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82 Cards in this Set
- Front
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Pain is defined as an unpleasant sensory and emotion experience associated with
A. actual tissue damage B. actual or potential tissue damage C. observable pain behaviors D. physiologic signs and symptoms that the pain exists |
Answer: B. actual or potential tissue damage
Rationale: Pain is a warning sign of actual or potential tissue damage; thus the damage may not have occurred yet. Although observable signs such as grimacing and splinting may indicate pain, these behaviors are often unreliable and are affected by gender, culture and familial preferences. In addition, physiologic signs such as tachycardia and hypertension may be associated with acute pain. This is inconsistent; physiologic adaptation occurs over time, and vital signs may or may not be affected. |
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Neuropathic pain characteristics include
A. well-localized syndrome with aching and gnawing sensations B. the activation of nociceptors in deep and cutaneous tissue C. peripheral or central mediation of pain D. cramping and poorly localized sensations |
Answer: C. peripheral or central mediation of pain
Rationale: Neuropathic pain is the result of compression or injury that is mediated (generated and spread) through the peripheral, central, and/or sympathetic nervous system. Well-localized pain that is aching or gnawing is consistent with somatic pain such as bone metastases. Visceral pain such as pancreatitis can be characterized by cramping and poorly localized pain. Both somatic and visceral pain are nociceptive pains that stimulate deep and cutaneous tissues. |
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After experiencing nausea and vomiting for 48 hours, a client is unale to take the scheduled opioids for cancer pain and begins to withdraw. The withdrawal is due to
A. physical dependence B. drug tolerance C. addiction D. equinanalgesia |
Answer: A. physical dependence
Rationale: Withdrawal occurs in clients who are "physically dependent" on an opioid and abrupt cessation occurs. The administration of an antagonist can also precipitate withdrawal. This is a physiologic phenomenon that the client cannot control. Tolerance means that after repeated administration of an opioid, a given dosage begins to lose effectiveness; it begins to have a shorter duration of action and then less analgesic action. Addiction is a psychologic occurrence when clients have an overwhelming need to obtain and use a drug for a nonmedical purpose. |
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The pain physiology step that includes neurons descending from the brainstem to the dorsal horn of the spinal cord to release neuromediators is called
A. transduction B. transmission C. perception D. modulation |
Answer: D. modulation
Rationale: In response to the pain stimuli, the brain sends neuromediators to the dorsal horn such as opioids, norepinephrine, and serotonin to modulate the pain experience. |
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The most common source of cancer pain is
A. bone metastases B. liver metastases C. pancreatic involvement D. nerve compression or injury |
Answer: A. bone metastases
Rationale: Bone destruction or compression of the bone on nerves and soft tissue is the most common source of cancer pain. Bone metastases are common in the following malignancies: breast, prostate, lung, and multiple myeloma |
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When assessing for pain in the pediatric population,
A. ask the parent about the child's level of pain B. use the "0-10" scale to assess pain intensity for children aged 7 and older C. encourage children to use the pain faces to describe pain D. use a pain scale that is appropriate to the developmental level of the child |
Answer: D. use a pain scale that is appropriate to the developmental level of the child
Rationale: Biologic age cannot be used when choosing a pain assessment tool for the pediatric population; rather the clinician should choose the tool that the child can developmentally interpret. |
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Mrs. J. recently was given the diagnosis of multiple myeloma and is undergoing her first cycle of chemotherapy. While her pain is rated as "2" on a scale of "0-10" when she is at rest and not moving, the pain increases to "8" with 30mg of controlled-release oxycodone every 12 hours and 5 to 10mg of immediate-release oxycodone every 4 hours as needed. The nurse's best recommendation for the management plan would be to
A. add a nonsteroidal antiinflamatory medication for the bone pain B. increase the dose and frequency of teh breakthrough opioid medication and administer before anticipated activity C. encourage Mrs. J. to use a bedside table to keep tems near her to prevent movement D. encourage her that the pain will decrease once the chemotherapy begins to work |
Answer: B. increase the dose and frequency of teh breakthrough opioid medication and administer before anticipated activity
Rationale: The client is experiencing "incident pain," that is, increased pain with movement or activity. It is important to get on top of the pain quickly and before anticipated activity, and so the best response is to increase the dose and interval of the breakthrough medication approximately 30 minutes before activity so that the medication will be most effective while the client is moving, and hence the client can move and complete activities of daily living more easily and comfortably. |
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Mrs. Q. has a history of rheumatoid arthritis and has been taking pentazocine (Talwin) for the last 2 years. She was recently given the diagnosis of metastatic breast cancer and has been experiencing low back pain related to bone metastases of "8" intensity. She is given a fentanyl (Duragesic) patch. What should be considered with this client?
