Ch 32: Dynamic Study Module Pain and Neuropathy and Headache
A patient describes bilateral foot pain as prickling, tingling, itching, burning, and skin crawling. Which term should the nurse use when documenting this patient's pain? Hypoesthesia Allodynia Hyperalgesia Paresthesia
Paresthesia Paresthesia is described as abnormal sensations such as prickling, tingling, itching, burning or cold, skin crawling or impaired sensations. Allodynia is a type of pain that occurs in response to a stimulus that usually isn't painful like light touch. Hyperalgesia is an increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves. Hypoesthesia is decreased sensitivity to tactile or thermal stimulation.
A patient with a right below the knee amputation reports right foot pain. The nurse should plan interventions for which type of pain? Unselected Acute Phantom limb Visceral Psychogenic
Phantom limb Phantom pain is pain that feels like it's coming from a body part that is no longer there, but these real sensations originate in the spinal cord and brain. Psychogenic pain, also called psychalgia, is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors. The patient is not experiencing visceral or acute pain.
The nurse should plan interventions for which type of pain
Phantom limb Phantom pain is pain that feels like it's coming from a body part that is no longer there, but these real sensations originate in the spinal cord and brain. Psychogenic pain, also called psychalgia, is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors. The patient is not experiencing visceral or acute pain.
After lifting several heavy boxes at work, a patient reports pain, numbness, and tingling in the right leg. While assessing the patient, the nurse notes decreased strength in the patient's right arm. Which type of pain should the nurse suspect this patient is experiencing? Chronic pain Radicular pain Psychogenic pain Somatic pain
Radicular pain Radicular pain is caused by compression, inflammation, and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis, and peridural fibrosis. Leg pain can be accompanied by numbness and tingling, muscle weakness, and loss of reflexes. Psychogenic pain is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors. Chronic pain is often defined as any pain lasting more than 12 weeks. Somatic pain is a type of nociceptive pain that is also referred to as skin pain, tissue pain, or muscle pain.
A patient recovering from the surgical removal of both breasts is experiencing a feeling of twitching of the aerolas. Which information should the nurse include when explaining this sensation to the patient? Sensation that an amputated or missing limb is still attached Desensitization of a limb Sensation that is increased by massaging, rubbing, and tapping the end of the limb Sensation created by acupuncture
Sensation that an amputated or missing limb is still attached Sometimes after a body part has been amputated, it feels as if that part is still there. It is a normal part of healing after surgery. Phantom sensation is not pain, but is a "tingly," cramping, or itching feeling where the missing part used to be. For some people, phantom sensation goes away with time. Acupuncture, massaging, rubbing, and tapping the end of the limb are some forms of therapies. Desensitization of a limb refers to a rehabilitation program's desensitization exercises, which are designed to help decrease hypersensitivity that may occur after an amputation.
The nurse suspects a patient is experiencing trigeminal neuralgia (TN). Which finding did the nurse most likely assess in this patient? Pain focused in several spots or spread in a smaller pattern Episodes of mild, shooting, or jabbing pain Unselected Episodes of pain lasting from a few hours to several minutes Spontaneous paroxysms of facial pain
Spontaneous paroxysms of facial pain With trigeminal neuralgia (TN), extreme, sudden burning or shock-like paroxysms of facial pain occur spontaneously or in response to non-noxious tactile stimulation of a trigger point on the face or the mouth or motor activities such as chewing, speaking, yawning, eating, or brushing the teeth. TN is characterized by episodes of severe (not mild), shooting, or jabbing pain that may feel like an electric shock. Bouts of pain last from a few seconds to several minutes, not hours. Pain is focused in one spot or spread in a wider, not smaller, pattern.
A patient is experiencing pain and blisters along the right side of the torso. Which health problem should the nurse suspect this patient is experiencing? Allergic reaction Psoriasis Infection Shingles caused by the varicella zoster virus (VZV)
The varicella zoster virus (VZV) is reactivated when the immune system is suppressed by aging or disease. The reactivated virus travels anterograde to the skin to cause zoster and retrograde to the central nervous system (CNS) to produce meningoencephalitis, myelitis, and stroke. Psoriasis is a chronic autoimmune disease characterized by skin redness and white dry skin patches and is usually found behind the knees and upper limbs at cubital regions. There is no indication that the patient is experiencing an infection. Allergic reaction usually happens when exposed to an allergen. Widespread presence of hives, swelling, itching, warmth, redness, or rash would be signs of allergy.
