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293 Cards in this Set
- Front
- Back
The fifth vital sign is ______. |
pain
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Pain is a response to both _____ and _____ stressors.
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physical and psychologic
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Pain is a _____, _____ and _____ experience.
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universal, complex and subjective
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Pain plays a _____ role.
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protective
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The nurse's role in pain management is to be the ______ and promote healing, prevent complications, reduce ____ and prevent development of ______ pain states.
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client advocate
suffering incurable |
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____ pain can suppress your immune system and affect healing.
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Chronic
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During the first 24 hours post op the nurse should assess for pain _____. Otherwise, assess for pain ______.
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q4h
q12h |
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A pain report of 1-3 is considered as _____ pain.
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mild
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A pain report of 4-6 is considered as _____ pain.
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moderate
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A pain report of 7-10 is considered as ______ pain.
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severe
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Pain is an unpleasant subjective ____ and _____ experience associated with actual or potential tissue damage.
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sensory and emotional
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Pain is influenced by ____, ____, _____, _____ and _____ factors.
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physical, emotional, cognitive, sociocultural, and spiritual
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_____ pain is temporary and has a sudden onset. It is often localized.
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Acute
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As healing occurs, _____ pain resolves.
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acute
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_____ pain is prolonged, recurring, intermittent, and/or constant.
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Chronic
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Acute pain lasts less than ____ months. Chronic pain lasts more.
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3
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The sympathetic nervous system is activated by _____ pain.
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acute
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The parasympathetic nervous system responses take over when there is _____ pain.
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chronic
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_____ pain is not easily localized and the cause is often unknown making it very difficult to manage. It can affect a person's ADL's/
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Chronic
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When a person has _____ pain there may not be a change in their BP, P or R.
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chronic
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_____ pain can generally be managed easily with meds or nonpharmacological methods.
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Acute
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____, _____, and _____ are linked with chronic pain.
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Withdrawal, irritability, and depression
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_____ pain is associated with cancer progression and toxicities of treatment.
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Chronic cancer
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_____ pain results from activation of nociceptors.
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Nociceptive
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Nociceptors are _____ that transmit pain.
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nerve receptors
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There are two types of nociceptive pain:
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somatic and visceral
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_____ pain involves injury to the skin, subcutaneous tissue, muscle, bone, joints,and connective tissue.
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Somatic
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2 types of somatic pain are:
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cutaneous and deep somatic
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_____ is a type of somatic pain that comes from an injury involving the skin and cutaneous tissue.
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Cutaneous
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An example an injury that would cause cutaneous pain is a _____.
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paper cut
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_____ is a type of somatic pain that involves the musculoskeletal system (bones, muscles, joints).
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Deep somatic
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A type of nocicepetive pain that radiates or is referred is called _____ pain.
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visceral
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Visceral pain results from an injury to the _____ and supporting tissue.
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viscera
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Visceral pain is dull and more poorly localized than somatic pain because...
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there are fewer nociceptors in the viscera.
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When real pain is felt in a missing limb it is called ______.
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phantom pain
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Phantom pain is an example of injury to nerves in the _____.
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peripheral nervous system
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____ pain is often associated with NV and hypotension.
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Visceral
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_____ pain is associated with damaged/malfunctioning nerves.
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Non-nociceptive
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CNS neuropathic pain can be due to...
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spinal cord injuries or conditions like multiple sclerosis.
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_____ Neuropathic pain refers to injury to nerves in the PNS or CNS and phantom pain.
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Chronic
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Chronic neuropathic pain is often the result of ineffective _____ particularly during the perioperative period.
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treatment of pain
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_____ pain is a hypersensitivity in an area surrounding an injury. It involves sympathetically controlled functions.
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Sympathetic
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Complex Regional Pain Syndrome is an example of ____ pain syndrome.
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sympathetic
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With ____ pain there is a disconnect between nerves that transmit pain and the CNS.
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sympathetic
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When pain receptors become sensitized to pain and the pain continues to persist beyond healing it is known as ______.
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Complex Regional Pain Syndrome
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Vasoconstriction, edema, and color changes are associated with ______ pain.
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sympathetic
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Pain that is confined to the site of origin or injury is described as ______ pain.
