Exam 5 Chapter 36: Pain

-When a patient is anxious, fearful, or angry, the nurse addresses the patient's physical needs ______. -then the nurse will allow the patient to ____ -after that the nurse will: ____

*physical needs first* -The nurse provides a comfortable environment and privacy for the patient. Then the nurse communicates with clear, simple validating statements to *relieve the stress of the situation and to develop a trusting relationship with the patient.* -The nurse needs to allow time for the patient to *verbalize feelings and concerns regarding pain relief* to *assess the patient's coping abilities.* -The nurse *acknowledges the patient's pain experience and expresses acceptance of the patient's response to pain.* *After pain has been assessed,* the nurse uses nursing diagnoses to *develop a plan of care* for the patient.

after an intervention for a pt for pain, the reassessment time should be: ( by minute) 1. nonpharma techniques 2. intramuscular sub q, or oral admin 3. transdermal 4. intravenous, or sublingual

1. 30 to 60 min 2. 30 to 60 min 3. 12 to 16 hour 4. 15 to 30 min

A patient reports shoulder pain during a gallbladder attack. How does the nurse document this pain? a. Referred pain b. Phantom pain c. Chronic pain d. Psychogenic pain

ANS: A Referred pain is pain in another area of the body from where the pain originated. Phantom pain is pain from an amputated extremity that is no longer present. Chronic pain is pain that lasts more than 6 months. Psychogenic pain is pain without a physical cause.

The patient has been experiencing chronic pain from fibromyalgia for the past 6 months. What change will the nurse note in the patient's vital signs? a. Increase in blood pressure and pulse b. Decrease in blood pressure and pulse c. Increase in temperature and respirations d. Decrease in temperature and respirations

ANS: B *Chronic pain* stimulates the parasympathetic system resulting in a *decrease in blood pressure and pulse*. Acute pain causes an increase in blood pressure and pulse. Temperature and respirations are not affected.

The patient who had surgery to remove part of the intestines is reporting pain. What type of pain is the patient experiencing?

ANS: B Visceral pain is pain originating from a body organ. Somatic pain is from skin, bone, muscle, and joints. Referred pain is pain in a different area from where pain originated. Radiating pain extends into another area of the body.

nursing diagnoses for pain

Acute Pain: Supporting Data: long-bone fracture, reported pain of 10 of 10, pain with movement, request for pain medication Chronic Pain: Supporting Data: deformity of joints, limited mobility, inability to manage activities of daily living, and feelings of helplessness Difficulty Coping: Supporting Data: severe pain, inability to ask for help, lack of appetite, and poor concentration

factors that influence pain

Age, gender, morphology, disabilities, culture, ethnicity, and religion play a role in the behavioral reaction to pain and in the perception of pain.

physiological reasons a person may have pain

Alterations in pain pathways Damage and hypersensitivity anywhere along the pain pathway can alter a patient's perception of pain Physiologic alterations caused by pain Acute injury triggers physiologic stress responses; these responses may have adverse effects for the patient if pain is left untreated.

issues with pain meds

Although opioid analgesics are essential in adequate pain management, risks of tolerance, physical dependence, addiction, and accidental ingestion are associated with their use. -The nurse needs to understand these risks and be able to differentiate them -Drug tolerance is an adaptation to the medication, which eventually leads to less effective pain relief. -It is better to change to another medication than to continue increasing the dose of the same medication. -Physical dependence builds as the body becomes unable to function normally without the medication, reaching the point of withdrawal symptoms on abrupt cessation of the medication.

used for the treatment of opioid analgesic overdose. They compete with opioids at the opioid receptor sites, decreasing the side effects of opioids. They are administered intravenously, intramuscularly, subcutaneously, or into an endotracheal tube every 2 to 3 minutes until symptoms of opioid overdose subside. -Signs of opioid withdrawal, such as vomiting, hypertension, and anxiety, may occur up to 2 hours after administration.

Antagonist analgesics (such as naloxone)

How to administer analgesics to an elderly patient?