A. the pentazocine and Duragesic will work synergistically to provide more optimal pain relief B. Mrs. Q. will have an exacerbation of side effects related to the two opioids she is taking C. the pentazocine, an agonist-antagonist, should be discontinued, because the Duragesic will not work effectively in combination with an agonist-antagonist D. an alternative agent to pentazocine, such as nalbuphine (Nubain), should be substituted for the arthritic pain |
Answer: C. the pentazocine, an agonist-antagonist, should be discontinued, because the Duragesic will not work effectively in combination with an agonist-antagonist
Rationale: Pentazocine is not an optimal drug of choice for any type of pain because of the psychomimetric effects. When agonist-antagonists are added to pure agonists, the combination can also prevent full receptor binding of the agonist and can precipitate withdrawal in some clients. |
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Bisphosphonates such as pamidronate (Aredia) and zoledronic acid (Zometa) are used for relief of pain associated with
A. visceral metastases B. neuropathic pain C. osteolytic bone metastases D. headache associated with increased intracranial pressure |
Answer: C. osteolytic bone metastases
Rationale: Bisphosphonates are used for the relief of pain in osteolytic bone metastases such as metastatic breast cancer. |
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One type of autonomic nervous system block used to prevent pain from pancreatic cancer is the
A. peripheral nervous system block B. celiac plexus block C. dorsal rhizotomy D. commissural myelotomy |
Answer: B. celiac plexus block
Rationale: The celiac plexus block is a surgical intervention for pain related to pancreatic cancer that is effective in up to 80% of clients. |
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Drug tolerance is which type of phenomenon?
A. physiologic B. psychologic C. addictive D. obsessive-compulsive |
Answer: A. physiologic
Rationale: Drug tolerance is a physiologic phenomenon that occurs after repeated administration of an opioid, and the opioid begins to lose effectiveness with a shorter duration of action and less analgesic action. |
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Which class of analgesic adjuvants is helpful for peripherally mediated neuropathic pain?
A. analeptics B. tricyclic antidepressants C. serotonin-specific reuptake inhibitor antidepressants (SSRI) D. benzodiazepines |
Answer: B. tricyclic antidepressants
Rationale: The tricyclic antidepressants block the reuptake of serotonin, norepinephrine, and dopamine in the central nervous system. No research suggests that the serotonin-specific antidepressants are as effective for pain. Analeptics are used to counteract sedation, and benzodiazepines are used for pruritic pain and anxiety associated with pain. |
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A client with cancer has a pain score of "2" on a "0-10" scale but complains of "always being sleepy". An appropriate intervention would be to recommend the addition of
A. amitriptyline (Elavil) B. phenytoin (Dilantin) C. methylphenidate (Ritalin) D. a nonsteroidal antiinflammatory drug |
Answer: C. methylphenidate (Ritalin)
Rationale: Analeptics such as Ritalin may counteract sedation and may improve quality of life. Another commonly used analeptic is dextroamphetamine. |
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The most common side effect of cancer therapy is
A. pain B. nausea and vomiting C. mucositis D. fatigue |
Answer: D. fatigue
Rationale: Fatigue affects approximately 100% of clients undergoing all types of cancer therapy. |
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Chemotherapy-related fatigue generally peaks
A. on the day of the chemotherapy administration B. on the third day after the chemotherapy administration C. 3 to 4 days after the nadir D. throughout the course of chemotherapy |
Answer: C. 3 to 4 days after the nadir
Rationale: Chemotherapy-related fatigue often peaks on the third or fourth day after the nadir, possibly related to the declining red blood cell count. |
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A potential laboratory finding in anemia-related fatigue includes a(n)
A. decreased white blood cell count B. decreased red blood cell count C. increased hemoglobin D. increased PO2 |
Answer: B. decreased red blood cell count
Rationale; A decreased red blood cell count often is indicative of anemia and fatigue. The hemoglobin and PO2 result in a decreased oxygen capacity caused by a low number of red blood cells. The white blood count is not a laboratory test for anemia. |
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Red blood cell growth factors used in the management of anemia include
A. erythropoietin (rHuEPO) (Epogen, Procrit) and oprelvekin (Neumega) B. darbepoetin alfa (Aranesp) and erythropoietin C. oprelvekin and pegfilgrastim (Neulasta) D. erythropoietin and sagramostim (Leukine) |
Answer: B. darbepoetin alfa (Aranesp) and erythropoietin