A patient is experiencing extreme pain. At which step of the World Health Organization (WHO) analgesic ladder should the patient receive medication? Third First with a steroid Second First with an NSAID only
Third Because acute pain can be intense, its initial management usually starts at the third step of the WHO ladder with gradual movement down the ladder during the recovery phase. It would be inappropriate pain management to medicate this patient at the first or second steps of the ladder.
A patient with diabetic neuropathy reports a burning and electrical-type pain in the lower extremities that is not responding to nonsteroidal anti-inflammatory drugs (NSAIDs). Which type of medication should the nurse anticipate being prescribed for this patient's pain? Tricyclic antidepressant (TCA) Sedative Opioid Corticosteroids
Tricyclic antidepressant (TCA) The most effective medications for treating diabetic peripheral neuropathy (DPN) are the TCAs, which inhibit the reuptake of norepinephrine and serotonin. The other medications are not indicated for this type of pain.
A patient is experiencing phantom limb pain. For which reason should the nurse prepare teaching about mirror box therapy for this patient? The affected limb is kept uncovered always and the unaffected limb is kept on the other side whose reflection can be seen on the mirror. A reflective illusion of an affected limb is created in order to trick the brain into thinking movement has occurred without pain. It involves placing the healthy limb behind a mirror, which is sited so the reflection of the opposing limb appears in place of the hidden limb. A mirror box is a device that allows the patient to easily create the missing limb illusion as real.
A reflective illusion of an affected limb is created in order to trick the brain into thinking movement has occurred without pain. The principle of mirror therapy is the use of a mirror to create a reflective illusion of an affected limb in order to trick the brain into thinking movement has occurred without pain. It involves placing the affected limb behind a mirror, which is sited so the reflection of the opposing limb appears in place of the hidden limb. A mirror box is a device which allows the clinician to easily create this illusion. It is a box with one mirror in the center where on each side of it, the hands are placed in a manner that the affected limb is kept covered always, and the unaffected limb, whose reflection can be seen in the mirror, is kept on the other side.
A patient with trigeminal neuralgia (TN) is experiencing severe pain. Which medication should the nurse expect to be prescribed for this patient? Antibiotics Immunomodulators Anticonvulsants Steroids
Anticonvulsants Anticonvulsants are the primary medication used to treat trigeminal neuralgia (TN). Immunomodulators are medications used to help regulate or normalize the immune system. Antibiotics and steroids are not used to treat this health problem.
Which drugs are most effective for the treatment of diabetic neuropathy, postherpetic neuralgia (PHN), and other neuropathic pain? Anticholinergics Immunomodulators Antibiotics Antidepressants
Antidepressants
Which drugs are most effective for the treatment of diabetic neuropathy, postherpetic neuralgia (PHN), and other neuropathic pain? Anticholinergics Immunomodulators Antidepressants Antibiotics
Antidepressants Antidepressants and anticonvulsant medications tend to be the most effective medications for neuropathic pain. An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Immunomodulators weaken or modulate the activity of the immune system. Antibiotics are prescribed to fight infection and are not used to treat peripheral neuropathy.
The nurse is assessing a patient who is experiencing extreme pain. Which first order neurons transmit deleterious stimulus? A and D-delta fibers D and A-delta fibers C and A-alpha fibers C and A-delta fiber
C and A-delta fiber A delta fiber transmits primarily carry sharp/pricking pain. Deep, visceral, burning, or aching pain are carried by C fibers. Only C fibers and the A-delta carry pain to central nervous system (CNS). There is no fiber named A-alpha, D fibers, or D-delta that carry pain stimuli to the CNS. Afferent nociceptive fibers travel back to the spinal cord where they form synapses in its dorsal horn. This nociceptive fiber (located in the periphery) is a first-order neuron. The cells in the dorsal horn are divided into physiologically distinct layers called laminae. Different fiber types form synapses in different layers, and use either glutamate or substance P as the neurotransmitter. C fibers connect with neurons in lamina II. Aβ fibers connect with lamina I, III, and V.
The nurse is assessing a patient experiencing pain. Which types of afferent nociceptive fibers are responsible for transmission of a noxious stimulus to the central nervous system (CNS)? A and D-delta fibers C and A-delta fibers D and A-delta fibers C and A-alpha fibers
C and A-delta fibers A delta fiber transmits primarily carry sharp/pricking pain. Deep, visceral, burning, or aching pain are carried by C fibers. Only C fibers and the A-delta carry pain to central nervous system (CNS). There is no fiber named A-alpha, D fibers, or D-delta that carry pain stimuli to the CNS.
