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ATI Module
Pain (Exam 3)
| Question | Answer |
|---|---|
| acute pain | Anticipated or predictable end; lasts less than 3 months. |
| adjuvant analgesics | Aid in pain relief by working on underlying pain generators, such as antidepressants, corticosteroids, and botulinum toxin. |
| autonomy | Independence or freedom, ability to make one's own decisions. |
| beneficence | Doing good and acting in the best interest of a client by providing care that benefits them. |
| cancer pain | A newly recognized category of pain that can involve tumor pain, bone pain, and treatment-associated pains such as chronic postsurgical pain. |
| chronic pain | Constant or recurring; lasts longer than or equal to 3 months. |
| cognitive behavioral therapy (CBT) | Therapy to help clients learn to manage and target negative thoughts to help reduce pain, especially chronic pain. |
| Crying, Requires Oxygen, Increased Vital Signs, Expression, Sleeplessness (CRIES) Scale | A neonatal pain assessment tool that evaluates crying, oxygen requirements, vital signs, facial expression, and sleep patterns to determine pain severity. |
| cutaneous stimulation | Therapy applied to the skin such as heat and cold, touch, massage, acupuncture, acupressure, or TENS. |
| ethics | The application of principles that guide moral behavior of an individual or group. |
| Face, Legs, Activity, Cry, Consolability (FLACC) Scale | Scale is an observational pain measurement tool designed to be used with children 2 months to 7 years and clients who are cognitively disabled. |
| justice | Treating all clients fairly and equally. |
| malpractice | A negligent act that has been performed by a professional or trained person. |
| morality | An individual's principles and their concepts of right and wrong. |
| negligence | Failing to perform in a manner that a reasonable and prudent person should perform. |
| neuropathic pain | Nerve pain that arises from the somatosensory system, described as intense, burning, and shooting. |
| nociceptive pain | Pain that is felt in the tissue, an organ, a damaged part of the body, or a referred pain. |
| nociceptors | Found in multiple parts of the body (skin, joints, muscles, viscera) and activated by many different chemical substances, extreme temperature and pressure changes, and tissue damage |
| nonmaleficence | Doing no harm, or the least amount of harm to the client, while trying to achieve the best possible outcome. |
| nonopioid analgesics | Can be administered for the treatment of pain by the nurse and include local anesthetics, nonsteroidal anti-inflammatory medications (NSAIDs), and acetaminophen. |
| Nonverbal Pain Scale (NVPS) | Designed for clients who are unable to verbalize their pain level. |
| Numeric Rating Scale | The most frequently used pain scale where the client is asked to rate the intensity of their pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain the client can imagine. |
| objective | Assessed, observed, or collected data that can be noticed by seeing, hearing, smelling, and feeling. |
| opioids | The most common pain medications, which have the risk of sedation and depression, such as morphine, hydromorphone, and fentanyl. |
| pain | Subjective and can be caused by stimuli that are actual or anticipated; official IASP definition: "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." |
| pain threshold | The point at which a stimulus causes the client perceive pain. |
| pain tolerance | How much of a stimulus the client is willing to accept |
| patient-controlled analgesia (PCA) | A computerized pump controlled by the client capable of delivering pain medication through a syringe to their IV line. |
| subjective | Data that is based upon the client's feelings, perception, and assumptions. |
| Wong-Baker FACES Pain Rating Scale | Scale with facial expressions to indicate level of pain. |
| Pain is | subjective and is whatever the client says it is |
| Acute pain lasts for | the duration of an injury or damage to the body, until healing has taken place |
| Chronic pain lasts longer than acute pain and for | a more extended period than it should for the injury or damage to the body |
| Nociceptive pain either comes from | the tissues or organs or is referred pain |
| Neuropathic pain comes from | nerve damage or misfiring |
| Acute pain may be treated with | oral, intravenous, PCA, or epidural medications |
| chronic pain may be treated with | oral medications |
| The nurse has legal, ethical, and moral obligations to | the client as part of the overarching concept that clients have the right to effective and safe pain management. |
| Assessment of pain is complex and involves the use of pain rating scales (the nurse determines the appropriate scale), consideration of | influencing factors, and awareness of diversity considerations including age, race, gender, culture, socioeconomic status, and literacy level. |
| Descriptive Characteristics of Pain | Throbbing Stabbing Pounding Sharp Gripping Dull Tearing Radiating Cutting Burning Scalding aching |
| Merkel’s definition of pain, still used today, identifies it as | subjective and linked to both the physical and the emotional-psychological experiences of individual |
| Pain is both a | physical feeling and an emotional response that can occur when tissue is damaged or when the body senses the possibility of harm. |
| The biopsychosocial model of pain suggests that three categories of factors form the experience of pain: | biological, psychological, and social |
| Biopsychosocial factors include | disease severity, nociception, inflammation, and brain function |
| Psychological factors | comprise mood/affect, catastrophizing (assuming the worst), stress, and coping. |
