session 3 nurse 102

Adjuvants

: Drugs without analgesic properties that can be critical to pain management in certain populations and for treatment of related symptoms that may exacerbate pain (e.g., muscle relaxants, anxiolytics, sleep medications)

hyperalgesia

: Enhanced sensation of pain produced by a noxious stimulus

allodynia

: Enhanced sensation of pain produced by an innocuous stimulus, such as a light touch

adjuvant

: Medication added to a regime, often in pain management, to increase therapeutic effects (e.g., antidepressant used in addition to opioid to manage chronic pain)

transcutaneous electrical nerve stimulation

: Mild electrical impulse to an area or over the pain zone and controlled by the patient

central sensitization

: Nociceptive nerve signals triggered by inflammation or nerve injury bombard the central nervous system from the periphery

nociceptive pain

: Occurs in tissues other than the nervous system and is transmitted via intact nociceptors during normal pain transmission

tolerance

: Occurs when a patient receives a drug, such as an opioid, continuously over an extended period of time and a neuroadaptive response occurs, requiring a larger dose of the drug to produce the same effect

exogenous opioids

: Opiate-like substances administered to the patient

neuropathic pain

: Pain caused by nerve damage

acute pain

: Pain that lasts less than 6 months

somatic pain

: Pain that originates in bone, skin, and soft tissue and is often well localized

spinal dorsal horn

: Site in the spinal cord where complex processing of messages occurs; one of the most important areas for pain modulation

dermatome

: The band of skin innervated by the sensory root of a single spinal nerve

nociception

: The normal processing of painful stimuli described in terms of a four-step process that occurs when acute pain becomes a conscious event

multimodal therapy

: Uses two or more analgesics with different mechanisms of action to maximize pain relief and diminish side effects

A nurse applies intermittent heat and cold to a client's leg

A nurse attempts to relieve the pain of a client by using cutaneous stimulation. Which of the following describes usage of this technique? -A nurse guides a client to use imagery. -A nurse applies intermittent heat and cold to a client's leg. -A nurse uses deep-breathing exercises to distract a client from his pain. -A nurse distracts the client by playing his favorite music.

The nurse gives the client a massage before bed

A nurse implements cutaneous stimulation for a client as part of a strategy for pain relief. Which nursing action exemplifies the use of this technique? -The nurse plays soft music in the client's room. -The nurse gives the client a massage before bed. -The nurse assists the client to focus on something pleasant rather than on pain. -The nurse teaches the client deep breathing techniques for relaxation.

Pain level

A nurse is assessing a client with arthritis. What should the nurse consider in the initial assessment of the client? -Glucose level -Blood group -Pain level -Anxiety level

FACES scale

A nurse is assessing a mentally challenged adult client who is in pain after a fall from a staircase. Which scale should the nurse use to assess the client's pain? -Numeric scale -FACES scale -Word scale -Linear scale

Sedation

A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics? -Diarrhea -Insomnia -Anxiety -Sedation

Transduction

A nurse is caring for a client whose injured cells are releasing chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. Which phase of pain is the client experiencing? -Modulation -Perception -Transduction -Transmission

whenever the vital signs are measured and documented

A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain? -six hours after administering a prescribed analgesic -after the client is discharged from the health care facility -whenever the vital signs are measured and documented -once per day when the pain is a potential problem

Phantom pain

A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain? -Cutaneous pain -Visceral pain -Phantom pain -Referred pain

tolerance

A nurse observes that a client who underwent knee surgery 2 weeks ago needs progressively larger doses of analgesics to get relief from pain. The nurse interprets this as: -addiction -sedation -dependence -tolerance

Avoid stereotypical responses to pain in clients

How may a nurse demonstrate cultural competence when responding to clients in pain? -Treat every client exactly the same, regardless of culture. -Be knowledgeable and skilled in medication administration. -Avoid stereotypical responses to pain in clients. -Know the action and side effects of all pain medications.

infants young children clients who have dementia clients whose primary language is different from that of the health care team clients who have a decreased level of consciousness

Which client population is at high risk for inadequate pain management? Select all that apply. -infants -clients who have dementia -clients whose primary language is different from that of the health care team -young children -clients who have a decreased level of consciousness -clients who have significant visual impairment