Rationale: Darbepoetin alfa and erythropoietin are both growth factors that stimulate the production of red blood cells in the bone marrow. Oprelvekin is a platelet growth factor, and sargramostim and pegfilgrastim are white blood cell growth factors. |
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Mary is a 42 year old client with lymphoma who is undergoing chemotherapy. She has completed two of six cycles of therapy and is complaining of fatigue level "8" on a "0-10" scale. What suggestions would help Mary with her fatigue
A. maintain a vegetarian diet to increase the vitamin stores in her body B. sleep during the day when fatigued and get up only as needed C. engage in some activity as tolerated during the day to maintain energy stores D. continue the regular schedule that was used before the illness |
Answer: C. engage in some activity as tolerated during the day to maintain energy stores
Rationale: It is important to take part in some type of activity or exercise as tolerated. Studies show that clients who exercise have decreased levels of fatigue. Too much sleep will not assist with the fatigue. A diet should be balanced with adequate amounts of protein, and schedule adjustments with prioritizing needs are important to manage the overwhelming fatigue. |
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Which of the following should be included in the assessment of fatigue?
A. blood urea nitrogen (BUN) and creatinine B. platelet count C. family perception of the client's fatigue D. depression scales |
Answer: D. depression scales
Rationale: Depression and fatigue often share the same symptoms, and therefore a differential diagnosis is important. Blood urea nitrogen, creatinine, and platelet counts are not reliable tests in the assessment of fatigue. In addition, family perceptions are often inaccurate, and fatigue can only be measured by asking the individual client. Fatigue, like pain, is a subjective symptom. |
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To assess the effect of fatigue on a client's cognitive or mental function, ask the client
A. about the ability to concentrate on the family finances and paperwork B. to count backwards by 3s beginning at 100 C. to read a paragraph in a book D. about the ability to organize and perform activities of daily living (ADLs) |
Answer: B. to count backwards by 3s beginning at 100
Rationale: The cognitive or mental dimension of fatigue involves the assessment of concentration, memory, and alertness; counting backward by 3s is an example. Asking the client about the ability to concentrate or organize and perform ADLs provides a subjective rather than an objective answer. Reading a paragraph does not assess cognitive function but rather ready skills. |
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Which statement is true about the physiology of pruritus?
A. the physiology of pruritus is closely linked to the physiology of pain B. delta fibers are the neurons responsible for itch C. the initiating stimulus occurs external to the body D. serotonin is the neurotransmitter responsible for the transmission of pruritus |
Answer: A. the physiology of pruritus is closely linked to the physiology of pain
Rationale: Pruritus transmission is closely linked to the transmission of pain and is conducted along polymodal C--nociceptors. The stimuli can originate anywhere along the afferent pathway, and cause is often linked to an internal cause. |
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Which of the following is a risk factor for pruritus?
A. history of alcohol abuse B. male gender C. history of cardiac disease D. age older than 70 |
Answer: D. age older than 70
Rationale: pruritus increases with age and is especially prevalent in those over the age of 70. |
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One malignancy that typically causes pruritus is
A. Hodgkin's disease B. breast cancer C. bladder cancer D. melanoma |
Answer: A. Hodgkin's disease
Rationale: Pruritus is common in hematologic malignancies including Hodgkin's and nonHodgkin's lymphomas. |
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Mrs. O. returned from colon resection surgery 2 hours ago. Client-controlled analgesia morphine was begun in the postanesthesia recovery unit, and he is now complaining of pruritus. The nurse phones the physician to recommend the best intervention, which is to
A. administer an opioid antagonist to block the pruritic influence B. administer diphenhydramine, and H1- receptor antagonist C. change the opioid to meperidine D. place a fan in the room to control the pruritis |
Answer: B. administer diphenhydramine, and H1- receptor antagonist
Rationale: H1-receptor antagonists are the first drugs of choice for pruritus. Small doses of opioid antagonists are sometimes used for pruritus caused by intraspinal analgesia. Rotating opioids takes time and interrupts the pain management plan, and meperidine is not a drug of choice. Placing a fan in the room does not manage the underlying cause of the pruritus. |
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Which malignancy can cause facial and nasal itching?
