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Theory Test IV
Unit XII Pain
| Question | Answer |
|---|---|
| Margo McCaffery | Internationally known nurse expert on pain |
| Margo McCaffery's definition of pain | "Pain is whatever the person says it is, and exist whenever he says it does" |
| Widely agreed on definition of pain | "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" |
| Pain Management | Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the client. |
| How severe pain is viewed | As an emergency situation deserving attention and prompt professional treatment. |
| Four terms in which pain may be described | Location, duration, intensity, and etiology |
| Importance of pain location | To be able to differentiate treatment for a particular area. (eg. knee pain is treated differently than chest pain) |
| Radiating pain (location) | Pain spreads or extends to other area's (eg. lower pack pain extends to legs) |
| Referred pain (location) | Pain that appears to arise in different parts of the body. (eg. cardiac pain may be felt in the shoulder or left arm, with or without chest pain) |
| Visceral pain (location) | Pain arising from organs or hollow viscera. Often perceived in an area remote from the organ causing the pain. (eg. stomach ache) |
| Acute pain (duration) | When pain lasts only through the expected recovery period, whether it has a sudden or slow onset, regardless of its intensity. |
| Chronic pain (duration) | Persistent pain, is prolonged, usually recurring or lasting 3 months or longer, and interferes with functioning. |
| How to classify intensity | Most practitioners use a standard scale: 0 (no pain) to 10 (worst possible pain) scale. Mild = 1-3, Moderate = 4-6, severe pain = 7-10 |
| Broad categories of etiology of pain | Nociceptive and Neuropathic |
| Nociceptive pain | Experienced when an intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care. |
| Subcategories of nociceptive pain | Somatic and Visceral |
| Somatic pain | Originates in the skin, muscle, bone, or connective tissue (Sharp sensation of a paper cut or aching of a sprained ankle) |
| Visceral pain | Results from activation of pain receptors in the organs and/or hollow viscera. Cramping, throbbing, pressing, or aching. (Feeling sick) |
| Neuropathic pain | Associated with damage or malfunctioning nerves due to illness, injury, or undetermined reasons. Typically chronic. Described as burning, "electric-shock", tingling, dull, and aching. Difficult to treat. |
| Subtypes of neuropathic pain | Peripheral neuropathic pain and Central neuropathic pain |
| Peripheral neuropathic pain | Follows damage or sensitization of these nerves. (eg. phantom limb pain, post-herpetic neuralgia, carpal tunnel syndrome) |
| Central neruopathic pain | Results from malfunctioning nerves in the CNS. (eg. spinal cord injury pain, poststroke pain, multiple sclerosis pain) |
| Pain Threshold | The least amount of stimuli needed for a person to label a sensation as pain. Varies slightly from person to person. Changes little in the same individual over time. |
| Pain Tolerance | Maximum amount of pain a person is willing to tolerate before taking evasive measures. Varies considerable from person to person, even within the same person at different times/circumstances. |
| Hyperalgesia and hyperpathis | May be used interchangeably. Heightened responses to painful stimuli. (severe response to a papercut) |
| Allodynia | Includes non-painful stimuli that produces pain. (light touch) |
| Dysesthesia | Unpleasant abnormal sensation that can be either spontaneous or evoked. (mimics pain that follows a stroke or spinal cord injury) |
| Four physiological processes involved with nociception | Transduction, transmission, perception, modulation. |
| Nociception | The physiological process related to pain perception. |
| Transduction | During this stage harmful stimuli (knife, fire) trigger the release of biochemical mediators which sensitize nociceptors, |
| Nociceptors | Specialized primary sensory neurons in the PNS that detect mechanical, thermal, or chemical conditions associated with potential tissue damage. |
| Transmission | Second process of nociception. Includes three segments. Pain impulse travels from peripheral nerve to brain. |
| First segment of transmission | Pain impulse travels from peripheral nerve fibers to spinal cord. |
| Second segment of transmission | Transmission of signal though and ascending pathway in the spinal cord to the brain. |
| Third segment of transmission | Transmission of information to the brain where pain perception occurs. |
| Substance P | Neurotransmitter that enhances movement of impulses across the nerve synapse from the primary afferent neuron to the second-order neuron in the dorsal horn of the spinal cord. |
| How opioids affect the transmission process | Block the release of neurotransmitters, particularly substance P, which stops pain at the spinal level. |
| Perception | Third process of nociception. When the client becomes conscious of the pain. The CNS gives meaning to the pain (character and intensity) |
| Modulation | The fourth and final process of nociception. Known as the "Descending system". Neurons in the brain send signal back down to the dorsal horn of the spinal cord. |
| What do the descending fibers release during the modulation process? | Substances such as endogenous opioids, serotonin, and norepinepherine, which can inhibit or reduce the ascending painful impulses in the dorsal horn. |