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localized
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Pain that is perceived initially at the source and then radiates and is less localized is described as ______ pain.
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radiating
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Pain that is felt at a part of the body distal from the source of painful stimuli is called ______.
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referred
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_____ pain is highly resistant to relief.
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Intractable
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Pain that travels along a nerve or nerve root, such as sciatic pain, is called _____ pain.
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projected/radicular
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_____ are pain receptors that are stimulated by direct injury to the cell itself or biochemical mediators.
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Nociceptors
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Nociceptors are especially numerous in the _____ and ____ and less numerous in the _____.
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skin and muscle
viscera |
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The process by which an individual becomes consciously aware of pain is called ______.
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nociception
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_____ is a biochemical mediator that is the most abundant and potent pain producing chemical.
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Bradykinin
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Bradykinin is released from _____ that leaks around the site of injury, binds to ____ and excites nociceptors.
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plasma
peripheral nerves |
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Bradykinin is a biochemical mediator that is involved in ______ response, causes vaso_____ and ____ capillary permeability.
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inflammatory
dilation increased |
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_____ is a biochemical mediator that excites nociceptors and produces redness, swelling, pain and inflammation.
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Histamine
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_____ are biochemical mediators that enhance the pain provoking effect of the bradykinin.
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Prostaglandins
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Prostaglandins are hormone like substances that like bradykinin, cause vaso_____ and _____ capillary permeability.
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dilation
increased |
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The exchange of _____ and ______ across the cell membrane helps to move pain impulses toward the brain.
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hydrogen and potassium
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_____ is a neurotransmitter that enhances the movement of nerve impulses across the nerve synapse.
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Substance P
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There are 4 main processes involved in nociception:
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transduction
transmission perception modulation |
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_____ is the activation of pain receptors and the release of neurotransmitters. It occurs at the source of the pain when the injury occurs.
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Transduction
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After the pain receptors are activated, nerve impulses are going to move from the site of injury to the brain. This is called _______.
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Transmission
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Transmission is carried out by 2 types of fibers. they are...
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A-delta fibers and C fibers
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_____ fibers are associated with "first pain" they are larger and myelinated (fast moving).
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A-delta
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_____ fibers are associated with 2nd pain and chronic pain. They are slower in transmission because they are smaller and not myelinated.
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C
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3 things occur during transmission . First the NI must move from the ____ to the ____ thru the dorsal horn of the spinal cord. Next it goes up the _____ to the brain and thalamus. From the thalamus the Ni is sent to _____.
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PNS --> CNS
ascending pathway other parts of the brain |
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4 parts of the brain that NI are transmitted to are:
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sensory cortex
limbic system reticular system associational cortex |
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The part of the brain that is involved with perception and interpretation of pain is the ______.
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sensory cortex
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The part of the brain that is responsible for emotional and behavioral response to pain is the ______ system.
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limbic
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The part of the brain that is responsible for motor and autonomic responses to pain (warning) is the _____ system.
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reticular
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The part of the brain that holds memories and experiences of past cognitive activities is the ______.
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Associational cortex
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Once the NI reaches the brain ____ occurs.
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perception
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Our pain threshold is part of the _____ portion of nociception.
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perception
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The last step of nociception is ______.
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modulation
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Modulation is the response of the _____ to the _____.
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brain
pain impulse |
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During modulation ____ (endogenous substances/opiates) are released along a descending pathway to help inhibit the movement of pain impulses to the brain.
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neurotransmitters
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The 4 neurotransmitters released during modulation are:
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endorphins
enkephalins serotonin norepinephrine |
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The effects from the release of neurotransmitters during modulation is ______. Therefore we still need pain meds for long term relief.
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temporary pain relief
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_____ are neurotransmitters released during modulation that bind to opiate receptors and affect or inhibit the release of substance P and the movement of impulses to the brain.
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Enkephalins
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Many nonpharmacological methods for managing pain are based on the _____.
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Gate Control theory
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The Gate Control theory states that the interaction of two systems determines ____ and its _____.
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pain
perception |
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The 2 systems involved in Gate Control theory are _____ and _____.
