Nursing fundamentals comfort and pain

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Nursing fundamentals comfort and pain
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2009-11-29 20:09:08
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nursing fundamentals comfort and pain
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  1. it is generally rapid in onset, varies in intensity from mild to severe. It is protective in nature; that is it warns the individual of tissue damage or organic disease. After underlying cause is resolved, it disappears. It should end once healing occurs. Causes include a pricked finger, sore throat, or surgery. Last less than 6 months.
    acute pain
  2. it is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Patients have difficulty describing _____ _____ because it may be poorly localized. Perceived as meaningless and may lead to withdrawal, depression, anger, frustration, and dependency. last 6 month +++, no protective purpose
    chronic pain
  3. Commonly people with ________experience periods of ________ (when the disease is present but the person does not experience symptoms)
    • chronic pain.
    • remission
  4. _______ are the symtoms that reappear
    exacerbation
  5. pain associated with cancer or other progressive disorders is termed ______ _______ _______
    chronic malignant pain
  6. pain in people whose tissue injury is nonprogressive or healed is termed ______ ______ ______
    example: arthritis, lower back
    chronic nonmalignant pain
  7. Pain can also be categorized according to its location. Which pain involves the skin or subcutaneous tissue? Example a paper cut that produces sharp pain with a burning sensation is an example of what location of pain?
    cutaneous (or superfical pain)
  8. Deep ______ ____ is diffused or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep _____ _____
    Somatic pain
  9. this is poorly localized and originates in body organs in the thorax, cranium and abdomen. This pain occurs as organs stretch abnormally and become distended, ischemic, or inflamed.

    guarding maybe the protective response present .
    Visceral pain
  10. Pain also can be classified based on its mode of transmission. Pain can originate in one part of the body but be perceived in an area distant from its point of origin. This is known as _____ _____
    Example pain associated with myocardial infarction, or heart attack, is frequently referred to the neck, shoulder, or arms (often the left arm).
    referred pain.
  11. This results from an injury to or abdnormal functioning of peripheral nerves or the CNS. The exact cause of neuropathic pain is unknown and it can occur in many forms. This can be of short duration or lingering and is often described as burning or stabing.
    e.g. neuropathy
    neuropathic pain
  12. ______ a characteristic feature of neuropathic pain is pain that occurs after a normally weak or nonpainful stimuli, such as a light touch or a cold drink
    allodynia
  13. When pain is resistant to therapy and persists despite variety of interventions, it is referred to as _______
    intractable
  14. The pain that is often referred to an amputated leg when receptors and nerves are clearly absent is a real experience for the patient. This type of pain is called ________

    sensory misrep
    Phantonm pain or phantom limb pain
  15. ______physical cause for the pain cannot be identified.
    no defined reason, can not find a physical reason for the pain to occur
    psychogenic pain
  16. Pain may be classified into 5 parts. What are the 5 parts?
    • 1. duration
    • 2. location
    • 3. source
    • 4. mode of transmission
    • 5. its etiology
  17. what are the 3 types of responses to pain?
    • 1. physiologic
    • a. parasympathetic
    • b. sympathetic
    • 2. behavioral
    • 3. affective
  18. The mechanism or process of pain is believed to involve four stages. What are the 4 stages?
    • 1.transduction
    • 2.transmission
    • 3.perception
    • 4.modulation of pain
  19. The activation of pain receptors is referred to as....
    it involves conversion of painful stimuli into electircal impulses that travel from the periphery to the spinal cord at the dorsal horn.
    transduction
  20. The peripheral nerve fibers that transmit pain are called....
    nerve receptor that is responsible for the transmission of pain
    nociceptors
  21. What are prostaglandis (hormone-like substances that send additional pain stimuli to the CNS), substance P (sensitizes receptors on the nerves to feel pain and also increases the rate of firing of nerves), and serotonin (a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vasoconstriction)
    neurotransmitters or pain receptors
  22. Pain sensation from the site of an injury or inflammation are conducted along pathways that have been rather clearly defined in certain areas but are still somewhat unclear in other areas to the spinal cord and then on to higher centers. This process is known as