A. lymphomas B. prostate cancer C. leukemia D. gliomas |
Answer: D. gliomas
Rationale: Gliomas are often associated with facial and nostril itching, and the pruritus may be a presenting sign. |
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Which of the following is an appropriate nursing intervention for pruritus?
A. keep the room humidity at 30% to 40% B. keep the room temperature warm to prevent vasoconstriction C. encourage fluid intake of 1000 mL/day D. wear tight clothing that will rub on the pruritic skin |
Answer: A. keep the room humidity at 30% to 40%
Rationale: All of the answers are inappropriate interventions for pruritus except for A. Fluid intake should be at least 3 L/day, and the room should be kept cool to prevent vasodilation. The room humidity should be kept at 30% to 40% to prevent dry skin that can contribute to pruritus. |
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The nurse makes a home visit to a client with end-stage pancreatic cancer. Upon assessment, the nurse discovers scratch marks and scabs on the trunk and upper extremities. The client reports that she has been itching in the evenings before bedtime, and the itching is "driving her crazy". In addition to managing the underlying cause, an appropriate nursing intervention to prevent further scratching would be to
A. encourage the family member to scratch the affected area to prevent skin irritation B. encourage a warm bath in the evening when the pruritus is most likely to occur C. drink a glass of wine each evening before bedtime for relaxation D. encourage television, reading, and crafts in the evening to distract from the pruritus |
Answer: D. encourage television, reading, and crafts in the evening to distract from the pruritus
Rationale: Scratching should be avoided because it can disrupt the skin integrity. Medicated baths can help with pruritus, but the temperature should be cool to minimize vasodilation. Alcohol can cause vasodilation and contribute to the pruritus. Distraction methods such as television and other activities may be helpful, because pruritus is often exacerbated with stress anxiety. |
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Which of the following is true about rapid eye movement (REM) sleep?
A. it is the transition between wakefulness and sleep B. it is also called quiet sleep C. the cycle of REM sleep is approximately 30 minutes D. REM sleep cycles occur approximately four to five time per night in clients with optimal sleep patterns |
Answer: D. REM sleep cycles occur approximately four to five time per night in clients with optimal sleep patterns
Rationale: REM sleep, also known as paradoxical sleep, is characterized by deep sleep cycles of 90 minutes in duration that occur four to five times per night. Non-REM sleep is the transition between wakefulness and sleep. |
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Approximately how many clients with a new diagnosis of cancer or who have reently been treated for cancer experience sleep disorder?
A. 100% B. 60-80% C. 30-50% D. <25% |
Answer: C. 30-50%
Rationale: Approximately 30% to 50% of clients with a recent diagnosis of cancer or those recently treated experience sleep disorder. |
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Melatonin is a hormone released by the pineal gland that
A. mediates night and day rhythms B. increases with age C. increases during the daylight hours D. increases with menopause |
Answer: A. mediates night and day rhythms
Rationale: Melatonin mediates or regulates the day and night rhythms. Normally, the levels increase at night during sleep and decrease during the daylight hours. Melatonin decreases with menopause and age, and this is reflective of the fact that as people age, they experience sleep disturbances more often. |
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Which category of sleep medications has more selective hypnotic properties with fewer residual side effects the next day?
A. benzodiazepines B. nonbenzodiazepines C. tricyclic antidepressants D. anxiolytics |
Answer: B. nonbenzodiazepines
Rationale: The nonbenzodiazepine hypnotics such as zopidem and zaleplon are more selective for sleep, and clients experience less drowsiness and sedation the next day. |
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Nonpharmacologic interventions for sleep include
A. going to bed at a scheduled time whether sleepy or not B. arising at the same time each morning C. exercising 1 hour before retiring for bed D. staying in bed upon awakening at night until sleep resumes |
Answer: B. arising at the same time each morning
Rationale: Arising at the same time each morning facilitates a routine that enhances sleep. Going to bed when not sleepy may not be helpful, and although routine exercise often helps with sleep disturbance, exercise should be avoided 2 hours before bedtime. Exercise can stimulate the client and lead to insomnia right before bedtime. If clients awaken at night, it may be helpful to leave the bed and return when sleepy. |
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Which of the following characteristics or lifestyle factors may interfere with sleep?
