(308) Pain management

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(308) Pain management
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2011-08-15 09:43:20
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MED SURG
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  1. Health care professionals have the ___________ to accept the __________ report of pain by the pt.
    • responsibility
    • subjective
  2. Pain meds should be _______ for the dose of _________ effect while limiting ________ side-effects.
    Titrated (a method of estimating the amount of solute in a solution)

    maximum

    adverse
  3. True or false?

    There are NO lab studies that can measure the prescence or intensity of pain.
    True
  4. JCAHO requires that we recognize pts right to ___________ and ___________ of pain.
    assessment

    management
  5. JCAHO requires that we ______ and assess _______ of pain in all pts.
    • Screen
    • intensity
  6. JCAHO requires that we ____________
    and _______-__ on all pts pain.
    • Document
    • follow-up
  7. JCAHO requires that the staff be ____________.
    Competent (the ability of an individual to perform a job properly)
  8. JCAHO requires that we follow _______ and _________ for pain management.
    • policy
    • procedures
  9. JCAHO requires that we __________ pt and family.
    educate
  10. JCAHO requires that ________ needs are addressed.
    discharge
  11. JCAHO requires that pain doees not interfere with _____ or ____, etc.
    • rehab
    • goals
  12. An unpleasant sensory or emotional experience related to actual or potential tissue damage is known as?
    Pain
  13. Pain is whatever a person ___ __ __
    says it is.
  14. Pain is a _______ experience.
    subjective
  15. True or false?

    Their is a definitive measurement to asses pain.
    False
  16. what is the single most reliable indicator of pain?
    Self-report
  17. The lowest intensity of pain stumulus that is perceived as pain is?
    Pain threshold
  18. The amount of pain a person is willing or able to tolerate.
    Pain tolerance
  19. Consequences of unrelieved pain increases _______ demands, leading to _____ breakdown and eventually ____ loss.
    • catabolic
    • muscle
    • weight
  20. Consequences of unrelieved pain can cause _____, poor ________, impaired ______ response.
    • fever
    • healing
    • immune
  21. Consequences of unrelieved pain puts a strain on the Cardiovascular system leading to increased _____, __, ______ oxygen demand, and hyper_________.
    • pulse
    • BP
    • myocardial
    • hypercoagulation
  22. Consequences of unrelieved pain can cause what three things?
    • immobility
    • weakness
    • fatigue
  23. Consequences of unrelieved pain can cause inhibited ___ motility.
    GI
  24. Consequences of unrelieved pain cause development of ______ _____.
    chronic pain
  25. Consequences of unrelieved pain can cause sleep ________, ______, _____, _______ thoughts
    • deprivation
    • depression
    • anxiety
    • suicidal
  26. This type of pain is caused by ongoing responses to noxious stimuli by damage to somatic or visceral stimuli.
    Nociceptive pain
  27. This type of pain results from damage to peripheral nerves or CNS.
    Neuropathic pain
  28. List 6 causes for Neuropathic pain?
    • 1. trauma
    • 2. inflammation
    • 3. metabolic diseases
    • 4. infections
    • 5. tumors
    • 6. toxins
  29. List the 8 ways that Neuropathic pain may be perceived?
    • 1. shooting
    • 2. tingling
    • 3. electric shock-like
    • 4. prickling
    • 5.sqeezing
    • 6. jabbing
    • 7. spasm
    • 8. cold
  30. List the common classifications of pain:
    • a) acute or chronic
    • b) persistent or intermittent
    • c) malignant or non-malignant
  31. True or false?

    Malignant pain can be successfully treated.
    False
  32. This type of paon is of short duration with a known cause.
    Acute pain
  33. This type of pain may have no identifiable pathology to serve to explain the presence or extent of the pain.
    chronic pain
  34. This type of pain is usually associated with high levels of pathology or tissue damage and the pain resolves with healing of the underlying injury.
    acute pain
  35. List the 6 signs and symptoms of Acute pain:
    • 1. hypertension
    • 2. anxiety
    • 3. tachycardia
    • (4) tachypnea
    • 5. dilated pupils
    • 6.diaphoresis
  36. List the 4 signs and symptoms of chronic pain:
    • 1. No alteration in VS
    • 2. depression
    • 3. fatigue
    • 4. decreased level of functioning
  37. When assessing pain, minimal expression of pain may be due to _______ or the pt may want to be the "_____" pt.
    • fatigue
    • "good"
  38. When assessing pain remember that pain can be __________.
    exhausting
  39. When assessing pain person can _____ even in the presence of severe pain.
    sleep
  40. If a pt complains of pain, and falls asleep, it is appropriate to do what?
    wake pt up to give pain med.
  41. Based on the notes what 3 things can make pain bearable?
    • walking
    • talking
    • laughing
  42. True or false?