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peripheral nervous system and higher centers in the brain
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In the PNS, there are non-nociceptive nerve fibers that are faster than A-delta and C fibers and therefore block them from entering the dorsal horn. These fibers are called _____.
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A-beta fibers
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The A-beta fibers of the PNS block pain in the gate theory because they respond primarily to _____ such as...
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tactile stimulation
ice, heat, massage, etc... |
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The second part of the Gate theory is the effect of _____.
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higher centers in the brain
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Higher centers in the brain help control pain because they activate the _____. Our thoughts, beliefs, emotions, and previous experiences effect how we perceive pain.
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descending pathway
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The effects of uncontrolled pain include decreased quality of ____, impaired _____, and ______ and _____ sensitization
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life
immune function CNS and PNS |
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Uncontrolled pain suppresses immune function therefore the person is
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susceptible to infection
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When the CNS and PNS are sensitized there is a change in structure and function of the ____ due to _____.
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nervous system
persistent pain |
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Sensitization causes increased sensitivity of a _____ after repeated activation by noxious stimuli.
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nociceptor
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Sensitization results in a _____ pain threshold. Non-painful stimuli may become painful.
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lowered
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Sensitization affects the ____.
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PNS
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_____ is increased excitability and sensitivity of spinal cord neurons in the CNS.
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Windup
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Windup is a result of repeated stimulation of _____ which are associated with chronic pain.
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C fibers
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Factors that influence a person's response to pain are:
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pain threshold
pain tolerance age sociocultural emotional status past experiences placebo effect |
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______ is the amount of pain stimulation a person requires to feel pain.
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Pain threshold
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Excessive sensitivity to pain is called _____.
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hyperalgesia
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When non-painful stimuli produces pain it is called _____.
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allodynia
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The amount of pain we can endure before responding in some was is called _____.
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pain tolerance
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The _____ is when a response to pain is actually based on the expectation that a medication will work.
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placebo effect
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Elderly people may have a _____ pain tolerance because of decreased perception of sensory stimuli.
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decreased
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Pain assessment must be initiated by the _____.
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nurse
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A client's perceptions of pain can be assessed with one of two models:
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PQRST or COLDERR
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PQRST stands for
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Precipitating factors
Quality Region, radiation, relief Severity (intensity) Timing (onset, rapid, duration) |
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The FLACC pain assessment tool involves the ____ observations.
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nurse's
|
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COLDERR stands for
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Character
Onset Location Duration Exacerbation Relief Radiation |
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The _____ pain assessment tool can be used with children 2 months to 7 years of age and with anyone who is nonverbal.
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FLACC
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FLACC stands for
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Face
Legs Activity Crying Consolability |
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Muscle tension, anxiety, restlessness, ↑HR, ↑BP, tachypnea, dilated pupils, sweating and pallor are all _____ responses to pain.
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physiologic
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Bracing, guarding, crying, moaning, grimacing, sad facial expression, restlessness, purposeless body movements and immobilization are all _____ responses to pain.
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behavioral
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Physiologic responses to pain that you may not see with chronic pain include:
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↑HR
↑BP tachypnea (↑Respirations) dilated pupils |
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When assessing a patients self management of pain and the effectiveness of their strategies, the nurse should look at...
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-alleviating factors
-associated symptoms -affect on ADL's -past pain experiences -affective responses -coping resources -daily pain diary |
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A daily pain diary is used for people with ______ pain.
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chronic
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A daily pain diary is useful for identifying _____ and factors ____ or _____ the pain experience.
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pain patterns
exacerbating or mediating |
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____ is when a person becomes less sensitive to the analgesic properties and side effects of a drug.
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Tolerance
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____ is an adaptation manifested by withdrawal symptoms upon cessation, rapid reduction, decreased blood levels and/or administration of an antagonist
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Dependence
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_____ is a chronic neurobiologic disease influenced by genetic, psychosocial and environmental factors.
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Addiction
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Addiction is characterized by one of the following:
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-impaired control over drug use
-compulsive use -cravings -continued use despite harm |
|
_____ is an iatrogenic syndrome created by the undertreatment of pain.
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Psuedoaddiction
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_____ is an adaptation to a drug in which exposure induces changes that result in a decrease in one or more of the drugs effects over time.