| Social factors include | cultural and economic factors, the social environment, and social support |
| Biopsychosocial model of pain | Pain is at the center, with biological factors, psychological factors, and social factors surrounding it. The directional arrows indicate the relationships between these factors and pain, as well as among these three factors. |
| Pain can be categorized in various ways: | by duration (acute vs. chronic), by origin (nociceptive vs. neuropathic), or by the disease or condition that causes it, such as cancer. |
| Acute pain is pain that lasts from | minutes to less than 3 months |
| chronic pain usually has a duration of | lasting equal to or longer than 3 months |
| Chronic pain can be both | physically and emotionally debilitating |
| If acute pain is not addressed | it can become chronic. |
| categorize pain is by its origin | either nociceptive or neuropathic |
| Cutaneous pain may also be referred to as | somatic pain. |
| Neuropathic pain is frequently described as | intense, shooting, or burning. Some clients may describe the pain as numbness, pins and needles, and even an intense itching. |
| Neuropathic pain: | Nerve pain in the absence of tissue damage. |
| Nociceptive pain: | Pain felt in a tissue, organ, or damaged part of the body or referred pain. |
| Types of pain that may arise from cancer include | tumor pain, bone pain, and treatment-associated pain, such as chronic postsurgical pain, radiation-induced pain, and neuropathies related to chemotherapy |
| The nurse should use pain scales appropriate for children, such as | the Wong-Baker FACES scale, FLACC scale, or CRIES scale, to determine the child’s level of pain. |
| Adults aged 35 to 65 years commonly experience | headaches, back pain, abdominal pain, and temporomandibular discomfort more frequently than other clients in other age groups. |
| Young children aged 1 to 3 years often cannot verbalize their pain clearly. Therefore, nurses must rely on | validated behavioral tools such as FLACC, CRIES, or the Wong‑Baker FACES scale to accurately assess pain intensity. |
| older adults 65 years and older experience high rates of | persistent and chronic pain, with national health data showing that 53% report bothersome pain in the past month. Pain in this group is often influenced by comorbid chronic illnesses |
| clients with cognitive impairment may be unable to self‑report pain reliably. Thus, behavioral indicators such as | guarding, facial grimacing, and restlessness are essential assessment cues for nurses. |
| Managing pain is guided by several ethical concepts, including | beneficence, nonmaleficence, autonomy, and justice. |
| Barriers for pt to not want to receive pain management | fear of addiction, intellectual abilities, and the belief that pain is an expected part of illness and the dying process are barriers that clients and family members may pose to effective pain management. |
| When using a pain scale, the nurse can determine | the client’s view of the severity of pain |
| subjective reporting from the client includes | the location of the pain, the length of time the pain has been present, what precipitated the pain, what relieves the pain, any radiation of the pain, and how the client characterizes the pain. |
| Objective indicators of pain are manifestations that the nurse observed by the nurse using the senses of sight, hearing, smell, and touch. | crying, sweating, restlessness, grimacing, or guarding by the client. |
| To monitor the client’s objective pain, the nurse can collect objective data such as | vital signs, physical assessment findings, laboratory tests, imaging reports, and any other diagnostic information the provider has prescribed. |
| To determine a client’s pain, nurses frequently employ the | PQRST mnemonic |
| PQRST stands for | P: Precipitating cause Q: Quality R: Region S: Severity T: Timing |
| PQRST Questions or statements the nurse might use include the following | P: “What were you doing when the pain started?” Q: “Describe what your pain feels like.” R: “Show me the location where you are experiencing pain.” S: “On a scale of 1 to 10, how would you rate your pain?” T: “When did your pain first begin? |
| Some of the more commonly administered pain scales are the | Numeric Rating Scale, the Visual Analog Scale, the Wong-Baker FACES Pain Rating Scale, the FLACC scale, the Nonverbal Pain Scale, and the CRIES scale for neonates. |
| Numeric Rating Scale | rate the intensity of their pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain the client can imagine. Scores are interpreted as follows: 0 is no pain, 1 to 3 is mild pain, 4 to 6 is moderate pain, and 7 to 10 is severe pain |
| The Visual Analog Scale (VAS) | consists of a single line, either vertical or horizontal, with one end representing no pain and the other representing the worst pain imaginable. The nurse asks the client to select a point along the line that represents the intensity of their pain |
| Wong-Baker FACES Pain Rating Scale | it has faces, words, and numbers. chooses the face that best represents how they feel. In face 0, the client has no pain; in face 10, the client has the worst pain they can imagine. |
| The Face, Legs, Activity, Cry, Consolability (FLACC) Scale | is an observational pain measurement tool designed for use with children aged 2 months to 7 years and clients who are cognitively disabled |
| The Face, Legs, Activity, Cry, Consolability (FLACC) Scale how it works | observes 1 to 5 min (if awake) or for 5 min or longer (if asleep) and gives a numeric score of 0 to 2 for each behavior: facial expression, leg movement, bodily activity, cry or verbalization, and consolability. Total scores can range from 0 to 10. |