| What do excitatory amino acids do? Name two. | Glutamiate, N-methyl-d-aspartate (NMDA). They increase pain signals. |
| What happens to the inhibitor neurotransmitters during the modulation process? | They are reabsorbed into the nerves. Effects are short lived. |
| How do Tricyclic antidepressants relieve pain? | By blocking the resorption of norepinephrine and serotonin and more available. |
| What are A-delta or C fibers? | Small-diameter peripheral nerve fibers that carry noxious (painful) stimuli to the dorsal horn. |
| When are noxious stimuli modified? | When they are exposed to the substantia gelatinosa. |
| Another name for the milieu in the CNS | Substantia gelatinosa |
| What happens when the ion channels (gates) in the pre- and postsynaptic membranes are open? | Permit positively charged ions to rush into the second-order neuron, sparking an electrical impulse and sending pain signals to the thalamus. |
| What are A-beta fibers? | Large diameter nerve fibers. |
| Actions of A-beta fibers | Send messages of touch or warm or cold temperatures, and may activate descending mechanism that can inhibit the transmission of pain - closing the ion gates. |
| Natural responses to pain | Stop activity, tense muscles, and withdraw from pain-provoking activities. |
| How would persistent, severe pain change the nervous system? | Intensifies, spreads, and prolongs the pain, risking development of incurable chronic pain syndromes. |
| What is the fifth vital sign? | Pain assessment |
| FLACC | Used for clients that are unable to verbalize pain. Facial expression, Leg movement, Activity, Cry, Consolability. |
| Opioid Tolerance | Dose, over time, leads to a decreased sensitivity of the drug's analgesic effect. Increasing doses are needed to provide the same level of pain relief. |
| Physical dependence | Dose significantly reduced or withdrawn. Withdraw symptoms experienced. Physiological dependence. |
| Addiction | Chronic, relapsing, treatable disease influenced by genetic, psychosocial, and environment factors. Phychological dependence. |
| 4 C's of addiction characterization | Craving for the substance. lace of Control over substance. Compulsive use. Continued use despite harm. |
| Pseudoaddiction | Condition that results from undertreatment of pain. Client becomes focused on obtaining medications. May "clock-watch" and seem to be "drug-seeking". |
| Preemptive analgesia | Administration of analgesics before surgery to decrease or relieve pain after surgery. |
| Pharmacologic pain management | Involves the use of opioids, nonopioids, and coanalgesics. |
| The most common NSAID | Nonsterioidal antiinflammatory drug - Aspirin |
| Three primary types of opioids | Full Antagonists, Mixed agonists-antagonists, Partial Agonists |
| Full antagonist | Pure opioid that has no ceiling on the level of analgesia from these drugs. (Morphine, oxycodone) |
| Mixed agonists-antagonist | Can act like opioid and relieve pain (agonist effect) or can block or inactivate other opioid analgesics when taken with pure opioids (antagonist effect). Does have a ceiling that limits dose. |
| Partial agonist | Have a ceiling effect. Buprenorphine is emerging as a safer and more favorable alternative to methadone for opioid maintenance. |
| Opioid Side Effects. Which one is most concerning? | Sedation, respiratory depression, nausea/vomiting, urinary retention, blurred vision, sexual dysfunction, and constipation. RESPIRATORY DEPRESSION! |
| Coanalgesic | Medication not classified as a pain med. Has properties that may reduce pain. Antidepressants, anticonvulsants, and local anesthetics. |
| Preferred rout of opiate administration | Orally because of the ease of administration. |
| Advantage of transnasal administration of opiates | Rapid action because of direct absorption through the vascular nasal mucosa. |
| Advantage of transdermal drug therapy | Delivers a relatively stable plasma drug level and is noninvasive. |
| Advantage of transmucosal opiate administration | Good for "breakthrough pain" (cancer patients). Oral mucosa is well vascularized. Rapid absorption. |
| Advantage of rectal opiate administration | Particularly useful for clients with aphasia or nausea and vomiting. |
| Advantage of topical opiate administration | Work directly at the point of application on the body. |
| Advantage of subcutaneous catheters opiate administration | Provides continuous subcutaneous infusion (CSCI). Small, battery operated pump with a butterfly needle in the anterior chest, subclavicular region, abdominal wall, outer upper arms, or thighs. |
| Advantage of intramuscular opiate administration | No advantages. Opiates should not be administered through this route. Variable absorption, unpredictable onset of action and peak, tissue damage may result. |
| Advantage of intravenous opiate administration | Provides the most rapid onset for pain with few side effects. Onset as well as adverse effects can occur within 5-10 minutes. |
| Advantage of intraspinal opiate administration | Superior analgesia with less medication used. |
| Patient Controlled Analgesia (PCA) | Interactive method of pain management that permits the client to treat their pain by self-administering doses. |
| Nerve block | Chemical interruption of a nerve pathway, caused by injecting local anesthetic into the nerve. Widely used during dental work. |
Created by:
Jnford15
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