Nonopioid analgesics (such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs))

are usually the drugs of choice for both acute and persistent moderate chronic pain

Therapeutic Touch

involves using one's hands to direct an energy exchange consciously from the practitioner to the client in order to facilitate healing or pain relief

Transcutaneous electrical nerve stimulation (TENS)

is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers.

biofeedback

is a technique that uses a machine to monitor physiologic responses through electrode sensors on the client's skin

Hypnosis

is an alteration in a person's state of consciousness so that pain is not perceived as it normally would be

Modulation.

last phase of pain impulse transmission, during which the brain interacts with the spinal nerves to alter the pain experience

Naloxone

displaces the opioid at the receptor site and counteracts the opioid's effect

A-Delta fibers

give rise to bright sharp well localized pain that is immediately associated with injury

Analgesic ceiling

going beyond a maximum dose will not provide additional relief

Perception

occurs when the pain threshold is reached

pain modulation

the inhibition of nociceptive impulses in the CNS neurons originating in the brain stem utilize the descending pathway in the spinal cord, releasing naturally occurring pain inhibitory substance that decrease the pain sensation

Visual distraction

this type of distraction can be accomplished through reading or watching television.

tactile kinesthetic distraction

this type of distraction include holding or stroking a loved one, pet, or toy; rocking; and slow rhythmic breathing

Project distraction

this type of distraction includes playing a challenging game or performing meaningful work

Versatile

works peripherally and centrally along the pain pathway and comes in many forms, routes, and doses.

Corticosteroids

would be used to address inflammation and swelling

addiction

: A maladaptive or compulsive use of a substance for effects that are not therapeutic

physical dependence

: A physiologic adaptation that is characterized by the development of withdrawal symptoms such as diaphoresis, anxiety, tachycardia, or nausea when an opioid drug is stopped abruptly

visceral pain

: A type of nociceptive pain that originates internally and is the result of stretching, distention, inflammation, or damage to the hollow and solid organs

persistent (chronic) pain

: An abnormal pain signaling process with origins that can occur both peripherally and centrally

suffering

: An emotional response to increased pain, associated with events that threaten a person's intactness

endogenous opioids

: Chemical substances with an opioid effect produced by the body

Flat affect

A client comes to the clinic for an evaluation. The client has a history of severe persistent pain. What would the nurse most likely expect to assess? -Flat affect -Facial grimacing -Elevated blood pressure -Tachycardia

The dose that is delivered when the client activates the machine is preset

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system? -Thorough client education is necessary to prevent overdoses. -Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. -An antidote is automatically delivered if the client exceeds the recommended dose. -The dose that is delivered when the client activates the machine is preset.

Stool softeners and increased fluid intake

A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention? -Calorie restriction and dietary supplements -Supplementary oxygen and chest physiotherapy -Stool softeners and increased fluid intake -Frequent turns and application of skin emollients

Constipation

A client is prescribed oxycodone for pain relief. After teaching the client about the medication and common side effects, the nurse determines that the education was successful when the client identifies which side effect as most common? -Pruritus -Vomiting -Delirium -Constipation

the release of endorphins

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort? -the release of dopamine -the release of serotonin -the release of melatonin -the release of endorphins

Opioid analgesics

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? -NSAIDs -Opioid analgesics -Corticosteroids -Nonopioid analgesics

Neuropathic pain

A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing? -Cutaneous pain -Neuropathic pain -Chronic pain -Visceral pain

biofeedback

A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as: -biofeedback. -transcutaneous electrical nerve stimulation (TENS). -Therapeutic Touch (TT). -hypnosis.

somatic pain

A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as: -phantom pain. -somatic pain. -visceral pain. -cutaneous pain.

Older adults may not report pain so they won't be thought of as a bother

A fellow staff nurse working with a client who has two broken femurs states to another nurse, "My older adult client is so easy to care for because he says he doesn't have a bit of pain." What is the appropriate response from the other nurse to whom the statement was made? -"That has to make care very easy; just document that he has no pain." -"Older adults may not report pain so they won't be thought of as a bother." -"I frequently find that my older adult clients do not have pain, too." -"I'm glad you performed a thorough assessment."

