Pain Management- Ch 44 FUNDAMENTALS OF NURSING
List some examples of chronic pain
1. Arthritis 2. Low back pain 3. Fibromyalgia 4. Headache 5. Peripheral neuropathy
What are the 2 types of nociceptive pain?
1. somatic 2. visceral
What is the maximum daily dose to acetaminophen?
4 g or 4,000 mg (p. 1035)
Why is acetaminophen often combined with opioids?
B.c it reduces the dose of opioid needed to achieve successful pain control. (p. 1035)
What are adjuvants?
Co-analgesics, or medications that enhance the effects of analgesics. (p. 1035)
What should the nurse closely monitor for in a patient who is opioid-naive?
Sedation
Choose the sentence that best defines *acute pain* a. Acute pain is protective and usually has an identifiable cause. b. Acute pain is not protective and does not always have an identifiable cause.
a. Acute pain is protective and usually has an identifiable cause. (p. 1017)
A patient's chief complaint is toothpain. Which intervention would be effective? a. Ice b. heat pack
a. Ice
The nurse is caring for a client who is receiving morphine sulfate by the intravenous route for acute pain. The nurse ensures that which medication is available in the event that the client's respiratory status and level of consciousness deteriorate? a. Naloxone b. Promethazine c. Atropine sulfate d. Protamine sulfate
a. Naloxone RATIONALE: Naloxone is an opioid antagonist that is used to treat opioid overdose. Atropine sulfate is an anticholinergic. Promethazine is an antiemetic medication, and protamine sulfate is the antidote for heparin.
A client with a fractured femur who has had an open reduction-internal fixation is receiving ketorolac. Which assessment measurement will assist the nurse in determining the effectiveness of this medication? a. Pain rating b. Temperature c. Serum calcium level d. White blood cell count
a. Pain rating
The nurse is instructing a client about receiving patient-controlled analgesia to control postoperative pain. What comment by the client indicates that further instruction is needed?" a. That's great that overdosing can't happen." b. "It will keep my pain at a pretty consistent level." c. "I feel a lot less nervous because I can control my own pain." d. "I'm glad I can give myself some medication and not have to wait for the nurse to give me something."
a. That's great that overdosing can't happen." RATIONALE: Because human error is always a possibility, overdosing can happen. Naloxone is always ordered if quick reversal of the effects of the opioid is needed. With patient-controlled analgesia, the client adjusts the dosage of the analgesic based on the pain level and response to the medication. It allows more consistent pain relief and more control by the client.
The nursing instructor is discussing the topic of pain with a student nurse who is assessing the status of pain in a cognitively impaired older adult. What comment by the student implies that further education is needed? a. Older adults tend to report pain less often than do younger adults. b. Clients in this age group are less sensitive to pain and have a greater pain tolerance. c. Mental images of pain are a less effective means to assess pain in this group than visual representations. d. Pain in the cognitively impaired older adult may require more frequent assessments than in clients who are not impaired.
b. Clients in this age group are less sensitive to pain and have a greater pain tolerance.
Which statement by the patient indicates that he needs further clarification on the proper use of his PCA? a. I don't have to call my nurse every time I'm going to press the button b. My wife is allowed to press the button for me c. Every time I press the button a small dose is delivered to stabilize the level of the medication in my blood d. I have control over my pain relief
b. My wife is allowed to press the button for me p. 1038-1039
What is the single most reliable indicator of pain? a. a significant change in vital signs b. a patient's self-report of pain c. a heart monitor d. signs and symptoms related to pain
b. a patient's self-report of pain read p. 1024 Subtitle 'Patient's expression of Pain'
When a patient *initially* receives epidural anesthesia, how often should the nurse assess the patient? a. ever 5 mins b. every 15 minutes c. every hour d. no need to assess because the anesthesiologist will periodically assess the patient
b. every 15 minutes p. 1041
A 23 year old man is brought into the ER via ambulance. His parents tell the triage nurse that they found him in his room passed out with an empty bottle of acetaminophen in his hand. The nurse is aware that this patient may have severe hepatotoxicity due to acetaminophen overdose. Which medication is anticipated to administer to the patient? a. Vitamin K b. Protamine sulfate c. Acetylcysteine d. Narcan
c. Acetylcysteine Dangerous hepatotoxic overdoses of acetaminophen are treated with acetylcysteine. (p. 1035)
How often should the nurse evaluate the patient who has received naloxone following drug administration? a. every 5 minutes b. Every hour c. Every 15 mins for 2 hours d. No need to evaluate because respiratory depression does not return once naloxone is administered.
c. Every 15 mins for 2 hours The nurse must evaluate patients who receive naloxone every 15 mins for 2 hrs following drug administration because its duration may be less than that of the opioid and respiratory depression sometimes returns. (p. 1036)
A patient is describing her pain: " It's a burning, shooting type of pain. It kind of feels like pins and needles." The nurse suspects that the patient has what type of pain? a. Visceral b. Nociceptive c. Neuropathic d. Somatic
c. Neuropathic Neuropathic pain is usually burning, shooting, or electric like. (p. 1027)
The health care provider (HCP) writes a prescription for acetylsalicylic acid, or aspirin, for a client who was admitted to the hospital with joint pain from rheumatoid arthritis. The nurse contacts the HCP to verify the prescription if which finding is noted in the assessment data? a. Renal colic b. Hypertension c. Diabetes mellitus d. Gastric ulceration
d. Gastric ulceration RATIONALE: Acetylsalicylic acid is a nonsteroidal agent that is prescribed for its antiinflammatory, antipyretic, and anticoagulant properties. Contraindications to the medication include gastrointestinal bleeding or ulceration, bleeding disorders, history of hypersensitivity to aspirin or other nonsteroidal antiinflammatory medications, impaired hepatic function, and chickenpox or flu in children or teenagers. The items noted in options 1, 2, and 3 are not contraindications to this medication.
Which of these patients would have a higher risk for opioid related adverse drug events? a. A patient who snores b. A patient using an opioid for the first time d. A patient who under went recent surgery e. All of the above
e. all of the above table 44-15 p. 1037
A client who had abdominal surgery is receiving epidural analgesia. The nurse monitors the client closely, knowing that which is a potential complication of this therapy? a. Constipation because of the location of the epidural catheter b. Dislodgment of the epidural catheter because the catheter is not sutured in place c. Permanent lower motor weakness because of the proximity of the catheter to the sciatic nerve d. Chronic addiction to the epidural medication because epidural analgesia is a more powerful means of pain relief than patient-controlled analgesia therapy
b. Dislodgment of the epidural catheter because the catheter is not sutured in place RATIONALE: Epidural analgesia (also known as peridural or extradural analgesia) refers to the instillation of a pain-blocking agent into the epidural space. Complications that occur with epidural analgesia are directly related to catheter placement, catheter maintenance, and the type of analgesia. Epidural catheters are not sutured in position and must be taped in place to help prevent dislodgment. Low concentrations of medications are used to avoid any sensory and motor deficits that can accompany epidural analgesia. Constipation and chronic addiction are not specific complications of epidural analgesia