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Tolerance
|
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When a person's behaviors appear to be indicative of addiction but disappear once the pain needs are adequately met, it is called ________.
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pseudoaddiction
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Factors affecting addiction include
|
-genetics
-stress -mental illness |
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Over time a person's body or cells change and how require a drug in order to function properly. This is known as ______.
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dependence
|
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If a patient is _____, he/she will experience withdrawals when the drug is withdrawn.
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dependent
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If a person has developed tolerance to a drug it means that they require a _____ or _____ frequent dose to get the same amount of pain relief.
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higher
more |
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A patient that is addicted needs a _____ dose.
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higher
|
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Medications used to relieve pain are called _____.
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analgesics
|
|
Factors that are considered when selecting analgesics include:
|
-effectiveness of the agent
-duration of action of the drug -duration of therapy -ability to cause drug interactions -patient allergies -route of administration |
|
In regards to duration of action, for minor procedures you may use a ____ acting analgesic.
|
shorter
|
|
Chronic pain is often treated with _____ instead of opioid analgesics because of the potential for dependency.
|
NSAIDS
|
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The WHO Three-Step Analgesic ladder is an approach to treating _____ pain.
|
cancer
|
|
The WHO Three-Step Analgesic ladder identifies for mild, moderate and severe pain and the types of ______ used to try to manage them.
|
medications
|
|
____ medications can decrease the need for high doses of opioids therefore reducing side effects and toxic effects.
|
Combination
|
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According to the WHO Three-Step ladder, pain that is mild should be treated with _____ and ______.
|
NSAIDS and acetaminophen
|
|
____ is when a person becomes less sensitive to the analgesic properties and side effects of a drug.
|
Tolerance
|
|
____ is an adaptation manifested by withdrawal symptoms upon cessation, rapid reduction, decreased blood levels and/or administration of an antagonist
|
Dependence
|
|
_____ is a chronic neurobiologic disease influenced by genetic, psychosocial and environmental factors.
|
Addiction
|
|
Addiction is characterized by one of the following:
|
-impaired control over drug use
-compulsive use -cravings -continued use despite harm |
|
_____ is an iatrogenic syndrome created by the undertreatment of pain.
|
Psuedoaddiction
|
|
_____ is an adaptation to a drug in which exposure induces changes that result in a decrease in one or more of the drugs effects over time.
|
Tolerance
|
|
When a person's behaviors appear to be indicative of addiction but disappear once the pain needs are adequately met, it is called ________.
|
pseudoaddiction
|
|
Factors affecting addiction include
|
-genetics
-stress -mental illness |
|
Over time a person's body or cells change and how require a drug in order to function properly. This is known as ______.
|
dependence
|
|
If a patient is _____, he/she will experience withdrawals when the drug is withdrawn.
|
dependent
|
|
If a person has developed tolerance to a drug it means that they require a _____ or _____ frequent dose to get the same amount of pain relief.
|
higher
more |
|
A patient that is addicted needs a _____ dose.
|
higher
|
|
Medications used to relieve pain are called _____.
|
analgesics
|
|
Factors that are considered when selecting analgesics include:
|
-effectiveness of the agent
-duration of action of the drug -duration of therapy -ability to cause drug interactions -patient allergies -route of administration |
|
In regards to duration of action, for minor procedures you may use a ____ acting analgesic.
|
shorter
|
|
Chronic pain is often treated with _____ instead of opioid analgesics because of the potential for dependency.
|
NSAIDS
|
|
The WHO Three-Step Analgesic ladder is an approach to treating _____ pain.
|
cancer
|
|
The WHO Three-Step Analgesic ladder identifies for mild, moderate and severe pain and the types of ______ used to try to manage them.
|
medications
|
|
____ medications can decrease the need for high doses of opioids therefore reducing side effects and toxic effects.
|
Combination
|
|
According to the WHO Three-Step ladder, pain that is mild should be treated with _____ and ______.
|
NSAIDS and acetaminophen
|
|
According to the WHO Three-Step ladder, pain that is moderate should be treated with _____, ______, ______ and ______.
|
codeine
hydrocodone oxycodone tramadol |
|
According to the WHO Three-Step ladder, pain that is severe should be treated with ______, ____, ______ and ______.
