Pain Managment
A 34-year-old client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. Her initial surgeries occurred more than 1 month ago and you are concerned with her increasing requests. What would you expect to be the cause of her frequent appeals for pain medication?
Tolerance
Allodynia
exaggerated pain response due to increased sensitivity to stimuli such as air currents, pressure of cloths, vibration
The client is taking continuous-release oxycodone (Oxycontin) for chronic pain and now reports constipation. The first question the nurse asks is
"When was your last bowel movement?"
A patient is being treated in a substance abuse unit of a local hospital. The nurse understands that when a patient has compulsive behavior to use a drug for its psychic effect, the patient needs to be monitored for which of the following?
Addiction .
A patient has been prescribed a Fentanyl patch for pain control. The nurse understands that this patch should be replaced every:
72 hours
You are assessing an 86-year-old postoperative patient who is very stoic. When you enter the room, the patient is curled into the fetal position, and he is moaning. His vital signs are elevated and he is perspiring. You ask the patient what his pain level is on a zero-to-ten scale that you did patient education on with this patient prior to surgery. The patient indicates a pain level of two to three. You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patient's pain?
Believe what the patient says.
The nurse is caring for a client with acute pain. The nurse is aware that the client's pain has lasted for less than?
Correct response: 6 months
While working on his home, Tim Taylor inadvertently hit his hand with a hammer and was brought to your Emergency Department. During your interview and assessment, Tim vomits as a result of his painful hand. What type of pain is Tim experiencing?
Deeper somatic pain such as that caused by trauma (e.g., a fracture) produces localized sensations that are sharp, throbbing, and intense.
Which of the following nursing interventions should a nurse perform when caring for a patient who is prescribed opiate therapy for pain?
Do not administer if respirations are less than 12 per minute
The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to
Educate the client that this goal may not be achievable.
A client is admitted to your trauma unit after being the victim of an industrial accident. As her nurse, you need to carefully monitor her traumatic injuries. How often should you assess and document her pain?
Every time Suzanna's vital signs are assessed
About which of the following issues should the nurse inform patients who use pain medications on a regular basis?
Inform the primary health care provider about the use of salicylates before any procedure, and avoid OTC analgesics consistently without consulting a physicianbasis
You are part of the health care team caring for a 77-year-old woman who has been admitted to your rehabilitation facility after falling and breaking both legs. The patient complains of pain in both legs. Pain management has become an issue for the patient and her family. The patient appears to be getting more and more ill and may have to be readmitted to an acute-care facility. What do you know about the negative effects of the stress of pain?
It is particularly harmful in the elderly who have been injured or who are ill.
You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain. According to the patient's history, the patient's pain has not responded to previous treatment. What treatment would you expect might be tried with this patient?
Long-term intrathecal or epidural catheter
An 82-year-old client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. He is without breakthrough pain at this point in time. How would his pain be classified?
Neuropathic and chronic
Endogenous
Produced within the body
An older adult has been medicated with an oral opioid for postoperative pain. To make the pain medication more effective, the nurse first
Provides the client with a fresh gown and changes the bed linens
Which of the following is a gastrointestinal route of administration for analgesics?
Rectal Explanation: A gastrointestinal route of administration of analgesics is the rectal route. The epidural space, oral mucosa, and subcutaneous sites are not related to the gastrointestinal route.
An elderly client has a fractured hip and is in Buck's traction. The client is disoriented and cannot express herself. At 0730 the client was calm. Now, at 0930, the client is restless and agitated. The nurse reviews the medication administration record. The last dose of opioid was at 0330. The nurse assesses the client's agitation may be from
Recurring pain
Your grandmother suffers from osteoarthritis and is prescribed a scheduled dose of analgesics to manage her chronic pain. As she lives on a limited income, she frequently skips doses or takes half-doses to "make her medicine last longer". What client teaching would you perform to assure uniform pain management for your grandmother?
Take medication doses when ordered .
The nurse caring for a 74-year-old man who has just returned to the medical-surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the pre-operative assessment where the patient stated that he has "been confused in the past when he takes pain medications." What does the nurse realize that the elderly may do?
The elderly may require lower doses of medication and are easily confused with new medications.
The nurse is assessing a patient's pain. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates the pain as a two at this time using a zero-to-ten pain scale. What conclusion would be most accurate?
The nurse should reinforce teaching about the pain scale number system. .
A 39-year-old client has been taking opioid analgesics for more than 2 weeks to control his post-surgical pain. While the surgeon is pleased with Louis's healing progress, he wants to change the analgesic to a non-opioid drug. He prescribes a gradually lower opioid dose and increasingly larger non-opioid drug doses. Why is the surgeon changing medications in this manner?
