Fund Q4 U8-9

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Referred pain

Referred pain—appears to arise in different areas, pain that is felt at a place in the body different from the injured or diseased part where the pain would be expected

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Visceral pain

pain arising from organs or hollow visceral, being perceived in an area remote from the organ causing pain

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Transcendence

a state of being or existence above and beyond the limits of material experience

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Etiology of pain: Peripheral

follows damage and/or sensitization of peripheral nerves (phantom limb pain)

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Etiology of pain: Central

results from malfunctioning nerves in the CNA (spinal cord injury pain, MS)

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Etiology of pain: sympathetically maintained pain

abnormal connections between pain fibers (edema)

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Pain threshold

the lowest intensity of stimulation at which pain is experienced

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Pain tolerance

amount of pain that a person can withstand before breaking down

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Hyperalgesia and Hyperpathia

heightened response to painful stimuli (severe pain to paper cut)

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Allodynia

pain caused by a normally non-painful stimulus e.g. soft brush

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Dysesthesia

an unpleasant sensation which may resemble prickling, itching, burning, or electrical shock

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Stages of Nicoception

Transduction Transmission Modudulation Perception--The physiological system by which one feels the sensation of pain.

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Tranduction

Tissue Damage, release of chems (prostaglandins), they release stimulate pain receptors (nociceptors), painful stimuli causes movement of ions across cell membranes. NSAIDS work well at this stage by blocking prostaglandins and dec movement of ions.

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Transmission

pain impulse to spinal cord, pain quality depends on C (dull) or A (sharp) pain, opiods work well in this phase which stops the pain at the spinal level

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Modulation

Brain signals back with the release of opioids, serotonin and nerepinephrine. Antidepressants work well at this stage.

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Perception

client becomes aware of pain, non-pharmalogical methods work well.

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Gate theory of pain

inhibition or excitation of nerve fibers and transmission of pain messages.

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Assessisng pain

COLDERR Character, Onset, Location, Duration, Exacerbation, Relief and Radiation

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Pain management

Implementing pain management is the alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the client.

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Preemptive analgesia

is administration of analgesics prior to an invasive procedures in order to treat pain before it occurs

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World Health Organization three step approach

1-3 non opioid analgesic is appropriate. 4-6 weak opioid (codeine, tramadol) or a combo of opioid and nonopioid med. 7-10 strong opiates (morphine, fentanyl)

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Equianalgesic dosing

refers to relative potency of various opioid analgesics compared to a standard dose of parenteral morphine.

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Coanalgesics (aka adjuvant)

medication that is not classified as a pain medication (antidepressants)

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Nonpharmacologic invasive therapies

message, heat/cold app, acupressure, contralateral stimulations, immobilization, TENS, cognitive behavioral distraction, relaxation, repatterned thinking, coping, spiritual

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Types of opioids

Full agonist, mixed agonist-antagonist, and partial agonist

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Full agonist

bind tightly to receptor sites (morphine)

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Mixed agonist-antagonist

releive pain when given to client who has not taken any pure opiods, if so, withdrawal of the morphine will take lace (TAlwin, Stadol, Nubain)

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Partial agonist

have a ceiling effect in contrast to full agonist, codein, tramadol.

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PCA

patient controlled analgesia, minimizes roller coast effct of peaks of sedation. conduct assessment every 2-4 hours.

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Client who is experiencing continuous, severe pain. In planning for the client’s treatment, the nurse is aware of the principles of pain management and that it is appropriate to expect treatment to include:

Administering opioid with nonopioid analgesics for severe pain experiences

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The nurse must frequently assess a client experiencing pain. When assessing the intensity of the pain, the nurse should:

Offer the client a pain scale to objectify the information

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The client tells the nurse about a burning sensation in the epigastric area. The nurse should describe this type of pain as:

Deep visceral

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The nurse tells the client that the urinary catheter insertion may feel uncomfortable. This is most accurately an example of:

Anticipatory teaching

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Nurses working with clients in pain need to recognize and avoid common misconceptions and myths about pain. In regards to the pain experience, which of the following is correct?