|
morphine
hydromorphone fentanyl oxycodone |
|
An _____ is any drug natural/synthetic with actions similar to morphine.
|
opioid
|
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_____ are compounds present in opium. They are derivatives of the opium plant.
|
Opiates
|
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_____ reduce pain and provide a sense of euphoria.
|
Opioid analgesics
|
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Opioid analgesics are schedule ____ drugs for moderate to severe pain.
|
2
|
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Opioid analgesics attach to _____ in the CNS and affect release of neurotransmitters that help to move the pain impulses to the brain.
|
opiate receptors
|
|
There are 3 types of opioid receptors:
|
mu, kappa, and delta
|
|
The ____ receptors are the opiate receptors most commonly associated with pain relief.
|
mu
|
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The most potent pain relieving drugs available are _______.
|
opioid analgesics
|
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Opiate receptors are in heavy concentration in the ____ but are also found in other parts of the body.
|
CNS
|
|
Opiates decrease or inhibit the release of _____ and pain impulses the get to the brain.
|
substance P
|
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The opiate receptors that are associated with physical dependence are _____ receptors.
|
mu
|
|
Opioid analgesics have widespread _____ effects.
|
pharmacologic
|
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Opioid analgesics are metabolized in the _____ and excreted by the _____.
|
liver
kidney |
|
Opioid analgesics are effected by the first-pass effect. When taken PO they go straight to liver and are metabolized rapidly therefore, the PO dose is _____ than the IV or IM dose.
|
higher
|
|
Opiate receptors that cause analgesia sedation and constipation are the _____ receptors.
|
kappa
|
|
Opiates that activate mu receptors will produce _____, _____, ______, and ______.
|
analgesia, respiratory depression, sedation, and euphoria
|
|
2 types of opioids are
|
full agonist and mixed agonist-antagonist.
|
|
A _____ is a pure opioid drug that binds tightly to the receptor site and produces maximum pain inhibition.
|
full agonist
|
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Full agonist opioids activate _____ and _____ receptors.
|
mu and kappa
|
|
Activation of mu and kappa receptors in a full agonist opioid can result in 6 possible side effects:
|
analgesia
euphoria sedation respiratory depression dependence decreased GI motility |
|
_____ opioids have no ceiling on level of analgesia but _____ opioids do have ceiling effects.
|
Full agonist
Mixed agonist-antagonist |
|
_____ generally have no max daily dose limit unless in combination with a nonopioid.
|
Full agonists
|
|
You must always be mindful of the max daily dose of _____.
|
nonopioids
|
|
Morphine, codeine, hydromorphone, oxycodone and fentanyl are examples of _____ (full agonist/mixed-agonist/antagonist) opioids.
|
Full agonist
|
|
_______ opioids act like opioids and relieve pain when given to clients clients who have not taken a pure opioid or agonist for at least a couple of weeks.
|
Mixed agonist/antagonist
|
|
Mixed agonist-antagonist opioids are antagonist at the ____ receptor and agonist at the _____ receptor.
|
mu
kappa |
|
Side effects from a mixed agonist-antagost opioid include:
|
analgesia, sedation, and decreased GI motility
|
|
3 Examples of mixed agonist-antagonists are
|
Talwin, Stadol, and Nubain
|
|
_____ opioids can block or inactivate other opioid analgesics therefore there is less pain relief, but they can also precipitate withdrawal.
|
Mixed agonist-antagonist
|
|
_____ happens once a certain amount of a drug is given and the maximum pain relief is reached.
|
Ceiling effect
|
|
______ is a type of chart that lists doses of various opioid analgesics that provide approximately the same pain relief as 10mg of morphine.
|
Equianalgesic dosing
|
|
Nasal and rectal analgesics have a _____ action because they are absorbed they the mucosa.
|
rapid
|
|
Continuous subcutaneous infusion is when a needle is inserted into the anterior chest/abdomen and subcutaneously provides a combination of some ____ and ______.
|
opioid and a local anesthetic
|
|
The various routes of administration for opioid analgesics include:
|
oral
nasal transdermal rectal subcutaneous intramuscular intravenous intraspinal |
|
A route of administration for opioid analgesics that is rapid, effective, and has few side effects is ______.