    when assessing pain pts may work while still in pain.
    true
  43. When assessing pain what are some reasons that pts may deny pain?
    • fear injection
    • fear they are getting worse
  44. The nurses role is to have clinical ________ in assessment of pain.
    competency
  45. When assessing pain a nurse must use ___________ measurements for pain assessment.
    standardized
  46. One of the nurses roles is to partner with the physicians in the _________ and effective ________ of pain medications.
    • scheduling
    • titration
  47. One of the nurses role is to _______ pt and family about pain.
    educate
  48. One of the nurses roles is to insure access to quality pain ____________ _____ and _____________ ______ for ready use in the clinical area.
    • assessment tools
    • equianalgesic charts
  49. One of the nursing roles is to ensure the assessment of pain as the what?
    5th vital sign
  50. A thorough pain assessment includes what two things?
    • direct interview
    • observation
  51. When doing a thorough pain assessment have the pt describe the pain how?
    In their own words
  52. When doing a thorough pain assessment you want to know what 12 main things?

    clue: (paid leaq)
    History of onset, pattern, associated symptoms, intensity (severity), duration, location, exacerbating or alleviating factors, quality.

    • current managment efforts
    • relevant medical and family history
    • impact of pain on daily life
    • Relation to exercise and pain
  53. When assessing pain assess the pts ___________ for pain management.
    expectations
  54. When assessing pain as a nurse you want to know what makes the pain better and what makes the pain worse also known as?
    Aggravating and alleviating factors.
  55. When assessing pain the nurse needs to know about the pt environmental factors such as:
    extreme heat, cold, humidity, noise.
  56. When assessing pain what two stresses does the nurse need to know about?
    • physical
    • emotional
  57. What does PQRST stand for?
    • Provokes
    • Quality
    • Radiates
    • Severity
    • Time
  58. When assessing pain a __ point scale is commonly used.
    10
  59. When assessing pain a ___________ flow sheet allows for consistency in evaluating pain management.
    standardized
  60. For pts in the home setting, consider use of a pain ____ or ___
    diary or log
  61. When assessing pain on a flow sheet include documentation of _____ of med, _____, _____, _____ of pain med given.
    • name
    • time
    • route
    • dose
  62. When assessing pain on a flow sheet include documentation of _____ _____ prior to, and 30 min after med is given.
    pain rating
  63. True or false?

    Notify physician when pain relief not achieved.
    True
  64. For the Wong-baker pain rating scale face 0 means
    very happy because does not hurt anymore
  65. For the Wong-baker pain rating scale face 1 means
    hurts just a little bit
  66. For the Wong-baker pain rating scale face 2 means
    hurts a little bit more
  67. For the Wong-baker pain rating scale face 3 means
    hurts even more
  68. For the Wong-baker pain rating scale face 4 means
    hurts a whole lot more
  69. For the Wong-baker pain rating scale face 5 means
    hurts as much as you can imagine
  70. When assessing pain in Non-verbal pts based on the notes what is #1 pain cues?
    • eyes tight shut
    • wrinkled forehead
    • grimacing
    • frowning
  71. When assessing pain in Non-verbal pts based on the notes what is #2 pain cues?
    • moaning
    • sighing
    • fidgeting
    • restlessness
  72. When assessing pain in Non-verbal pts based on the notes what is #3 pain cues?
    • tensing muscles
    • kicking
  73. When assessing pain in Non-verbal pts based on the notes what is #4 pain cues?
    massaging or rubbing areas of the body.
  74. When assessing pain in Non-verbal pts based on the notes what is #5 pain cues?
    perspiration, n&v, increase BP by 15%, increase HR by 15%
  75. When managing pain in Non-verbal pts consider the ______ or ________ assessment of pt.
    • family
    • caregiver's
  76. When assessing pain you want to check back with the pt within __ minutes of ________ med. administration.
    • 30
    • parenteral
  77. When assessing pain you want to check back with the pt within __ ___ of ___ med. administration.
    • One hour
    • oral
  78. When assessing pain check back with each report of ___ or _____ pain.
    • new
    • changed
  79. When assessing pain what should pts be coached to do?
    report changes in pain
  80. True or false?