Due to decreased metabolism and clearance of medications, start with a lower dose and increase as indicated for pain relief. A high dose may result in drug toxicity. Too low of a dose will not relieve pain.

signs of pain might be

Elevated pulse and blood pressure values may indicate acute pain and a need for pain medication. A decrease in blood pressure and pulse rate may indicate chronic pain. With chronic or prolonged pain, the parasympathetic nervous system responds with a decrease in the systolic blood pressure and a decrease in the pulse rate below the patient's normal baseline.

What happens when a patient has pain/discomfort with an amputated extremity? what is this called?

Feeling an extremity after amputation is phantom pain. This type of pain decreases over time as the brain adjusts to the missing extremity

A patient thinks about vacationing on a beach to help relieve pain, its a nonpharmocologic way of dealing with it but what kind?

Imagery is the use of visual concentration to change the perception of pain.

Inadequate pain management may lead to detrimental outcomes such as:

Impaired recovery and progression to chronic pain Compromised ability to carry out ADLs Inability to get adequate rest and sleep, leading to a diminished quality of life Significant suffering, with increasing anxiety, depression, fear, and anger Work absenteeism and potential underemployment or loss of employment Increased health care costs Difficulty accessing disability compensation

Patient-controlled analgesia (PCA) is a system in which an electronically controlled infusion pump immediately delivers a prescribed amount of analgesic to the patient when he or she activates a button, without the need for a nurse to administer it. The purpose of PCA is improved pain control. PCA uses more frequent but smaller doses of medication, usually opioids (i.e., morphine sulfate, fentanyl, or hydromorphone), and provides more even levels of medication in the patient's body. The PCA pump can deliver medicine into a vein (intravenously, the most common method), under the skin (subcutaneously), or between the dura mater and the spinal cord (epidurally). When the medication is delivered intravenously, the site must be monitored for infiltration and phlebitis.

PCA

PCA pt. 2

Patient-controlled analgesia involves the intravenous administration of a controlled substance as a pain medication. Patient control of the infusion pump is restricted to certain parameters, as prescribed by the primary care provider (PCP) Nurses should refer to the manufacturer's instructions for pump operation. Nurses should follow facility policies for frequency of assessment and documentation of PCA use. Documentation Concerns Note the patient and family education that was provided. Education may initially occur preoperatively. Education must be reinforced postoperatively. Record assessment and monitoring results. Document the medications administered, medications remaining, and pump settings on each shift. Evidence-Based Practice Research indicates that PCA provides more effective analgesia and fewer episodes of breakthrough pain. Some studies indicate that PCA reduces patient length of hospitalization, and increases patient satisfaction and feelings of control in their treatment (Katz, Takyar, et al, 2016)

During acute, pain the endocrine system releases excessive hormones. what would a patient experience?

Release of hormones causes the blood glucose level to increase, causing hyperglycemia

pain lasting less than 3 to 6 months.

acute pain

Restlessness would be a response to what kind of pain? and what kind of response?

acute, psychologic

The following are additional methods by which opioids are delivered: On-Q infusion pump provides continuous infusion of local anesthesia through an antimicrobial catheter, which destroys or inhibits microorganism growth on the catheter. It is most often used for postoperative pain control following abdominal surgery. Transdermal administration consists of a medicated adhesive patch (e.g., fentanyl ITS) that is placed on the skin to deliver a specific dose of medication through the skin, allowing absorption into the bloodstream. Intrathecal injection or infusion of a narcotic or local anesthetic into the subarachnoid space through a needle or catheter provides pain relief to a large area of the body. It may be used as spinal anesthesia for surgery, cancer pain, or relief from spasms that occur with spastic cerebral palsy. Epidural analgesia is continuous infusion of a narcotic or local anesthetic into the epidural space by insertion of a needle or catheter for relief of acute or chronic pain. It is used for labor pain, surgery, and cancer pain because it numbs the nerve endings in a local area of the body. Nerve block is an injection of a local anesthetic into or near spinal nerves for temporary pain control. The anesthetic can be injected into the cervical, thoracic, lumbar, and sacral areas of the spinal column. Nerve blocks can be used for migraine headaches, dental work, back pain, herniated disks, and cancer pain.

