3802 test 3
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| What is the term of this definition? "Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms such as damage?" | International association for the study of pain.
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| True/false: It is up to the nurse to decide whether or not the Pt is experiencing pain and the extent of their pain. | False! It is NOT up to the nurse but to the Pt.
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| Define pain threshold | Point at which a stimulus evokes pain
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| Who quoted this: "Pain is whatever the experiencing person says it is existing whenever the experiencing person says it does." | Margo McCaffery
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| Define pain tolerance | The duration or intensity of pain a person is willing to endure.
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| How does tolerance to opioids develop? | After repeated administration of the medication, a given dose begins to lose it effectiveness.
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| What side effect is present, even when tolerance develops with opioids? | Constipation
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| With opioids, you will develop tolerance to not only analgesic effects but to what else? | The side effects, except constipation.
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| True/False? There is no "ceiling dose" or a limit of how much opioid you can give a Pt. Not every Pt will tolerate the highest dose. | True!
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| What is the term for: involuntary behavior in which abrupt discontinuance of a drug leads to withdrawal symptoms? | Dependency
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| Just b/c Pt's become dependent does NOT mean they become....what? | addicted
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| Is there a low or high chance of addiction with opioids? | LOW
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| Define addiction | primary, chronic, neurobiological disease with genetic, psychosocial, & environmental factors influencing its development and manifestations.
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| What are behaviors that reflect an addiction? | Impaired control over medication use, compulsive use, continued use despite harm, and craving.
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| This is an ex of? A Pt that is continuously looks at the time to see when they get their next dose of medicine. But the Pt is trying to get some relief from when the med is actually working. | clockwatching
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| Giving morphine three times orally when the med is a lesser dose when given IV is an example of? | Equal analgesic dosing
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| Clockwatching, a pt knowing the name and dose of opioids, a pt that orders opioids in anticipation of pain, and a pt requesting more frequent doses is usually mislooked at as an addiction or tolerance? | Addiction
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| What does it usually mean if a Pt requires more and frequent doses? | They have developed a tolerance
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| Define acute pain | usually temporary, well-defined onset- serves as warning sign, commonly declines over time, less than 3 months
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| What kind of physiological responses activate acute pain? | Stress response
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| What are some behavioral responses assoc. with acute pain? | The Pt focuses on pain, cries and moans, frowns, or grimaces.
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| Describe Chronic Pain | usually greater than 6 months in duration- may start as acute injury or event but continues past the normal recovery time poorly defined onset, no useful purpose.
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| What is unique about the physiological responses r/t chronic/persistent pain? | Adaptation
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| Behavioral responses from a Pt with chronic/persistent pain will show....? | No report of pain unless questioned, quiet, rests, inactive, immobile, blank or normal facial expression
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| what is the negative side with adaptation r/t daily living for Pt's experiencing chronic pain? | Can be disabling and is often accompanied by anxiety and depression
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| T/F? There are warning signs with acute and chronic pain. | False! Only with acute pain
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| T/F? A Pt with chronic pain will not experience flight or fight b/c of the adaptation from chronic pain. | True
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| What is nociceptive pain? | Normal processing of stimuli that damages normal tissue or has the potential to do so if prolonged
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| What is nociceptive pain responsive to? | Nonopioids and/or opioids
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| Name the two type of nociceptive pain | somatic and visceral pain
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| Somatic Pain | arises from the bone, joint, muscle, skin, or connective tissue. Usually aching or throbbing in quality and is well localized
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| WHERE does visceral pain arise from? | arises from viscera, such as the GI tract and pancreas.
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| WHAT may visceral pain be derived from? | Tumor involvement of the organ capsule that causes aching and fairly well-localized pain or obstruction of hollow viscus, which causes intermittent cramping and poorly localized pain.
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| If tissue is damaged will the Pt experience pain? | Yes!
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| This helps our body deal with pain. An ex is: they are released when running. What am I talking about? | Endorphines
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| Obstruction of the bowel would be r/t visceral, somatic, or neuropathic pain and why? | Visceral b/c it deals with intermittent cramping and poorly localized pain.
