Ns128 Wk 4 Altered Comfort Part 1

Front 1

definition of pain:

Back 1

an unpleasant sensory and emotional reaction to actual or POTENTIAL tissue damage

Front 2

Physiological impact of unrelieved pain

(table 3.1):

Back 2

- prolongs stress response

- Increases HR, BP, and oxygen demand

- decreases GI motility

- causes immobility

- decreases immune response

- delays healing

- increases risk for chronic pain

Front 3

QOL impact of unrelieved pain

(table 3.1):

Back 3

- interferes with ADLs

- causes anxiety, depression, hopelessness, fear, anger, and sleeplessness

- impairs family, work, and social relationships

Front 4

financial impact of unrelieved pain

(table 3.1):

Back 4

- costs americans billions of dollars per year

- increases hospitals lengths of stays

- leads to lost income and productivity

Front 5

characteristics of acute pain

(table 3.2):

Back 5

- has short duration

- usually has well-defined cause

- decreases with healing

- is reversible

- serves a biologic purpose (warning sign)

- ranges from mild to severe in intensity

- may be accompanied by anxiety and restlessness

Front 6

characteristics of chronic/persistent pain

(table 3.2 - 4.2 in version 7 p 40):

Back 6

- lasts longer than 3 months

- may or may not have well-defined cause

- begins gradually and persists

- is exhausting and serves no biological purpose

- ranges from mild to severe in intensity

- may be accompanied by depression and fatigue, as well as decreased functional ability

Front 7

2 big classifications of pain:

Back 7

acute

chronic

Front 8

2 types of chronic pain:

Back 8

- cancer

-non-cancer

Front 9

Chronic cancer pain is:

Back 9

pain associated with cancer OR ANOTHER PROGRESSIVE DISEASE, SUCH AS AIDS

Front 10

Chronic non-cancer pain is:

Back 10

is associated with tissue injury that has healed or is not associated with cancer, such as arthritis or chronic back pain

Front 11

physiological responses to acute pain

Back 11

- increased HR

- increased BP

- increased Resp rate

- dilated pupils

- sweating

Front 12

population groups who are more likely to have inadequately treated pain:

Back 12

- older adults

- peds

- drug abusers

- those who speak a different primary language than hcp

Front 13

Misconceptions associated with peds pain:

Back 13

- nb and infants don't feel pain

- kids feel less pain than adults

- infants can't express pain

- parents exaggerate pain

- children are not in pain if distracted or asleep

- repeated pain allows child to be more toleratnt and cope better

- kids recover from painful experiences more quickly than adults

- kids will tell you they are in pain

- kids w/o obvious physical reasons for pain are not likely to have pain

- kids run risk of becoming addicted to pain meds

Front 14

characteristics of acute pain:

Back 14

- serves a biological purpose

- severe pain activates SNS

- response to pain is highly individual

- usually temporary, sudden onset, and easily localized

Front 15

characteristics of chronic cancer pain:

Back 15

- increases as the disease advances

- need round the clock dosing of meds

- often inadequately treated

- treatment can cause acute pain

Front 16

Gate control theory:

Back 16

spinal cord has a gate; when open impulses go to brain and pain is perceived; when closed, impulses are blocked and pain is not perceived

Front 17

preemptive analgesia is designed:

Back 17

- technique designed to decrease pain in post-op period

- decreases requirements for post-op analgesia

- prevent morbidity

- decreases hospital stay

Front 18

preemptive analgesia definition:

Back 18

giving pain meds during pre-, intra-, or post-op to inhibit changes in the spinal cord, thereby inhibit the pt's post-op perception of pain

Front 19

nociceptive pain:

Back 19

arises from damage to or inflammation of tissue other than that of peripheral and central nervous system

- the activation of normal processing of painful stimuli

Front 20

nocecptive pain is typically described as:

Back 20

- throbbing

- aching

-localized

Front 21

nocecptive pain typically responds to:

Back 21

opioids and

nonopioid meds

Front 22

2 types of nociceptive pain:

Back 22

visceral and

somatic

Front 23

somatic pain:

Back 23

in bones, joints, muscles, skin or connective tissue

Front 24

visceral pain:

Back 24

- in internal organs such as stomach or intestines. It may also be referred pain in other body locations separete from the stimulus

Front 25

neuropathic pain:

Back 25

- arises from abnormal or damaged pain nerves

Front 26

neuropathic pain includes:

Back 26

- phantom limb pain

- pain below the level of a spinal cord injury

- diabetic neuropathy

Front 27

neuropathic pain is often described as:

Back 27

- intesnse

- shooting

'pins and needles"

Front 28

transduction:

Back 28

the conversion of painful stimuli to an electrical impulse through peripheral nerve fibers

Front 29

transmission

Back 29

occurs as the electrical impulse travels along the nerve fibers, where neurotransmitters regulate it

