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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: Complex, multidimensional , that causes suffering and reduces quality of life, and major reason that people seek health care Answer: Question: What are the of the nursing role in regards to pain (4)? Answer: 1. Assess and communicate 2. Ensure adequate pain relief 3. Evaluate effectiveness of pain relief 4. Advocate for patient with Question: What are the of untreated pain? Answer: unnecessary suffering, physical and psychosocial dysfunction, impaired recovery from acute illness and , immunosuppression , and sleep disturbances Question: What is the definition of pain according to Margo ? Answer: “Whatever the person experiencing the pain says it is, whenever the person says it does.” Question: What is the definition of pain to the International Association for the Study of Pain? Answer: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in of such damage” Question: Who is the expert, most valid means of pain ? Answer: the Question: What does the do if the patient cannot verbally communicate their pain? Answer: incorporate nonverbal information such as behaviors into pain assessment Question: What are responses to pain? Answer: Anger, fear, , anxiety Question: Studies have consistently demonstrated a link between __________ and __________. Answer: and Pain Question: suffering. Answer: the of severe distress associated with events that threaten the intactness of the person Question: What are some cues to pain? Answer: grimacing, withdrawal, less physical activity Question: What is the physiologic process by which information tissue damage is communicated to the central nervous system?Answer: Question: What the four of nociception? Answer: transduction, , perception, modulation Question: What is the of a mechanical, thermal, or chemical stimulus into a neuronal action potential called? Answer: Transduction Question: Where does take place? Answer: at the peripheral nerves, the free nerve endings/nociceptors Question: Give some of the chemicals that excite nociceptors to excitation? Answer: prostaglandins, , serotonin, substance P, histamine Question: How does the action potential get from the to the spinal cord? Answer: Via small, rapidly conducting, myelinated A-delta fibers and unmyelinated, conducting C fibers Question: What is pain? Answer: Pain caused by the activation of nociceptors Question: What would a pain therapy need to do in order to transduction and initiation of an action potential? Answer: Decrease the effect of the chemicals released at the periphery or alter the sensitivity of the peripheral Question: What block the action of cyclooxygenase thereby blocking the production of prostaglandins? Answer: NSAIDS Question: Name some NSAIDS. Answer: Advil, Motrin, Naprosyn, Question: What drugs block the action of phospholipase thereby blocking the production of prostaglandins and ? Answer: Corticosteriods Question: Name some that block action potential on pain nerves by stabilizing the neuronal membrane and inactivating the sodium channels. Answer: anesthetics like Lidocaine, bupivacaine (Sensorcaine) and antiseizure drugs like carbamazepine (Tegretol), oxcarbazepine (Trileptol), and lamotrigine (Lamictal) Question: What is ? Answer: the movement of pain impulses from the site of transduction to the Question: What are the 3 involved in transmission? Answer: 1. Peripheral nerves to spinal cord 2. horn processing 3. Transmission to the thalamus and cortex Question: What are ?Answer: on the skin that are innervated primarily by a single spinal cord segment Question: are nocieptive signals first processed in the CNS? Answer: the horn of the spinal cord Question: What kind of signal do these produce? Glutamate, aspartate, substance P Answer: Question: What kind of signal do these neurotransmitters ? Y-aminobutyric acid (GABA), serotonin, norepinephrine Answer: Question: In the dorsal horn, how do opioids work to pain? Answer: They block the of neurotransmitters, particularly substance P. Question: What are two of opioids? Answer: exogenous and Question: Morphine is an example of what kind of ? Answer: exogenous Question: Enkephalin and Beta Endorphin are of what kind of opioid? Answer: Question: What is sensitization? Answer: a in which neurons activated by noxious mechanical and chemical stimuli are sensitized by such stimuli and become hyper-responsive to all subsequent stimuli delivered to the neurons' receptive fields (thefreedictionary.com). Question: What is it called when enhanced in the spinal neurons occurs? Answer: Central Question: What is necessary to maintain central ? Answer: continued input from the periphery Question: What causes firing of specialized dorsal horn neurons to gradually ? Answer: ongoing stimulation of c-fiber (slow) Question: What is ? Answer: gradually increased firing of specialized dorsal horn neurons in to ongoing stimulation of c-fiber nociceptors Question: What are NMDA receptor promising agents for treating central sensitization? Answer: because windup is dependent on the of NMDA Question: What kind of are thought to play a role in central pain modulation? Answer: glial Question: What are 4 clinical results of sensitization? Answer: Hyperalgesia, allodynia, pain, referred pain Question: What is ? Answer: Increased response to noxious stimuli- what used to hurt, now hurts. Question: What is ? Answer: painful response to normally innocuous – what used not hurt, now hurts! Question: What is pain? Answer: prolonged pain after the noxious stimulus is gone – It shouldn’t hurt, but it does. Question: What is pain? Answer: the spread of pain to uninjured – That spot shouldn’t hurt, but it does. Question: What is a order neuron? Answer: a that conducts impulses from a somatic receptor into the brainstem or spinal cord Question: What is a second neuron? Answer: a neuron that conducts impulses from the brain stem and spinal cord to the Question: What do order neurons do? Answer: conduct impulses from the thalamus to the Question: does nociceptive stimuli go from the dorsal horn? Answer: to third order neurons primarily in the thalamus and to several other areas of the Question: What is it called when pain is recognized, defined and responded to by the experiencing the pain? Answer: perception Question: In what area of the does pain perception occur? Answer: There is no single area in the for pain perception Question: What area of the brain is believed to be for warning the individual to respond to the pain stimulus? Answer: the activating system (RAS) Question: What area of the brain is believed to be responsible for localization and of pain? Answer: system Question: What area of the brain is believed to be responsible for the emotional and responses to pain? Answer: system Question: What area of the is believed to be responsible for constructing the meaning of the pain? Answer: structures Question: What is ?Answer: Modulation involves the activation of descending pathways that inhibitory or facilitatory effects on the transmission of pain. Question: The degree of __________ determines the amount of nociceptive stimulation that may or may not be perceived as pain. Answer: Question: Name some drugs that use modulation to relieve pain by blocking the reuptake of serotonin and norepinephrine so that there is more to inhibit noxious stimuli. Answer: Cymbalta, Elavil, Effexor (used for pain) Question: What are the two categories of pain based on the underlying ? Answer: and neuropathic Question: Pain caused by damage to somatic or visceral tissue is _________ ________. Answer: Pain Question: Somatic and visceral pain are types of ______ ______. Answer: pain Question: does somatic pain come from? Answer: Bone, , Joint, Skin, Connective tissue Question: What is the quality of somatic pain? Answer: fairly , usually aching or throbbing Question: does visceral pain come from? Answer: organs Question: Which type of pain is not well controlled by opioid analgesics alone? Answer: Neuropathic Question: The fifth sign Answer: Question: Name 7 pain characteristics that should be . Answer: onset, duration and of pain, location, intensity, quality, associated symptoms, and factors that increase or relieve pain Question: Patients typically describe ________ pain as burning, numbing, shooting, stabbing , or itchy sensations. Answer: Question: Patients typically describe _________ pain as sharp, aching, throbbing, and cramping. Answer: nociceptive Question: What are the non ? Answer: acetaminophen, aspirin and other salicylates, and Question: Name 3 things that characterize non . Answer: 1) analgesic ceiling 2) No tolerance or dependence 3) OTC Question: What kind of pain is caused by to peripheral nerves or the CNS?Answer: Question: Name 3 affect associated with aspirin. Answer: gastric , platelet dysfunction, and bleeding Question: How is (Tylenol) like aspirin and how is it different? Answer: Like: analgesia and effects Different: no anti-platelet or anti-inflammatory effects Question: is acetaminophen metabolized? Answer: In the Question: Which patients are in danger of hepatotoxicity with ? Answer: Patients with liver or alcoholism Question: What is the maximum dose for acetaminophen especially for older adults? Answer: 3 Question: Cox Answer: Question: What have NSAIDs (except aspirin) been to? Answer: increased cardiovascular events such as and myocardial infarction Question: Patients who have just had heart surgery should not have _______. Answer: Question: What does COX 1 do? Answer: gastric and renal blood flow and platelet adhesion Question: What does COX 2 do? Answer: promotes Question: What kind of drug was and why was it pulled from the market? Answer: selective cox 2 inhibitor, Vioxx was pulled from the market along with Bextra due to about adverse cardiovascular events (MI). Question: Use of what non should be limited with elderly patients and patients with a history of PUD? Answer: Question: What is the same Morphine, Oxycontin, hydrocodone, codeine, methadone, Dilaudid and Levo-Dromoran? Answer: They are pure opioid Question: What kind of pain are pure agonists used for and why? Answer: moderate to severe because they are and have no analgesic ceiling Question: What vital sign is very to monitor when our patient is on Morphine and why? Answer: Respirations because morphine can cause respiratory Question: If we are to administer morphine to our patient but their respirations are > 12, what do we do? Answer: We the medication and alert the physician. Question: When are prescribed for moderate pain, what other analgesic is often included? Answer: or NSAIDs Question: Give some opioids mixed with nonopioid analgesics. Answer: Tylenol 3= codeine plus acetaminophen, Vicodin = hydrocodone plus acetaminophen, Vicoprofen = plus acetaminophen Question: What are the five of pain? Answer: physiologic, affective, , cognitive, sociocultural Question: What is the dimension of pain? Answer: the genetic, , and physical determinants of pain Question: What is the dimension of pain? Answer: response to pain including anger, depression, fear, and anxiety Question: What is the component of pain? Answer: the actions used to express or control the pain like grimacing or becoming less physically active or socially withdrawn Question: What does the cognitive of pain refer to? Answer: the beliefs, attitudes, memories, and meaning attributed to Question: What does the dimension of pain encompass? Answer: factors like (age, gender, education, socioeconomic status) support systems, social roles, and culture Question: Name some modulating chemicals sent down by the to tone down pain signals. (SON GABA)Answer: Serotonin, Opioid, Norepinephrine, Question: Name three antidepressants that work for pain modulation in by blocking the reuptake of serotonin and norepinephrine. Answer: Elavil, Effexor, and Question: If the patient describes describes deep,cramping, sharp, aching, or throbbing pain, what kind of pain is he likely to be ? Answer: pain Question: If the patient describes pain that is numbing, burning, , stabbing or electirical in nature, what kind of pain is he experiencing? Answer: Neuropathic Question: What is the definition that quantifies pain as ?Answer: lasting 3 months or past the time when pain is expected to should subside Question: What are the characteristics of pain that we need to ?Answer: onset, duration, pattern, location, intensity, quality, associated symptoms, what makes it or worsens it Question: What are the categories of pain drug therapy? Answer: nonopioid, , and co-analgesic/adjuvant drugs Question: What pain are included in the nonopioid category (4)? Answer: acetaminophen, aspirin, , and NSAIDs Question: What are shared by nonopioid analgesics? Answer: analgesic (more drug does not equal more pain relief after reaching the ceiling), no tolerance/physical dependence, often OTC/no RX required Question: What level of pain is aspirin for and what are its ? Answer: aspirin is for mild pain, drawbacks=gastric upset, platelet dysfunction, and Question: How is like aspirin and how is it different (2 sames/2 differents)? Answer: Has analgesic and like asa. Does not have anti-inflammatory or anti-platelet Question: What organ could suffer from doses greater than 3 to 4 g/day of ? Answer: is metabolized in the liver/hepatotoxicity Question: What kind of analgesic by inhibiting the enzyme that converts arachidonic acid into prostaglandins?Answer: (Cox inhibitors) Question: ¬¬¬Inhibition of _________ causes renal function impairment, bleeding tendencies, GI upset and ulceration, the bad side effects of NSAIDs. Inhibition of__________ reduces inflammation in injured tissues. Answer: Cox 1 cox Question: Why were Vioxx and Bextra pulled from the ? Answer: Concerns about increased risk of adverse cardiovascular effects: MI, , and Heart failure Question: What intensity of pain are for? Answer: to severe Question: Why is it that opioids