    Pain sensitivity may decrease with age.
    True
  81. Many eldery pts will not do what for themselves?
    speak up for themselves
  82. When dealing with the elderly assess for what types of feelings?
    AND
    What may these feelings due to?
    depression and unworthinesss

    pain
  83. When assessing pain in the elderly which pain scale is the best to use?
    Face scale
  84. Cognitively impaired pts are at risk for poor what?
    Pain management
  85. True or Fales?

    Pain treatment needs to be individualized.
    True
  86. There is never a role for the use of _______ in the assessement or treatment of pain.
    placebos
  87. A barrier to adequate pain management is that pain is often ____-_____
    under-treated
  88. Barrier's to adequate pain management when dealing with doctors are?
    (list 5)
    • 1. lack of education
    • 2. threat of lawsuits for over-prescribing opiates
    • 3. lack of support from insurance carriers
    • 4. fear of tolerance
    • 5. fear of addiction
  89. A Barrier to adequate pain management when dealing with nurses is?
    lack of education
  90. Barrier's to adequate pain management when dealing with Pharmacists is?
    (list3)
    • 1. fear of investigation
    • 2. do not stock opiates
    • 3. give pt limited supply
  91. Non-opioids are used for what type of pain?
    mild pain
  92. Non-opioids are also called what?
    • Non-steroidal anti-inflammatory drugs
    • (NSAIDS)
  93. Opioids are used for what kind of pain?
    moderate to severe pain
  94. give 2 example of a NSAID?
    Acetaminiphen and Aspirin
  95. Adjuvants are used for what kind of pain?
    can be used in any pain state.
  96. Which analgesic group when added to primary analgesics, further improve pain control?
    Adjuvants
  97. Which type of pain is a transient, moderate to severe pain that occurs beyond the pain treated by current analgesics?
    Breakthrough pain
  98. Which type of pain is usually rapid in onset and brief in duration with variable intensity and frequency in occurrence?
    breakthrough pain
  99. This method is of adjusting doses or administration interval for safety and effectiveness.
    titration
  100. True or false?

    titration can be upward or downward.
    true
  101. Titration Goal: is to use the _______ dose to provide desired effective analgesic _______ and with ________ _____-_______.
    • smallest
    • control
    • minimal side-effects
  102. Titration is a ______________ effort between physician and nurse.
    collaborative
  103. What type of assessment tool is essential for effective titration?
    pain flow sheet
  104. When dealing with titration which route is the preferred route?
    oral
  105. When dealing with titration, Nonopioids have a _____ _____ and may cause _________ ________ at high doses.
    • ceiling effect
    • significant toxicity
  106. When dealing with titration, most opioids do not have an _________ ________, so the dosage can be titrated __ until ____ ______ occurs.
    • anelgesic ceiling
    • up
    • pain relief
  107. ____ provide superior pain relidf with fewer side effects, however, a short acting, rapid-onset ____ med should be used to manage _________ ____.
    • ATC
    • PRN
    • breakthrough pain
  108. Titrating analgesics should be based upon pt ____, ____, _______, ______ of undesirable or adverse drug effects, measures of __________, _____, _________ states and the pts/________ reports of the impact of the pain on _______ of life.
    • goals
    • pain
    • intensity
    • severity
    • functionality
    • sleep
    • emotional
    • cargiver's
    • quality
  109. A dose of one analgesic that is equivalent in pain-relieving effect compaored with another analgesic is know as?
    Equianalgesic Dosing
  110. When dealing with equianalgesic dosing _______ doses are given orally to get same iffect as __ doses.
    • larger
    • IV
  111. With physician consultation, RN may use a __________ _________ _____ for safe dosing.
    standardized equianalgesic chart
  112. If one opioid is not effective after appropriate titration, or it produces significant adverse effects what should be done?
    another opioid should be considered
  113. List 6 examples of Adjuvants:
    • 1. Anticonvulsants as analgesics (Gabapentin)
    • 2. tricyclic antidepressants (Amitriptyline)
    • 3. corticosteroids (Dexamethazone)
    • 4.Baclofen
    • 5. Capsaicin (Zostrix)
    • 6. Complementary medicine
  114. Which adjuvant blocks reuptake of serotonin and norepinephrine in the CNS?
    Tricyclic anti-depressants
  115. True or false?

