Pain 103

a back rub, the heat of a warm compress, or the cold from ice applications will close the gates to painful stimuli

A bombardment of sensory impulses, such as those from the pressure of

1."Can you describe the pain?" 2."What other symptoms are you experiencing?" 4."What did you experience right before the headache began?" 5."Do you or a family member have a history of severe headaches?"

A client arrives at the clinic complaining of a severe headache. The client states "It's a 10/10 headache. I took 600 mg of Ibuprofen (Motrin) over the past few hours, and it has not decreased the pain." The nurse suspects that the client is experiencing a migraine but wants to validate the suspicion by asking which questions? Select all that apply.

1.Verapamil (Calan) 2.Propranolol (Inderal)

A client with new onset migraine headaches is being seen in the clinic. The client has a history of hypotension and diabetes mellitus. The nurse predicts that the client will experience undesirable cardiac side effects if the health care provider prescribes which medications? Select all that apply.

Episode

A nurse is assessing a patient in pain. What word might the nurse use when documenting the pattern of a patient's pain?

distract patients and help make pain more tolerable

Auditory or visual stimuli can

Assess site, severity, duration, and location of pain Ask the patient what relieves the pain, what causes the pain to be worse, and what does not relieve the pain Identify usual coping mechanisms and the patient's, family's, and friends' expectations of appropriate behavior when in pain

Nursing assessment of pain Collection of subjective data Characteristics and description

is an expert about that pain

Only the person who is bearing the pain

morphine sulfate, fentanyl (Sublimaze), and codeine, are appropriate for treating moderate to severe pain (postoperative pain, myocardial infarction pain, cancer pain).

Opioid analgesics

Relieve pain mainly by action in the CNS, binding to opioid receptor sites in the brain and spinal cord

Opioids

Add stool softeners to medication list

Opioids are commonly given to patients for pain control. Constipation is the most common side effect of opioid use. Which intervention will help reduce the risk of constipation?

gastric emptying, slow bowel motility, and decrease peristalsis

Opioids can delay

reduce secretions from the colonic mucosa; result is slow-moving, hard stool that is difficult to pass

Opioids may also

1."What does the pain feel like?" 2."Where is the pain located?" 4."How does the pain affect you?" 6."What makes your pain better or worse?"

The nurse is assessing a client's postoperative pain using the PQRSTU method, which questions should the nurse ask the client? Select all that apply

FACES pain scale

The nurse is caring for a 6-year-old child who complains of pain. To provide proper documentation of this pain, what would the nurse use to assess the level of pain?

Nalbuphine is less likely to cause significant respiratory depression.

The nurse is comparing the use of nalbuphine (Nubain) versus meperidine (Demerol) for pain management for a pregnant client. Which statement is true with regard to the use of nalbuphine or meperidine?

clarifying concerns, answering questions, supplying all the information the patient needs to make decisions about care, and supporting the patient's decisions

The nurse should advocate for the patient by

Encourage coughing and deep breathing

The nurse should be sure to implement which measure for a postoperative patient to reduce the risk of adverse effects from morphine sulfate given every3-4 hrs ?

Frequency of bowel movements

The nurse should make note of which finding to detect an adverse effect of codeine sulfate?

probably more important than that of any other member of the health care team

The nurse's role in pain management is

nonopioids, opioids, and adjuvants.

The three classes of analgesics are

Stress and pain

activate endorphins

The body contains a natural supply of morphine-like substances called

endorphins

in the dorsal horn of the spinal cord

location of gates are

Changes in facial expressions—frowning or gritting teeth Clenched fists Withdrawal Crying, moaning, or tossing in bed Fetal position Clutching at the affected body part Pacing

more objective data

Tachycardia Increased rate and depth of respirations Diaphoresis Increase systolic or diastolic blood pressure Pallor Dilated pupils Increased muscle tension Possibly nausea or weakness

objective data for pain

Gastrointestinal dysfunction can

result in ileus, fecal impaction, and obstruction

are believed to cause the release of endorphins

transcutaneous electric nerve stimulation, acupuncture, and placebos

Cutaneous (skin) stimulation

transcutaneous electrical nerve stimulation (TENS), heat, cold, therapeutic touch, and massage Interruption of pain pathways Cold for inflammation Heat to increase blood flow and to reduce stiffness

Acupuncture

vibration or electrical stimulation via tiny needles inserted into the skin and subcutaneous tissues at specific points

monitor and intervene for adverse effects of opioid use

Constipation, Orthostatic hypotension, Urinary retention, Nausea/vomiting, Sedation, Respiratory depression

diffuses slowly from the epidural space across the dura and arachnoid membranes into the cerebrospinal fluid

Epidural analgesia Medication

as much as a dose that would be injected directly into the cerebrospinal fluid

Epidural analgesia may be 10 times

Imagery

Focusing on a pleasant thought to divert focus Requires an ability to concentrate

suggests that pain impulses can be regulated or even blocked by gating mechanisms located along the central nervous system

Gate control theory

altered by thoughts, feelings, and memories

Gating mechanisms can also be

Meperidine (Demerol)

The LPN is working in a long-term care facility. Which analgesic is a particularly poor choice for pain control in older adults?