A. male gender B. younger age C. regular, phsyical acitivty D. alcohol intake |
Answer: D. alcohol intake
Rationale: Female gender rather than male, increased age rather than younger age, and physical inactivity versus physical activity are all factors that can interfere with sleep. Alcohol intake can also interfere with normal sleep patterns. |
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Physical signs of sleep deprivation include
A. dark circles under the eyes, nystagmus, incorrect word use B. dark circle under eye, over-pronunciation of words, and a loud voice C. stuttering, nystagmus, and loss of balance D. slurred speech, a loud voice, and an impaired gait |
Answer: A. dark circles under the eyes, nystagmus, incorrect word use
Rationale: Dark circles under the eyes, nystagmus, incorrect word use, slurred speech, frequent yawning, and ptosis of the eyelids are all physical signs of sleep deprivation. Stuttering and a loud voice are not usually associated with sleep disorders. |
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The respiratory center that controls breathing lies within
A. the medulla B. the bronchus C. the carotid receptors D. the chemoreceptors |
Answer: A. the medulla
Rationale: The respiratory center is the autonomic control of respiration that lies within the medulla. |
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Examples of mechanoreceptors that may provide input into the respiratory center to create dyspnea include
A. pulmonary edema and pleural effusion B. poor nutritional status C. changes in oxygenation D. input from the cerebral cortex |
Answer: C. changes in oxygenation
Rationale: Mechanoreceptors are sensitive in changes in pressure on the lung. The pressure can be caused by fluid in or around the lung or by compression on the lung such as a tumor. |
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Which of the following is a disease-related risk factor for dyspnea
A. peripheral edema B. syndrome of inappropriate antidiuretic hormone C. hepatomegaly D. hypercalcemia |
Answer: C. hepatomegaly
Rationale: Coexisting pulmonary disease, superior vena cava syndrome, and hepatomegaly can all interfere with pulmonary function and contribute to dyspnea. Hypercalcemia does not cause dyspnea. |
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To assess the intensity of the dyspnea that a client is experiencing,
A. ask the client to describe how the dyspnea feels B. ask the client what makes the dyspnea worse C. ask the client about smoking history that may affect the dyspnea D. ask the client to rate the dyspnea on a "0-10" scale |
Answer: D. ask the client to rate the dyspnea on a "0-10" scale
Rationale: The intensity of dyspnea, like pain, is best rated by the client on a "0-10" scale, with "0" being no breathlessness and "10" being the worst breathlessness imagined. |
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Mr. W. is a 79 year old man with mantle cell lymphoma. He recently completed two cycles of chemotherapy that included cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin), and prednisone. He arrives at the clinic with complaints of dyspnea. His lungs have a few rales bilaterally on auscultation. Before chemotherapy. his pulmonary function and cardiac ejection fraction were within normal limits. The two most likely differential diagnoses of the dyspnea include
A. anemia and congestive heart failure B. anemia and pleural effusion C. superior vena cava syndrome and congestive heart failure D. pulmonary embolism and anemia |
Answer: A. anemia and congestive heart failure
Rationale: Anemia and congestive heart failure should be evaluated first. Anemia likely is due to the chemotherapy. In addition, the client received doxorubicin, a cardiotoxic chemotherapeutic agent that can cause congestive heart failure, and so this needs to be carefully evaluated as well. Pleural effusion is not likely, because the lower lobe breath sounds are not decreased and pleural effusion is not highly associated with lymphoma. Assessment finding with superior vena cava syndrome would also include edema of the upper extremities and possibly jugular vein distention. A pulmonary embolus usually would be accompanied by chest pain. |
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The most reliable way to assess dyspnea is to
A. monitor the 02 saturation B. monitor the hemoglobin and hematocrit for anemia C. ask the client about the intensity of dyspnea D. ask the family members about how the dyspnea interferes with the client's activities of daily living |
Answer: C. ask the client about the intensity of dyspnea
Rationale: Dyspnea, like pain, is subjective phenomenon. The most accurate method to assess dyspnea is to ask the client. Other methods may be unreliable. |
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Ms. A. has lung cancer with superior vena cava syndrome. A chest x-ray film shows that a tumor is compressing the vena cava. One strategy used to manage the underlying cause of the dyspnea would be to
A. administer a respiratory sedative to slow the respiratory rate B. administer supplemental oxygen C. begin nebulized morphine D. begin radiation therapy |