A patient experiencing pain has a history of epilepsy. Which pain syndrome is this patient most likely experiencing? Central Psychogenic Somatic Visceral
Central Central pain syndrome is a neurologic condition caused by damage to or dysfunction of the central nervous system (CNS), which includes the brain, brainstem, and spinal cord. This syndrome can be caused by stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson disease. It may develop months or years after injury or damage to the CNS. Somatic pain rises from the skin, ligaments, muscles, bones, or joints as the result of an acute injury or chronic degenerative disease. Psychogenic pain has a psychological cause such as stress. Visceral pain originates from inflammation or obstruction of internal organs.
Following an episode of a generalized seizure, a patient is experiencing pain. Which type of pain syndrome is this patient most likely experiencing? Phantom Central Vascular Somatic
Central Central pain syndrome is a neurologic condition caused by damage to or dysfunction of the central nervous system (CNS), which includes the brain, brainstem, and spinal cord. This syndrome can be caused by stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson disease. It may develop months or years after injury or damage to the CNS. Phantom pain is associated with a missing body part. Vascular pain is associated with dilation or constriction of blood vessels. Somatic pain arises from the skin, ligaments, muscles, bones, or joints, as the result of an acute injury or chronic degenerative disease.
A patient has been experiencing progressively worsening pain for 4 months caused by terminal cancer. Which type of pain is this patient most likely experiencing? Chronic progressive pain Chronic intractable pain Chronic recurrent pain Short chronic pain
Chronic progressive pain Chronic progressive pain is characterized by continuous pain that increases in intensity. An example of chronic progressive pain is cancer pain that worsens as the disease nears its terminal phase. Chronic recurrent pain is characterized by repeated and intense episodes of pain separated by pain-free periods. Chronic intractable benign pain is characterized by continuous pain but with varying levels of intensity. Chronic pain is defined as any pain that lasts 12 weeks or longer. There is no short chronic pain.
The nurse reviews the World Health Organization's recommendations for pain management of a pediatric patient. Which medication should the nurse question before giving to this patient? Codeine Ibuprofen Paracetamol Morphine
Codeine Codeine is not recommended for control of pediatric pain. Codeine is a prodrug that is converted to an active metabolite, morphine, by the enzyme CYP2D6. Fetal CYP2D6 activity is less than 1% of adult values and less than 25% of the adult values in children below the age of 5 years. Consequently, the analgesic effect of codeine is essentially absent in neonates and young children. The other medications would be appropriate for this patient.
A patient is being treated for diabetes. Which type of pain is this patient at risk for developing? Visceral pain Radicular pain Somatic pain Diabetic peripheral neuropathy (DPN)
Diabetic peripheral neuropathy (DPN) Diabetic peripheral neuropathy (DPN) is the most frequent form of peripheral neuropathy and is a common complication of diabetes characterized by a progressive loss of nerve fibers in both the autonomic and peripheral nervous systems. Approximately 60-70% of people with diabetes have some form of neuropathy. Radicular pain a type of neuropathic pain, and is caused by inflammation or compression of a spinal nerve root. Visceral pain is internal, arising from the organs or the blood vessels. Somatic pain is associated with damage to the skin, soft tissues, ligaments, muscles, bones, and joints.
A pediatric patient is prescribed codeine for pain. Which action should the nurse take before providing this medication to the patient? Assess most recent urine output Discuss the use of this medication with the healthcare provider Measure the patient's heart rate and blood pressure Ask the healthcare provider to prescribe a lower dose
Discuss the use of this medication with the healthcare provider Codeine is not recommended for control of pediatric pain. Codeine is a prodrug that is converted to an active metabolite, morphine, by the enzyme CYP2D6. Fetal CYP2D6 activity is less than 1% of adult values and less than 25% of the adult values in children below the age of 5 years. Consequently, the analgesic effect of codeine is essentially absent in neonates and young children. Providing a lower dose would not improve the patient's response to the medication. Assessing blood pressure, heart rate, and urine output has no effect on the patient's response to this medication.
Which affects a patient's pain perception? Type of pain medication Unselected Location of the pain Emotional stress Length of time the pain has been occurring
Emotional stress Perception is the cognitive appreciation of a noxious stimulus. It involves the somatosensory cortex and limbic structures and includes the subjective, sensory, and emotional aspects of pain. The perception of pain is influenced by emotional or psychological stress, cultural and religious beliefs, and prior experience with pain. The other choices are not identified as influencers of pain perception.