This type of pain is typically aching, sharp, or throbbing. Pain receptors for tissue injury (nociceptors) are located mostly in the skin or in internal organs.

Nociceptive

caused by an injury to body tissues.

Nociceptive pain

Transcutaneous electric nerve stimulation, Distraction, Relaxation, Guided imagery,Hypnosis,Biofeedback

Noninvasive pain relief techniques

include motor, sensory and autonomic fiber derangements that feed into the central nervous system.

Peripheral neuropathies

vital part of the role of a nurse

Promoting physical and psychological comfort is a

urinary retention, postural hypotension, pruritus, nausea/vomiting, respiratory depression

Side effects of Epidural analgesia

removing the sensation of pain from the center of attention

Some patients can be distracted by

Believe what the patient says

What should the nurse do when a patient complains of pain?

need to know that the nurse believes what they say about their pain.

When caring for patients in pain, it is important for the nurse to consider that patients:

1.Report an inability to void. 2.Notify the nurse if nausea and vomiting occur. 3.Let the nurse know the pain level the client is experiencing. 5.Instruct the client to push the button when the pain level begins to increase.

When reinforcing instructions to an oriented client and the client's family regarding how to use the patient controlled analgesia (PCA) pump with both a basal and demand dose, the nurse should include which instructions? Select all that apply.

1.Lift, not pull the patient up in bed 2.Check Foley catheter for patency

Which interventions are most helpful in assisting the patient with comfort and pain control? (Select all that apply.)

Often occurs where there is actual or potential tissue damage

Which statements best describes a characteristic of pain?

Pain, acute or chronic Activity intolerance Anxiety Body image, disturbed Caregiver role strain Coping, ineffective and/or disabled family Disuse syndrome, risk for Family processes, interrupted Fatigue Fear

Nursing Diagnoses for pain

the pain while it is interpreting the other stimuli

The brain cannot acknowledge

has harmful physical effects as well as psychological effects

Unrelieved pain

allows patients to clearly articulate their pain and makes them more likely to receive proper treatment

Use of a pain-rating scale

results when certain endorphins attach to opioid receptor sites in the brain and prevent the release of neurotransmitters, thereby inhibiting the transmission of pain impulses

Analgesia

typically bring about quicker recoveries, shorter hospital stays, fewer readmissions, and improved quality of life

Appropriate pain management will

Stage 4

At which stage of NREM sleep are sleepwalking and enuresis most likely to occur?

Chronic pain

A new patient is admitted to the hospital with a diagnosis of rheumatoid arthritis. The patient reports that she has had difficulties with pain in her leg for the last 2 years. This is an example of what type of pain?

Intravenous narcotics

A nurse is caring for patients receiving a variety of interventions for pain management. Which pain relief method has the shortest duration of action?

A pain scale can help the client measure the amount of pain he has and its intensity.Offer the client a pain scale to measure his pain.

A nurse is collecting data from a client who is reporting pain. Which of the following actions should the nurse take to determine the client's pain intensity?

Presence of associated symptoms Nausea and vomiting are common symptoms clients have when they are in pain.

A nurse is collecting data from a client who reports severe abdominal pain. The nurse asks the client whether he has nausea and has been vomiting. The nurse is collecting data regarding which of the following?

C. Bradypnea, D. Orthostatic hypotension, E. Nausea

A nurse is monitoring a client who is receiving opioid analgesia for adverse effects of the medication. Which of the following effects should the nurse anticipate? (Select all that apply.)

Pain is a subjective experience, and the client is the best source of information about it. Pain is whatever the client says it is.

A nurse is obtaining a history from a client who has pain. The nurse should consider which of the following when collecting data?

Pain

A patient has just returned to the unit from surgery. The patient's skin color is pink; the dressing is intact with no drainage noted to be coming through, but the patient is moaning and showing facial grimacing and is restless. Which vital sign will the nurse assess related to these findings

Offer a bedtime snack and glass of milk

A patient went to bed around 8:00 PM. At 9:00 PM the patient is calling the nurse with the complaint of being unable to sleep. The patient does not have an order for sleep medication. Which intervention would be most appropriate for the nurse to implement?

regular assessment, and aggressive management are required

A preventive approach

"Needles are inserted in the subcutaneous tissue to stimulate the nerve."

A transcutaneous electrical nerve stimulation (TENS) is prescribed for a client with pain, and the nurse provides information to the client about the TENS unit. Which statement by the client indicates the need for further teaching?