Answer: D. begin radiation therapy
Rationale: Radiation therapy is the only strategy listed that will treat the underlying cause of the dyspnea, a tumor that is pressing on the vena cava. Other interventions are used for symptom management. |
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Respiratory sedatives such as phenothiazines and benzodiazepines are given to suppress respiratory awareness and
A. treat the underlying cause of the dyspnea B. decrease the inflammation in the lungs that is causing the dyspnea C. manage anxiety associated with dyspnea D. act as a bronchodilator for airway obstruction |
Answer: C. manage anxiety associated with dyspnea
Rationale: Many benzodiazepines and phenothiazines are also anxiolytics and can assist with anxiety that can accompany dyspnea. These agents are not antiinflammatory, and they are not bronchodilators. Strategies used to treat the underlying cause include anticancer therapies. |
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The pharmacologic agents of choice for bronchial airway obstruction include
A. bronchodilators and corticosteroids B. respiratory sedatives and antidepressants C. opioids and anxiolytics D. antidepressants and anxiolytics |
Answer: A. bronchodilators and corticosteroids
Rationale: Bronchodilators act by expanding the ventilatory airway that can be compromised by obstruction, while corticosteroids decrease the inflammation caused by obstruction. |
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Shivering or chills may occur as a response to
A. fever B. heat loss C. tumor cells D. paraneoplastic syndromes |
Answer: B. heat loss
Rationale: Chills and shivering often follow fever and are the result of heat loss from the body. |
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The body temperature is regulated by the
A. medulla B. cerebral cortex C. hypothalamus D. parathyroid |
Answer: C. hypothalamus
Rationale: The hypothalamus is the body's thermal regulator |
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Larry is a 25 year old client with acute myelocytic leukemia. He is on day 14 after induction therapy. A red blood cell transfusion was completed 1 hour previously when he calls the nurse to the room complaining of fever and chills. The best initial intervention would be to
A. administer 650mg acetaminophen B. call the physician and request starting an antibiotic C. collect a urine specimen D. administer intravenous meperidine for the chills |
Answer: A. administer 650mg acetaminophen
Rationale: Providing the client with acetaminophen initially will bring the fever down and make the client more comfortable. Drawing blood cultures would be the second intervention, because the fever and chills likely are due to infection during an immunosuppressive period. Although the client recently had a transfusion, it was completed, and the fever and chills likely are not due to this. |
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Acetaminophen, often used to treat fever and chills, should be limited to
A. 2 g/day B. 4 g/day C. 6 g/day D. there is no ceiling dose |
Answer: B. 4 g/day
Rationale: Acetaminophen overdose can lead to hepatotoxicity. The dose should be limited to 4 g (4000mg) / day. |
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Pain
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unpleasant sensory and emotional experience associated with actual or potential tissue damage
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Acute pain
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usually lasts less than 6 months
etiology of the pain is often known objective pain behaviors are more frequently exhibited |
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Chronic nonmalignant pain
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usually lasts longer than 3 months
etiology of the pain is often unknown fatigue and depression are common |
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Cancer pain
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includes acute cancer-related pain caused by the cancer or cancer therapy and chronic cancer-related pain from tumor progression or cancer therapy
increased pain may may precipitate fear of cancer progression increased pain worsens anxiety |
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What is nociceptive pain and what are the 2 types?
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results of activation of nociceptors (pain fibers) in deep and cutaneous tissues
2 types: Somatic visceral |
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Somatic pain
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arises from the bone, joint, or connective tissue, usually well localized, characterized by an aching or gnawing sensation
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Visceral pain
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result of nociceptor activation in thoracic or abdominal tissue
arises from the viscera such as the pancreas, liver, and GI tract usually poorly localized characterized by a cramping or aching sensation |
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What is neuropathic pain and what are the 3 types?
