Pain Management - ATI

(...) has a sudden or slow onset of any intensity and an anticipated or predictable end. By definition, it lasts less than six months

Acute Pain

Providing (...) to clients entails granting them the right of self-determination. It allows clients the freedom of choice, but that choice must be based on informed decisions.

Autonomy

Doing good and acting in the best interest of clients by providing care that benefits them is an act of (...). To do good also requires that nurses decrease the suffering of their clients.

Beneficence

The biopsychosocial model of pain suggests that three categories of factors form the experience of pain: (...)

Biological, psychological, and social

(...) is newly recognized category of pain that can involve tumor pain, bone pain, and treatment-associated pains such as chronic post-surgical pain.

Cancer pain

(...) has a sudden or slow onset of any intensity and is constant or recurring without an anticipated or predictable end. By definition, it usually has a duration of lasting longer than six months.

Chronic pain

(...) is the study of moral principles that guide personal or group behavior.

Ethics

What are conditions associated with acute pain?

Examples include pain that results from tissue damage caused by trauma or injury, incisional pain from surgery, and pain from environmental factors such as heat or cold.

What conditions are examples of chronic pain?

Examples of chronic pain include arthritis, back pain, and headaches. Chronic pain can be both physically and emotionally debilitating. If acute pain is not addressed, it can become chronic.

What are the barriers to end-of-life care may potentially leave pain undertreated, or not treated at all?

Fear of addiction, intellectual abilities, and the belief that pain is an expected part of illness and the dying process are barriers that clients and family members may pose to effective pain management.Barriers that can arise from providers include pain assessments that may be inadequate or lacking in specificity for the particular client, a deficit in knowledge of the inclusive effects that pain can have in an individual, and, as with clients and families, an uninformed fear of addiction.Finally, the health care system can erect monetary boundaries based on the costs of medications or the lack of insurance coverage that can prevent adequate treatment of clients' pain.Shortages of palliative care providers and education resources are other system-related barriers that can occur.Clients nearing the end of life may also believe nothing can be done about their pain, so that they do not report their pain to their families or their health care provider.

What is the Wong-Bakers FACES scale? What client population would you use the FACES scale on?

It is appropriate to use in children ages 3 and older. This scale is intended only for clients to rate their own pain—not for others to rate the pain experienced by the client. It is used for patients who cannot quantify their pain.The FACES scale is actually three scales in one, as it has faces, words, and numbers. The scale is shown to the client, who chooses the face that best represents how they feel. In face 0, the client has no pain; in face 10, the client has the worst pain they can imagine. Other faces are assigned scores of 2, 4, 6, and 8, each indicating more pain than the previous face. After the client chooses the face that best describes how they feel, the nurse should record the number and words associated with that face.

The final ethical principle supporting pain management is (...), which requires that all clients be treated equally. The relief of pain should be available to all, regardless of age, race, background, or history.

Justice

Not adhering to standards of care for pain management can lead to a charge of (...), defined as a negligent act that has been performed by a professional or trained individual

Malpractice

(...) refers to an individual's sense of right and wrong or their personal values.

Morality

(...) is defined as failing to perform in a manner that a reasonable and prudent person would perform.

Negligence

(...) is often referred to as nerve pain and arises from the somatosensory system. It can include diabetic neuropathy, phantom limb pain, and pain associated with a spinal cord injury. It is frequently described as intense, shooting, or burning and some clients may describe the pain as numbness, "pins and needles," and even an intense itching.

Neuropathic pain

(...) is felt in the tissue, an organ, a damaged part of the body, or a referred pain.

Nociceptive pain

(...) are found in multiple parts of the body and may be activated by chemical substances, tissue damage, and extreme temperature and pressure changes.

Nociceptors

The (...) is designed for clients who are unable to verbalize their pain level. This scale was originally developed for clients in burn units, but it is now also used in critical care areas where clients are unable to report pain due to the severity of their illness, sedation, or mechanical ventilation. Two versions it are currently in use.

Nonverbal Pain Scale (NPS)

(...) indicators of pain are manifestations that the nurse can observe and measure, such as crying, sweating, restlessness, grimacing, or guarding by the client.

Objective

(...) is whatever the client says that it is.

Pain

The (...) is the point at which a stimulus causes the client to perceive pain.

Pain Threshold

(...) is how much of a stimulus the client is willing to accept.

Pain tolerance

(...) indicators of pain are based on the client's report or opinion.

Subjective

What does CRIES stand for? What client population would you use this scale for?

The Crying, Requires oxygen, Increased vital signs, Expression, Sleeplessness (CRIES) Scale is an observational scale used for infants who were born at 38 weeks of gestation or greater. It has been found to be useful in assessing postoperative pain in neonates. The CRIES Scale also can be used for clients who are cognitively disabled and cannot report their pain. Characteristics of crying, oxygen requirement, changes in vital signs, facial expression, and sleep state are scored by the nurse on a scale of 0 to 2 for each category. For a CRIES score greater than 4, further pain assessment should be completed. Analgesics should be administered for a score of 6 or higher. The total scores can range from 0 to 10.

What does FLACC stand for? What client population would you use this scale for?

The Face, Legs, Activity, Cry, Consolability (FLACC) Scale is an observational pain measurement tool designed to be used with children ages 2 months to 7 years, and clients who are cognitively disabled. It is one of the most frequently used scales for children and other clients who cannot self-report their pain. The nurse observes the client for 1 to 5 minutes (if awake) or for 5 minutes or longer (if asleep), and gives a numeric score of 0 to 2 for each behavior: facial expression, leg movement, bodily activity, cry or verbalization, and consolability. Total scores can range from 0 to 10.

The (...) is also widely used to assess the severity of clients' pain. It consists of either a vertical or horizontal single line, with one end representing no pain, and the other end representing the worst pain imaginable. The nurse asks the client to select a point along the line that represents the intensity of their pain.

Visual Analog Scale

What is the numeric pain scale? Who would you use the scale for?

With the NRS, nurses ask the clients to rate the intensity of their pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain the client can imagine. Scores are interpreted as follows: 0 is no pain, 1 to 3 is mild pain, 4 to 6 is moderate pain, and 7 to 10 is severe pain.It can be used with patients 8 years and older (or children who are old enough to understand numbers), and adults who are alert and oriented with no cognitive disabilities.

What are forms of cutaneous stimulation?

heat and cold therapy, touch, massage, acupuncture, acupressure, and transcutaneous electronic stimulation (TENS) unit.

Another ethical concept involved in pain management is (...), or working to do no harm. Failing to manage a client's pain can indeed cause harm, and it is each nurse's ethical responsibility to avoid this outcome.

nonmaleficence