Which disease is characterized by main widespread pain throughout the body that can vary in intensity in specific areas, such as the back or neck? Crohn disease Migraine Multiple sclerosis Fibromyalgia
Fibromyalgia Symptoms may vary from person to person, but the main symptom of fibromyalgia is widespread pain throughout the body. This may be worse in certain areas, such as the back or neck. Crohn disease is an inflammatory bowel disease (IBD). Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) that disrupts the flow of information within the brain, and between the brain and body. A migraine can cause severe throbbing pain or a pulsing sensation, usually on just one side of the head.
Which disease is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep issues, memory issues, cognitive difficulties, and mood issues? Fibromyalgia (FM) Arthritis Osteoporosis Irritable bowel syndrome (IBS)
Fibromyalgia (FM) Fibromyalgia (FM) is associated with widespread areas of tenderness distributed symmetrically on the trunk and proximal limbs. Eighteen symmetric tender points (9 pairs) have been identified that are sensitive to tactile stimulation, although there is no evidence of gross muscle pathology. They include the neck, back, chest, elbows, hips, buttocks, and knees. Irritable bowel syndrome is a gastrointestinal disorder. Arthritis is joint inflammation. Osteoporosis is a bone disorder caused by demineralization of the skeletal structure.
The nurse observes this rash on a patient's torso. Which other symptom should the nurse assess in this patient? Headache and fever Nausea and vomiting Joint aches and stiffness Shortness of breath
Headache and fever This patient rash indicates an outbreak of shingles (herpes zoster) on the torso. Before the rash appears, pain, itching, or tingling may be present in the area where the rash will develop; headache and fever frequently accompany the rash. Joint aches and stiffness, nausea and vomiting, and shortness of breath are not associated with this health problem.
A patient with a throbbing headache on the right side of the head is nauseated and asks for the lights to be turned off. Which health problem is this patient most likely experiencing? Bilateral throbbing headache Lack of peripheral and central sensitization Migraine Hormonal changes not related to menstruation
Migraine The exact cause of migraine headaches (MH) is not clearly understood, though experts believe they are due to a combination of the expansion of blood vessels and the release of certain chemicals, which causes inflammation and pain. The chemicals dopamine and serotonin are among those involved in migraines. These chemicals are found normally in the brain and can cause blood vessels to act abnormally if they are present in abnormal amounts or if the blood vessels are unusually sensitive to them. They can be triggered by hormonal changes during menstruation, and does involve peripheral and central sensitization usually with unilateral throbbing headache.
A patient reports right wrist pain for the past 2 weeks that becomes worse when typing and using the computer mouse. Which condition caused by repetitive strain can provoke this pain? Nerve entrapment syndrome Central neuropathy Complex regional pain syndrome (CRPS) Endocrine disorders
Nerve entrapment syndrome Neuropathies can occur in a large number of unrelated conditions, including repetitive stress that leads to nerve entrapment. Central neuropathies are a result of injury, stroke, disease, or congenital conditions in the brain and/or spinal cord. Endocrine disorders cause progressive loss of nerve fibers in both the autonomic and peripheral nervous systems. Complex regional pain syndrome (CRPS) is a neuropathic pain disorder that affects one of the upper or lower limbs after an injury or trauma and is associated with significant dysfunction of both the PNS and CNS.
A patient is experiencing mild pain. Which analgesic corresponds to the first step in the World Health Organization's analgesic ladder? Nonsteroidal anti-inflammatory drug Nonsteroidal anti-inflammatory drug and tramadol Acetaminophen and codeine Morphine
Nonsteroidal anti-inflammatory drug The World Health Organization (WHO) pain ladder is a guideline for the use of drugs in the management of pain. It has 3 steps. The first step is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The second step uses an NSAID with another agent such as codeine or tramadol. The third step uses a powerful opioid like morphine.
An older adult patient is experiencing an itching and burning sensation on the left side of the back and chest. Which virus should the nurse suspect has been activated in this patient? Yersinia pestis virus Herpes simplex Varicella zoster virus (VZV) Impetigo
Varicella zoster virus (VZV) Acute herpes zoster (HZ) causes a painful unilateral rash with vesicular eruptions in one or more dermatomes harboring the varicella zoster virus (VZV). Before the rash appears, pain, itching, or tingling may be present in the area where the rash will develop. The patient's symptoms are not associated with the other disease processes.
Which virus should the nurse suspect has been activated in this patient?
