MED SURG EXAM 1
Module 1: Pain
Pain Management
• Pain is #1 reason to seek medical care
• What is pain
• What are the different types of pain
• How ill you assess, treat, and reassess
• What are the nursing implications for managing
pain The Fundamental concepts
• Acute: tissue damage as a result of surgery, trauma, or burns (expected to have relatively short
duration and resolve with normal healing
• Chronic: (persistent)- cancer or non-cancer origin and can be time limited (may resolve
within months) or persist throughout the course of a person’s life
• Nociceptive: physiologic pain
o May be described as “normal” pain transmission
o Normal functioning of physiologic systems that leads to the perception of noxious stimuli
(tissue injury) as being painful
o INCLUDES 4 SPECIFIC PROCESSES
1. Transduction- the processes by which noxious stimuli, such as a surgical
incision or burn, activate primary afferent nercous called nociceptors, which
are located throughout body in skin, subcutaneous tissue, and visceral and
somatic structures
o the conversion of chemical info at the cellular level into
electrical impulses that move toward spinal cord
o begins when cells injured
o cells release chemicals
o chemical excite norciceptors
2. Transmission- second process involved in nociception.
o Stimuli move from the peripheral nervous system toward the brain
o A-delta fibers- carry impulses rapidly
o C-Fibers-carry impulses slower
o In the thalamus, within the brain
▪ Transmits the message to the cortex
▪ Notifies norciceptors that message was received
▪ To discontinue the transmission
3. Perception-third process- is the result of the neural activity associated
with transmission of noxious stimuli
o Requires activation of higher brain structures for the occurrence
of awareness, emotions, and drives associated with pain.
o Each person tolerates pain differently
o Pain is influenced by
o Genetic
o Learned behavior
o Culture
4. Modulation-last phase of the pain impulse
o Brain interacts with the spinal nerves to alter the pain experience
o Involves many different neurochemicals
• Neuropathic
, o Pathologic and results from abnormal processing of sensory input by the nervous system
as a result of damage to the peripheral or central nervous system or both
• Mixed
o A combination of. nociceptive and neuropathic
• Somatic
o Caused by injury to skin, muscles, bone, joint, and connective tissues. Deep somatic pain
is usually described as dull or aching, and localized in one area.
• Visceral
o Results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera
(organs). Visceral structures are highly sensitive to distension (stretch), ischemia and
inflammation, but relatively insensitive to other stimuli that normally evoke pain such
as cutting or burning.
• Central
o Syndrome is a neurological condition caused by damage to or dysfunction of the central
nervous system (CNS), which includes the brain, brainstem, and spinal cord. This
syndrome can be caused by stroke, multiple sclerosis, tumors, epilepsy, brain or spinal
cord trauma, or Parkinson's disease.
• Peripheral neuropathic pain:
o Refers to the conditions that result when nerves that carry messages to and from the
brain and spinal cord from and to the rest of the body are damaged or diseased
o They range from carpal tunnel syndrome (a traumatic injury common after chronic
repetitive use of the hands and wrists, such as with computer use) to nerve damage
linked to diabetes.
• Harmful effects of unrelieved pain:
o Cardiac and respiratory:
▪ Increased HR
▪ Increased cardiac workload
▪ Increased vascular resistance
▪ Decreased respiratory volume
▪ Increased cough reflex
o Endocrine and metabolism
▪ Fight or flight response
▪ Increased glycogenesis
▪ Hyper glycaemia
▪ Decreased urine output
▪ Decreased motility and GI issues
▪ Fatigue, poor muscle function
▪ Decreased immune response
▪ Depression
o Quality of life
decrease Pain Assessment
• Self report
o Best use
o Do not judge always believe when a patient report pain
• Conduct through assessment
o COLD ERA/ OLD CART
o Location
o Intensity (Pain Scale) ask pain level using scale
, ▪ Numeric Rating Scale
▪ Wong-Baker FACES
▪ Face pain scale revises
▪ Visual analog scale
o Quality
▪ Stabbing, sharp, throbbing
o Onset and Duration
▪ When did it start
▪ How long did it last
o Aggravating/ Reliving factors
▪ Anything make it worse
▪ Anything make it better
o Comfort function Goals
▪ Function goal:
• Example: ambulate to the bathroom
▪ Comfort goal
• Where they want to be on the pain scale
Patient Education
• Educating patients and their family on how to use a pain rating scale
o Show pain scale and explain why using it
o Explain how it works
o Explain what you are measuring
