EAQ Chapter 10
Which patients will require antidepressant therapy for pain management? A patient with fibromyalgia A patient with osteoarthritis A patient with a sports injury A patient with trigeminal neuralgia A patient with diabetic nephropathy
Antidepressants are required for the management of chronic pain conditions. Fibromyalgia involves chronic widespread pain and allodynia, a heightened and painful response to pressure. Antidepressants will help to alleviate the pain, depression, fatigue, and anxiety associated with the disease. A patient with trigeminal neuralgia has chronic pain manifested in the form of severe stabbing pain in the facial muscles. A patient with diabetic neuropathy, who has chronic pain symptoms such as burning pain in the feet bilaterally, also benefits from this therapy. A patient with osteoarthritis and a sports injury may not require antidepressant medications because the damage is due to tissue degeneration, not nerve degeneration.
Which pathologic disorders are associated with nociceptive pain? Arthritis Mechanical back pain Central poststroke pain Carpal tunnel syndrome Complex regional pain syndrome
Arthritis and mechanical back pain are the physiologic disorders associated with nociceptive pain. Central poststroke pain, carpal tunnel syndrome, and complex regional pain syndrome are physiologic disorders associated with neuropathic pain.
The nurse is caring for a patient who had an accident several years ago and is complaining of arm pain. The nurse gently presses the patient's arm with the blunt end of a tongue depressor and finds that the patient has severe pain in the arm. Which treatment strategy would be most beneficial for the patient? Administering corticosteroids Administering anticonvulsants Administering aspirin (Acuprin) Administering acetaminophen (Tylenol)
By using a tongue depressor, the nurse can evaluate the intensity of pain experienced by the patient. If the patient reports severe pain, it may indicate that the patient has allodynia, which is a symptom of neuropathic pain and can be treated by the administration of anticonvulsant medications. These medications block the transmission of ion channels and prevent the transmission of pain impulses. Corticosteroids have a mild analgesic action and help to relieve nociceptive pain associated with arthritis or mechanical back pain. Aspirin (Acuprin) and acetaminophen (Tylenol) are nonsteroidal antiinflammatory drugs, which help to relieve pain associated with sport injuries. They reduce the prostaglandin levels, but do not block the nerve impulses.
Which physiologic change can cause hyperalgesia and allodynia in a patient? Depletion of GABAergic interneurons Decrease in prostaglandin and bradykinin levels Increase in opioid receptors along the spinal cord Increase in enkephalins and dynorphins levels
Depletion of GABAergic interneurons causes a decrease in the levels of gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter. A decrease in GABA levels increases the sensitivity of the nerves and causes hyperalgesia and allodynia in the patient. A decrease in prostaglandin and bradykinin levels results in decreased pain impulses. It does not cause hyperalgesia and allodynia. An increase in opioid receptors reduces the transmission of pain but does not cause hyperalgesia and allodynia. Enkephalins and dynorphins are endogenous opioids and alleviate pain, but do not cause hyperalgesia and allodynia.
A patient with diabetic neuropathy reports burning, electric shock-like pain in the lower extremities. Which category of medications would be helpful in treating this patient? Opioids Corticosteroids Antidepressants Anticonvulsants Muscle relaxants
Diabetic neuropathy is a neuropathic disorder that is associated with burning, electric shock-like pain in the lower extremities. Opioids alleviate neuropathic pain by activating the opioid receptors located in the spinal cord. These medications block the transmission of the pain impulses from the brain to the thalamus. Antidepressants and anticonvulsant medications decrease the serotonin levels and increases gamma-aminobutyric acid (GABA), so these medications alleviate pain by blocking the transmission of pain impulses from the damaged nerves and reducing their sensitivity. Corticosteroids are prescribed for the treatment of nociceptive pain, which is associated with redness and inflammation at the site of injury. These medications reduce prostaglandin levels, and inhibit inflammatory responses. Muscle relaxants are effective in preventing muscle spasm and can alleviate the pain associated with musculoskeletal injuries. These medications do not alter neurotransmitter levels, however, nor do they prevent neuropathic pain.
Which phase of nociceptive pain involves the release of bradykinin and prostaglandins? Perception Modulation Transmission Transduction
During the transduction phase, bradykinin and prostaglandins are released from the injured tissues. These chemicals transmit pain signals from the injury site to the spinal cord. Perception is the third phase of nociception and is associated with conscious awareness of a painful sensation. The modulation phase is associated with alleviation of the pain stimulus, because there is no release of bradykinin and prostaglandins from injured tissues. During the transmission phase, endogenous opioids are released which activate opioid receptors and block the transmission of pain impulses.
