NU 273 Week 4 Pain MGMT
A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client
"Only you are to push the button for medication." With a PCA machine, clients control the administration of their pain medication within prescribed parameters. Family members or other visitors should not push the button on the PCA machine for the client; doing so overrides the safety features of the machine. Clients may become frustrated if pushing the button frequently does not result in pain relief. The nurse needs to instruct the client about time limits. Other instructions include not waiting until the pain is severe before pushing the button and that the PCA machine is used to control pain.
The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.
"What aggravates your chest pain?" "Please point to where you are experiencing pain." "How long have you experienced this pain?" "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain."
A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies
"What do you mean by the word sick?" Nausea may occur with opioid use; however, before taking any other action, the nurse needs to clarify that this is what the client means by the word "sick."
Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission?
A child quickly removing a hand when touching a hot object Transduction, the first process involved in nociception, refers to the processes by which a noxious stimulus, such as a burn, releases of a number of excitatory compounds, which move pain along the pain pathway. Transmission, the second process involved in nociception, is responsible for a rapid reflex withdrawal from painful stimulus. The third process involved in nociception is perception. Imagery is based on the belief that the brain processes can strongly influence pain perception. A dual-mechanism analgesic agent, such as tramadol, involves many different neurochemicals as in the process of modulation.
Which of the following is a disadvantage of using the transdermal route of opioid administration?
A delay in effect until the dermal layer is saturated A disadvantage of using the transdermal route of administration is that there is a delay in effect when the dermal layer is saturated. Advantages include a consistent opioid serum level, slightly less constipation than with oral opioids, and less cost as compared to the parenteral route.
How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?
Administering the analgesics on a regular basis Routine scheduling of the administration of analgesics, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician.
Carbamazepine (Tegretol) is an example of which medication classification used in analgesia?
Anticonvulsant
When applying a fentanyl patch, the last dose of sustained-release morphine should be administered at what point?
At the same time the first patch is applied Because it takes 12 to 18 hours for the fentanyl concentrations to gradually increase from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The other time frames are incorrect
Which action by the nurse indicates understanding of one basic principle of providing effective pain management?
Awakening a new postoperative client to take pain medication
A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given:
Before pain is experienced.
The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for?
Bradypnea Most patients experience sedation at the beginning of opioid therapy and whenever the opioid dose is increased significantly. If left untreated, excessive sedation can progress to clinically significant respiratory depression (bradypnea, or reduced breathing rate).
According to the Joint Commission, which of the following is a focus of assessment related to quality of pain?
Description in the client's own words
The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?
Diaphoresis Observe behavioral signs, e.g., facial expressions, crying, restlessness, diaphoresis (sweating), and changes in activity. A pain behavior in one patient may not be in another. Try to identify pain behaviors that are unique to the patient ("pain signature"). Increased heart rate, blood pressure, and respiratory rate would be more likely to be associated with pain rather than decreased levels of these measures
Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain?
Do not administer if respirations are less than 12 breaths per minute The nurse should not administer the prescribed opiate therapy if respirations are less than 12 breaths per minute. The nurse should instruct a client who is prescribed psychostimulants to avoid caffeine or other stimulants, such as decongestants. The nurse should monitor weight, vital signs, and serum glucose concentration when administering corticosteroids. When administering anticonvulsants, the nurse should also monitor blood counts and liver function tests.
Which substance reduces the transmission of pain?
Endorphins Chemicals that reduce or inhibit the transmission of perception of pain include endorphins and enkephalin, which are morphinelike endogenous neurotransmitters . Acetylcholine, serotonin, and substance P are chemicals that increase the transmission of pain
A 20-year-old man has presented to the emergency department with a 24-hour history of abdominal pain. The nurse who is admitting the patient notes that he is diaphoretic, wincing, and guarding the lower right quadrant of his abdomen. The nurse asks the patient to rate his pain on a scale of 1 to 10, to which the patient responds, "One or two." How should the nurse best respond to this patient's statement?
Explain the 0-to-10 pain scale in greater detail. While it is important to accept a patient's self-report of pain, this does not mean that further education about pain scales is not sometimes necessary. This is especially the case when there is a clear inconsistency between patient's subjective pain report and the nurse's assessment findings. Thus, further teaching should take place prior to choosing an intervention or documenting the patient's pain as "slight."
An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client?
Follow a bowel regimen. The nurse should ensure that a bowel regimen to prevent constipation is started when any older adult is treated with opioids. A high-fiber diet along with increased fluids should be encouraged. The client should not reduce fiber intake because this increases the risk for constipation. The client need not exercise regularly or avoid harsh sunlight because these have no effects on the drug therapy.
About which issue should the nurse inform clients who use pain medications on a regular basis?
Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician. Clients should be advised to inform the primary health care provider or dentist before any procedure when they use pain medications, especially salicylates or nonsteroidal anti-inflammatory agents, on a regular basis. Over-the-counter analgesic agents, such as aspirin, ibuprofen, or acetaminophen, should not be avoided consistently to treat chronic pain without consulting a physician. Pain medications administered 30 to 45 minutes before meals may enable the client to consume an adequate intake, while a high-fiber diet may help ease constipation related to narcotic analgesics. Clients need not avoid harsh sunlight after administering analgesic agents because these drugs do not cause photosensitivity.