▪ Tell them to report all types of pain
• Tingling, pulling, tightness
o Be sure patient understanding
▪ Teach back method of examples of pain in lifetime
o Practice using scale
▪ Current pain or past pain
• Purpose of pain scale
o Quality of life
▪ Want to give them best quality of life possible
• Goals
o Determine goals for their comfort and quality of life
o What pain rating will get them
there Assess and then Reassess
• Make goals, make interventions and reassess to see if its
working Choosing a Method
• Analgesics: opioid
• Analgesics: non-opioid
• Alternative therapies
• RN not writing orders but can make
suggestions Non-Opioid Analgesics
• NSIDS
o Aspirin, Aleve, Ibuprofen, Tylenol
▪ What are considerations for administration
o Given for mild-moderate pain or given with opioids when there is severe pain
o Can be administered: PO, IV, rectally
, o Side effects:
▪ Tylenol
• Hepatotoxicity risk
• Part of Percocet (pay attention to total dose)
▪ NSIDS:
• GI complications
• Renal toxicity
• Cardiovascular problems
• Administer with food and water
• Things to consider:
o What options do you have for non-opioid pain management
o When would you use these and why
o What are your nursing
considerations Opioid Analgesics
• Mu aganoist:
o Morphine and morphine like drugs
• Agonist antagonist
o Nalbuphine and buprenophine
o Interact with opioid receptor
• Antagonist:
o Bind same receptor but produce no effects
▪ Use to reverse effects of opioids
• GOAL:
o Improve maintain pain control and improve activity
▪ Keep pain level low so they can function
o When administering re-assess pain
o Consider leas invasive route and what will work best for pt to keep goals
• Adverse effects
o Constipation
o Respiratory depression
• Watch for sing of
o Withdrawal
o Tolerance
• Considerations:
o What options do you have for opioid pain management
o When would you use these and why
o What are your nursing considerations
• Physical Dependence
o Opioids over 2 weeks
o Not addiction
o When its stops there are withdrawal symptoms
o Needs to tapper off medication so it doesn’t happen drastically
• Tolerance
o Decreased effects of administration
• Addiction
o Disease
o Crave substance and take despite results
Module 1: Pain
Pain Management
• Pain is #1 reason to seek medical care
• What is pain
• What are the different types of pain
• How ill you assess, treat, and reassess
• What are the nursing implications for managing
pain The Fundamental concepts
• Acute: tissue damage as a result of surgery, trauma, or burns (expected to have relatively short
duration and resolve with normal healing
• Chronic: (persistent)- cancer or non-cancer origin and can be time limited (may resolve
within months) or persist throughout the course of a person’s life
• Nociceptive: physiologic pain
o May be described as “normal” pain transmission
o Normal functioning of physiologic systems that leads to the perception of noxious stimuli
(tissue injury) as being painful
o INCLUDES 4 SPECIFIC PROCESSES
1. Transduction- the processes by which noxious stimuli, such as a surgical
incision or burn, activate primary afferent nercous called nociceptors, which
are located throughout body in skin, subcutaneous tissue, and visceral and
somatic structures
o the conversion of chemical info at the cellular level into
electrical impulses that move toward spinal cord
o begins when cells injured
o cells release chemicals
o chemical excite norciceptors
2. Transmission- second process involved in nociception.
o Stimuli move from the peripheral nervous system toward the brain
o A-delta fibers- carry impulses rapidly
o C-Fibers-carry impulses slower
o In the thalamus, within the brain
▪ Transmits the message to the cortex
▪ Notifies norciceptors that message was received
▪ To discontinue the transmission
3. Perception-third process- is the result of the neural activity associated
with transmission of noxious stimuli
o Requires activation of higher brain structures for the occurrence
of awareness, emotions, and drives associated with pain.
o Each person tolerates pain differently
o Pain is influenced by
o Genetic
o Learned behavior
o Culture
4. Modulation-last phase of the pain impulse
o Brain interacts with the spinal nerves to alter the pain experience
o Involves many different neurochemicals
• Neuropathic
, o Pathologic and results from abnormal processing of sensory input by the nervous system
as a result of damage to the peripheral or central nervous system or both
• Mixed
o A combination of. nociceptive and neuropathic
• Somatic
o Caused by injury to skin, muscles, bone, joint, and connective tissues. Deep somatic pain
is usually described as dull or aching, and localized in one area.
