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N103 test 1 (GRCC)
N103 test 1 (GRCC) : Pain Management
| Question | Answer |
|---|---|
| McCaffrey and Beebe | Whatever pain the person says it is, exists where they say it does. |
| A patient with poor hygiene complains that pain meds aren't helping with back pain. Do you believe him? | According to McCaffery and Beebe, whatever pain the person says it is, exists where they say it does. |
| Relief of pain is a clients right and facilities are required to implement certain procedures. | JCAHO Pain Standards |
| An unpleasant sensory and emotional experience associated to actual or potential tissue damage | Pain definition |
| T or F. Only the persona affected can experience pain and pain for that person has a personal meaning. | True. The is one of our basis of nursing assessment of pain. |
| The personal satisfaction of having a baby is worth all the pain. | This is an example of an individuals experience of pain and the meaning associated to it. Having a baby is worth the pain. |
| The client says he has pain. | If the client complains of pain, then their pain is real. |
| What is factored in when a patient rates their pain? | Physical, emotional, cognitive, sociocultural, and spiritual. |
| Two patients have the same conditions, but each of them rate their pain differently. | Physical, emotional, cognitive, sociocultural, and spiritual. Elderly people under report pain is an example of this. |
| T or F. Pain is usually a positive experience. | False. Pain effects the whole body and is usually negative. |
| Pain may be a warning sign for what? | A response or warning of actual or potential trauma. |
| Nerve receptors in the body. Pick up sensations related to temperature, vibration and swelling in the skin, joints and muscles. | Nociceptors |
| What is the fifth vital sign? | Pain |
| Acute Pain | Sudden onset, usually temporary, less than six months, identified cause, and is usually localized. |
| Somatic Pain | Nociceptive; effects tissues such as skin, muscle, joints, bones, and ligaments - often known as musculoskeletal pain. |
| Pain symptoms include sharp, cutting, burning or dull & diffuse, may be accompanied by nausea and vomiting. | Somatic pain. |
| Temperature, vibration and swelling in the skin, joints and muscles. What type of pain is it when there is inflammation from a cut in skin, or if a muscle is stretched too far, or a charlie horse due to oxygen starvation? | Somatic pain. |
| Skin inflammation caused by a cut, charlie horse from oxygen starvation, muscle pain when over stretching are examples of.. | somatic pain |
| Visceral pain | Poorly localized, deep, dull and associated with nausea, vomiting, hypotension and restlessness. |
| Pain that effects internal organs of the main body cavities. There are three main cavities - thorax (heart and lungs), abdomen (liver, kidneys, spleen and bowels), pelvis (bladder, womb, and ovaries). | Visceral pain |
| Pain that is caused by compression in and around the organs, or by stretching of the abdominal cavity. Sometimes it may radiate to other areas in the body, making it even harder to pinpoint its exact location. | Visceral pain |
| Pain percieved in an area distant from the site of the stimuli. | Referred Pain |
| This type of pain is common with visceral pain. | referred pain. |
| When a patient has gall stones, yet his pain is felt in lower back. | Referred pain |
| Stressor, initiates fight or flight autonomic response. | Acute pain |
| Increased heart rate, Increased BP, Increased blood sugar, rapids shallow respiratory, dilated pupils, sweating. | Body response to acute pain. |
| Body's response to acute pain | Person responds with anxiety and fear which increases physical response causing restlessness and increased respiratory rate. |
| Cortacoid steroid raises blood sugar which is another symptom of this type of pain. | Acute pain. |
| Chronic Pain | Prolonged pain that lasts longer than 6 months, and is not always associated with identifiable cause. |
| Lower pain threshold as a result of depression of serotonin and endorphin levels, leads to depression and irritability. | Chronic pain. |
| T o F. Chronic pain is easy to detect and is identifiable. | False, chronic pain is more complex and poorly defined. |
| Body's response to Chronic Pain. | Physiologic adaption results in normal vital signs. |