    conduction along pathways (a-delta & C-delta fibers)
    transmission
  23. The _________ of pain involves the sensory process that occurs when a stimuli for pain is present. It includes the person's interpretation of the pain.
    perception
  24. the thresold of perception, the _________, is the lowest intensity of a stimulus that causes the subject to recognize pain.
    pain threshold
  25. what is considered the 5th vital sign?
    pain
  26. Migraines, malignant last long periods -- maybe intracetable.
    intermittent chronic pain
  27. A patient who has bone cancer is most likely experiencing which of the following types of pain?
    a.cutaneous
    b. somatic
    c. visceral
    d.referred
    somatic -- deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels and nerves
  28. _____ pain can be identified
    physical pain
  29. The process where sensation of pain is inhibited or modified is referred to as....
    (initiation of the protective reflex response_
    modulation
  30. Relationship between pain and emotions. Small and large diameter nerve fibers conduct and inhibit pain stimuli. Gating mechanism determine impulses that reach the brain. What theory is this?
    Gate Control Theory of Pain
  31. this is the amount of pain the client is willing to endure
    pain tolerance
  32. this is the compulsive use of substance even when you know that this is harmful and is affecting life, physical and other
    addiction
  33. a biologic need for a substance, if they do not have they will go through withdrawl
  34. this is what the body requires a progressivley greater amount of a drug to achieve the same results
    drug tolerance
  35. Which of the following modulators of pain is thought to reduce pain sensation by inhibiting the release of substance P from the terminals of afferent neurons?
    A. endorphins
    B. dynorphins
    C.enkephalins
    D.nociceptors
    C. enkephalins are thought to reduce pain by inhibiting the release of substance P from the terminals of afferent neurons
    (this multiple choice question has been scrambled)
  36. _____ & _______ are released when certain measures are used to relieve pain
    endorphins & dynorphins
  37. _______ are the peripheral nerve fibers that transmit pain
    nociceptors
  38. what are the sympathetic response to pain (fight or flight)?
    ^resp., dilated bronchial tubes, ^HR, Pallor, diaphoretic, ^blood glucose, ^adrenalin, muscle tension, pupils dilated, descreased gastric motility
  39. What is the parasympathetic response to pain? (rest and digest)
    pallor, rapid, irregular breathing, nausea, vomiting, weakness, fainting, heart rate decreased, hypotension, prostration (extreme mental or emotional depression or dejection)
  40. What is the behavioral responses to pain?
    Moving away from the painful stimuli, clenching teeth, clenching, fist, guarding, refusing to move, crying, grimacing, tensing the muscles, demanding, bending over
  41. What is the affective response to pain?
    withdrawal, anxiety, depression, anger, anorexia, hopelessness, powerless, stoicism
  42. what factors affect the pain experience?
    culture, ethnic variables, family, gender, and age variables, religious beliefs, environment, and support people, anxiety and other stressors, past pain experience
  43. When assess for pain you look for these factors?
    • does the pt's verbalize and description of pain?
    • duration of pain
    • location of pain
    • quantity and intensity of pain
    • quality of pain
    • chronology of pain
    • aggravating and alleviating factors
    • physiologic indicators of pain
    • behavioral responses
    • effect of pain on activities and lifestyle
  44. True or false.
    the best judge of the existence and severity of a patient's pain is the physician or nurse caring for the patinet.
    • false
    • the best judge of the existence and severity of the pt's pain is the PATIENT
  45. What does WILDA stand for
    • Words that describe the pain
    • Intensity of pain
    • Location of pain
    • Duration of pain
    • Aggravating or alleviating factors
  46. Which of the following pain assessment tools is recommended for use with children?
    A. Wong-Baker Faces
    B. WILDA pain measurement scale
    C. McGill-Melzach pain questionnaire
    D. McCaffery method
    A. Wong-Baker faces
    (this multiple choice question has been scrambled)
  47. what are some nonpharmacologic pain relief measures?
    distraction, humor, music, imagery, releaxation, cuaneous stimulation, acupuncture, hypnosis, biofeedback, therapeutic touch
  48. What do you obtain before you give narcotics?
    baseline leve of consciousness, resp rate, O2 saturation, BP
  49. _____ ____various medication are given to the patient for surgical procedures to produce pain relief and amnesia
    general anesthesia
  50. by trained RN medication for pain and amnesia but should not render unconscious, should be able to maintain airway. Precautions for airway, suction
    conscious sedation
  51. A patient complains of abdominal pain that is difficult to localize. The nurse categorically interprets this as.
    A. causalgia
    B. visceral
    C. superficial
    D. psychogenic
    B. visceral
    (this multiple choice question has been scrambled)
  52. complex regional pain syndrome
    causalgia
