Nursing 120 - Test 4- Olol- Comfort & Pain

Front 1

Comfort is?

Back 1

1. subjective in nature
2. concept central to the art of nursing
3.ultimate goal of pain interventions

Front 2

When was comfort/pain relief declared a legal right?

Back 2

by the American Bar Assoc. in 2000

Front 3

Pain is?

Back 3

1. subjective in nature
2. can only be quantified by the client
3. pain scale used to evaluate effectiveness of interventions

Front 4

Physiology of Pain

Back 4

a. transduction
b. transmission of impulse
c. perception
d. modulation
e. release of:

Front 5

Physiology of Pain: Transduction

Back 5

conversion of pain stimuli energy into electrical energy

Front 6

Physiology of Pain: Perception

Back 6

awareness of pain-psychological and cognitive factors act here

Front 7

Physiology of Pain: Modulation

Back 7

inhibition of pain impulse

Front 8

Physiology of Pain: Release

Back 8

of inhibitory neurotransmitters, endogenous opioids, serotonin, norepinephrine, gamma aminobutyric acid (GABA), producing an analgesic effect

Front 9

Physiology of Pain: Neurotransmitters

Back 9

1.Substance P
2.Serotonin
3.Prostaglandins

Front 10

Substance P is?

Back 10

found in pain neurons, needed to transmit pain impulses, causes vasodilation

Front 11

Serotonin is?

Back 11

released from brain stem & dorsal horn

Front 12

Prostaglandins are?

Back 12

generated from the breakdown of phospholipids; believed to increase sensitivity to pain-inflammatory, alert response

Front 13

Physiology of Pain: Neuromodulators

Back 13

1. Endorphins & dynorphins
2. Bradykinin

Front 14

Endorphins & dynorphins are?

Back 14

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)

Front 15

Bradykinin is?

Back 15

released from plasma at site of tissue injury; binds to receptors on peripheral nerves; binds to cells that cause the chain reaction production prostaglandins

Front 16

Wall & Malzack's Gate-Control Theory of Pain

Back 16

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

Front 17

Pain relief measures

Back 17

when you control and close the gate then you have found the right med or method

Front 18

Pain Threshold

Back 18

the point at which a person feels pain

Front 19

Client Responses: Physiological responses

Back 19

1. low-moderate & superficial pain elicit fight or flight
2. The brain & body eventually adapt

Front 20

Client Responses: Behavioral Responses

Back 20

1. Pain threatens physical & psychological well-being
2. Is under reported, anticipated in chronic conditions, tolerated differently by each individual

Front 21

Types of Pain

Back 21

1. Acute pain
2. Chronic pain
3. Cancer pain
4. pain by inferred pathology
5. idiopathic pain

Front 22

Factors that Influence Pain

Back 22

1. Physiological factors
2. Social Factors
3. Spiritual Factors
4. Psychological Factors
5. Cultural Factors
(see notes for each)

Front 23

Nursing Process: Assessment of Comfort Level: characteristics of pain

Back 23

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

Front 24

Nursing Process: Nursing Diagnosis

Back 24

1. Anxiety
2. Ineffective coping
3. Fatigue
4. Acute pain
5. Chronic pain
6. Ineffective role performance
7. Disturbed sleep pattern

Front 25

Nursing Process: Planning

Back 25

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

Front 26

Nursing Process: Implementation

Back 26

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

Front 27

Nursing Process: Implementation: Health Promotion

Back 27

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

Front 28

Nursing Process: Implementation: Client Education

Back 28

understanding intervention use; evaluation of effectiveness; safety
a. Holistic care- may be more than physical pain; all possibilities should be explored and addressed

Front 29

Nursing Process: Implementation: Nonpharmacological Pain Relief

Back 29

a. Relaxation & guided imagery
b. distraction
c. biofeedback
d. cutaneous stimulation-massage, application of hot/cold, TENS
e. herbals
f. reducing painful stimuli & perception

Front 30

Nursing Process: Implementation: Controlling Painful Stimuli

Back 30

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

Front 31

Nursing Process: Implementation: Comfort Measures

Back 31

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

Front 32

Nursing Process: Implementation: Other Comfort Measure Considerations

Back 32

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

Front 33

Nursing Process: Implementation: Barriers to Effective Pain Mgmt

Back 33

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

Front 34

Nursing Process: Implementation: Restorative Care

Back 34

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

Front 35

Nursing Process: Evaluation

Back 35

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

Front 36

This organization declared pain relief a basic legal right?

Back 36

American Bar Association-

Front 37

Pain is viewed as a?

Back 37

separate disease

Front 38

This type of pain lasts longer than anticipated, may not have a identifiable cause, and leads to great personal suffering?

Back 38

Chronic pain

Front 39

One of the reasons many nurses avoid acknowledging a client's pain is?

Back 39

fear that the intervention may cause addiction- a common biase and misconception

Front 40

Cognitively this age-group is unable to recall explanations about pain or associate pain with exsperiences that can occur in various situations?

Back 40

Preschoolers-unable to recall explanations about pain or associate pain with experiences that can occur in various situations

Front 41

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?

Back 41

assess and document physical and behavioral data-by assessing the client's withdrawal from communication, grimacing and moaning, as well as verbalization of discomfort

Front 42

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?

Back 42

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

Front 43

Approx. 30 min, after admin. a complementary trtmt such as heat therapy or back massage, the nurse should?

Back 43

evaluate the effectiveness of the treatment-

Front 44

A preventive approach for acute pain relief means that analgesic meds are given?

Back 44

before the pain becomes severe

Front 45

One of the reasons that pt-controlled analgesia (PCA) pumps are frequently used for postoperative pain mgmt is to?

Back 45

encourage the use of pain meds before the client experiences severe pain

Front 46

Because of the high discomfort level during the transition phase of labor, nursing care should be directed toward:

Back 46

1. admin.meds
2. helping the clt maintain control
3. decreasing the rate of IV
4. having the clt breathe in uniform patterns

Front 47

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?

Back 47

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

Front 48

When a client who had an above-the knee amputation complains of phantom limb sensations, the nursing staff should?

Back 48

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

Front 49

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?

Back 49

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

Front 50

Which of the following definitions best describes dysuria?

Back 50

--Urine containing pus
--Voiding during normal sleeping hours
--Painful voiding usually associated with UTI
--Formation and excretion of decreased amounts of urine

Front 51

The nurse should advise the patient which of the following when the patient is complaining of early morning stiffness associated with rheumatoid arthritis?

Back 51

--Take aspirin before bedtime
--Take a hot bath or shower in the morning
--Use Icy Hot liberally
--Sleep with legs elevated

Front 52

the primary reason for administering morphine to a client with a myocardial infarction?

Back 52

1. for sedation
2. to decrease pain
3. to decrease anxiety
4. to decrease oxygen demand on the heart

Front 53

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.

Back 53

A. Adjust the room temperature
B. Give a bolus of IV fluids
C. Start O2
D. Administer meperidine (Demerol) 75mg IV push

Front 54

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

Back 54

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