Which associated disorders may be found in a patient with neuropathic pain? Herpes zoster Liver metastasis Postoperative pain Trigeminal neuralgia Distal polyneuropathy
Herpes zoster, trigeminal neuralgia, and distal polyneuropathy are the disorders that cause neuropathic pain because they cause a primary lesion, called a neuroma, and damage the nervous system. Liver metastasis is visceral damage that results in nociceptive pain. Postoperative pain is somatic damage that causes nociceptive pain.
Which neurotransmitters are released at the site of injury? Glutamate Histamine Bradykinin Prostaglandin Gamma-aminobutyric acid
Histamine, bradykinin, and prostaglandin are the neurotransmitters that are released at the site of injury. These neurotransmitters send the signal of pain to the spinal cord. Glutamate and gamma-aminobutyric acid are released from the brain and block the transmission of pain impulses.
In which phase of nociception does the opioid drug block the signal of pain? Perception Modulation Transduction Transmission
In the transmission phase, the opioid receptors present in the spinal cord block the signal of pain and inhibit the perception of pain. The opioid receptors are not present in the perception, modulation, and transduction phases. In the perception phase, the patient shows an emotional response to the pain stimulus. In the modulation phase, the release of a third set of neurotransmitters from the brain will show analgesic effects. In the transduction phase, the release of neurotransmitters from the injury site to the spinal cord takes place.
The nurse is caring for a patient who has undergone liver transplantation. The patient reports severe lower back pain while standing for the past 2 days. Which type of pain is the patient experiencing? Chronic pain Incident pain Breakthrough pain Malignant pain
Incident pain is a type of acute pain caused due to certain body movements. Lower back pain while standing indicates that the patient is having incident pain. If a patient experiences lower back pain for more than 6 months, which is not the case here, then it indicates chronic pain. Breakthrough pain occurs in patients who undergo opioid therapy; the patient experiences sudden pain due to the reduced half-life of the medication. Malignant pain is a type of chronic pain; it is induced by tissue necrosis or stretching of an organ by the growing tumor.
The nurse is assessing a patient who has a knee injury that occurred while playing soccer. Which intervention would be helpful in treating this patient? Leaving the wound uncovered Applying heat to the site of the injury Administering antineuroleptic medications Administering nonsteroidal antiinflammatory (NSAID) medications
Nonsteroidal antiinflammatory drugs have analgesic and antiinflammatory actions that help to alleviate the nociceptive pain caused by sports injuries. In order to prevent infection, the nurse should clean the wound and apply a dressing rather than leaving it uncovered. If the patient has a disorder related to the neuropathic pain, then the primary health care provider would prescribe antineuroleptic medications. Sports injuries are often accompanied by inflammation and swelling, which can be treated with ice packs. Heat should not be applied to this type of injury as heat will not reduce swelling and may increase the pain.
A patient who has undergone an open bladder surgery reports severe pain, which has not been reduced by analgesics. The nurse finds that the patient has tachycardia and hypertension. What other uncontrolled pain responses does the nurse expect in this patient?
Oliguria Joint stiffness Decreased respiratory rate A patient who has undergone a surgery may experience acute pain due to the release of prostaglandins, histamine, and bradykinin at the surgery site. If the pain is not properly managed the patient may have several uncontrolled pain responses including oliguria, muscle spasm, and bronchoconstriction. Trauma and swelling from the bladder surgery may cause oliguria. Increased muscle spasm reduces the patient's mobility and causes joint stiffness. Bronchoconstriction causes breathing difficulty and decreases the rate of respiration. Acute pain is associated with an increase in the norepinephrine levels, which results in increased adrenergic activity and myocardial oxygen demand.
A nursing instructor is teaching a group of students about fetal brain development and its response to pain. Which statement made by a student indicates the need for further teaching? The fetus develops ascending sensory fibers by 20 weeks of gestation. The fetus responds to pain due to development of connection to the thalamus. The fetus that has propercortex development responds to pain stimuli at 20 weeks of gestation. The fetus is sensitive to pain stimuli due to the presence of inhibitory neurotransmitters.