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| Neuropathic pain | Abnormal processing of sensory input by the peripheral or central nervous system. A physical cause for reports of excrutiating pain may
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| Adjuvent drugs are given for which type of pain: visceral, somatic, or neuropathic pain? | Neuropathic pain
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| Anticonvulsive drugs and electrical shock are an examples of which type of pain? | Neuropathic
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| Phantom limb pain is an ex of which type of pain? | neuropathic
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| What is phantom limb pain | may reflect injury to the peripheral nervous system
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| Name 5 harmful effects of unrelieved pain | 1. Unnecessary suffering 2. Physicial and psychosocial dysfunction 3. Impaired recovery from acute illness and surgery 4. Immunosuppression 5. Sleep disturbances
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| If you have high pain levels at the time of the dying phase, what will the pt experience as they die. | Excrutitating pain until death
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| T/F: Depression causes pain | False. Pain can cause depression
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| Gate Control Theory | hypothetical gating mechanism in the spinal cord that allows nerve fibers to receive pain sensations
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| These ex's are r/t which theory? Getting Pt's explanation, massage, heat and cold therapy may decrease painful impulses | Gate control theory
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| When assessing for pain what should the nurse look for? | Location, quality, intensity, onset/duration, precipitating/relieving and aggravating factors.
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| Does it radiate to any other part of his body is pertaining to which part of the pain physical assessment?A)LocationB)QualityC)IntensityD)Onset/DurationE)Preciptating, relieving, and aggravating factors | A)Location
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| "How long does the pain last?""Constant or intermittent" r/t which part of the pain assessment? | Duration
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| Asking the Pt to rate their pain level on a 0 to 10 r/t which part of the pain assessment? | Intensity
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| "What is the pain like'"Can you describe how it feels""What would you do to me for me to feel the same pain?"....are questions that pertain to which part of the pain assessment? | Quality
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| "What, if anything, brought on the pain?""Is there anything that makes the pain worse?"...deals with which part of the pain assessment? | Precipitating and aggravating factors
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| Why do half the ppl who suffer moderate to severe pain will continue to suffer? | Primarily b/c clinicians fail to assess pain.
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| Name the first four pharmacological measures: nursing responsibilites | 1. Assessing pain 2. Determining when to administer analgesics 3. Selecting the appropriate analgesic (titrating opioids-- increase dosage in small amnts until you get desired effects)4. Evaluating effectiveness of the analgesics
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| Name the last three pharmacological measures: nursing responsibilies | 1. Monitoring and managing medication side effects 2. suggesting changes 3. consider the needs of special populations (cognitively impaired, pt's with substance abuse problems)
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| T/F? Even Pt's that are substantially cognitively impaired may be able to use a pain rating scale? | TRUE!
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| What is the usual pain scale preferred for Pt's that have substantial cognitive impairment? | A 0-5 pain scale
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| What are non-opioids? | Acetaminophen NSAIDS
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| What are NSAIDS? | Aspirin, Ibuprofen, Ketorolac, and Naproxen
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| What are the indications for Pt's who should take non-opioids? | 1. Inflamm conditions 2. Mild to moderate or chronic pain of peripheral origin 3. Co-analgesic for severe pain 4. Desire by Pt to avoid opioids 5. Conditions assoc w/ excessive prostaglandin @ site of injury or pain 6. Post op pain
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| What are disadvantages of using non-opioids? | Analgesic ceiling, GI upset, prolonged bleeding time, fluid retention
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| Name all opioid agonists | Codeine, Meperidine, Hydrocodone, Methadone, Hydromorphone, Morphine, and Oxycodone
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| Why is Demerol not appropriate for first-line opioid for management of any type of pain? | Because of the narrow therapeutic range, Demerol can become very toxic in the body and should not be used as the first option to help decline pain levels.
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| What is normeperidine and how does it r/t demerol toxicity? | Normeperidine is a CNS-stimulant - can produce irritability, tremors, muscle jerking, agitation, and seizure. Normeperidine is an active metabolite, meaning: when demerol is broken down, it breaks down into normeperidine --> toxicity.
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| What is the half-life of normedperidine? | 15-20 hours half life
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| When is normeperidine r/t demerol toxicity going to cause delirium? | In postop pt's of all ages.
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| An example is when their foot was amputated but they feel pain that is in their toe that is not there anymore. What am I describing? | Phantom limb pain
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| Pins and needles effect; burning sensations in feet is an ex of neuropathic pain (but more specifically what type of neuropathic pain)? | Diabetic neuropathy
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| Why is it so important to be relieved of pain after surgery r/t the healing process? | B/c if pain is not relieved it is possible that the Pt will not heal completely
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| What will a stress response lead to? | Immunosuppression and sleep disturbances
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| What level on the pain score of 0-10 will interfere with the Pt's activity? | Score of 4 or higher
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| When will a Pt's enjoyment of life be interfered as determined by a pain score? | With a pain score of 6 or 7 and greater
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| When is there a high incidence of divorce? | With Pt's experiencing chronic pain
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| If the pain is constant when should the nurse administer the medication? | administer medication in first 24 to 48 hours NOT PRN
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| If pain is intermittent, when will the nurse administer pain meds? | PRN and let pt know what PRN means
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| What is the best thing a nurse can do to help a patient understand about them receiving pain medicine? | That the Pt needs to ask for pain medicine way before it gets too severe.