• Visceral
o Results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera
(organs). Visceral structures are highly sensitive to distension (stretch), ischemia and
inflammation, but relatively insensitive to other stimuli that normally evoke pain such
as cutting or burning.
• Central
o Syndrome is a neurological condition caused by damage to or dysfunction of the central
nervous system (CNS), which includes the brain, brainstem, and spinal cord. This
syndrome can be caused by stroke, multiple sclerosis, tumors, epilepsy, brain or spinal
cord trauma, or Parkinson's disease.
• Peripheral neuropathic pain:
o Refers to the conditions that result when nerves that carry messages to and from the
brain and spinal cord from and to the rest of the body are damaged or diseased
o They range from carpal tunnel syndrome (a traumatic injury common after chronic
repetitive use of the hands and wrists, such as with computer use) to nerve damage
linked to diabetes.
• Harmful effects of unrelieved pain:
o Cardiac and respiratory:
▪ Increased HR
▪ Increased cardiac workload
▪ Increased vascular resistance
▪ Decreased respiratory volume
▪ Increased cough reflex
o Endocrine and metabolism
▪ Fight or flight response
▪ Increased glycogenesis
▪ Hyper glycaemia
▪ Decreased urine output
▪ Decreased motility and GI issues
▪ Fatigue, poor muscle function
▪ Decreased immune response
▪ Depression
o Quality of life
decrease Pain Assessment
• Self report
o Best use
o Do not judge always believe when a patient report pain
• Conduct through assessment
o COLD ERA/ OLD CART
o Location
o Intensity (Pain Scale) ask pain level using scale
, ▪ Numeric Rating Scale
▪ Wong-Baker FACES
▪ Face pain scale revises
▪ Visual analog scale
o Quality
▪ Stabbing, sharp, throbbing
o Onset and Duration
▪ When did it start
▪ How long did it last
o Aggravating/ Reliving factors
▪ Anything make it worse
▪ Anything make it better
o Comfort function Goals
▪ Function goal:
• Example: ambulate to the bathroom
▪ Comfort goal
• Where they want to be on the pain scale
Patient Education
• Educating patients and their family on how to use a pain rating scale
o Show pain scale and explain why using it
o Explain how it works
o Explain what you are measuring
▪ Tell them to report all types of pain
• Tingling, pulling, tightness
o Be sure patient understanding
▪ Teach back method of examples of pain in lifetime
o Practice using scale
▪ Current pain or past pain
• Purpose of pain scale
o Quality of life
▪ Want to give them best quality of life possible
• Goals
o Determine goals for their comfort and quality of life
o What pain rating will get them
there Assess and then Reassess
• Make goals, make interventions and reassess to see if its
working Choosing a Method
• Analgesics: opioid
• Analgesics: non-opioid
• Alternative therapies
• RN not writing orders but can make
suggestions Non-Opioid Analgesics
• NSIDS
o Aspirin, Aleve, Ibuprofen, Tylenol
▪ What are considerations for administration
o Given for mild-moderate pain or given with opioids when there is severe pain
o Can be administered: PO, IV, rectally
, o Side effects:
▪ Tylenol
• Hepatotoxicity risk
• Part of Percocet (pay attention to total dose)
▪ NSIDS:
• GI complications
• Renal toxicity
• Cardiovascular problems
• Administer with food and water
• Things to consider:
o What options do you have for non-opioid pain management
o When would you use these and why
o What are your nursing
considerations Opioid Analgesics
• Mu aganoist:
o Morphine and morphine like drugs
• Agonist antagonist
o Nalbuphine and buprenophine
o Interact with opioid receptor
• Antagonist:
o Bind same receptor but produce no effects
▪ Use to reverse effects of opioids
• GOAL:
o Improve maintain pain control and improve activity
▪ Keep pain level low so they can function
o When administering re-assess pain
o Consider leas invasive route and what will work best for pt to keep goals
• Adverse effects
o Constipation
o Respiratory depression
• Watch for sing of
o Withdrawal
o Tolerance
• Considerations:
o What options do you have for opioid pain management
o When would you use these and why
o What are your nursing considerations
• Physical Dependence
o Opioids over 2 weeks
o Not addiction
o When its stops there are withdrawal symptoms
o Needs to tapper off medication so it doesn’t happen drastically
• Tolerance
o Decreased effects of administration
• Addiction
o Disease
o Crave substance and take despite results