| Hormonal responses increases the blood sugar when this type of pain persists. | Body's response to chronic pain. |
| T or F. A person with chronic pain learns to cope and is generally in good spirits. | False. person develops depression, withdrawal, irritability, immobility, and may be demanding and controlling. |
| Damage to peripheral or central nervous systems. | Neuropathic pain |
| Neuropathic pain symptoms | Burning, cold, tingling, pin and needle sensations. |
| Peripheral neuropathy is a normal complication of diabetes, periperal vascular pain, and phantom pain. | Examples of neuropathic pain |
| Breakthrough pain | Pain that exceeds the baseline treated pain. It is a sudden flare that exceeds the analgesic effects of long lasting pain meds such as mscontin. |
| Is the point at which pain begins to be felt. | Pain Threshold |
| Doctors misinterpret this type of pain. | Break through pain. Weather changes may cause temporary physical symptoms. |
| Pain experienced in absence of any diagnosed physiological cause or event. | Psychogenic pain. |
| Common problems related to this pain is depression because pain goes undefined. | psychogenic pain. |
| T or F. Everybody has the same pain threshold and perceives pain stimuli at the same stimulus intensity. | True. What varies is the persons tolerance based on perception of and reaction to pain. |
| The amount of pain a person can endure before outwardly responding. | Pain tolerance. |
| Decreased pain tolerance | Factors affecting pain responses occurs as a result of repeated episodes of pain, fatigue, anger, anxiety and sleep deprivation. |
| Increased Pain tolerance | Factors affecting pain response with giving of pain meds, alcohol, hypnosis, warmth, distraction and spiritual practices. |
| T or F. Nurses should avoid giving Elderly people pain meds as it would cause respiratory depression. | False. There is no scientific evidence that proves age determines pain perception or sensitivity to pain. |
| T or F. Elderly people under report their pain. | True. Older people tend to self medicate with over the counter drugs. |
| Different races and ethnic groups respond differently to pain meds. | Socio-cultural factors. |
| Ethnopharmacy | the perception and use of pharmaceuticals (especially traditional medicines)within a given human society. |
| Cultural background doesn't have to be factored in by the nurse. T or F | False. Socio-Cultural factors affecting the response to pain is critical to patient care. |
| Emotional status affects the response to pain. | Intense concentration blocks pain, however, fear and anxiety increases pain. |
| Pt previous experience with pain influences their response with current pain experience. | Past experiences with pain is a factor that affects pain response. |
| Source and meaning of pain are factors that affect pain response. | Having a baby effects perception of pain or increased may result when patient gets more attention & more help due to pain. (attention seeking) |
| Patient can deal with pain better if they have knowledge, whereas lack of knowledge could cause fear and anxiety and the response to pain is negative. | Knowledge deficits affect the response to pain. |
| Pain is a result, not a cause. T or False | False. Pain is a cause. |
| Chronic pain is a form of depression. T or F | False. Pain and depression co-exist with regards to chronic pain. |
| Narcotics are too risky to use for chronic pain. T or F | False. Narcotics are not risky to use for chronic pain. only 1% of those taking meds developing a serious addiction. |
| it is best to wait until a client has pain before giving pain meds. T or F | False. Pain meds should be given before the pain sets in. |
| Many patients lie about the existence or severity of their pain. T or F | False. They are very honest about their pain. |
| Post operative meds are best treated with IM meds. T or F | False. IM meds only work well when the needle hits the muscle, and that doesn't always happen. Usually makes it through the layer and affects of drug to longer to work. |
| Pain relief interferes with diagnosis. | False. Pain relief does not interfere with diagnosis. Think of when you are menstrating, taking an advil will help with the pain, but it doesn't make the physical causes go away. |
| TENS unit | Transcutatneous electricl stimulator normally used for chronic pain. |