A fetus responds to pain stimuli due to the development of sensory fibers. The presence of inhibiting neurotransmitters in the fetus is responsible for the pain perception in a full-term fetus. In the 20th week of gestation, the fetus develops ascending sensory fibers and connections to the thalamus, which may help in experiencing "emotional pain". A fetus that has proper cortex development will respond to pain stimuli in the 20th week of gestation.
While assessing a patient with joint pain, the nurse finds that the health care provider has ordered a functional magnetic resonance imaging (fMRI) test. What is the reason for this intervention? To determine the source of pain To help control the pain To find a genetic link for the pain To assess the intensity of the pain
An fMRI shows changes in brain activity during episodes of pain and after medication is administered, which can be helpful in revealing the brain's response to pain and promoting the patient's control over pain perception. An fMRI scan does not provide body images to help assess the source of the pain. The fMRI scan shows the functional aspects of the brain, but does not help to assess the genetic link to pain. The pain assessment scale, not an fMRI, helps measure the intensity of the pain.
A patient with a shoulder injury tells the nurse, "My shirt is chafing my shoulder and causing me pain. Can you get me a sleeveless shirt?" What does the nurse interpret from the patient's response? The patient has allodynia. The patient has analgesia. The patient has incident pain. The patient has breakthrough pain
An increase in pain due to a slight touch of a cloth or cotton swab indicates that the patient has allodynia, which is damage to the nerve fibers at the injury site. If a patient experiences no pain at the injury site, then it could indicate analgesia. If the patient has pain at a particular site due to movement, then it indicates incident pain. If the patient experiences a transient spike in pain despite taking analgesics to control pain, this is called breakthrough pain.
A patient with cancer reports having severe pain. The health care provider prescribes opioid analgesics for pain relief. Which event of nociception will be inhibited after administering opioid analgesics to the patient? Secretion of histamine, bradykinin, and prostaglandins at the site of injury Secretion of glutamate and adenosine triphosphate at the synaptic cleft Movement of the pain impulses from the spinal cord to the thalamus via the ascending fibers Movement of the pain impulse across the synaptic cleft to the dorsal horn neurons
Opioid analgesics block the transmission of pain impulses and relieve pain. These analgesics activate the opioid receptors located in the spinal cord and block the transmission of the pain impulses from the spinal cord to the thalamus; this occurs in the second phase of nociception. The secretion of histamine, bradykinin, prostaglandin, glutamate, and adenosine triphosphate (ATP) takes place during the first phase of nociception. The opioid analgesics do not inhibit the events of the first phase, because they do not block the receptors which secrete histamine, bradykinin, prostaglandin and glutamate. The transmission of the pain impulses across the synaptic cleft to the dorsal horn neurons takes place due to the secretion of glutamate and ATP. Because the opioid analgesics do not inhibit the secretion of glutamate, they do not hinder the transmission of the impulses across the synaptic cleft to the dorsal horn neurons.
What is the PQRST scale?
PQRST is a pain assessment scale; it stands for Provocation/Palliation, Quality/Quantity, Region/Radiation, Severity Scale, and Timing. Because the patient is describing methods that provide comfort and relieve the pain, it indicates that the patient is addressing Provocation/Palliation. If the patient reports about severity of pain on a scale of 0 to 10, then it indicates that the patient is addressing Severity. When addressing the Quality/Quantity of the pain, the patient describes the pain felt. If the patient reports about the site of pain, then the patient is addressing Region/Radiation.
What are the signs of somatic pain? Nausea Sweating Tachycardia Hypotension Hyperpigmentation
Somatic pain is caused by the transmission of pain impulses from ascending nerve fibers to the autonomic nervous system (ANS). This results in increased autonomic functioning. An increase in autonomic functioning triggers the chemoreceptor zone in the brain that causes nausea and vomiting. It also causes sweating, and increases heart rate, resulting in tachycardia. Increased autonomic functioning increases blood pressure and causes hypertension, not hypotension. Due to vasoconstriction, the patient may exhibit pallor, but not hyperpigmentation.