Front 30

perception:

Back 30

awareness of pain; occurs in various areas of the brain, with influences from thought and emotional responses

Front 31

pain threshold

Back 31

the point at which a person feels pain

Front 32

pain tolerance

Back 32

the amount of pain a person is willing to bear

Front 33

substances that may increase pain transmission and cause an inflammatory response:

Back 33

- substance P

- prostaglandins

- bradykinin

- histambrady had a hissy fit & peed his pantsine

Front 34

Substances that may decrease pain transmission and produce analgesia:

Back 34

- seratonin

- endorphins

Front 35

A Delta fibers

Back 35

myleniated fibers that carry rapid, sharp, pricking, or peircing sensations

- found primarily in the skin and

- usually intermittent

Front 36

Where are A Delta fibers primarily found:

Back 36

- skin

- muscle

Front 37

C fibers:

Back 37

- unmyleniated or poorly myelinated fibers that conduct thermal, chemical, or strong mechanical

- slower and more diffuse

- often described as dull, burning, or achy

- usually persistent

Front 38

Where are C fibers typically found:

Back 38

- muscle

-periosteum (around bones, but not joints)

- viscera (guts, organs)

Front 39

2 types of somatic pain:

Back 39

- superficial or cutaneous

- deep

Front 40

superficial or cutaneous pain is typically described as:

Back 40

- sharp, burning

Front 41

deep somatic pain is often described as:

Back 41

dull, aching, cramping

Front 42

deep somatic pain vs visceral pain:

Back 42

?? look up

Front 43

Referred pain:

Back 43

pain felt somewhere distant from point of injury

Front 44

radiating pain:

Back 44

along the nerve or group of nerves (ie radiating pain in left arm with MI)

Front 45

parasethesia:

Back 45

itching/tingling/crawling skin

Front 46

dysthesia:

Back 46

light touch to skin causes pain

Front 47

allodynia:

Back 47

can be tactile or thermal; felt as pain

Front 48

phantom limb pain:

Back 48

pain in amputated body part

Front 49

psychogenic pain:

Back 49

pain that arises from prolonged emotional state

Front 50

hypalgesia:

Back 50

decreased sensitivity to pain

Front 51

hyperalgesia:

Back 51

increased/exaggerated sensitivity to pain

Front 52

breakthrough pain:

Back 52

pain that occurs despite scheduled meds; treated with PRN meds

Front 53

tolerance:

Back 53

a normal phsyiological response after regular admin of opioids, pt becomes "used to" the med and more tolerant of it's s/e

- may need to up dosage or change the opioid

Front 54

dependence:

Back 54

a normal physiological response where the body is now dependent on having that med to function normally

- if d/c abruptly, pt will have withdrawals

Front 55

addiction:

Back 55

a pattern of behavior in which a pt seeks a meds and has become emotionally (and physically) dependent on it; will seek out despite negative consequences

Front 56

pseudoaddiction:

Back 56

pain is not controlled well enough by med, do pt seeks more of it

Front 57

Factors that influence pain

Back 57

- age

- gender

- culture

- anxiety

- coping style

- family and social support

- perception

- previous experience

- preparation for what to expect

- response of health professionals

- religious beliefs

Front 58

Subjective data to collect:

Back 58

- onset

- duration

- location

- severity/intensity

- quality

- pattern

- relief mesaures

- other s/s

Front 59

types of pain scales:

Back 59

- pediatric pain

- acute pain

- chronic pain

- end of life pain

- non-responsive/comatose pain

Front 60

numeric

Back 60

0-10

Front 61

Wong-Baker:

Back 61

faces

Front 62

Faavs:

Back 62

--

Front 63

Flavvs:

Back 63

--

Front 64

PQRST pain assessment mneumonic:

Back 64

P- precipitaing or palliative

Q- quality or quantity

R- region or radiating

S- severity scale

T- timing; when did it start, how long does it last, how often does it happen

Front 65

Objective data to collect in pain assessment:

Back 65

- inspection

- VS

- Overt signs/related behavior

-- vocalization

-- facial expression

-- body movement/guarding

-- social interaction

Front 66

Autonomic s/s data collection in pain assessment:

Back 66

..

Front 67

Influence of ADLs:

Back 67

- sleep

-hygiene

- sexual function

- home management/work

- social activities

Front 68

Barriers to successful pain management:

Back 68

- HCP

- client

- client and family fears

Front 69

Nursing diagnoses r/t pain:

Back 69

- impaired comfort

- acute pain

- chronic pain

-other related diagnoses

Front 70

Principles for admin of analgesics:

Back 70

- previous response

- selecting proper meds

- normal dosages

- lifespan considerations

- determining right time and intervals

- choosing route

- acute vs chronic pain

- WHO analgesic ladder

Front 71

WHO analgesic ladder

Back 71

1. non-opioid

2. weak opioid

3. strong opioid