|
intravenous
|
|
The _____ route of administration for opioid analgesics is the least desirable because absorption is variable and administration is painful.
|
Intramuscular
|
|
Side effects of opioid analgesics relate directly to the _____.
|
receptor site
|
|
Side effects of opioid analgesics include:
|
-drowsiness and lethargy
-euphoria -NV and constipation -pruritis -orthostatic hyportension, flushing -urinary retention -miosis -cough suppression -respiratory depression |
|
_____ is itching.
|
Pruritis
|
|
Opiates affect the smooth muscle resulting in decreased peristalsis therefore leading to _____.
|
constipation
|
|
After taking opioid analgesics for a while a person may develop tolerance to ____, ______, and _____.
|
drowsiness, vomiting, and respiratory depression
|
|
The most significant problem resulting from taking opioid analgesics is ______.
|
respiratory depression
|
|
_____ is constriction of the pupils and affects vision in dim light.
|
Miosis
|
|
When administering opioid analgesics via IV, side effects will usually occur within ____ minutes.
|
10-20
|
|
When administering opioid analgesics via IM, side effects will usually occur within ____ minutes.
|
30 minutes
|
|
When administering opioid analgesics via SQ, side effects will usually occur within ____ minutes.
|
60-90
|
|
When administering opioid analgesics via PO, side effects will usually occur within ____ minutes.
|
60 minutes
|
|
If a client's respirations are less than 12 you should
|
withhold the opioid and notify the physician
|
|
When assessing the effectiveness of opioid analgesics it should be within _____ of administration.
|
1 hour
|
|
Nursing responsibilities for patients taking opioid analgesics include:
|
-assess effectiveness of med
-assess and manage adverse effects -record keeping of meds -client teaching |
|
When assessing levels of sedation, a 1 means _____, a 2 means ______, a 3 means _____, and a 4 means ______.
|
1-awake/alert
2-slightly drowsy 3-frequently drowsy 4-somnilant- no/minimal response to physical stimulation |
|
Respiratory depression can be treated with _____, a narcotic antagonist, that reverses effects of the opiate.
|
Narcan
|
|
Narcan can be administered ____, _____, or ____. The effects should be seen within ____ minutes and should last 1-2 hours.
|
IV
IM SC 2-5 minutes |
|
If respiratory depression occurs as a side effect of an opioid analgesic, the nurse should administer _____ and then monitor and assess the patient q___m for at least 2h.
|
Narcan
15 |
|
Client teaching for patients taking opioid analgesics should include:
|
-avoid alcohol, OTC meds, driving, operating machinery
-report tolerance/side effects -increase fluid and fiber intake -facts about addiction |
|
A ____ allows self administration of doses of analgesics when needed.
|
PCA pump
|
|
The purpose of patient-controlled analgesia (PCA) is to maintain steady _______ of medication to more effectively manage the client's pain.
|
plasma levels
|
|
Things to know about PCA pumps:
|
-allow self administration of doses of analgesia prn
-minimizes peaks and valleys that occur with traditional prn administration -has preset dose (bolus) -has "lockout" interval (10-15min) |
|
A variation of the PCA pump is low continuous infusion. This type of administration is ____ and the patient is getting _____.
|
preset
continuous infusion |
|
When a PCA pump drug is discontinued, 2 nurses must look at it and assess...
|
the amount administered and the amount remaining.
|
|
Other types of pharmacologic management are:
|
-topical analgesics
-local anesthetics -sympathetic nerve blocks -regional anesthesia/analgesia |
|
_____ can be put on extremities 30-60 minutes prior to beginning and IV or other procedures.
|
Topical analgesics
|
|
_____ are things like perineural local anesthetics. They are called painbusters/OnQ
|
Local anesthetics
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_____ are used in the management of sympathetic maintained pain states (CRPS).
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Sympathetic nerve blocks
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A SC catheter placed near nerves around a surgical wound with a patient controlled pump that provides continuous local anesthesia is called ____.
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OnQ/painbuster
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Capsaicin cream, EMLA cream and lidocaine are all examples of _______.
