Fundamentals of Nursing CH 43 Pain Management

acupressure
Therapeutic technique of applying digital pressure in a specified way on designated points on the body to relieve pain, produce anesthesia, or regulate body function.
acute pain
Follows acute injury, disease, or surgical intervention and has a rapid onset; varies in intensity, and lasts for a brief time, usually less than 6 months.
addiction
A primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
breakthrough pain
Pain that extends beyond treated steady chronic pain.
chronic pain
Pain that lasts longer than anticipated (usually over 6 months), may not have an identifiable cause, and may lead to great personal suffering. Chronic pain may be noncancerous (nonmalignant) or cancerous.
cutaneous stimulation
Stimulation of a person’s skin to prevent or reduce pain perception. A massage, warm bath, application of liniment, hot and cold therapies, and transcutaneous electric nerve stimulation are some ways to reduce pain perception.
drug tolerance
A state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug’s effects over time.
epidural space
Where the epidural analgesia is administered.
guided imagery
Method of pain control in which the client creates a mental image, concentrates on that image, and gradually becomes less aware of pain.
idiopathic pain
Pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of organic pathological condition.
modulation
Alteration in the magnitude or any variation in the duration of an electrical current.
nociceptor
Somatic and visceral free nerve endings of thinly myelinated and unmyelinated fibers; these fibers usually react to tissue injury but may also be excited by endogenous chemical substances.
nutrients
Foods that contain elements necessary for body function, including water, carbohydrates, proteins, fats, vitamins, and minerals.
opioid
Pertaining to natural and synthetic chemicals that have opium-like effects although they are not derived from opium.
pain
“An unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” (International Association for the Study of Pain, 1979)
pain threshold
The point at which a person feels pain.
pain tolerance
The level of pain that a person is willing to put up with.
patient-controlled analgesia (PCA)
Drug delivery system that allows clients to self-administer analgesic medications as desired.
physical dependence
A state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level or the drug, and/or administration of an antagonist.
placebo
Inert substance with no active ingredient.
prostaglandins
Potent hormonelike substances that act in exceedingly low doses on target organs; they can be used to treat asthma and gastric hyperacidity.
pruritus
Symptom of itching.
pseudoaddiction
Patient behaviors (drug seeking) that may occur when pain is undertreated.
pseudotolerance
The need to increase opioid dose for reasons other than opioid tolerance: progression of disease, onset of new disorder, increased physical activity, lack of adherence, change in opioid formulation, drug-drug interaction, drug-food interaction (Wall and Melzack, 1999).
transcutaneous electrical nerve stimulation (TENS)
Technique in which a battery-powered device blocks pain impulses from reaching the spinal cord by delivering weak electrical pulses directly to the skin’s surface.
transduction
Process that begins in the periphery when a pain-producing stimulus sends an impulse across a peripheral nerve fiber.
transmission
Transfer or conveyance of a thing or condition.
analgesics
Medications that provide pain relief
epidural anesthesia
Pain management via the epidural space
perineural infusion
An unsutured catheter from a surgical wound placed near a nerve or groups of nerves connects to a pump containing a local anesthetic
perception
Person’s mental image or concept of elements in the environment, including information gained through the senses.
local anesthesia
Loss of sensation at the desired site of action.
relaxation
Relief from work or stress that leaves one feeling relaxed or less tense.
biofeedback
Behavioral therapy that involves giving individuals information about physiological responses (such as blood pressure or tension) and ways to exercise voluntary control over those responses.
neurotransmitter
Chemical that transfers an electrical impulse from the nerve fiber to the muscle fiber.
regional anesthesia
Loss of sensation in an area of the body supplied by sensory nerve pathways.
adjuvants
enhance analgesics or have analgesic properties
Gate Theory of Pain
The theory that pain is a product of both physiological and psychological factors that cause spinal gates to open and relay patterns of intense stimulation to the brain, which perceives them as pain.Pain impulses pass through when the gate is open and are blocked when the gate is closed.
which of the following signs or symptoms in an opioid-naive patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
1. oxygen saturation of 95%
2.difficulty arousing the patient
3. respiratory rate of 10 breaths/min
4. pain intensity rating of 5 on a scale of 0 to 10
2. difficulty arousing the patient
a health care provider writes the following order for an opioid-naive patient who returned from the operating room following a total hip replacement. “Fentanyl patch 100 mcg, change every 3 days.” Based on this order, the nurse takes the following action:
1. calls the health care provider, and questions the order
2. applies the patch the third postoperative day
3. applies the patch as soon as the patient reports pain
4. places the patch as close to the hip dressing as possible
1. calls the health care provider, and questions the order
a patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication?