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result of compression or injury to peripheral, sympathetic, and/or central nervous system (CNS)
3 types: peripheral neuropathic pain centrally mediated pain sympathetically maintained pains |
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Peripheral neuropathic pain
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caused by injury and pain along the peripheral nerves, often characterized by a numbness and tingling sensation
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Centrally mediated pain
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characterized by radiating and shooting sensations with a background of burning and aching
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Sympathetically maintained pain
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centrally generated, caused by autonomic dysregulation, referred to as complex regional pain syndrome (CRPS)
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Transduction (pain)
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initiated by a mechanical, thermal, or chemical noxious stimulus at the periphery that sensitizes nociceptors (receptors sensitive to noxious stimuli)
an action potential is generated along the neuron when sodium moves into the cell and potassium out of the cell, and the pain message begins its way to the CNS |
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Transmission (pain)
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action potential continues to the dorsal horn, where nociceptors terminate
some neurons continue the message to the thalamus, and others carry the message to various centers in the brain the thalamus transmits the message to the cerebral cortex |
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Perception (pain)
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the cerebral cortex processes the experience of pain
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Modulation (pain)
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descending neurons originating in the brainstem travel to the dorsal horn and release neuromediators - endogenous opioids, norepinephrine, serotonin
the neuromediators inhibit nociception at the dorsal horn |
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____________ metastases are the most common source of cancer pain
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bone
bone destruction or compression of the bone on nerves and soft tissue |
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What are causes of abdominal visceral pain?
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may be caused by tumor obstruction of the bowel, liver metastasis, blood flow occlusion to visceral organs, and other causes
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What are the disease related factors for pain?
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bone metastases
abdominal visceral pain nerve compression or injury to peripheral, sympathetic, and/or central nerves |
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What are the treatment related risk factors for pain?
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chemotherapy related pain
radiation therapy related pain chronic pain related to cancer surgery |
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Whare are examples of chemotherapy related pain?
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mucositis
peripheral neuropathies (vinca alkaloids, cisplatin, taxanes, and thalidomide have the highest incidence); characterized by burning and numbness on the hands and feet herpetic neuralgia - often occurs from the immunosuppression of chemotherapy; characterized by burning, aching, and shock like pain in the area of the lesions |
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What are examples of radiation therapy related pain?
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mucositis often occurs with radiation therapy to the head and neck
radiation may induce peripheral nerve tumors characterized by a painful, enlarging mass in a previously irradiated area Radiation skin changes -- radiation enhancement and radiation recall |
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The _________ are at higher risk for chronic pain and inadequate pain management
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elderly
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Breakthrough pain
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a flare in the pain pattern that occurs in conjunction with persistent pain
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Incident pain
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transient pain precipitated by any movement or activity
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End of dose pain
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pain that increases before the next scheduled dose
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Fatigue
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self recognized state in which an individual experiences an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work that is not relieved by rest
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What is the physiology of fatigue?
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physiology is unclear - may result from endogenous cytokines that act on tumor growth factors
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_________ is the most common side effect of chemotherapy?
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fatigue
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Fatigue generally peaks _____ to _____ days following the _____ and can occur with each cycle
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3
4 nadir |
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Fatigue affects almost 100% of _________ patients and is cumulative over the course of treatment; onset at approximately ___ weeks and peaks at ___ weeks.
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radiation
2 6 |
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definition of sleep
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natural suspension of consciousness in which processes of the body are restored
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Sleep disorder
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interruption in the amount or quality of sleep: inability to go to sleep, stay asleep, sleep long enough, and feel restored and relaxed on awakening
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What are the stages of non-rapid eye movement (NREM) sleep?
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Non-rapid-eye movement (NREM) - also called quiet sleep, the first sleep phase.
Stage 1 - transition between wakefulness and sleep Stage 2 - nonequivocal physiologic sleep Stage 3 and 4 - also called delta or slow-wave pattern; sequence moves from stage 2 to 3 to 4 and then back to stage 3 and stage 2, which leads to the first rapid eye movement (REM) cycle |
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What is REM sleep?
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also called paradoxical sleep
biologic activity - electroencephalographic activation, muscle atony, dreams cycle length is approximately 90 minutes, repeated four or five times per night with the latter REM episodes increasing in duration. |
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Melatonin
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hormone released by the pineal gland and mediator of night and day rhythms, sensitive to external light
low levels are frequently associated with depression, insomnia levels decrease with age |