alternate delivery methods of pain meds

Most accurate way to determine the pain level of a person who is alert and oriented?

ask them to describe the pain and rate its level

Nurse's role in pain management

assesses with pain assessment tool documents patient response after assessment and before AND after pain control interventions are performed or analgesics are administered. Pain management and pain relief are essential elements of nursing practice

Facial grimaces, clenched teeth, rubbing or guarding of the painful area, agitation, restlessness, and withdrawal from painful stimuli. (what kind of pain of response is this to pain?) -A patient in labor may use effleurage (rhythmic massaging of the abdomen with her hands) and immobilization to help deal with uterine contraction ____ -Vocalizations may be expressed as crying, moaning, or screaming. (these are what kind of responses to pain?)

behavioral resposponses (that the patient is exhibiting in response to pain) -help deal with uterine contraction *pain* -vocalizations all are behavioral responses

If given an If morphine at 8:30, when would you check on the PT?

by 9:00 (15-30 min after for iv opioids)

persisting longer than 3 months postoperatively, longer than 6 months, or beyond a normal healing period.

chronic pain

Nonpharmacologic pain management and complementary and alternative therapies Positioning, splinting, massage, progressive relaxation techniques, guided imagery, and meditation Distraction (television, music, and conversation) Spiritual support (prayer and meditation) Neurologic and neurosurgical pain therapies

complementary therapy

clinical manifestations of pain: genitourinary

decreased urine output urinary retention fluid overload hypokalemia

clinical manifestations of pain: gastrointestinal

delayed gastric emptying decreased intestinal motility constipation anorexia weight loss

other types of pain

dysesthesia (unpleasant and abnormal sensation) allodynia (pain from noninjury stimuli) hyperalgesia (excessive sensitivity) hyperpathia (greatly exaggerated pain reaction to stimuli). Phantom pain: occurs when the brain continues to receive messages from the area of an amputation. Over time, the brain adapts to the loss of the limb, and the pain stops. This adaption is called plasticity. Pain that is perceived by an individual but has no physical cause is called psychogenic pain. It may be caused, increased, or prolonged by mental, emotional, or behavioral factors. Some patients may report headaches, back pain, or stomach pain that is psychogenic pain. Although there is not a physical cause, the pain is treated through a variety of interventions to alleviate the patient's distress.

Based on the patient's report of pain, the nurse administers the dose of medication that is?

effective in relieving pain without causing adverse side effects Administering too small of a dose does not relieve pain. Administering a large dose may result in unwanted side effects.

clinical manifestations of pain: endocrine

fever shock

clinical manifestations of pain: immune

impaired immune function infection

clinical manifestations of pain: Cardiovascular

increased heart rate and force of contraction in acute pain increased systole in acute deceased systolic in prolonged or chronic decreased pulse in prolonged or chronic increased myocardial oxygen demand increased vascular resistance hypercoagulation chest pain

clinical manifestations of pain: respiratory

increased respiratory rate increased brochospasms pneumonia atelectasis

If the patient complains of moderate pain, the nurse may try giving a nonopioid pain medication, such as acetaminophen or ibuprofen.

moderate pain

clinical manifestations of pain: musculoskeletal

muscle spasm increased muscle tension impaired mobility weakness fatigue

pain results from nerve injury, and the pain continues even after the painful stimuli are gone. Sometimes referred to as pathologic pain, may stem from injury to nerves in the central or peripheral nervous system

neuropathic pain

most common type of pain. This type of physiologic (physical) pain occurs when nociceptors are stimulated in response to trauma, inflammation, or tissue damage from surgery.

nociceptive pain

varies in strength and use, from Tylenol to opioids.

pain medication

clinical manifestations of pain: sensory

pallor diaphoresis dilated pupils in acute pain constricted pupils in deep or prolonged pain rapid speech in acute pain slow speech in deep or prolonged pain

according to the textbook, necessary components of a pain assessment that a nurse should consider are:

previous medical history physical appearance age, gender, culture life style and loss of appetite

