NUR170 Exam 1 Study Guide: Key Concepts for Successful Review
NUR 170 EXAM 1 STUDY GUIDE
Assessment and Care of Patients in Pain
• Assessment—Location, Intensity, Quality, Onset and Duration, Aggravating and Relieving
Factors, Effects of Pain on QOL
• Best indicator of pain—
o Self-report-the patient is the authority on the pain and the only one who can
describe the experience.
▪ Elderly, substance abusers, Language barriers**HIGH RISK GROUP
▪ Pg. 25 table 3-1 Impact of unrelieved pain
• Pain scales—quality descriptive and best for feedback in assessing pain level.
o Numeric Rating Scale (NRS)- 0-10 pain scale verbalized by patient.
o Wong-Baker FACES- 6 cartoon faces with word descriptors
o Face Pain Scale—Revised (FPS-R)- 7 faces, patient picks face that best depicts
their pain.
o Verbal Descriptor Scale (VDS)—Words or phrases that describe intensity of
pain.
• Pain Goals—Prevent. Restore/Allow function. Good QOL—
o do not give unrealistic goals, bring goal to a tolerating level.
• Types of Pain—
o Acute- usually temporary, has a sudden onset, and is easily localized.
▪ Patients may experience fight or flight reactions such as— increased
vital signs, sweating, and dilated pupils (acute pain model).
o Chronic- persistent pain, often described as pain that lasts of recurs for an
indefinite period, usually for 3 months or more.
▪ Emotional and financial burdens—depression and hopelessness.
▪ The body adapts thus vital signs often will be lower than normal.
• Pg. 25 table 3-2—Characteristics of acute and chronic pain
• Pain challenges—
o Cognitively impaired—come up with a baseline from family or friends.
o Critically ill (intubated, unresponsive)—body behaviors, withdrawal-
physiological signs.
o Comatose
o Imminently Dying
▪ Pg. 33 table 3-5—Hierarchy of Pain Measures
1. Attempt to obtain self-report
2. Consider underlying pathology of pain
3. Observe behaviors
4. Evaluate physiologic indicators
5. Conduct an analgesic trial
NUR170 Exam 1 Study Guide: Key Concepts for Successful Review
, NUR170 Exam 1 Study Guide: Key Concepts for Successful Review
• Types of pain meds—
o Non-opioid analgesic—
▪ Acetaminophen—Analgesic and antipyretic properties- not effective w/
inflammation
▪ NSAID's— Analgesic, antipyretic, and anti-inflammatory properties
• Can be combined with opioids
o Opioid Analgesic—Treats moderate to severe pain:
▪ Morphine—vasodilator; watch BP can cause decrease and orthostatic
hypertension, urinary retention, UTI, and confusion in elderly patients.
▪ Fentanyl
▪ Hydromorphone
▪ Hydrocodone
▪ Oxycodone
▪ Oxymorphone
▪ Methadone
• PCA teaching—
o PCA (patient-controlled analgesia)—Has safety settings. Basal-Continuous rate.
Demand-Bolus patient controlled pre-programed dose.
o Cannot overdose medication is programmed for lock out- Only patient pushes
button.
• PCA interventions—
o If RD (assess LOC and O2) stop basal. May need Naloxone
• Side effects of opioids— (Pg. 43 Table 3-9)
o Sedation—Raspatory Depression (table 3-10) use sedation scale
o Constipation (no bulk lax)—push ambulation and adequate fluid intake
o Nausea and Vomiting (n/v)—Zofran; educate that tolerance will develop if
regular doses of opioids are needed, consider a different opioid if un resolved
n/v
o Respiratory depression—snoring is NOT normal, ask for baseline upon
admission
o Low 02—Diaphoresis (sweating)
• Interventions for opioids—
o Narcan—Assess 1st. Admin slowly. Just enough to reverse Respiratory
depression.
• Factors that Influence pain—Culture, religion. Age. Mental status. Nutrition.
• Physical Modalities—
o Interdisciplinary team work:
▪ PT. OT. Aqua therapy, Acupuncture, minimal impact exercise programs.