    Tricyclic anti-depressants are equally effective in depressed and non-depressed pts.
    true
  116. Which Adjuvants are useful in treatment of neuropathic pain states, such as migraines, low back pain, cancer pain, and fibromyalgia?
    tricyclic anti-depressant
  117. List two side effects for tricyclic anti-depressants:
    • dry mouth
    • constipation
  118. list 3 contraindications for tricyclic anti-depressants:
    • cardiac dysrhymias
    • narrow-angle glaucoma
    • significant prostate enlargement
  119. Which adjuvant inhibits prostagandin synthesis and reduce edema?
    steroids
  120. Which adjuvant is useful in treating neuropathic pain and bone pain?
    steroids
  121. Which adjuvant is useful in the relief of spasm-associated pain?
    Baclofen
  122. Which adjuvant relieves pain by releasing then depleting supplies of "P", a protein released from pain neurons involved in transmission of pain?
    Topical capsaicin (Zostrix)
  123. True or false?

    Topical capsaicin (zostrix) may cause pain then will relieve pain.
    true
  124. When dealing with topical capsaicin (zostrix) what is a problem for many pts who have tried the med?
    Burning
  125. Acetaminophen's mechanism of action is ________.
    unknown
  126. Acetaminophen has minimal ___-________ effect.
    anti-inflammatory effect
  127. True or false?
    Increasing dose of NSAIDS deyond a pint will not increase relief.
    true
  128. What may need to be used to minimize GI effects, especially those with a history of gastric bleeding?
    AND
    Give example of drug?
    • gastric cytoprotection
    • ex: Famotidine
  129. If coagulation is impaired, _______ may be cantraindicated.
    NSAIDS
  130. When dealing with NSAIDS what 2 things to you what to ensure to minimixe risk of renal impairment?
    • adequate hydration
    • good urine output
  131. NSAID, including ____, are good Step __ analgesics.
    • ASA
    • 1
  132. NSAIDS, including ASA, work in part by inhibiting ____-________, the enzyme that converts ________ acid to prostaglandins.
    • cyclo-oxygenase
    • arachidonic acid
  133. True or false?

    NSAIDS can have significant adverse effects.
    true
  134. Opioids produce ________.
    analgesia
  135. Opioids _____ perception of and _________ responses to pain.
    • Alter
    • emotional
  136. Opioids reach ______ concentration approximately ___-___ minutes after oral (including _____-____) or rectal administration, ___ minutes after subcutaneous or ___ administration and __ minutes after IV injection.
    • plasma
    • 60-90 minutes
    • feeding rubes
    • 30 minutes
    • IM
    • 6 minutes
  137. List 8 commonly used opioids:
    • Morphine (MS Contin, Oramorph, Roxanol)
    • Hydromorphone (Dilaudid)
    • Fentanyl (Duragesic patch)
    • Oxycodone (OxyContin)
    • Hydrocodone (Lortab, Vicodin)
    • Codeine
    • Tramadol (Ultram)
    • Methadone (Dolophine)
  138. List the 9 routes for opioids:
    • oral
    • mucosal
    • sublingual
    • rectal
    • topical
    • parenteral
    • transdermal
    • intrathecal
    • epidural
  139. This type of Opioid is used to manage intermittent pain and breakthrough pain.
    Short-acting Opioids
  140. Long acting and sustained release varieties of Opioids are used for what 2 reasons?
    • Useful for contunuous pain states
    • Allow sleep through the night
  141. Expected physiologic phenomenon in which the effects of a drug become less with repeated use.
    tolerance
  142. Expected physiologic respinse manifested vy a withdrawal syndrome that occurs when blood levels of the drug are abruptly decreased.
    physical dependence
  143. A complex neurobiologic condition characterized by a drive to obtain and take substances for other than the prescribed, therapeutic value.
    psychological dependence or addiction
  144. A syndrome of poorly or under-treated pain.
    Pseudo-addiction
  145. Addiction is a clinical problem in pts with moderate to severe pain treated with opioids is a common what?
    myth
  146. True or false?