Intense and of short duration Usually lasts less than 6 months Generally provides a warning to the individual of actual or potential tissue damage Creates an autonomic response that originates within the sympathetic nervous system Floods the body with epinephrine—"fight or flight" response

Acute pain

Composed of diverse classes of drugs that relieve pain via a variety of mechanisms

Adjuvant analgesics

Acute nociceptive

After a fall, Mrs. Jones complains about pain in her arm. The nurse knows this is most likely what type of pain?

1.anti-inflammatory 2.scheduled analgesic 3.prn combination opiod

An xray confirms Mrs. Jones has a closed, non-displaced fracture of the radius. An appropriate medication order may include a(n) (select all that apply):

occur as a result of injury, stroke, disease or congenital conditions involving the brain and/or spinal cord."

Central nervous system disorders

Pain lasting longer than 6 months Can be continuous or intermittent and may be as intense as acute Does not serve as a warning sign of tissue damage; may be due to damage that has already occurred Patient may develop chronic low self-esteem, change in social identity, changes in role and social interaction, fatigue, sleep disturbance, and depression

Chronic pain

If a therapy is ineffective at first, encourage the patient to try it again before abandoning it Keep an open mind about what may relieve pain Keep trying Protect the patient

Guidelines for individualizing pain therapy

the "gate" through which the pain impulse must travel is temporarily blocked by the stimuli

If cutaneous stimuli other than pain are transmitted

Distraction

Includes ambulation, deep breathing, visitors, television, and music

Relaxation

Includes meditation, yoga, and progressive muscle relaxation

Unreliably absorbed Painful and traumatic May cause fibrosis of muscle and soft tissue

Intramuscular (IM)

Route of choice for opioid analgesics after major surgery Bolus and continuous infusion

Intravenous (IV)

Nerve blocks Epidural analgesics Neurosurgical procedures Acupuncture

Invasive approaches to pain

Acetaminophen and nonsteroidal antiinflammatory drugs (aspirin, ibuprofen, and naproxen sodium) Most widely available and frequently used analgesic group Used primarily for mild to moderate pain

Medication for pain management Nonopioids

Morphine, meperidine (Demerol), and codeine Act on higher centers of the brain to modify perception and reaction to pain Manage moderate to severe acute pain Tolerance and physiologic dependence are unusual with short-term postoperative use, and psychological dependence and addiction are extremely unlikely after taking opiates for acute pain

Medication for pain management Opioids

has two components: a nociceptive one and a neuropathic one. Low back pain is a good example

Mixed pain

degenerative disc disease (DJD and related herniated disc, back/neck pain, chronic sciatica), migraines

Mixed types of pain

To request a consultation from a pain specialist for chronic pain.

Months after the injury has healed, Mrs. Jones complains of persistent shooting pain in her forearm. The nurse's best response is:

Anti seizure medication

Mrs. Jones is an 80 year old client has been the diagnosed with neuropathy. The most appropriate treatment is:

Damaged pain nerves (phantom limb pain, spinal cord injury, diabetic neuropathy, carpal tunnel syndrome, vitamin deficiencies)

Neurologic types of pain

'disease or disorder' involving the nerve itself as the source of the pain.

Neuropathic pain

larger syndrome of 'neuropathy' which is a disorder/dysfunction of peripheral nerves.

Neuropathic pain, however, is part of the

burns, sprains, fractures, bruises... Somatic (bones, joints, muscles, skin, connective tissue) Visceral (organs) Cutaneous (skin, subcutaneous tissue)

Nociceptive types of pain

Exert analgesic effects through the inhibition of prostaglandin production

Nonopioids

Optimal route, especially for chronic pain Convenient, flexible, and relatively steady blood levels Appropriate to use as soon as the patient can tolerate oral intake Mainstay of pain management for ambulatory surgical patients

Oral

is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"

Pain

same pathways through the large nerves in the spinal cord

Pain and other sensations of skin and muscle travel the

a challenge that every nurse must face, regardless of the practice setting is

Pain management

This drug delivery system allows patients to administer pain medications whenever needed Analgesia is more effective when the patient, rather than the nurse or provider, is in control Patient must be alert, oriented, and able to follow simple directions

Patient-controlled analgesia (PCA)

Nociceptive pain

The injury may be a cut, bruise, bone fracture, crush injury, burn, or anything that damages tissues

depend on the individual's learned experiences and involve psychosocial and cultural factors

The interpretation and significance of the pain

Anxiety, Constipation, Constricting edema, Depression, Diaphoresis, Diarrhea, Distention, Dry mouth, Dyspnea, Fatigue, Fear, Flatus, Grief, Headache Hopelessness

The lack of comfort can be the result of many factors and can take many forms, including

often worsening when a person moves, coughs, laughs, or breathes deeply or when the dressings over the surgical wound are changed, and most of the pain due to cancer

The nociceptive pain may be constant or intermittent

1.Observe for grimacing. 2.Listen for vocalizations. 3.Observe facial expressions. 5.Monitor for changes in behavior.

The nurse has just received report on a newly admitted client who is cognitively impaired and experiencing pain. Which data collection techniques should be included in this client's plan? Select all that apply.