can treat to severe pain when nonopioids can not? Answer: opioids have no analgesic ceiling, increase dose=increase pain Question: Name 6 opiods. Answer: oxycodone (Oxycontin), hydrocodone, codeine, methadone, hyromorphone (Dilaudid), and (Levo-Dromoran) Question: opioid is the standard of comparison for all other opioids? Answer: Question: Which opioid should not be used in doses more than 600mg per 24 hours, for more than 2 days, for chronic pain, nor for on Monoamine oxidase inhibitors because its metabolites are neurotoxic? Answer: meperidine (Demoral, ) Question: What are the side effects of opioids (5 )? Answer: constipation, sedation, N&V, depression, pruritus Question: Which opioid side is not likely to improve with time? Answer: Question: Why are patients who are on an often also taking Reglan-metocloparmide? Answer: with nausea and vomiting/ antiemetic Question: Which patients would be at an increased risk for respiratory depression on an ? Answer: opioid , elderly, underlying lung disease, receiving other CNS depressants (sedatives, benzodiazepines, antihistamines) Question: What drug will be carefully employed if you cannot rouse your patient from a induced somnolence? Answer: Narcan-Naloxone 0.4mg in 10mL saline in 0.5mL increments every 2 IV or subcut Question: What drug class, also used as an adjuvant drug, works by preventing reuptake of and norepinephrine? Answer: antidepressants Question: What side should we monitor for if our patient is taking an antidepressant for pain relief? Answer: anticholinergic side like dry mouth, urinary retention, sedation, orthostatic hypotension, weight gain and sexual dysfunction Question: Amitriptyline, doxepin, imipramine, and nortriptyline are all what type of ? Answer: antidepressants Question: Carbamazepine (Tegretol), and Gabapentin (Neurontin) are what kind of ? Answer: antiseizure Question: What kind of drug is (Lioresal)?Answer: muscle - particular useful for neuropathic pain and muscle spasms Question: What kind of drugs are (Duraclon, Catapres) and tizanidine (Zanaflex)? Answer: Alpha two andrenergic Question: Which group of adjuvant drugs is good for pain as well as prophylaxis of migraine headaches? Answer: drugs Question: What kind of drugs are dexamethasone (Decadron), prednisone, and (medrol)? Answer: Question: group of adjuvant drugs is good for neuropathic pain as well as chronic headache? Answer: alpha two antagonists Question: What are the common side effects of the alpha two adrenergic ? Answer: sedation, dry mouth, hypotension Question: Which kind of adjuvant drugs are especially useful when injected epidurally for acute and subacute disk because they can decrease activation of an inflamed neuron? Answer: Question: What class of adjuvant drugs is used for acute and chronic cancer pain, pain secondary to cord compression and inflammatory joint pain syndromes? Answer: Question: What are the side associated with corticosteroids? Answer: hyperglycemia, fluid retention, , GI bleeding, impaired healing, muscle wasting, osteoporosis, adrenal suppression, and immunosupression – eeesh! Question: What class of drugs should not be at the same time as corticosteroids because they work through the same final pathways? Answer: NSAIDS Question: Which type of drug works by interfering with nociceptive impulses, and is mainly used for muscle spasms? Answer: GABA receptor agonist like (Lioresal) Question: What is analgesic ? Answer: dose adjustment based on assessment of pain vs. side effects Question: What is the goal of titration? Answer: to use the smallest dose of analgesic that provides effective pain relief and with the fewest side Question: Give 8 we follow when treating pain. Answer: everybody deserves pain relief, treatment based on goals, combine drug and nondrug therapy, manage side effects, collaborate, Evaluate, educate Question: Name two that we don’t use often because of limited efficacy or toxicities. When we do use them, it is definitely not for long term. Answer: propxyphen (Darvon) and meperidine (Demerol, ) Question: Therapies that alter either the local environment or sensitivity of the peripheral nociceptors can prevent ____________ and initiation of an action potential. Answer: Question: Give some examples of that prevent transduction. Answer: By blocking pain sensitizing chemicals: NSAIDs like ibuprofen (Advil, Motrin), (Naproyn, Aleve); corticosteroids like dexamethasone (Decadron)- By changing the sensitivity of peripheral nociceptors: local anesthetics and antiseizure drugs. Question: What kind of opioid is administered transmucosally and for before surgery and procedures and cancer break through