The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient?
Older people experience reduced sensory perception. Pain affects individuals of every age, sex, race, and socioeconomic class (American Geriatrics Society, 2009; Johannes, Le, Zhou, et al., 2010; Walco, Dworkin, Krane, et al., 2010).
Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy?
Risk for impaired gas exchange Problems that may develop with opioid and opiate therapy include risk for impaired gas exchange related to respiratory depression, constipation related to slowed peristalsis, and risk for injury related to drowsiness and unsteady gait.
Which condition is a heightened response that occurs after exposure to a noxious stimulus?
Sensitization Sensitization is a heightened response that occurs after exposure to a noxious stimulus. Pain tolerance is the maximum intensity or duration of pain that a person is willing to endure. Pain threshold is the point at which a stimulus is perceived as painful. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued.
Which of the following is a disadvantage to using the IV route of administration for analgesics?
Short duration Disadvantages of using the IV route for analgesic administration include short duration, the occurrence of possible respiratory depression, and that careful dosage calculations are needed. Intramuscular analgesics have a slower entry into the bloodstream.
A client reports abdominal pain as "8" on a pain intensity scale of 0-10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses
That the client's past experiences with pain may influence her perception of current pain Clients who have had previous experiences with pain are usually more frightened about subsequent painful events, as in the client who experienced partial-thickness burns to more than 60% of her body. The clients in these situations are less able to tolerate pain. Insufficient data in the stem support that the client is dependent on drugs or that this current pain is related to the client's previous burn injuries.
Which of the following is a true statement with regards to the nursing process of pain control?
The use of physiologic signs to indicate pain is unreliable. Use of physiologic signs to indicate pain is unreliable. Although it is important to observe for any and all pain behaviors, the absence of these behaviors does not indicate an absence of pain. It is unwise to make judgments and formulate treatment plans based on behaviors that may or may not indicate pain. Not all patients exhibit the same behaviors, and there may be different meanings associated with the same behavior. Nonverbal and behavioral expressions of pain are not consistent or reliable indicators of the quality or intensity of pain, and they should not be used to determine the presence or severity of pain experienced.
A client comes to the clinic and informs the nurse that he needs more analgesics for chronic pain. The client states that the medication is not as strong, and he requires more than the prescribed dose. What does the nurse suspect is occurring with the client?
Tolerance Tolerance is a condition in which a client needs increasingly larger doses of a drug to achieve the same effect as when the drug was first administered. Addiction refers to a repetitive pattern of drug seeking and drug use to satisfy a craving for a drug's mind-altering or mood-altering effects. Physical dependence means that a person experiences physical discomfort, known as withdrawal symptoms.
Regarding tolerance and addiction, the nurse understands that
although clients may need increasing levels of opioids, they are not addicted.
The client experienced abdominal surgery the previous day and has just received an opioid medication for report of pain. The client is sitting in a chair next to the bed. An additional activity that the nurse uses to relieve pain is
encourage the client to watch television Distraction, such as watching television, helps relieve pain. Ice may be applied for 15 to 20 minutes at a time but may be uncomfortable when applied to the abdomen. Ambulating has other benefits for the client but may not relieve pain. The client should concentrate on breathing slowly in and out, not hold the breath.
A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen?
hepatotoxicity The nurse will need to monitor the client receiving acetaminophen for hepatotoxicity. Intravenous acetaminophen should not cause renal toxicity, bleeding, and gastrointestinal effects.
A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends
increasing the amount of bran and fresh fruits and vegetables Constipation is a common problem with the use of opioid medications, such as methadone. Activities to prevent constipation include increasing bran and fresh fruits and vegetables in the diet. The client should ingest 8 to 10 glasses of fluids per day. Milk of magnesia may be used if no bowel movement is produced in 3 days. Milk of magnesia is not to be used daily. A glycerin suppository, not bisacodyl, may be used to make the bowel movement less painful.
According to The Joint Commission's pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment?
location, onset, alleviating factors, and aggravating factors Location, onset, alleviating factors, and aggravating factors are all essential components of a comprehensive pain assessment according to The Joint Commission's standards. Family history is not an essential component of a comprehensive pain assessment according to The Joint Commission's standards. Nutritional deficiencies are not an essential component of a comprehensive pain assessment according to The Joint Commission's standards. Range of motion is not an essential component of a comprehensive pain assessment according to The Joint Commission's standards.
A client is on a second round of radiation therapy for an inoperable tumor, and asks the nurse for medication to help with pain. The nurse suspects that the client's pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing?
neuropathic pain Neuropathic pain can affect cancer patients due to nerve damage from chemotherapy or radiation therapy. Somatic pain is caused by damage or disorders that affect bones, joints, muscles, skin, or other structures. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is pain felt in the body in a location that is different from the actual source of the pain.