  53. a patient complains of pain in a site that is different from where it originates. The nurse documents this as
    A. phantom pain
    B. transient pain
    C. superfical pain
    D. referred pain
    D. referred pain
    (this multiple choice question has been scrambled)
  54. A patient who has fallen and injured his wrist carefully cradles it with the other hand. the pt is demonstrating which of the following responses to pain?
    A. affective
    B. involuntary
    C. behavioral
    D. physiologic
    C. behavioral (protecting or guarding a painful area is a behavioral response)
    (this multiple choice question has been scrambled)
  55. To help relieve her pain, Ann concentrates on a favorite vaction setting. The nurse interprets this technique as
    a. distraction
    b. relaxation
    c. recall
    d. imagery
    imagery is a mind--body interaction that decreases pain sensation by focuing on a pleasurable image
  56. The nurse best describes intractable pain as being
    a. intermittent in nature
    b. resistant to treatment
    c. excruciating
    d. widespread
    • b. resistant to treatment.
    • Intractable pain is severe pain that is resistant to relief measures
  57. Applying the gate control theory of pain, an effective nursing intervention for paitient with lower back pain would be.
    a.encourage regular use of analgesics
    b. applying a moist heating pad to the area at prescribed intervals
    c. reviewing the pain experience with the patient
    d. ambulating the patient after administering medication
    • b. applying a moist heating pad to the area at prescribed intervals.
    • (nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain)
  58. Which of the following would the nurse expect to assess as a physiolgic response to moderate pain?
    a.^ BP
    b. restlessnes
    c. decreased pulse rate
    d. protection of the painful area
    • a. ^BP
    • increaed BP is a physioligc or involuntary response to moderate pain, whereas decreased pulse rate occurs when pain is severe and depp. Restlessness and protection of the painful area are behavioral responses
  59. Mrs. young is receiving ATC medication for treatment of terminal cancer. She has recently reported several episodes of breakthrough pain. What treatment is most effective to manage these sudden flare--ups of pain?
    d. supplementing w/doses of a short-acting opioid
  60. When assessing pain in a child, the nurse needs to be aware that?
    A.narcotic analgesic use should be avoided
    B. inadequate or inconsistent relief of pain is widespread
    C. immature neurologic development results in reduced sensation pain
    D. reliable assessment tools are currently unavailable
    B. inadequate or inconsistent relief of pain is widespread
    (this multiple choice question has been scrambled)
  61. Mr. Wright is recovering from abdominal surgery. When the nurse assists him to walk, she observes that he grimaces, moves stiffy, and become pale. She is aware that he has consistently refused his pain medication. A priority nursing diagnosis would be?
    A. impaired physical mobility related to surgical procedure
    B. acute pain related to fear of taking prescribed medication in the postoperative period
    C. anxiety related to outcome of surgery
    D. risk for infection related to surgical incision
    B. acute pain related to fear of taking prescribed medications in the postoperative period
    (this multiple choice question has been scrambled)
  62. When planning strategies for pain control in older patients, the nurse should be aware that
    A. pain is a natural outcome of the aging process
    B. narcotic use should be avoided
    C. sensitivity to pain increase with age
    D. denial of pain may occur
    D. denial of pain may occur
    (this multiple choice question has been scrambled)
  63. chronic pain is most effectively relieved when analgesics are administered
    A. intramuscularly
    B. around the clock (ATC)
    C. on a p.r.n. (as needed) basis
    D. conservatively
    B. ATC
    (this multiple choice question has been scrambled)
  64. Using a placebo for pain control w/out the pt's consent is
    A. justified to determine whether pain is real
    B. consistenly effective
    C. deceptive and unethical
    D. a widespread practice
    C. deceptive and unethical
    (this multiple choice question has been scrambled)
  65. The patient receiving epidural analgesia requires vigilant monitoring to prevent the occurrence of
    A. respiratory depression
    B. urinary retention
    C. nausea & vomiting
    D. pruritus
    A. respiratory depression
    (this multiple choice question has been scrambled)
  66. When assessing a pt receiving a continuous opiod infusion, the nurse immediately notifies the physician when the patient has.
    A. mild confusion
    B. reported constipation
    C. a respiratory rate of 10 with respirations of normal depth
    D. a sedation level of 4
    D. sedation level of 4

    1=awake and alert
    2=occasionally drowsy but easy to arouse; requires no action
    3=frequently drowsy and drifts off to sleep during conversation; descrease the opiod dose
    4= somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone
    (this multiple choice question has been scrambled)

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