pain? Answer: citrate (Actiq) Question: Name some long acting forms of (12-24 hours). Answer: Kadian, , MSContin Question: Name some release formulations of oxycodone. Answer: OxyContin, SR Question: What opioid is administered intranasally for acute headache and other intense, types of pain? Answer: (Stadol) Question: What is an GI route for a patient who needs pain relief but nauseous and vomiting? Answer: rectal Question: Name the analgesics that are in rectal formulations (4 PHs). Answer: hydromorPHone, , morPHine, acetaminoPHen Question: What could we do for a patient with a fetanyl patch if they get rashes from the adhesive on the patch? Answer: prepare the skin one hour before placement with a corticosteroid . Question: What kind of patch can be used to help with pain (if the skin is unbroken)? Answer: Lidoderm patch (5% lidocaine impregnated) good for up to 12 few side effects Question: What are and Myoflex used for? Answer: joint and pain Question: Which aspirin side effect is avoided with Aspercream and ? Answer: GI Question: Name a topical pain relief drug from red chilli peppers. Answer: Capsaicin (ICY-HOT, ) Question: What kind of pain relief is covered with plastic for 30 to 60 minutes before a painful procedure? Answer: EMLA (eutectic [melty] mixture of anesthetics) Question: What administration route is best for immediate , rapid titration, and maintaining steady analgesia and blood levels of drug ? Answer: IV Question: What administration route is not recommended, although frequently used, because it hurts, absorption is , and chronic use can result in fibrosis and abcesses? Answer: Question: Why does it only take a little bit of drug if it delivered ? Answer: because it is delivered close to the receptors in the cord dorsal horn Question: 1mg of intrathecal morphine is equal to ____mg of epidural morphine is equal to _____mg of IV morphine is equal to _____mg of oral morphine. Answer: 10mg,100mg, Question: Name 6 that are administered intraspinally. Answer: morphine, fentanyl, sufentanil (Sufenta), hydromorphone (Dilaudid), ziconotide (Prialt) (a channel receptor modulator for use in neurpathic pain syndromes) and clonidine. Question: What are the common side effects with intraspinal ? Answer: Nausea, itching, urinary retention; clonidine- hypotension; ziconotide dizziness, ataxia, nausea, , headache Question: a “Wet tap”? Answer: Oops, we and a little CSF leaked out. Results in severe headache that only hurts when the patient is sitting or standing Question: How do we check if a catheter is correctly placed (hasn’t migrated)? Answer: we CSF Question: Give three types of areas that not be treated with cold therapy. Answer: areas being treated with therapy, open wounds, and areas with poor circulation Question: Give four types of that should not be treated with heat therapy. Answer: areas being treated with therapy, bleeding areas, recently injured (within the past 24 hours), or areas with decreased sensation Question: What are six things we want our patients to know when we about pain? Answer: Negative if unrelieved, maintain a record of level and relief, don’t wait till pain gets bad to ask for pain relief, dosage can be adjusted if loses effectiveness, side effects, report when not relieved Question: What is the formula for tapering a patient off an to which they have developed dependence. Answer: daily dose x 50%= New dose give 1/4 q6hrs for 2 days. New daily dose x 75% give 1/4 q6hrs for 2 days. Repeat till daily dose is 30mg per day for 2 days. Then stop. Question: Give 10 early (6-12hrs) of opioid withdrawal. Answer: Anxiety, tears, runny nose, sweating, yawning, piloerection, chills, dilated pupils, anorexia, tremor Question: Give 9 late (48-72 hrs) of opioid withdrawal. Answer: excitation, diarrhea, restlessness, fever, nausea and , cramping abdominal pain, hypertension, tachycardia, insomnia Question: What is the rule of effect teach us? Answer: The rule states that if an consequence (hastened death) occurs as a result of an action taken to achieve a moral good (pain relief), the action is justified because the nurse’s intent is to relieve pain. Question: What age group is the adage “start low and go relevant for and why? Answer: for older patients because they metabolize drugs more slowly so are at greater risk for high blood levels and side Question: Why is acetaminophen preferred to in older adults? Answer: because NSAIDs are associated with a high frequency of GI bleeding Question: what are the components of the role in regards to pain the rhyming way(4)?Answer: assess and comminicate, , evaluate, advocate |
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