While assessing pain in a 2-year-old-patient, the nurse observes facial expression, leg movement, activity level, cry, and consolability in the child. Which pain assessment scale does the nurse use for this patient? FLACC scale CRIES Scale PAINAD scale Faces pain scale-revised (FPS-R scale)
The FLACC scale is a nonverbal pain assessment tool that is used to assess the intensity of pain in infants and children less than 3 years of age. While using the FLACC scale, the nurse observes the facial expression, leg movement, activity level, cry, and consolability in the child and gives a score from 0 to 10. The CRIES scale is a 3-point scale that helps to assess postoperative pain in preterm infants and neonates. The PAINAD scale is a pain assessment tool that helps to measure pain in patients with dementia. It uses breathing, vocalization, and facial expression as assessment tools. Faces pain scale-revised (FPS-R scale) is a pain assessment tool that helps to assess the intensity of pain through drawings of different facial expressions.
After assessing pain in a 2-year-old child, the nurse documents the score as five using the FLACC scale. How does the nurse interpret this score? The child has no pain. The child has mild pain. The child has severe pain. The child has moderate pain.
The FLACC scale is an objective assessment of pain in young children less than 3 years of age. The tool assesses five behaviors of pain: facial expression, leg movement, activity level, cry, and consolability. A score range of 4 to 6 indicates that the child has moderate pain. As the documented score falls within this range, the nurse interprets that the patient may have moderate pain. The score of 0 indicates that the child is relaxed and comfortable and is not experiencing any pain. The score range of 1 to 3 indicates that the child has mild pain. The score range of 7 to 10 indicates that the child has severe pain.
The nurse is assessing a patient with dementia who has severe back pain. The nurse uses the PAINAD scale to evaluate the intensity of the pain and check the vocalization and breathing in the patient. What other parameters should the nurse evaluate to determine the pain intensity in the patient? Visibility Consolability Facial expression Hearing ability Body language
The PAINAD scale is a pain assessment tool used for evaluating the intensity of the pain in the patient with dementia. While using this pain assessment tool, the nurse should monitor five parameters: breathing, vocalization, consolability, facial expression, and body language. Because of the pain, the patient may suffer from hypoxia and hyperventilation. The nurse should check the patient's breathing rate. The patient may make a whimpering sound in response to pain, so the nurse should monitor vocalization. The patient may be confused due to the dementia and may not be open to suggestions. Therefore, the nurse should check if the patient is consolable. The patient may exhibit a facial grimace in response to pain and may change the body posture to promote comfort, so the nurse should monitor patient's facial expressions and body language. Pain does not impair visual acuity and does not cause hearing impairment. Therefore, the nurse need not monitor the patient's vision and hearing.
The nurse is assessing a pregnant patient at 20 weeks of gestation. On reviewing the 3D magnetic resonance reports of the fetus, the nurse finds that the cerebral cortex of the fetus is not well developed. What does the nurse interpret from these findings? The fetus will not experience emotional pain until 30 weeks of gestation. The fetus will experience somatic pain due to the increased sensory perceptions. The fetus will not experience cutaneous pain after birth while injecting medications. The fetus will experience immense pain during the prenatal test until 25 weeks of gestation.
The cerebral cortex plays an important role in the perception of pain. The fetal brain usually develops by the 20th week of gestation, and the fetus experiences the same intensity of pain as an adult. If the cerebral cortex is not well developed, the fetus will not experience any emotional pain until the 30th week of gestation. Due to impaired development of the cerebral cortex, the fetus will not have increased sensory perceptions and will not experience any somatic pain. At the time of birth, the fetal brain is developed enough to experience pain. Therefore, the nurse should not interpret that the fetus will not experience cutaneous pain after its birth. Because the cerebral cortex of the fetus is not well developed, the fetus will have reduced conscious awareness and may not experience any pain until 25 weeks of gestation.
The nurse is caring for a diabetic patient with peripheral neuropathy. Which finding will the nurse expect to observe in this patient? Burning pain in feet bilaterally Brittle nails with pale, shiny, dry skin Severe stabbing or piercing pain in face Burning, shooting pain in glove-and-stocking manner
The diabetic patient with peripheral neuropathy shows symptoms of burning pain in the feet bilaterally, which worsens during the night. The patient with reflexive sympathetic dystrophy has brittle nails, and the skin appears pale, dry, and shiny. Patients with trigeminal neuralgia have severe stabbing or piercing pain in the facial area. Cancer patients who undergo chemotherapy may develop chemotherapy-induced peripheral neuropathy. This symptom manifests as burning, shooting pain in glove-and-stocking manner.