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topical analgesics
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A ______ is an injection of local anesthetic into sympathetic nerve tissue (nerves around spine). A steroid may also be injected to help prolong the effects.
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Sympathetic nerve block
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_____ is when a catheter is placed with tubing attached to an infusion pump. The administration could be bolus, continuous infusion, or patient controlled.
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Regional anesthesia/analgesia
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Regional anesthesia/analgesia can be either _____ or _____.
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intrathecal (spinal) or epidural
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Intrathecal administration is when the catheter is placed in the _______.
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subarachnoid space of the spine
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Epidural administration is when the catheter is entered into the _______.
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epidural space of the spine.
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Between Intrathecal (spinal) and Epidural administrations, the one seen most often is _______.
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epidural
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______ is used for surgeries/procedures or to help the patient control or manage chronic cancer or post op pain.
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Intraspinal analgesia
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The nursing responsibilities that go along with regional anesthesia/analgesia are:
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-assess effectiveness of med
-assess for adverse effects -prevent infection -maintain placement of catheter |
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Adverse effects of regional anesthesia/analgesia include:
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-sedation
-respiratory depression -reduced/loss of sensation -bowel and bladder distention -constipation -decreased I&O |
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When administering regional anesthesia/analgesia, _____ should be available at the bedside at all times!
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Narcan
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Use _____ technique with catheters placed for regional anesthesia/analgesia.
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sterile
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2 things an epidural can cause are:
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decreased sensation and urinary retention (related to micturation reflex)
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_____ are often combined with narcotics for moderate to severe pain because it can reduce the dose of opioid needed and provides better relief when combined.
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NSAIDS
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NSAIDS serve the functions of _____, ______, and ______.
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Anti-inflammatory
Antipyretic Analgesic |
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NSAIDS can interfere with _____ synthesis (decreasing # of nociceptors stimulated) and ______ aggregation (impaired clotting/bleeding).
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prostaglandin
platelet |
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3 NSAIDS are:
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Aspirin
Ibuprofen Naproxyn |
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An adverse effect of NSAIDS is
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GI irritation.
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NSAIDS interfere with ____ synthesis. This can cause GI irritation because the _____ protect the stomach lining.
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prostaglandin
prostaglandin |
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NSAIDS may also increase the effects of ______ agents.
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hypoglycemic
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NSAIDS are the treatment of choice for _______.
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mild-moderate pain
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People who should not take NSAIDS are those with...
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GI bleeding, ulcers, and impaired clotting
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Things you should teach a client who is taking NSAIDS are:
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-take with food or milk
-don't administer with Aspirin or other NSAIDS -use of antacids -tinnitis |
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Using antacids when taking NSAIDS may...
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decrease GI distress but also decreases absorption and effectiveness of the medication.
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____ is associated with high doses of aspirin which is ototoxic.
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Tinnitis
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Tinnitis is ______. It is an early sign of _____.
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ringing in the ears
ototoxicity |
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______ are medications that were developed for another use but are found to reduce pain as well.
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Adjuvant analgesics
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Adjuvant analgesics are also called ______.
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coanalgesics
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Adjuvant analgesics that help to reduce stress, anxiety, and tension and promote sleep and rest are called ______.
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mild sedatives and tranquilizers
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Many _____ are SSRI (selective serotonin reuptake inhibitors) and prevent reabsorption of serotonin. More serotonin in the blood blocks pain impulses from getting to the brain where they are perceived.
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antidepressants
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A common antidepressant is _____.
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cymbalta
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_____ are adjuvant analgesics that stabilize nerve membranes therefore decreasing excitability and pain.
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Anticonvulsants
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Neurontin is developed for ______ but actually helps with neuropathic pain.
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seizures
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_____ is developed for the purpose of managing neuropathy/nerve pain.
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Lyrica
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2 Non-opioid centrally acting analgesics are:
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tramadol and clonidine
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_____ is a non-opioid centrally acting analgesic that is a weak agonist at the mu receptor site and acts somewhat like an opiate. It may inhibit reabsorption of norendorphins and serotonin therefore helping prevent pain impulses from getting to the brain.