Nociceptors

A group of nursing students is reviewing information about the pain process. The students demonstrate understanding of the information when they identify stimulation of which as the first component in the transmission of the pain stimulus? -Spinothalamic tract -A-delta fibers -C fibers -Nociceptors

Visceral pain

A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing? -Visceral pain -Cutaneous pain -Somatic pain -Referred pain

Pain can be kept within a consistently tolerable level

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA) by a physician. What is an advantage that PCA offers? -Pain can be kept within a consistently tolerable level. -Higher individual dosages reduce side effects. -The client has complete control over the timing and quantity of doses. -The small doses of opioids delivered by PCA offer instant relief.

client involved in sports activities

A physician has ordered a nurse to perform transcutaneous electrical nerve stimulation (TENS) for a client with back pain. Which candidate is most suitable for TENS? -client prone to irregular heartbeats -client with a cardiac pacemaker -client involved in sports activities -client who is pregnant

3

After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? -4 -2 -3 -1

focusing on another stimuli in the environment

Before inserting a urinary catheter, a nurse discusses the procedure with the client. When inserting the catheter, the nurse distracts the client by talking to him about his work. The nurse is attempting to relieve the client's procedural pain through: -decreasing the autonomic nervous system activity. -focusing on another stimuli in the environment. -voluntarily controlling autonomic functions. -using imagination to change the pain experience.

analgesics

During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is: -relaxation techniques. -surgery. -analgesics. -cutaneous stimulation.

the person who has the pain

Of the following individuals, who can best determine the experience of pain? -the nurse caring for the client -the person who has the pain -the person's immediate family -the physician diagnosing the cause

Tactile kinesthetic distraction

Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? -Visual distraction -Tactile kinesthetic distraction -Auditory distraction -Project distraction

occasionally drowsy but easy to arouse; requires no action

The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 2 = what?

frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose

The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 3 = what?

somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone

The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 4 = ?

awake and alert; no action necessary

The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: what does 1 =

"I will remind my family member to push the PCA pump button for me if I doze off during the day."

The nurse has completed a preoperative education session with a client who will receive morphine via a patient-controlled analgesia pump (PCA) after surgery. Which statements by the client indicates the need for further education? -"I will use the PCA pump until oral pain medication controls my pain." -"I will remind my family member to push the PCA pump button for me if I doze off during the day." -"I will let my nurse know if the pain medication is not effective enough to help me move after surgery." -"I can push the button whenever I feel pain."

Assess for pain control 30 minutes after administering an analgesic. Consider cultural implications of the perception of pain. Provide pain medication before activity that may increase pain

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? (Select all that apply.) -Infer that the client who does not complain has no pain. -Consider cultural implications of the perception of pain. -Provide pain medication before activity that may increase pain. -Delegate pain assessment to the UAP. -Assess for pain control 30 minutes after administering an analgesic.

acute, cutaneous

The nurse is caring for a client who reports throbbing pain at the site of a laceration that was occurred when placing his hand in his pocket and getting cut by a pocketknife. How will the nurse document this type of pain? (Select all that apply.) -chronic -visceral -referred -acute -cutaneous -somatic -neuropathic

Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy

The nurse is conducting an admission assessment, and asks the client what medication is taken for pain. The client responds, "I take a little white pill to control my pain, but I don't know the name of it," and presents the nurse with a plastic baggie full of white pills. What is the priority nursing intervention? -Tell the healthcare provider that the client is unsure of the pain medication taken. -Call the pharmacy to attempt to identify the pill. -Document what the client states. -Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy.

"How has your life changed since experiencing back pain?" "What pain level reflects an acceptable goal for you if total pain relief is not possible?" "Do you use recreational drugs to relieve your pain?" "How do you prefer to manage your back pain?"

The nurse is taking a history for a client who is being seen for chronic unrelieved back pain. Which assessment question will the nurse ask? (Select all that apply.) - "How has your life changed since experiencing back pain?" -"What pain level reflects an acceptable goal for you if total pain relief is not possible?" -"Why do you take so many medications for pain if they do not help?" -"Do you use recreational drugs to relieve your pain?" -"How do you prefer to manage your back pain?"