While performing an emotional pain assessment, the nurse asks the patient, "What does your pain feel like?" The patient responds, "I have numbness and tingling and occasionally shooting pain." What does the nurse infer from the patient's response? The patient is experiencing neuropathic pain. The patient is experiencing breakthrough pain. The patient is experiencing nociceptive visceral pain. The patient is experiencing nociceptive somatic pain.
The nurse infers that the patient has neuropathic pain because its characteristics including burning, shooting, and tingling. Breakthrough pain occurs beyond the chronic pain that is already being treated by appropriate analgesics. Nociceptive pain originating from visceral sites is described as aching if localized, and as cramping if poorly localized. Nociceptive pain originating from somatic sites is described as aching or throbbing.
While assessing pain in a patient the nurse asks about the effects of pain on the patient's mood, walking, functional ability, and sleep in the past 24 hours. Which pain assessment scale is the nurse using in the examination? Initial Pain Assessment Verbal Descriptor Scale The Brief Pain Inventory The McGill Pain Questionnaire
The nurse is using the Brief Pain Inventory scale. The assessment uses graduated scales from 0 to 10. The patient can rate the pain using these graduations based on the impact of pain on mood, walking, ability, and sleep in the past 24 hours. In the initial pain assessment, the nurse asks questions concerning location, intensity, and duration of pain. The nurse would ask the patient to describe the feelings about the intensity of pain when using the verbal descriptor scale. In the McGill Pain Questionnaire, the nurse asks the patient to rank a list of descriptors in terms of their intensity and to give an overall intensity rating of pain.
The nurse is caring for a patient who reports severe pain after surgery. What complications would the nurse expect in the patient related to a poorly controlled pain response? Hypoxia Atelectasis Increased cough Hypoventilation Hypotension
The patient who has undergone surgery may experience acute and severe pain that results in the secretion of prostaglandins, histamine, and bradykinin. The secretion of these neurotransmitters may impair the functioning of various organ systems. The prostaglandins may cause bronchoconstriction, which may result in hypoxia, atelectasis, and hypoventilation. Due to bronchoconstriction, the patient may have decreased, not increased, cough. The acute pain may result in hypoventilation, not hyperventilation in the patient. Prostaglandins may cause vasoconstriction resulting in hypertension, not hypotension.
The nurse is caring for a patient with breast cancer who is on long-acting opioid therapy. The nurse finds that the patient reports a sudden, frequent pain in the breast. Which treatment strategy would be beneficial for the patient? Increasing the dose of the medication Discontinuing the administration of the medication Administering the medication by the subcutaneous route Increasing the time interval between each dose of the medication
The patient who is on a long-acting opioid therapy may experience breakthrough or sudden pain due to rapid elimination of the medication from the body. In such conditions, increasing the dose of medication helps maintain the optimum blood levels of the drug and provides pain relief. Discontinuing the medication may cause severe pain. Opioids are either administered by the oral or the intravenous route. Administering the medication by the subcutaneous route may cause slow absorption of the drug and inadequate pain relief. Increasing the time interval between each medication dose will reduce the concentration of the drug in the blood, but will not help to alleviate the breakthrough pain.
The patient with a broken leg reports swelling, stiffness, and a burning pain in the leg. The nurse also finds that the patient has brittle nails along with pale, dry, and shiny skin. What does the nurse infer from these findings? The patient has osteoarthritis. The patient has Alzheimer disease. The patient has acute coronary syndrome. The patient has reflexive sympathetic dystrophy (RSD).
The patient with a broken leg may suffer from a nerve injury resulting in reflexive sympathetic dystrophy (RSD). The presence of swelling, stiffness, and a burning pain at the site of injury, along with brittle nails, pale, dry, and shiny skin all indicate that the patient has RSD. This is caused by impaired functioning of the sensory, motor, and autonomic nervous system. Osteoarthritis is a degenerative joint disease which is caused by inflammation of the synovial membrane, not impaired nervous system functioning. The patient with Alzheimer disease has loss of memory and muscle weakness, but does not have pale, dry, and shiny skin. Acute coronary syndrome occurs due to reduced flow of blood to the heart. It manifests as chest pain, dyspnea, and diaphoresis.
The nursing instructor is teaching about the transduction phase of nociception to a group of nursing students. Which statement, if made by a nursing student, indicates effective teaching? "The patient acknowledges painful sensations during this phase." "The endogenous opioids block the pain impulses during this phase." "The pain impulse moves from the spinal cord to the thalamus during this phase." "The peripheral tissue secretes histamine and prostaglandins during this phase."