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Tramadol
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____ is a non-opioid centrally acting analgesic that for HTN and administered transdermally for pain; sometimes epidurally with anesthetic for epidural analgesic and also for sympathetic pain blocks to prolong the effect of local anesthesia.
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Clonidine
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Many nonpharmacologic managements are based on the ______.
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gate control theory
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Examples of nonpharmacologic management through cutaneous stimulation are:
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-massage
-heat and cold -contralateral stimulation -Transcutaneous Electrical Nerve Stimulation (TENS) |
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Examples of nonpharmacologic management through cognitive or behavioral measures are:
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-distraction
-relaxation -guided imagery |
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Invasive therapies that are types of nonpharmacologic pain management are:
|
-neuroablative procedures
-trigger point injections -spinal cord stimulation |
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Stimulation to the skin and subcutaneous tissue which prompts closure of the "gate" is known as _____.
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Cutaneous stimulation
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Cutaneous stimulation increases the release of _____.
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endorphins
|
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_____ is the stimulation of skin in an area opposite to the painful area.
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Contralateral stimulation
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_____ is low voltage electrical stimulation applied to skin and subcutaneous tissue.
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TENS
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TENS works by stimulating _____ in the same area as the fibers transmitting pain therefore the large nonpain nerve fiber reaches the dorsal horn and prevents pain impulses from entering the spinal cord and going to the brain.
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non pain receptors
|
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_____ is focusing attention on something other than pain.
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Distraction
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____ is using one's imagination to achieve a specific effect.
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Guided Imagery
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_____ relaxes tense muscles and reduces anxiety and tension.
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Relaxation
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_____ produces a deeply relaxed state by helping muscles relax and increasing the release of endorphins.
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Meditation
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_____ is a cognitive/behavioral measure that must be done by someone who is certified.
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Hypnosis
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Cognitive/Behavioral measures that are nonpharmacologic methods of pain management are:
|
-distraction
-guided imagery -relaxation -meditation -hypnosis -diaphragmatic breathing |
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A _____ is a chemical interruption of a nerve pathway.
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nerve block
|
|
3 types of surgical interruptions of nerve pathways are:
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-neurectomy
-cordotomy -rhizotomy |
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The purpose of neuroablative procedures is to stop transmission of the ____ to the _____.
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nerve impulse to the brain
|
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______ interruption of a nerve pathway is used for more severe or chronic types of pain. The nerve is actually cut to prevent the NI from reaching the brain.
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Surgical
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______ is a permanent invasive therapy that delivers a low voltage electrical current continuously to the spinal cord nerves to block sensation of pain.
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Spinal Cord stimulation (SCS)/ neuromodulation
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|
A _____ is done to remove a nerve.
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neurectomy
|
|
Client teaching about pain management should include:
|
-Medication (frequency, side effects, drug/food interactions, special precautions, take prior to SEVERE pain)
-risk of addiction -scheduled periods of sleep and rest -non-pharmacologic measures |
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Some ____ believe pain and suffering is a part of life and is to be endured. Some may deny dealing with it until it is unbearable and some believe prayer and laying on of hands will free a person of suffering and pain.
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African Americans
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____ may view pain as part of life and seriousness of illness. For some enduring pain is a sign of strength.
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Mexican americans
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Some ______ may tend to be loud and outspoken in their expressions of pain. This is a socially learned way to cope with pain.
|
Puerto Ricans
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____ cultures value silence therefore some clients may be quiet when in pain so as not to dishonor their families or themselves.
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Chinese
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_____ may have a stoic response to pain. They may refuse pain meds. Bearing pain is considered a virtue and a matter of family honor.
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Japanese
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______ patients may believe that pain is God's will. Some elderly may refuse pain meds.
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Filipino
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If the client is a _____, remaining calm when in pain is viewed as bringing oneself to a higher state or being.
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Buddhist
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_____ in general are quiet, less expressive verbally and nonverbally, and may tolerate a high level of pain. They tend to not request pain medication and may tolerate pain until they are physically disabled.
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Native Americans
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Pain responses in ____ may be considered private and reserved for immediate family. As a result this may lead to conflicting perceptions among the family and the nurse regarding effectiveness of the client's pain relief.
|
Arab Americans
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_____ are an age group that often receives inadequate pain medication.
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Children
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