B. Nuchal rigidity on flexion of the neck
C. Pain when the head is turned to the left side
D. Dizziness when changing positions