The perception of pain depends on the functioning of nerve fibers. Nociception is categorized into four phases: transduction, transmission, perception, and modulation. In the transduction phase, the peripheral tissues secrete neurotransmitters such as prostaglandins and histamines at the site of the injury. These neurotransmitters transmit the pain impulses from the sensory nerve fibers to the spinal cord. During the perception phase, the pain stimuli are received and interpreted by the higher cortical structures of the brain and cause the sensory perception of pain. During the transmission phase, the endogenous opioids are secreted in the brain, and block the pain signals by activating opioid receptors. If the opioid receptor does not block the pain impulse during transmission, then the impulse moves from the spinal cord to the thalamus.
A patient with carpal tunnel syndrome reports having a tingling and burning sensation in the thumb, middle, and index fingers. What does the nurse interpret from these symptoms? The patient has referred pain. The patient has cutaneous pain. The patient has nociceptive pain. The patient has neuropathic pain.
The presence of a tingling, burning sensation in the thumb, middle, and index fingers indicates that the patient has neuropathic pain. It is caused by impaired processing of the pain impulses from the site of injury to the nerve fibers. The patient with referred pain has an injury at a particular site, but experiences pain at other sites of the body. Referred pain is caused by damage to a spinal nerve, which sends signals to two different parts of the body. If the patient has pain due to skin surface damage, it indicates that the patient has cutaneous pain. Nociceptive pain is associated with aching, throbbing, and a cramping sensation. Because the patient does not report having any aching or throbbing sensation, the nurse would not interpret that the patient has nociceptive pain.
A patient with joint pain has edema and skin discoloration at the knees. The patient feels severe knee pain when the nurse touches the affected area with a cotton swab. The nurse also observes the patient has pale, dry, shiny skin and brittle nails. Which medication would be helpful in treating this patient? Aspirin Pregabalin Prednisone Amitriptyline Acetaminophen
The presence of pale, dry skin, brittle nails, joint pain, edema, and discoloration of the affected extremity indicates that the patient has complex regional pain syndrome (CRPN). Damaged nerves result in impaired functioning of the sensory, motor, and autonomic nerves. Due to nerve damage, the patient feels severe pain even with the contact of a cotton swab. Pregabalin, prednisone, and amitriptyline block the pain impulses from the damaged nerves and help to alleviate pain and inflammation. Therefore, the primary health care provider would prescribe these medications to the patient. Aspirin and acetaminophen reduce prostaglandin levels and alleviate nociceptive pain. These drugs do not repair damaged nerve fibers and do not alleviate neuropathic pain.
A patient who has severe electric shock-like pain in the thighs has been prescribed a nonsteroidal antiinflammatory drug (NSAID). After assessing the patient, the nurse concludes that the NSAIDs are not effectively alleviating the patient's symptoms. What is the most likely reason the NSAIDs are inadequate in relieving this pain? The patient has visceral pain. The patient has cutaneous pain. The patient has neuropathic pain. The patient has breakthrough pain.
The presence of severe electric shock-like pain in the thighs indicates that the patient has neuropathic pain. Neuropathic pain is the result of abnormal processing of pain messages from the site of injury to the nerve fibers. NSAIDs decrease prostaglandin levels, but do not increase neurotransmitters or halt nerve damage. Therefore, neuropathic pain is not effectively treated by NSAIDs. Visceral pain, cutaneous pain, and breakthrough pain are effectively treated with NSAIDs, because they are examples of nociceptive pain. However, the patient who has visceral pain will experience a deep squeezing pressure with local tenderness. The patient who has cutaneous pain will experience a localized dull, aching pain. The patient who has breakthrough pain will have episodic pains with the symptoms of acute pain.
The nurse is collecting a complete pain history of a patient using the PQRST method. Which statement from the nurse indicates the Timing criteria of the PQRST scale? "Are you ever awakened by pain?" "Do you feel like the pain travels around?" "Does pain interfere with your activities?" "What aggravates it?"
The statement "Are you ever awakened by pain?" indicates the Timing criterion, because the nurse is assessing the timing of the pain. The statement "Do you feel like pain travels around?" indicates the Region/Radiation criterion, because the nurse is assessing radiation of the pain. The statement "Does pain interfere with your activities?" indicates the Severity Scale criterion, because the nurse is assessing the severity of the pain. The statement "What aggravates it?" indicates the Provocation/Palliation criterion, because the nurse is assessing the trigger for the pain.