Ask the nurse to speak privately for a moment, and educate about bias in pain treatment.

The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action? -Write the nurse up for disciplinary action. -Enter the conversation and tell the nurse and UAP that this type of discussion will not be tolerated. -Continue listening to the conversation before intervening. -Ask the nurse to speak privately for a moment, and educate about bias in pain treatment.

rest, before and after pain medications or interventions, and after activity

The nurse should assess pain intensity by asking the patient directly to rate his or her pain at ?

"The mild electrical impulses block the pain signal before it can reach the brain."

The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which response is most appropriate? -"The electricity produces numbness and alters tissue sensitivity." -"The mild electrical impulses block the pain signal before it can reach the brain." -"The electrode patches generate heat and decrease muscle tension." -"The machine tricks the mind into believing the pain does not exist."

asking the client

What is the most reliable method for assessing pain? -observing the client -asking the client -asking significant others -asking the primary care provider

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Whenever possible, the nurse who is treating the pain of older adults should avoid the use of which drug(s)? -Fentanyl -Morphine -Hydromorphone -Nonsteroidal anti-inflammatory drugs (NSAIDs)

Pain assessment may require multiple methods in order to ensure accurate pain data.

Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients? -Pain assessment may require multiple methods in order to ensure accurate pain data. -The developing neurologic system of children transmits less pain than in older clients. -Pharmacologic pain relief should be used only as an intervention of last resort. -A numeric scale should be used to assess pain if the child is older than 5 years of age.

Boredom and depression may affect an older person's perception of pain

Which statement accurately describes pain experienced by the older adult? -Boredom and depression may affect an older person's perception of pain. -A heightened pain tolerance occurs in the older adult. -Residents in long-term care facilities have a minimal level of pain. -The older client has decreased sensitivity to pain.

The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min.

Which statement accurately represents a consideration when using an epidural analgesia for client pain management? -Slight resistance should be felt during the removal of an epidural catheter. -The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min. -If the client develops a headache, a mild analgesic may be administered along with the epidural. -If a client is experiencing adverse effects, a peripheral IV line should be installed to allow immediate administration of emergency drugs, if warranted.

It interferes with normal functioning

Which statement is true of chronic pain? -It lasts for less than 6 months. -It interferes with normal functioning. -It disappears with treatment. -It is always present and intense.

The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval

Which statements accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain? - A PCA pump must be used and monitored in a health care facility. -The PCA pump is not effective for chronic pain. -This approach can only be used with oral analgesics. -The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.

Sometimes it seems like I can never get a moment to myself

While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain? -"Our insurance company finally found a way to cover my loved one's care." -"I feel badly because my loved one is in pain all of the time." -"Sometimes it seems like I can never get a moment to myself." -"Even when I do extra tasks around the house, I'm glad to help my loved one."

It warns an individual of tissue damage or disease.

Why is acute pain said to be protective in nature? -As an objective experience, it aids diagnosis. -It enables the person to increase personal strength. -As a subjective experience, it serves no purpose. -It warns an individual of tissue damage or disease.

pain

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

PCAs

are designed to make it impossible for the client to exceed the client-specific dosing parameters programmed into the machine

Nonsteroidal anti-inflammatory drugs (NSAIDs)

carry a risk of renal and gastric complications in older adults and should be used with particular caution.

C-fibers

cause a second pain sensation that is dull, poorly localized and persistent after injury

persistent paine

health care provides replaced the term chronic pain with?

Transmission

is the phase during which stimuli move from the peripheral nervous system toward the brain

WhO analgesic ladder

outlines a coordinated stepwise approach to pharmacologic pain management and is widely used as a guideline for cancer and noncancer pain treatment

analgesic

pain killers

Transduction

the first phase of pain in which injured cells release chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate.

1. nociceptors respond to stimuli 2. signals are carried to the dorsal horn of the spinal cord 3. information is conveyed to the sensory cortex 4. crossed and uncrossed pathways carry the signals to the thalamus

what are the steps in pain transmission

margo mccaffey

who described pain as "pain is whatever the experiencing person says it is, existing whenever he says it does."