NURSING 2349 Final Exam Study Guide 2023/2024

NURSING 2349 Final Exam Study Guide 2023/2024. How does age and gender affect responses to pain?  Children learn indirectly from their parents and caregivers how to respond to pain, as far as the level of pain that justifies a complaint, how to express pain, when to stop complaining about the pain and who to approach for help when experiencing pain.  *Socialization of children will influence the way they respond to pain as adults  About 80% of the elderly experience chronic, moderate to severe pain.  National Institutes of Health stated that women believe emotions of fear and anxiety effect their perception of pain adversely, whereas men focus more on the physical aspects.  Women are known to have a lower pain threshold and tolerance, and seek medical attention more frequently than men.  *Heart attacks are the number one threat to women – since they do not experience typical symptoms and type of pain, they are not hospitalized and treated as aggressively as men.  Women also experience more microvascular changes such as narrowing of the small coronary vessels.  Most prevalent painful disorders seen in both genders, but mainly women include fibromyalgia, Raynaud’s disease, rheumatoid arthritis, multiple sclerosis, headaches, facial pain, and TMJ.  Most prevalent painful disorders seen in both genders, but mainly men include pancreatitis, duodenal ulcer, and ankylosing spondylitis.  Men have a higher chance of injury related to sports and motor vehicle accidents. 2. What is intractable pain? Examples?  Pain that is refractory or resistant to some or all forms of treatment. o Pain due to a known cause - such as malignancy, nerve compression or entrapment, phantom limb pain, spinal cord damage, and myofascial syndromes - and is resistant to therapy is referred to as chronic intractable pain. o Incurable pain – goal is to reduce discomfort 3. What is Neuropathic pain? Example?  Pain that results from injury to a nerve, malfunction of neural transmission process, or impaired regulation. o Frequently described as paroxysmal (sudden spasm-like pain) o Examples: pain associated with trigeminal neuralgia, postherpetic neuralgia, and diabetic peripheral neuropathy 4. What is nociceptive pain? Examples?  Pain in response to potentially damaging stimuli o Occurs when the pain impulse is processed normally over intact nerves o Two types of nociceptive pain: somatic and visceral 5. What somatic pain? Examples?  Pain that originates from the bones, joints, muscles, skin, and connective tissue o In the skin and superficial structures - sharp, pulsatile, and well-localized o In the deep structures – dull, aching, pulsatile, not well localized o Examples: burns, lacerations, fractures, infections, inflammatory conditions, 6. What is visceral pain? Example?  Pain arising from the body organs or gastrointestinal tract o Intermittent, achy, crampy pain – poorly localized o Examples: Menstrual cramps, GI pain, appendicitis, gall stones, angina, bowel distention, pancreatitis 7. Describe referred pain? Example?  Transfer of visceral pain sensations and deep somatic pain through the autonomic nervous system to a part of the body distant from the actual origin of the pain o Pain felt in area other than where stimulus occurs o Example: myocardial infarction felt in the jaw or down the left arm 8. What is breakthrough pain? Examples?  A transitory increase in pain that occurs in addition to persistent pain o Commonly seen in advanced stages of cancer and late-stage diseases such as AIDS. o Acute "flare up" of pain in a patient who is on regular doses of pain medication for persistent pain. o Treated by "rescue" pain meds. These are quick acting meds that don't stay in the body long...e.g. quick release morphine. o *Think cancer pain 9. Know differences between acute and chronic pain, S/S, examples of each and treatment options of each.  Acute pain: usually short term and quick onset. Responds well to treatment. Can be a new flare up during chronic pain. o S/S: Increases systolic BP, increased HR and force of contraction, increased respirations, dilated blood vessels to brain, increased alertness, dilated pupils, rapid speech o Example: burn, muscle injury, fractured bone, surgical wound o Treatment: Acetaminophen, NSAIDs, Opioids, Adjuvants o *goal is to find and remove underlying cause  Chronic pain: Sudden or slow onset of mild to severe pain that is usually long term – typically slow onset. Poorly localized, hard to treat. Pain that lasts more than 6 months. o S/S: mild to severe pain that does not go away as expected after illness or injury, described as shooting, burning, aching, or electrical pain, discomfort, soreness, tightness, or stiffness. o Example: migraine headaches, sickle cell crisis, osteoarthritis, rheumatoid arthritis, cancer pain, fibromyalgia o Treatment: Physical therapy, occupational therapy, NSAIDs, nerve blocks, opioids, nonsteroidal anti-inflammatory drugs 10. Describe prolonged stress response and the cascade of harmful effects to the body system-wide.  Chronic stress that disrupts nearly every system in the body: o Suppress immune system o Upset digestive and reproductive systems o Increase risk of heart attack and stroke o Speeds up the aging process  Can cause psychiatric illnesses such as anxiety disorders, clinical depression, and PTSD  Prolonged stress can result in crisis and burnout (p. 259) o Crisis: an event that drastically changes the person’s routine that is perceived as a threat to self. Usual coping mechanisms are ineffective, resulting in anxiety and inability to function adequately. 5 phases of crisis: precrisis, impact, crisis, adaptive, postcrisis