| Non pharmacological interventions. | no drug side effects, can use with other therapies. The downside is that they can be expensive. |
| Cutaneous stimulation | non pharmacological intervention such as massage, vibration, heat & cold, therapeutic touch. |
| Most common approach to pain management | Pharmacological interventions - medications. |
| Analgesics | Reduces or relieves pain and come in forms of either non opiod or opiod. |
| Acetaminophen | Reduces pain and fever, but doesn't reduce inflammation. |
| Max dosage of Acetaminophen | 4000 mg (4g) in a 24 hour period. Exceed this amount can cause liver damage. |
| Any adverse effects of Acetaminophen | No adverse effects on kidney, gastric lining or platelets. Can cause liver damage if exceeds daily limit of 4000 mg (4g) in 24 hour period. |
| Non steroid anti-inflammatory drugs (NSAIDS) | Reduce pain by interfering with the prostaglandin synthesis; can cause increased bleeding and gastric ulcers. |
| Taking this type of analgesic can cause increased bleeding and gastric ulcers. | NSAIDS |
| NSAIDS are good for which type of pain? | Mild to moderate pain |
| Analgesic ceiling | Increased dosages will not decrease pain. |
| NSAIDS work on which nervous system? | Peripheral nervous system. |
| NSAIDS | This type of analgesic decreases bleeding that forms clots. |
| adjuvant drugs | Drugs with other specific uses that can provide analgesia in clients with certain types of pain and specific med diagnosis. |
| Steroids, anticonvulsants, antidepressants, muscle relaxants, local anesthetics, & others. | Adjuvant drugs |
| Steroids may will with inflammation. T or F | True |
| antipyretic activity | reduces fever |
| salicylates | in the aspirin family. |
| Acetaminophen | This analgesic, antipyretic activity and is part of the salicylate family. |
| The mechanism of action unknown of this analgesic | Acetaminophen |
| An analgesic that has no anti-inflammatory action. | Acetaminophen |
| What is the analgesic of choice when bleeding tendencies are an issue. | Acetaminophen- this analgesic does not inhbit platelet aggregation. |
| Good drug to manage pain r/t osteoarthritis | Acetaminophen. |
| This analgesic reduces fever, is for mild to moderate pain and is best for people with bleeding disorders. | Acetaminophen. |
| Acetaminophen comes in 325 & 500mg oral forms. What it the common dosage? | 2 tabs every 4-6 hours, and is also available in rectal suppository. |
| NSAIDS | Salicylates (aspirin and others) |
| Which analgesic functions as an antipyretic and an anti-inflammatory | NSAIDS (aspririn and others) |
| Most active against joint pain, muscle pain, headaches and menstrual cramps. | NSAIDS (aspirin and others) |
| Inhibits aggregation of platelets so prolongs bleeding time. | NSAIDS (aspirin and others) |
| NSAIDS (aspirin and others) | Prolongs bleeding time and are used to decrease MI, CVA, and TIA |
| Used for inflammatory disorders such as rheumatoid arthritis. | NSAIDS (aspirin and others) |
| Helps with mild to moderate pain, reduces body temp and inflammation problems. | NSAIDS (aspirin and others) |
| NSAIDS (aspirin and others)- adverse reactions. | gastric distress, heartburn, bleeding in places of body, renal impairments. |
| Salicylism | Overdose of an NSAID (salicytates) |
| Signs and symptoms of salycylism | tinnitus, sweating, headache, dizziness, respiratory alkalosis with rapid breathing. |
| Reyes syndrome | May result if children under age 18 years old are given an NSAID (aspirin). |
| NSAID dosage amount | Baby aspirin is 81 mg and adult is 325 orally every 2-4 hours prn. |
| Nonaspirin NSAIDS properties of | anti-inflammatory, analgesic and antipyretic. |
| 20 different non aspirin NSAIDS adverse effects | gastric distress, gastric ulceration, bleeding and renal impairment. |
| Doesn't protect against MI, CVA, or increased blood clots. | Non-aspirin NSAIDS |
| Which drug is considered safe in giving to pregnant women? Non-aspirin NSAIDS or Acetaminophen. | Acetaminophen |
| NSAIDS - Salicylates (aspirin & others)dosage in treating arthritis | 8 grams per day for arthritis |
| NSAIDS - Salicylates (aspirin & others)dosage in orally | 325 mg 2 tabs q 4 hours prn |
| NSAIDS - Salicylates (aspirin & others)dosage rectal | 325 - 650mg rectally |
| NSAIDS - Salicylates (aspirin & others)dosage baby aspirin | 81mg per day (can take for anti-coagulation prevention) |
| NSAIDS - Salicylates (aspirin & others)preventative dosage | 81mg - 325mg per day. |