Varicella zoster virus (VZV) Acute herpes zoster (HZ) causes a painful unilateral rash with vesicular eruptions in one or more dermatomes harboring the varicella zoster virus (VZV). Before the rash appears, pain, itching, or tingling may be present in the area where the rash will develop. The patient's symptoms are not associated with the other disease processes.
A patient describes pain as distant, squeezing, deep, and dull that occurs with nausea and vomiting. Which type of pain should the nurse suspect this patient is experiencing? Superficial Superficial somatic Deep somatic Visceral
Visceral Visceral pain is described with vague terms such as squeezing, pressure, cramping, and distention with a dull quality. The exact source of visceral pain is difficult to pinpoint, because the pain is frequently referred to a distant site of the body as a result of visceral and somatic convergence in the dorsal horn. Somatic pain is a type of nociceptive pain that is also referred to as skin pain, tissue pain, or muscle pain. Unlike visceral pain, the nerves that detect somatic pain are located in the skin and deep tissues. Superficial somatic pain or superficial pain refers to pain in the skin, deep somatic pain refers to pain that a person might feel in muscles or bone. Superficial somatic pain is usually confined to one area and often described as sharp or burning. Superficial somatic pain is also known as cutaneous pain.
A patient describes pain as distant, squeezing, deep, and dull that occurs with nausea and vomiting. Which type of pain should the nurse suspect this patient is experiencing? Visceral Superficial Superficial somatic Deep somatic
Visceral Visceral pain is described with vague terms such as squeezing, pressure, cramping, and distention with a dull quality. The exact source of visceral pain is difficult to pinpoint, because the pain is frequently referred to a distant site of the body as a result of visceral and somatic convergence in the dorsal horn. Somatic pain is a type of nociceptive pain that is also referred to as skin pain, tissue pain, or muscle pain. Unlike visceral pain, the nerves that detect somatic pain are located in the skin and deep tissues. Superficial somatic pain or superficial pain refers to pain in the skin, deep somatic pain refers to pain that a person might feel in muscles or bone. Superficial somatic pain is usually confined to one area and often described as sharp or burning. Superficial somatic pain is also known as cutaneous pain.
The nurse suspects that a patient is experiencing visceral pain. Which description of the pain did the nurse use to make this clinical determination? Dull pressure Burning Sharp Tingling
Visceral pain is described with vague terms such as squeezing, pressure, cramping, and distention with a dull quality. The other terms are not used to describe visceral pain.
A patient is using mirror box therapy to help reduce phantom limb pain. Which pathways are involved this therapy? Vision and proprioceptive Nociceptor and vision Proprioceptive and mechanoreceptors Interoceptors and vision
Vision and proprioceptive In mirror box therapy, the patient watches the movement of the intact limb in a mirror placed between the arms or legs and perceives the phantom limb as moving in a similar manner. Mirror neurons in the brain are activated and enable sensations of touch or movement in the phantom limb. The perception of movement in the phantom limb modulates the sensory input and blocks perception of the pain.
A 3-year-old pediatric patient is experiencing pain. Which tool should the nurse use to assess this patient's level of pain? Verbal numeric scale (VNS) Visual analogue scale for pain (VAS) Numeric rating scale for pain (NRS) McGill pain questionnaire (MPQ)
Visual analogue scale for pain (VAS) The visual analog scale is useful in determining pain in young children. The numeric rating scale (NRS) is a scale for a patient's self-reporting of pain. The McGill pain questionnaire measures not only the pain's intensity but also its quality. With the verbal numeric scale (VNS), patients verbally rate their pain on a scale of 0 (no pain) to 10 (most intense pain imaginable).
Which symptoms are used to diagnose fibromyalgia (FM)? Widespread pain in all four quadrants of the body for at least 3 months Tenderness or pain in at least 5 of the 18 specified tender points when pressure is applied Positive cognitive exam Refreshed sleep
Widespread pain in all four quadrants of the body for at least 3 months The diagnosis of fibromyalgia (FM) is one of exclusion; diagnostic criteria include a 3-month duration of widespread pain, presence and severity of pain in 7 of the 18 trigger points, fatigue, and absence of other disorders that could explain the pain.
Which symptoms are used to diagnose fibromyalgia (FM)
Widespread pain in all four quadrants of the body for at least 3 months The diagnosis of fibromyalgia (FM) is one of exclusion; diagnostic criteria include a 3-month duration of widespread pain, presence and severity of pain in 7 of the 18 trigger points, fatigue, and absence of other disorders that could explain the pain.