    Addiction risk is high when opioids are dosed propperly.
    false

    low
  147. What 2 routes are preferred with chronic treatment?
    • Oral
    • transdermal
  148. Opioids do not have what type of effect?
    ceiling
  149. What kind of effect has a dose beyond which no additional analgesia is achieved?
    cieling effect
  150. Opioids tend to have what kind of side effects? (list 8)
    • sedation
    • mental confusion
    • respirator depression
    • nausea
    • vomiting
    • constipation
    • pruitis
    • urinary retention
  151. When giving Opioids you should be cautions with pts with what kind of conditions?
    • impaired ventilation
    • liver failure
    • increased intracranial pressure
  152. Which Opioid is not indicated in long term treatment of pain?
    Meperidine (Demerol)
  153. Meperidine (Demerol) is metabolized in the _____, and excreted through the _______. In renal dysfunction, normeperidine is not _______ and accumulates in the ______ ______.
    • liver
    • kidneys
    • excreted
    • blood stream
  154. Normeperidine is toxic to the ____ and pts are at risk for _______.
    • CNS
    • seizures
  155. ___________, the active incredient in Darvocet/ Darvon, is converted to ___________ which can accumulate with renal __________ and can cause ______
    • Propoxyphene
    • norproposyhene
    • insufficiency
    • seizures
  156. True or false?

    Opioids depress respiratory function and are therefore too dangerous to be used safely.
    False
  157. Respiratory depression is often cited as a factor for what main reason?
    limits use of Opioids
  158. Respiratory depression is usually _____-______, and generally occurs in ____-_____ pts (pts who are receiving opioids for the first time).
    • short lived
    • opioid-naive
  159. Respiratory depression is anatagonized by what?
    pain
  160. Withholding appropriate use of opioids on the basis of respiratory concerns is __________. Concerns about respiatory depression do not apply to pts who receive _____-____ opioid therapy.
    • unwarranted
    • long-term
  161. When a pt is a naive pt monitor ______ and __________ status during ___ 24 hours.
    • sedation
    • respiratory status
    • 1st
  162. Use ________ for opioid reversal
    naloxone
  163. Use ________ for respiratory depression assessment.
    spirometry
  164. True or False?

    Unacceptable sedation and confusion are a frequent side-effect in opioid pts.
    False
  165. When managing sedation as an opioid side-effect you want to assess for concurrent ______ _____.
    sedating meds
  166. When managing sedation as an opioid side-effect you want consider use of ____ ________ during the day.
    mild stimulants
  167. When managing sedation as an opioid side-effect, if persistent, consider what?
    Different opioid
  168. When managing confusion as an opioid side-effect you want assess for pre-existing ____ ________.
    CNS conditions
  169. ________ is an opioid with antagonist activity that is useful in treating ________ and __________ pain. It appears to be ___ times as potent as high doses of morphine.
    • Methadone
    • nociceptive and neuropathic
    • 10
  170. Population at risk for undertreated pain are?
    clue (I.C.O.S)
    • infants
    • children
    • older adults
    • substance abuse
  171. List 5 Side-effects for opioids:
    • Pruritis
    • Nausea and vomiting
    • Urinary retention
    • Tolerence
    • Constipation
  172. Which drug obtained approval from the FDA as abuse-resistant pain-killer?
    Embeda
  173. When opioids are used always use preventative regimen such as?

    list 5
    • stool softeners
    • mild stimulants
    • dietary changes
    • hydration
    • mobility
  174. When a pt is suffering from pruritis you want to consider what 2 drugs?
    • benadryl
    • antihistamines
  175. If a pts gastric motility is slowed, use what?
    metoclopramide
  176. If a pt is suffering from Nausea and avomiting use what?
    antiemetics (droperidol, compazine)
  177. Urinary retention is common in what kind of pts?
    opioid-naive pts

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