| Non-Aspirin NSAIDS risks | Do not protect against MI, CVA, Increased clot risk, causes bleeding in all sorts of places in the body. |
| T or F. Individual pts respond the same to any of the 20 non-aspirin drugs available. | False. Individual pts may respond better to one of the 20 non-aspirin drugs than another. |
| T or F. Individual pts may tolerate one of the 20 non-aspirin NSAIDs better than the other. | True. Individual pts may tolerate one of the drugs better than the other. |
| Non-Aspirin NSAIDS uses | This drug is good for rheumatoid, osteoarthritis, fever, bursitis, tendonitis, mild to moderate pain and dismenaria. |
| Non-Aspirin NSAIDS dosages | Some of these drugs require an rx for higher therapeutic dosage of 800mg. |
| Non-Aspirin NSAIDS | Viox and vecstra were in this class of drugs but were taken off the market. |
| Non-Aspirin NSAIDS | Celebrex is in this class of drugs,acts for 24 hours, and available in prescription form only. |
| No signs of respiratory depression, will have consitpation and pinpoint pupils. | People with opiod tolerance demonstrate these signs and symptoms. |
| Natural substance obtained from raw opium and also called narcotics | Opiod |
| Member of the poppy family. | Opiod is a substance from raw opium and is part of which family? |
| Morphine, hydrocodone, oxycodone, codeine, meperidine, hydromorphone (dilauded) and others. | Opiod Analgesics (opiates) includes: |
| Control Substance Act says the manufacture, importation, possession, use and distribution of certain substances is regulated. | This is subject to abuse. |
| Relief of pain | Opiod Analgesics (opiates) uses |
| Classifications of opiates depend on how they bind on brain receptor sites as they compete for receptor sites. | agonists, agonists-antiagonists or antagonists. |
| agonist | Produces an action. It often mimics the action of a naturally occurring substance. |
| Antagonists | Acts against and blocks an action. |
| agonists-antiagonists | Mixed drug that have a relationship to the opioid receptors that includes activation and blockade |
| Scheduled I - V | Abuse decreases the higher the schedule drug. |
| Schedule I | LSD or Heroin (Highest form of abuse) |
| Schedule II | Morphine and Dilaudid |
| Schedule V | Hydrocodone in cough syrup (lowest rate of abuse) |
| Positive Side effects of opiates | reduces anxiety and improves persons sens of well being |
| Reason why opiates are given pre-operative. | Opiates reduce anxiety |
| T or F. Opiates improves patients sense of well-being | True. Cancer patients are given opiates as they give them the feeling of a better quality of life. |
| The most serious adverse effect of opiod use. | Respiratory depression |
| The most common adverse effect of opiod use. | Constipation- 95-99% regular users will have this. |
| Adverse effect of opiods that relaxes artials and arteries, resulting in drop of blood pressure. | Orthostatic Hypotension |
| Orthostatic Hypotension symptom | when patient sits up, blood doesn't rush to head causing dizziness. |
| Men who take opiods have an increased risk of this adverse effect. | Urinary retention |
| Miosis or pinpoint pupils | An adverse effect of opiod use that causes constricted pupils. |
| Opiods adverse effects | Suppress coughs, cause emesis, and increase intercranial pressure. |
| It is safer for patients with intercranial pressure. | Injectable codeine. |
| Opiod tolerance | A large dose is required to produce same response that could formally be solicited by smaller doses. |
| Dosage needs to be increased to maintain therapeutic effects of opiates. | Opiod tolerance |
| Abstinent syndrome will occur if opiate is abruptly discontinued. Person needs opiates to function normally. | Physical dependence |
| Addiction risk | Only 1% of population is at risk for addiction. |
| Morphine 1-4mg IVP or PCA every 6-30 minutes | Opiods for severe acute pain (post-op trauma) usually given to opiod nieve pts |
| Dilaudid 0.5-1mg IVP or PCA every 15-30 minutes | Opiods for severe acute pain (post-op trauma) usually given to opiod nieve pts |
| MScontin PO every 12 hours OR Oxycontin Po every 12hours | Oral opiods for severe chronic pain |
| MScontin | Morphine time released |
| Oxycontin | hydrocodone time released- considered to be highly addictive in the past few years. |
| A patient who is given MORE MScontin PO every 12 hours OR Oxycontin Po every 12hours | Pain Tolerance |