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| What is important Pt teaching for Pt's using PCA? | Tell Pt to administer pain meds before it gets too sever and ambulate before they become sedated.
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| When should pain medication be evaluated? | Before and after administration
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| If a Pt refuses an opioid because of the side effects, what can a nurse do so they will take the opioid? | Let the Pt know that the side effects can be treated with the help of other medications used along with the opioid.
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| What about the Pt that is a heroin user and the administration of opioids? | That Pt will be more tolerant, so give a higher dose. That Pt still deserves pain medicine.
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| Why would the nurse administer NSAIDS instead of opioid- analgesics when a Pt is experiencing bone injuries or dysmenorrhea? | because a lot of prostaglandins are released with these types of pain that NSAIDS will inhibit and helping with inflammatory response. Opioid analgesics are for moderate to severe pain and do not help with inflammation.
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| What is the limit per day in grams of tylenol/acetaminophen? | 4 grams per day
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| Would a Pt who is experiencing renal failure be given NSAIDS for daily inflammatory problems? | No because NSAIDS can cause kidney toxicity and damage the kidneys more than they already are.
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| What is the golden standard of opioids? | Morphine
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| Name all the drugs that will antagonize causing withdrawal syndromes in drug addicts? | Buprenex, Stadol, Nubain, Talwin, and Dalgan
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| What are the disadvantages of opioids? | Sedation, n/v, respiratory depression, constipation
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| T/F Promethazine (Phenergan) potentiate the analgesia of narcotics. | False. Phenergan does NOT potentiate the analgesia. It actually increases the perceived intensity of pain.
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| What does Phenergan potentiate? | Narcotic-related sedation, hypotension, and respiratory depression.
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| Name the four types of anjuvant drugs | antidepressants, antiseizure, corticosteriods, local anesthetics
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| What are some non-invasive non-pharmacological methods of pain relief? | Repositioning, heat/cold, TENS, acupressure, massage, therapeutic touch
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| Ex: morphine oral 30mg = parental 10mgOxycodone orally 20mg = parental NAIs an ex of what? | Equianalgesic Tables
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| T/F: Oral demerol 50 mg is equianalgesic to aspirin 650 mg? | True Don’t down grade the use of NSAIDS for a pt who says it works for their pain!
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| What is the first sign of opioid toxicity? | Sedation the respiratory depression. But first is sedation!
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| When does n/v usually occur with the use of opioids? | Within the first 24 hrs
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| What will a Pt not become tolerant to when using opioids? | CONSTIPATION
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| Since opioids are known for a development of tolerance, what is the percentage of addiction development with use of opioids for 3-6 months? | Less than 1%
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| We already know opioids will lead to Pt tolerance. We know addiction potential is very unlikely. If Pt's are using opioids, what will happen other than tolerance, if they are using opioids for more than 3 months? | Dependence may develop
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| Adjuvant drugs are considered pain relievers. True or false? | False. They are not pain medications
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| Which route is considered the cheapest and easiet route? Which is not usually preferred? Which is for tolerant Pt's? | Oral is cheapest and quickest way.IM is not preferred.Buccal/sublingual is for tolerant pt’s
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| What is the proper technique when putting a transdermal patch? | Nurse must wear gloves and hold over Pt's skin for over 10 secs
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| Until transdermal patch works,what can a nurse do? | Give a short acting pain reliever
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| What type of pain will a transdermal patch work for? | Neuropathic pain
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| Other than IM, what is another way Stadol is administered? | Intranasal
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| If a nurse is trying different types of non-pharmacological methods of pain relief for a Pt on anticoagulents, what must the nurse be careful of? (Hint: which type of non-invasive method would be the more cautious one?) | Giving a Pt a massage
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| what are the three invasive interventions | acupuncture, neuroaugmentation, and nerve blocks
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| What are psychological measures a nurse can use as an alternative to invasive...etc? | Distraction, music therapy, humor, relaxation, imagery, and hypnosis.
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