The client is the best authority on the pain experience.

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Upon entering the room, the nurse discovers that the client is experiencing acute pain. An expected assessment finding for this client is:

An expected assessment finding of a client experiencing acute pain would be diaphoresis due to sympathetic nerve stimulation.

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The client will be going home on medication administered through a PCA (patient-controlled analgesia) system. To assist the family members with an understanding of how this therapy works, the nurse explains that the client:

Explanation: With a PCA system, the client controls medication delivery.

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Which one of the following nursing interventions for a client in pain is based on the gate-control theory?

The gate theory suggests that cutaneous stimulation activates larger, faster-transmitting A-beta sensory nerve fibers.decreases pain transmission thru small-diameter A-delta and C fibers. A back massage is nursing inte based on the gate-control theory.

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The nurse on a postoperative care unit is assessing the quality of the client’s pain. To obtain this specific information about the pain experience from the client, the nurse should ask:

To determine the quality of the client’s pain the nurse might say, “What does your discomfort feel like?” It is more accurate to have clients describe the pain in their own words whenever possible.

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The nurse recognizes opiods are used to contol pain at this process of nociception.

Opiods controls pain during the second process of nociception which is transmission by blocking the release of neurotransmitters.

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Polyuria

Can occur due to excessive fluid intake.

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Dysuria

difficulty or pain in urinating

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A client in the hospital has an indwelling urinary catheter, and the nurse is instructing the nursing assistant in the appropriate care to provide. The nurse teaches the assistant to:

The urinary drainage bag should be emptied at least every 8 hours. If large outputs are noted, more frequent emptying will be required.

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The nurse recognizes that changes in elimination occur with the aging process. An expected change in bowel elimination is which of the following?

An expected change in bowel elimination is decreased chewing and decreased salivation, resulting in less efficient mastication.

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A client with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH). The nurse anticipates the client will exhibit:

Alcohol inhibits the release of antidiuretic hormone (ADH), resulting in increased water loss in urine. The client may show signs of decreased fluid volume (dehydration), including dry mucous membranes.

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A 6-month-old infant has severe diarrhea. The major problem associated with severe diarrhea is:

Excess loss of colonic fluid due to diarrhea can result in serious fluid and electrolyte or acid-base imbalances. Infants and older adults are particularly susceptible to associated complications.

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A timed urine specimen collection is ordered. The test will need to be restarted if the following occurs:

Missed specimens make the whole collection inaccurate. The test must be restarted.

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The nurse is visiting the client who has a nursing diagnosis of “Alteration in urinary elimination; retention”. On assessment, the nurse anticipates that this client will exhibit:

W/urinary retention, urine cont in the bladder, stretching its walls:pressure/discomfort/tenderness,restlessness,diaphoresis. The sphincter temporarily opens to allow a small volume of urine (25 to 60 ml) to escape, with no real relief of discomfort.

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Diaphoresis

sweating, especially when artificially induced.

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What is ileus

failure of forward movement of bowel contents.

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Minimum kidney filtration rate

30 cc/hour

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Urethra

male 6-8, femaile 1.5 infections

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Oligura

voiding scant amts, less than 500 mL/24 hours Less urination than normal

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Anuria

voiding less than 100 mL/24 hours. Anuria means nonpassage of urine

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Incontenence

is not a disease, never normal, and is a symptom

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Assessment of urine

if below 30 cc/hour, may indicate low blood volume or kidney failure

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Fluid intake

promote at least 1500 mL per day, and 2000-3000 mL to prevent UTI

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S/S of Acute pain

sympathetic nervous system, increase BP, P, RR, restless, anxious

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S/S of Chronic pain

parasympathetic nervous system (normal vitals)

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Etiology of pain: Neuropathic

damaged or malfunctioning nerves (postherpetic neuralgia), typically chronic

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Nociceptors

receptors that react to potentially damaging stimuli by sending nerve signals to the spinal cord and brain.

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Created by: mstcnurse