1. stool softener
2.stimulant laxative
3.H2 receptor blocker
4. proton pump inhibitor
2. stimulant laxative
a new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question?
1. the drug
2.the time interval
3. the dose
4. the route
2. the time interval
the nurse notices that a patient has received oxycodone/ acetaminophen (Percocet) (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?
1. the patient’s level of pain
2. the potential for addiction
3. the amount of daily acetaminophen
4. the risk for gastrointestinal bleeding.
3. the amount of daily acetaminophen
a patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of :
1. addiction
2. tolerance
3. pseudoaddiction
4. physical dependence
4. physical dependence
after having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient’s respiratory rate and depth are within normal limits. The nurse now plans to implement the following action:
1. discontinue all ordered opioids
2. close the room door to allow the patient to recover
3. administer the remaining naloxone over 4 mins
4. assess patient’s vital signs every 15 mins for 2 hrs.
4. assess patient’s vital signs every 15 mins for 2 hrs.
which one of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine?
1. only the patient should push the button
2. do not use the PCA until the pain is severe
3. the PCA prevents overdoses from occurring
4. notify the nurse when the button is pushed.
1. only the patient should push the button
a patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The health care provider’s order reads as follows: “Vicodin 1 tab, per tube, q4 hrs, prn” Which action by the nurse is most appropriate?
1. no action is required by the nurse because the order is appropriate
2. request to have the ordered changed to ATC for the first 48 hrs.
3. ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hrs, prn.
4. begin the Vicodin when the patient shows nonverbal symptoms of pain.
2. request to have the ordered changed to ATC for the first 48 hrs.
a patient returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. The nurse’s first action is to:
1. call the patient’s health care provider
2. administer pain medication as ordered
3. check the patient’s vital signs.
4. assess the characteristics of the pain
4. assess the characteristics of the pain
the patient rates his pain as a 6 on a scale of 0-10. The patient’s wife says that he can’t be in that much pain since he has been sleeping for 30 mins. Which is the most accurate resource for assessing the pain?
1. the patient’s wife is the best resource for determining the level of pain since she has been with him continually for the entire day
2. the patient’s report of pain is the best method for assessing the pain.
3. the patient’s health care provider has the best knowledge of the level of pain that the patient that should be experiencing
4. the nurse is the most experienced at assessing pain.
2. the patient’s report of pain is the best method for assessing the pain.
when using ice massage for pain relief, which of the following are correct? (select all that apply)
1. apply ice using firm pressure over skin
2. apply ice until numbness occurs and remove the ice for 5 to 10 mins
3. apply ice until numbness occurs and discontinue application
4. apply ice for no longer than 10 mins.
1. apply ice using firm pressure over skin
when teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include?
1. TENS works by causing distraction.
2. TENS therapy does not require a health care provider’s order.
3. TENS requires an electrical source for use
4. TENS electrodes are applied near or directly on the site of pain
4. TENS electrodes are applied near or directly on the site of pain
while caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends:
1. transitioning use of adjuvants with nonsteroidal anti-inflammatory drugs (NSAIDs) to opioids.
2. using acetaminophen for refractory pain.
3. limiting the use of opioids because of the likelihood of side effects
4. avoiding total sedation, regardless of how severe the pain is.
1. transitioning use of adjuvants with nonsteroidal anti-inflammatory drugs (NSAIDs) to opioids.
a postoperative patient is currently asleep. Therefore the nurse knows that:
1. the sedative administered may have helped him sleep, but assessment of pain is still needed.
2. the intravenous (IV) pain medication is effectively reliving his pain
3. pain assessment is not necessary
4. the patient can be switched to the same amount of medication by the oral route.
1. the sedative administered may have helped him sleep, but assessment of pain is still needed.