| Crying, Requires Oxygen, Increased Vital Signs, Expression, Sleeplessness Scale (CRIES) Scale | observational scale used for infants born at 38 weeks of gestation or later. It has been found to be useful in assessing postoperative pain in neonates |
| Crying, Requires Oxygen, Increased Vital Signs, Expression, Sleeplessness Scale (CRIES) Scale. How it works | Characteristics of crying, oxygen requirement, changes in vital signs, facial expression, and sleep state are scored. A maximum score of 10 is possible. |
| The Nonverbal Pain Scale (NVPS) is designed for clients who are | who are unable to verbalize their pain level. Originally developed for pts in burn units, but it is now also used in critical care areas where clients are unable to report pain due to the severity of their illness, sedation, or mechanical ventilation. |
| Two versions of the NVPS are currently in use: | the original scale and a revised version (R-NVPS). |
| The NVPS is based on the | FLACC Scale |
| the NVPS and the R-NVPS contain | five categories of observation, with each being assigned a score ranging from 0 to 2. The total scores can range from 0 to 10. The NVPS contains the categories of Face, Activity, Guarding, Physiologic I (vital signs), and Physiologic II. |
| The R-NVPS eliminated | Physiologic II and replaced it with a Respiratory category. |
| The client’s pain should be viewed holistically because it | affects physical, mental, social, environmental, and spiritual aspects of the client. |
| Multiple factors should be assessed regarding pain and the client’s past experiences related to pain | First, the client’s risk factors should be considered. The nurse should monitor the client, closely observing trends. Second, the nurse should consider the medication(s) used for pain management. |
| The nurse should identify that the factors influencing pain include | client risk factors, observe client trends, and consider which medications are being prescribed for pain management, along with the client’s level of anxiety |
| A TENS unit | emits low-voltage electrical impulses to the skin over painful areas. The care provider or the trained client attaches electrodes to the skin and can program the unit to deliver various intensities, pulse rates, and widths. |
| Examples of Cognitive behavioral therapy (CBT) | include distraction, relaxation, imagery, and music therapy |
| Opioids can cause both | sedation and depression of the respiratory system |
| Opioids are the medications most | commonly prescribed for the relief of pain. These agents suppress pain by activating opioid receptors in the brain, spinal cord, and central nervous system. |
| There are six different natural opioids, with the most common being | codeine and morphine. |
| Semisynthetic opioids are created from | the naturally occurring opiates |
| Synthetic opioids are manufactured products that include | fentanyl, fentanyl analogs, and tramadol. |
| Patient-controlled analgesia (PCA) allows the client to receive small amounts of | pain medication at a basal or continuous rate, as prescribed by the provider, or a small bolus when the client presses a button |
| Nonopioid analgesics These medications can include | local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen. |
| the use of NSAIDs is effective for both | acute and chronic pain |
| In addition to having analgesic properties, NSAIDs reduce | inflammation and fever |
| Nonopioid analgesics These medications work through a complex process of | inhibiting prostaglandin synthesis by blocking two cyclooxygenase enzymes (COX 1 and COX 2). Prostaglandins play a major role in the inflammatory process. |
| effectively for pain management when administered prior to the completion of a painful procedure | Sucrose |
| Corticosteroids used as adjuvants for pain relief include | hydrocortisone, cortisone, and prednisone |
| Antidepressants can cause | sedation, cardiac problems, and dry mouth, and should be used cautiously. |
| One major nursing consideration and teaching point for antidepressants is that | clients may experience an increased risk of suicidal thoughts or actions. Clients must be advised to speak immediately with a counselor or provider if this occurs. |
| s a reversal agent for respiratory depression caused by opioids. It works quickly to reverse the effects of opioids on the client's respiratory system. | Naloxone |
| A nurse is monitoring a client who is 2 hr postoperative and is receiving morphine via PCA pump. Which of the following findings should the nurse plan to monitor to detect opioid-induced ventilatory impairment (OIVI)? | Respiratory rate Capnography Oxygen saturation |
| Capnography | The nurse should recognize that capnography (measuring carbon dioxide) can assist with identifying OIVI. |
| transcutaneous electrical nerve stimulation (TENS) treatment with a client who has chronic lower back pain | -"You can be taught how to use TENS therapy at home" - "The TENS therapy delivers low-voltage electrical impulses to the skin over the painful areas" - "We will adjust the intensity, pulse rate, and duration of the electrical pulses during your therapy" |
| Malpractice is a | negligent act performed by a professional or trained personnel that can occur by not adhering to the standard of care for pain management. |
| Negligence means | failure to perform in a manner that a reasonable person would have. By failing to assess the client's pain and administer the client's pain medication, the nurse was negligent. |
| Nonmaleficence is an ethical term used to describe | causing no harm to clients. This nurse's negligence caused harm to the client from prolonged suffering with pain. |
| Beneficence is an ethical term used to describe | doing good for clients. This nurse would have done good for the client by medicating the client for their pain and reducing the amount of pain. |
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