Pain Assessment and Management: Fundamentals Midterm

How does a PCA pump work?

Allows patient the power to control their medication Set deliver a small, constant flow of pain medication with additional doses given to the patient as they push the button. Patient cannot give themselves too much Decreases anxiety and leads to decreased medication use

TENS unit

Applies electrical impulses to the nerve endings and blocks transmission of pain signals.

A nurse strains a back muscle when moving a patient up in bed. Which can the nurse do at home that utilizes the gate-control theory of pain relief to minimize the discomfort?

Apply a cold compress to the site for 20 minutes

A client is admitted with a diagnosis of terminal cancer and he is experiencing severe pain. The doctor has written an order for pain medication every 3 hours PRN. How will the nurse plan to administer the pain medication?

Assess the client and determine the need for pain medication every 3 hours

A patient request pain medication for severe pain. Which should the nurse do first when responding to this patient's request?

Assess the various aspect of the patient's pain

Which is the best goal for the nurse to include in the plan of care related to the problem statement of "acute pain related to strain on muscles with movement?"

Client reports pain of less than 1 on a 0 to 10 scale after pain medication

A neonatal nurse is assessing a 2 week olds pain level following open heart surgery. To assess the pain level using an age appropriate scale, which scales would be appropriate? (Select all that apply)

FLACC scale NIPS

A nurse is assessing a patient experiencing chronic pain. Which characteristic is more common with chronic pain than acute pain? (Select all that Apply)

Gradual onset Long duration Psychologically depleting

A transcutaneous electrical nerve stimulation (TENS) unit is a battery-operated device that some people use to treat pain. Which is the best explanation of how a TENS unit works?

It sends stimulating pulses through the skin to block the pain signals from reaching the brain

Non-pharamacological interventions

Massage therapy; cold and heat applications; relaxation techniques; acupuncture; distraction; music therapy

location of pain

The area of or location of pain.

gate control theory of pain

The theory that pain is a product of both physiological and psychological factors that cause spinal gates to open and relay patterns of intense stimulation to the brain, which perceives them as pain.

quality of pain

The words the patient uses to describe their pain. Such as cramping, burning, pins and needles, sharp, dull or achy, tingling, stabbing and so on

True or false: a patient's self report of pain is the single most reliable indicator of the existence and intensity of pain. (meaning you should medicate patient's based on this report, not their behaviors)

True

True or false: pain is the fifth vital sign.

True

True or false: pain medications work on pain in different ways (interrupt pathways in different points/ways), so can combine different types for maximal pain relief.

True

To assess the quality of a client's pain, the nurse asks which question?

What word best describes your pain?

Patient-controlled analgesia (PCA)

a drug delivery system that uses a computerized pump with a button the patient can press to deliver a dose of an analgesic through an intravenous catheter

NON-OPOID ANALGESICS

acetaminophen (tylenol) nonsteroidal anti-inflammatory drugs (NSAIDs)

adjuvants/co-analgesics

antidepressants; anticonvuslants

Analgesics (pain medications)

are important to prevent unnecessary discomfort/suffering.

respiratory opioid side effects

bradypnea hypoventilation

What are some medications that improve breathing?

bronchodilators, mucolytics HIGH PRIORITY

gastrointestinal opioid side effects

constipation N/V delayed gastric emptying

severity of pain

description of how bad the pain is, often described on a scale of 1 to 10

The nurse considers interventions to include in the plan of care for pain. Before implementing any interventions, what action is most important for the nurse to take?

discuss the plan of care with the client

Goal of palliative care

earn how to live life fully with an incurable condition.

What is the most important thing nurses can do when it comes to pain management?

establish a positive culture of pain management is actively listen to patients when they describe their pain

What behavior does a client exhibit that the nurse would document as an objective sign of acute pain?

frequent grimacing

endocrine opioid side effects

hormonal and sexual dysfunction hypoglycemia-reported with tramadol and methadone

relief measures of pain

how patients relieve their pain

Cardiac opioid side effects

hypotension bradycardia peripheral edema

Which of the following medications are non-steroidal anti-inflammatory drugs (NSAIDs) used to reduce inflammation and pain?

ibuprofen/motrin

immunological opioid side effects

immune system impairment possible with chronic use

musculoskeletal opioid side effects

muscle rigidity and contractions osteoporosis

Opioids

narcotics

Chronic pain

not protective in nature; lasts longer than 6 months constant or recurring and does not always have an identifiable cause does not respond to treatment well and leads to problems such as job loss, inability to perform daily activities, sexual dysfunction, and social isolation vital signs are usually unaffected

tolerance

over time, increased doses needed to obtain analgesic effect

analgesics

pain relievers

Acute pain

protective in nature, sudden onset, short duration, limited tissue damage; emotional response predictive ending and an identifiable cause; treated aggressively; vital signs are elevated

PQRST

provocative/palliative, quality, region/radiation, severity, timing

skin opioid side effects

pruritus (itching)

Ocular opioid side effects

pupil constriction

withdrawal syndrome

rapid or sudden cessation or marked does reduction may cause rhinitis, chills, pupil dilation, diarrhea, "gooseflesh"

What should you monitor in those using opioids/narcotics?

respiratory rate and depth (patient may develop effect of sedation and respiratory depression)

STAT

signify a single dose of a medication to be given immediately and only once.

Central Nervous System (CNS) toxicity

thought and memory impairment drowsiness, sedation, and sleep disturbance confusion hallucinations, potential for diminished psychomotor performance delirium depression dizziness and seizures

Pain

unpleasant but protective mechanism of defense serves as a warning related to physical, emotional, cognitive factors subjective & individualized

genitourinary opioid side effects

urinary retention

aggravating or precipitating factors

various factors or conditions conditions precipitate or aggravate pain

Pain is ______ the experiencing person says it is, occurring ____ whenever they say it does.

whatever; whenever

pregancy and breastfeeding opioid side effects

when at all possible, avoid opioid use during pregnancy to prevent fetal risks

Timing of pain: onset, duration, frequency

when did pain begin? how long has it lasted? does it occur at the same time each day? how often does it occur?