• Cutaneous Skin Stimulation—TEN's (Pins and needles). Heat. Cold. Massage
NUR170 Exam 1 Study Guide: Key Concepts for Successful Review
NUR 170 EXAM 1 STUDY GUIDE
Assessment and Care of Patients in Pain
• Assessment—Location, Intensity, Quality, Onset and Duration, Aggravating and Relieving
Factors, Effects of Pain on QOL
• Best indicator of pain—
o Self-report-the patient is the authority on the pain and the only one who can
describe the experience.
▪ Elderly, substance abusers, Language barriers**HIGH RISK GROUP
▪ Pg. 25 table 3-1 Impact of unrelieved pain
• Pain scales—quality descriptive and best for feedback in assessing pain level.
o Numeric Rating Scale (NRS)- 0-10 pain scale verbalized by patient.
o Wong-Baker FACES- 6 cartoon faces with word descriptors
o Face Pain Scale—Revised (FPS-R)- 7 faces, patient picks face that best depicts
their pain.
o Verbal Descriptor Scale (VDS)—Words or phrases that describe intensity of
pain.
• Pain Goals—Prevent. Restore/Allow function. Good QOL—
o do not give unrealistic goals, bring goal to a tolerating level.
• Types of Pain—
o Acute- usually temporary, has a sudden onset, and is easily localized.
▪ Patients may experience fight or flight reactions such as— increased
vital signs, sweating, and dilated pupils (acute pain model).
o Chronic- persistent pain, often described as pain that lasts of recurs for an
indefinite period, usually for 3 months or more.
▪ Emotional and financial burdens—depression and hopelessness.
▪ The body adapts thus vital signs often will be lower than normal.
• Pg. 25 table 3-2—Characteristics of acute and chronic pain
• Pain challenges—
o Cognitively impaired—come up with a baseline from family or friends.
o Critically ill (intubated, unresponsive)—body behaviors, withdrawal-
physiological signs.
o Comatose
o Imminently Dying
▪ Pg. 33 table 3-5—Hierarchy of Pain Measures
1. Attempt to obtain self-report
2. Consider underlying pathology of pain
3. Observe behaviors
4. Evaluate physiologic indicators
5. Conduct an analgesic trial
NUR170 Exam 1 Study Guide: Key Concepts for Successful Review
, NUR170 Exam 1 Study Guide: Key Concepts for Successful Review
• Types of pain meds—
o Non-opioid analgesic—
▪ Acetaminophen—Analgesic and antipyretic properties- not effective w/
inflammation
▪ NSAID's— Analgesic, antipyretic, and anti-inflammatory properties
• Can be combined with opioids
o Opioid Analgesic—Treats moderate to severe pain:
▪ Morphine—vasodilator; watch BP can cause decrease and orthostatic
hypertension, urinary retention, UTI, and confusion in elderly patients.
▪ Fentanyl
▪ Hydromorphone
▪ Hydrocodone
▪ Oxycodone
▪ Oxymorphone
▪ Methadone
• PCA teaching—
o PCA (patient-controlled analgesia)—Has safety settings. Basal-Continuous rate.
Demand-Bolus patient controlled pre-programed dose.
o Cannot overdose medication is programmed for lock out- Only patient pushes
button.
• PCA interventions—
o If RD (assess LOC and O2) stop basal. May need Naloxone
• Side effects of opioids— (Pg. 43 Table 3-9)
o Sedation—Raspatory Depression (table 3-10) use sedation scale
o Constipation (no bulk lax)—push ambulation and adequate fluid intake
o Nausea and Vomiting (n/v)—Zofran; educate that tolerance will develop if
regular doses of opioids are needed, consider a different opioid if un resolved
n/v
o Respiratory depression—snoring is NOT normal, ask for baseline upon
admission
o Low 02—Diaphoresis (sweating)
• Interventions for opioids—
o Narcan—Assess 1st. Admin slowly. Just enough to reverse Respiratory
depression.
• Factors that Influence pain—Culture, religion. Age. Mental status. Nutrition.
• Physical Modalities—
o Interdisciplinary team work:
▪ PT. OT. Aqua therapy, Acupuncture, minimal impact exercise programs.
• Cutaneous Skin Stimulation—TEN's (Pins and needles). Heat. Cold. Massage
NUR170 Exam 1 Study Guide: Key Concepts for Successful Review