The nurse is assessing a patient with severe back pain. The nurse lets the patient make a mark along a 10-cm horizontal line from "no pain" to "worst pain imaginable." Which pain assessment tool is the nurse using during the assessment? Numeric rating scale Visual analogue scale Simple descriptor scale Verbal descriptor scale
The visual analogue scale is a pain assessment tool that helps to identify the patient's level of pain. It has a 10-cm line with markings for "no pain" to "worst imaginable pain." Patients are asked to mark a point on the horizontal line based on the severity of their pain. When using the numeric rating scale, the nurse would ask the patient to choose a number to rate the pain's intensity. The simple descriptor scale consists of a list of words such as "no pain," "mild pain," "moderate pain," and "severe pain." These words help the patients describe the intensity of their pain. While using the verbal descriptor scale, the nurse would ask the patients to describe their feelings and the intensity of the pain that they are experiencing.
Which conditions are associated with visceral pain? Arthritis Appendicitis Fibromyalgia Cholecystitis Kidney stones
Visceral pain results from the activation of nociceptors of the visceral organs. Pain associated with appendicitis and cholecystitis is visceral pain. Chronic nonmalignant pain is often associated with musculoskeletal conditions such as arthritis and fibromyalgia. Pain due to kidney stones is an example of acute pain.
A patient with gastric ulcer has dull, deep, squeezing or cramping pain in the stomach. What do these symptoms indicate? The patient is having somatic pain. The patient is having visceral pain. The patient is having referred pain. The patient is having cutaneous pain.
Visceral pain. Gastric ulcer is usually associated with visceral pain characterized by dull, deep, squeezing or cramping pain in the stomach. It usually originates in the visceral organs, including the stomach, intestine, gallbladder, and the pancreas. Pain originating from the musculoskeletal tissues or the body surface is identified as somatic pain. If the patient has an injury at a particular site but experiences pain elsewhere, it indicates that the patient is having referred pain. If the patient has pain due to damage to the skin surface, it indicates that the patient has cutaneous pain.
A patient with trigeminal neuralgia has been experiencing intense facial pain for 1 year. The patient has been unresponsive to analgesics. Given this patient's profile, what other findings does the nurse expect to find? Mild anxiety Confusion Depression Hyperventilation Urinary incontinence
When a patient experiences intense pain for more than 6 months, it indicates chronic pain. If the patient is unresponsive to analgesics, however, then it indicates that the patient has poorly controlled chronic pain which can increase serotonin levels in the brain, resulting in confusion and depression. Anxiety, hyperventilation, and urinary incontinence may occur with chronic pain but are more often associated with acute pain. Acute pain is associated with the sudden onset of pain and it can be easily alleviated with analgesics. It is associated with an increase in norepinephrine levels that may cause panic attacks in the patient, resulting in anxiety, hyperventilation, and urinary incontinence.
After assessing a patient with knee pain, the nurse reports that the patient has persistent (chronic) pain behavior. Which behavior pattern in the patient helped the nurse to reach this conclusion? The patient rubs his or her knee frequently. The patient is still and has symptoms of diaphoresis. The patient is restless along with facial grimacing. The patient supports the knee when changing positions. The patient constantly sighs during the assessment.
When a patient experiences pain for months and years, he or she becomes adapted to the pain and may avoid mentioning the pain to the health care provider. This is why the nurse should be observant and mindful of the patient's behavior to identify whether the patient has pain. The patient with chronic pain may subconsciously rub the knee for pain relief. The pain may increase during a change of position from sitting to standing. The patient may support the knee when changing positions to help minimize the pain. The patient may also subconsciously respond to the pain by sighing constantly during the assessment. A patient with acute pain has increased autonomic functioning and will thus exhibit stillness, diaphoresis, restlessness, and facial grimacing.
Which examination identifies neurochemical changes in the brain caused by nociception?
functional magnetic resonance imaging (fMRI) determines the structural, functional, and neurochemical changes caused in the brain by nociception. The x-ray examination, computerized axial tomography (CAT) scan, or traditional magnetic resonance imaging (MRI) cannot help in determining the neurochemical changes in the brain that lead to pain perception.