| Duragesic (fentanyl) patches come in different strengths. Find and remove old patch before placing a new one | Topical opiod for severe chronic pain |
| Hydrocodone always in combination with a non-opiod. These are Oral opiods for moderate to severe pain (post-op or trauma) | Lortab, Vicodin, norco, vicoprofin |
| Varying dosages of hydrocodone with varying dosages of non-opiods (APAP, ibuprofen,etc) | Oral opiods for moderate to severe pain (post-op or trauma). |
| Dosage combination for 0ral opiods (i.e. hydrocodone) for moderate to severe pain (post-op or trauma) | 1-2 tabs q 4-6 hours, but not to exceed 4000mg (8g) of acetaminophen/24 hours |
| Oral opiods for moderate to severe pain (post-op or trauma) | oxycodone (oxyIR) or in combination with ASA (percodan) or acetaminophen (percocet) |
| oral Dosage for OxyIR, percodan, or percocet opiods for moderate to severe pain (post-op or trauma) | 1-2 tbs q 4-6 hours |
| Oral opiods for moderate to severe pain (post-op or trauma)- combining drugs | Codeine dispensed with APAP (acetaminophen).combining drugs increases pain relief. |
| Combined drug that increases pain relief | Tylenol # 2 (15mg codeine), Tylenol #3 (30mg of codeine), #4 (60mg codeine). Dosage is 1-2 tabs q 4-6 hours. |
| Propoxyphene (Darvon) frequently in combo with nonopiod, usually APAP (Darvocet). | Oral opiods for moderate to severe pain (post-op or trauma) |
| When alone, Darvon -N is prescribed in doses of 1-2 tabs q 4 hrs | Oral opiods for moderate to severe pain (post-op or trauma) |
| Pain assessment before drug administration | Level (rate), Location, type of pain, respiratory rate, last dose recieved, any symptoms such as itching. |
| Post-Op pts must be on oral pain with.... | documented pain relief upon d/c. Need to know oral pain meds are effective. |
| Respiratory depression, pinpoint pupils | Reverse actions of opiods using antagonist such as narcan (Naloxane) |
| Adjuvant drugs | Short term usage , co-analgesics |
| consider after the use of opiods has been optimized, provides relief in specific situations. | Adjuvant drugs |
| Powerful anti-inflammatory and immunosuppresive actions in high dosages | Corticoidsteroids (glucocortoids, steroids)Adjuvant drugs |
| Given for pain relief for bone and nerve pain, short term post-op neurosurgery d/t inflammation, edema and nerves | Corticoidsteroids (glucocortoids, steroids)Adjuvant drugs |
| Examples of Corticoidsteroids (glucocortoids, steroids)Adjuvant drugs commonly ordered | prednisone, cortisone |
| Anticonvulsants (anti-seizure drugs)Adjuvant drugs | Good for neuropathic pain-lancinating (sharp,darting) pain like with trigeminal neuralgia, cramping, aching, burning pain. |
| Pain originates from nerve | Trigeminal neuralgia, cramping, aching, burning pain. |
| Anticonvulsants (anti-seizure drugs)Adjuvant drugs | Most common drugs are Tegretol and newer drugs of gabapentin family- neurontin, Lyrica |
| Lyrica is a Anticonvulsants (anti-seizure drugs)Adjuvant drugs | (given for fibromilagia) |
| Tricyclic antidepressants - Adjuvant (co - analgesics) | Given for burning, stinging, neuropathic and muscolskeletal pain, preventing migraine and tension headaches. |
| Enhance effects of opiods | Tricyclic antidepressants - Adjuvant (co - analgesics) |
| Most common drug is amitriptyline (Elavil) given at bedtime (HS) | Tricyclic antidepressants - Adjuvant (co - analgesics) |
| Muscle relaxants - Adjuvant (co-analgesics) | For musculoskeletal pain from trauma, muscle spasms, post-op from ortho/neuro procedures. |
| Produces effects thru action in CNS, chiefly sedation, but also decreases local pain and tenderness and increases Range of Motion | Muscle relaxants - Adjuvant (co-analgesics) |
| Valium, Robaxin, Flexeril, Norflex, parafon Forte | Most common Muscle relaxants - Adjuvant (co-analgesics) given |
| Local Anesthetics - Adjuvant (co-analgesics) | usually given by pain clinics. |
| Local Anesthetics - Adjuvant (co-analgesics) | Includes nerve blocks for shingles, fractured ribs. |
| Local Anesthetics - Adjuvant (co-analgesics) | Lidocaine patches |
| Local Anesthetics - Adjuvant (co-analgesics)that increase blood flow to area to help decrease pain. | Topical creams: Ben-Gay, Capsacian cream |
| Capsacian cream | Derived from peppers that increases blood flow to an area. |
Created by:
Wends1984
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