Patients may exhibit anxiety, fear, depression, anger, irritability, helplessness, and hopelessness, which is what kind of response to pain

psychological responses to pain

pain that extends from the source to an adjacent area of the body (extends from other areas, usually gastric reflux, extending to thorax)

radiating pain

pain that originates in one area but hurts in another area, such as pain from a myocardial infarction (pain in area other than area causing pain such as jaw and left arm pain during myocardial infarction)

referred pain

if pt reports 9/10 pain an hour after given iv pain meds, you should

report to the Pcp

If the pain is severe, the nurse may begin with a higher dose or stronger opioid to obtain pain relief.

severe pain

nociceptive or physiologic pain that results from injury to skin, muscles, bones, and joints

somatic pain

Opioid analgesics are the most effective agents for relief of moderate to severe pain. These narcotic medications work by binding to the opioid receptors in the nervous system, which are sites of endorphin action. There are many types of opioid analgesics, including agonist analgesics and agonist-antagonist analgesics. type 1: Agonist analgesics, such as morphine, hydromorphone, oxycodone, fentanyl, and meperidine, are the most effective agents for relief of severe pain, which is rated 7 to 10 on a numeric pain scale. They may change the patient's perception of pain while relieving the pain. Routes of administration include oral, transdermal, intramuscular, or intravenous. Research continues to identify the best methods for pain relief in various situations. When administered intramuscularly or intravenously, these medications may be given every 1 to 3 hours, depending on the dose administered. The nurse needs to be aware of adverse effects such as respiratory depression, seizures, nausea, vomiting, constipation, itching, and urinary retention. The nurse may administer an antagonist analgesic for the respiratory depression, antiemetics for the nausea and vomiting, and an antihistamine for itching. Dizziness, blurred vision, confusion, and orthostatic hypotension may occur. type 2: Agonist-antagonist analgesics include pentazocine, butorphanol, dezocine, and nalbuphine. These medications are used for moderate to severe pain. They depress the pain-impulse transmission at the spinal cord by acting with opioid receptors. They are normally administered by the intramuscular or intravenous route. Dosing is every 1 to 4 hours, depending on the drug. The nurse needs to be aware of patient drowsiness, dizziness, nausea, vomiting, itching, and respiratory depression. Treatment for these adverse effects is the same as that for the adverse effects associated with agonist analgesics.

strong pain medication example

pain is ____, and may ____ injury, or ____ injury. an ____ and ____ person can explain what pain is.

subject, prevent, result from. alert and oriented.

Acute injury or tissue damage to the body leads to physiologic stress responses which is the body's attempt to protect itself. the first step in this is the stimulation of the ____ system, then if pain is not relieved, then the ____ system is stimulated-- each body system has a specific response to pain.

sympathetic nervous before parasympathetic

true/false: past experience influences how one perceives pain

true, pain is up to the individual

nociceptive or physiological pain that arises from the organs of the body (such as the heart, lungs, kidneys or gallbladder)

visceral pain

Non-opioid analgesics include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin. These drugs are used in the treatment of many types of mild to moderate pain. Although nonopioids are not addictive and are safer for the patient to use than opioid analgesics, patients may become dependent on nonopioids for pain relief. Acetaminophen has analgesic and antipyretic capabilities and is a safe pain relief agent for most patients, including those with liver disease, if monitored closely and administered within the safe dosage range. The nurse should review the entire list of medications a patient is taking, including over-the-counter (OTC) medications that may contain acetaminophen, to determine the total dose being received. Acetaminophen is used for fever reduction and for mild to moderate pain from conditions such as a mild headache or general achiness. NSAIDs are more useful than acetaminophen in treating inflammatory pain and bone pain. NSAIDs have anti-inflammatory effects in addition to analgesic and antipyretic qualities. Aspirin is also an effective agent for decreasing platelet aggregation in patients who are prone to blood clots or at risk for myocardial infarction. Unfortunately, NSAIDs have significant side effects, including possible gastrointestinal upset and bleeding and cardiac and renal complications. These side effects may be avoided by taking the drugs with food and taking the prescribed dose. Proton pump inhibitors (PPIs) or histamine H2-receptor blockers are often prescribed for patients who are on long-term NSAID therapy to help reduce the incidence of stomach ulcers.

weak pain medication example