To avoid withdrawal symptoms Explanation: To avoid withdrawal symptoms, drugs that are known to cause physical dependence are discontinued gradually. The dosage or the frequency of their administration is lowered over 1 week or longer.
patient is being treated in a substance abuse unit of a local hospital. The nurse understands that when a patient has compulsive behavior to use a drug for its psychic effect, the patient needs to be monitored for which of the following?
Various other techniques are used alone or in addition to more traditional pain management techniques. Some include imagery, biofeedback, humor, breathing exercises and progressive relaxation, and distraction.
Lily Martin, a 75-year-old female, is admitted to your hospital unit with generalized abdominal pain, nausea and vomiting, and hypotension. She has not passed stool in over one week and is visibly uncomfortable. What type of pain would you expect Lily to be experiencing?
Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Visceral pain usually is diffuse, poorly localized, and accompanied by autonomic nervous system symptoms such as nausea, vomiting, pallor, hypotension, and sweating.
Regarding tolerance and addiction, the nurse understands that
although patients may need increasing levels of opioids, they are not addicted.
Pain tolerance
amount of discomfort a person endures once the pain threshold has been reached
Tolerance
condition in which a client needs larger doses of a drug to achieve the same effect as when the drug was first administered
Physical dependence
condition in which a person experiences physical discomfort when a drug that he or she taken routinely is abruptly stopped
Visceral pain
discomfort that arises form diseases or injured internal organs
Nociceptive pain
discomfort that arises form noxious stimuli that are transmitted for the point of cellular injury to the cerebral cortex of the brain
Acute pain
discomfort that has a short duration (from a few seconds to less than 6 months)and is associated with trauma, including surgery, or some other recent indentifiable etiology
Referred pain
discomfort that is perceived in a general area of the body, but not in the exact site where the diseases organ is anatomically located
A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends
increasing the amount of bran and fresh fruits and vegetables
Adjuvant drugs
medications that are co-administered when treating pain (e.g., improving analgesic effect without increasing dosage, controlling current symptoms, moderating side effects)
Owen Li, a 59-year-old male, has returned from his hip repair surgery with a PCA to effectively control his post-op pain. What extra steps must you take to ensure he doesn't overdose on narcotic analgesia?
none- Patient-controlled analgesia (PCA) allows clients to self-administer their own narcotic analgesic by means of an intravenous pump system. The client infuses the drug by pressing a hand-held button. The dose and time intervals between doses are programmed into the device to prevent accidental overdosage.
Somatic pain
pain that arises from mechanical, chemical, thermal, or electrical injuries of disorders affecting bones, joints, muscles, skin, or other structures composed of connective tissue
Breakthrough
pain-acute pain that occasionally develops in those who have chronic pain Chronic pain-discomfort that lasts longer than 6 months
Perception
phase of pain impulse transmission during which the brain experiences pain at a conscious level, helps to discriminate the location of the pain, determines it's intensity, attaches meaningfulness to the event, and provokes emotional responses
Modulation
phase of pain impulse transmission during which the brain interacts with the spinal nerves to alter the pain experience by releasing pain-inhibiting neurochemicals neuropathic pain-discomfort that is processed abnormally by the nervous system as a result of damage to the pain pathways in peripheral nerves or pain processing centers in the brain
Transmission
phase of pain transmission during which peripheral nerve fibers form synapses with neurons within the spinal cord and pain impulses move from the spinal cord to sequentially higher levels in the brain
Transduction
phase of pain transmission involving conversion of chemical information in the cellular environment to electrical impulses that moves toward the spinal cord
Withdrawal symptoms
physical discomfort that follows when a person abruptly discontinues use of a drug that they have been taking for a long time
Pain threshold
point at which pain-transmitting neurochemicals reach the brain, causing conscious awareness or discomfort
Pain
privately experienced, unpleasant sensation usually associated with injury of disease
Addiction
repetitive pattern of drug seeking and drug use to satisfy a craving for a drug's mind altering or mood altering affect
Pain management
technique used to prevent, reduce, or relieve discomfort
The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.
• "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." • "What aggravates your chest pain?" • "Please point to where you are experiencing pain." • "How long have you experienced this pain?" .
The family practice physician group, where you practice nursing, treats a high number of older adult clients. Many of these older adults use nonopiod pain medications on a regular basis. Which of the following client education principles should you teach to these clients? Choose all correct options.
• Inform the primary healthcare provider about the use of salicylates before any procedure • Avoid OTC analgesics consistently without consulting a physician Explanation: Over-the-counter analgesic agents such as aspirin, ibuprofen, or acetaminophen, are effective tools in pain management and should not be avoided without consulting a physician.
The nurse administered an analgesic to a client who was reporting pain. The medication is ordered as needed every 3 hours. Forty minutes later the client states he has had little relief. The nurse does all of the following:
• evaluates the pain level using the established pain scale • assesses respirations, pulse, and blood pressure • consults with the healthcare provider about the client's report
