Nursing 1110 - Final Exam (Comfort) UPDATED ACTUAL
Questions and CORRECT Answers
Types of pain Nociceptive: Nociceptive pain is a normal, protective mechanism to alert the
brain to potential or actual tissue damage. Brain receives input from the
somatosensory pain receptors and interprets that information as an unpleasant,
painful sensation.
- Somatic: comes from bone, joint, muscle, skin, or CT - usually
ACHING/THROBBING px, localized
- Visceral: arises from organs - may cause referred px
Ex: pain from sunburn, broken bone, appendicitis
Neuropathic: results from a pathology or disease of the somatosensory system -
abnormal processing of sensory input by the peripheral nervous system or central
nervous system - BURNING/SHARP/SHOOTING px.
Ex: Diabetic/other neuropathies, phantom limb px, complex regional pain
syndrome (CRPS), Guillan Burre, nerve damage/neuralgias
Mixed: mix of nociceptive and neuropathic pain, acute and chronic pain, etc.
Patient goals: Acute v. Chronic pain Acute: treat aggressively to prevent chronic pain from developing. Should report
pain as close to 0 as possible on scale from 1/10 - reduce pain to tolerable level.
Chronic: may not be able to get pain level down to 0, but get to manageable level
to perform desired ADLs
Delegation: pain management Can NOT delegate a pain assessment - CAN screen/observe pt for px
Non-pharm tx can be delegated (massage, guided imagery, distraction, TENS,
hot/cold compress, exercise, repositioning)
Elements of pain assessment •Patient self-report of pain *MOST ACCURATE
-Location
-Intensity
-Quality
-Onset and duration
-Associated symptoms
-Aggregating or relieving factors
-Effect of pain on quality of life and functional status
-Comfort and function goal
P: palliative of provocative factors (what makes pain better or worse)
Q: quality (what does the pain feel like)
R: relief measures (what have you taken in the past that relieves pain/what makes
pain go away)
R: region (where is the pain located)
S: severity (pain scale, worst pain v. average pain)
T: timing (is pain constant or transient)
U: effect of pain (ADLs, what can't you do because of pain, do you have anyone
to help when you have pain)
, Reactions to pain Physiologic:
• Sympathetic Stimulation
-Increased respiratory rate
-Increased heart rate
-Increased blood pressure
-Increased blood glucose level
-Diaphoresis
-Increased muscle tension
-Dilation of pupils
-Decreased GI motility
• Parasympathetic Stimulation
-Pallor, Muscle tension, Decreased HR and BP, Irregular breathing, Nausea &
Vomiting
Behavioral:
• Facial expressions
• Restlessness
• Change in activity
• Crying
Pharmacologic Pain Management Opioid: moderate/severe pain
- morphine, oxycodone, codeine, fentanyl
Non-Opioid: moderate/mild pain
- acetaminophen (Tylenol), NSAIDS (aspirin, IB (Advil), naproxen
Adjuvants: meds not specifically designed for pain, but have pain mgt properties -
medications that enhance analgesics or have analgesic properties
- anticonvulsants, antidepressants, antipsychotics, baclofen, benzos
Questions and CORRECT Answers
Types of pain Nociceptive: Nociceptive pain is a normal, protective mechanism to alert the
brain to potential or actual tissue damage. Brain receives input from the
somatosensory pain receptors and interprets that information as an unpleasant,
painful sensation.
- Somatic: comes from bone, joint, muscle, skin, or CT - usually
ACHING/THROBBING px, localized
- Visceral: arises from organs - may cause referred px
Ex: pain from sunburn, broken bone, appendicitis
Neuropathic: results from a pathology or disease of the somatosensory system -
abnormal processing of sensory input by the peripheral nervous system or central
nervous system - BURNING/SHARP/SHOOTING px.
Ex: Diabetic/other neuropathies, phantom limb px, complex regional pain
syndrome (CRPS), Guillan Burre, nerve damage/neuralgias
Mixed: mix of nociceptive and neuropathic pain, acute and chronic pain, etc.
Patient goals: Acute v. Chronic pain Acute: treat aggressively to prevent chronic pain from developing. Should report
pain as close to 0 as possible on scale from 1/10 - reduce pain to tolerable level.
Chronic: may not be able to get pain level down to 0, but get to manageable level
to perform desired ADLs
Delegation: pain management Can NOT delegate a pain assessment - CAN screen/observe pt for px
Non-pharm tx can be delegated (massage, guided imagery, distraction, TENS,
hot/cold compress, exercise, repositioning)
Elements of pain assessment •Patient self-report of pain *MOST ACCURATE
-Location
-Intensity
-Quality
-Onset and duration
-Associated symptoms
-Aggregating or relieving factors
-Effect of pain on quality of life and functional status
-Comfort and function goal
P: palliative of provocative factors (what makes pain better or worse)
Q: quality (what does the pain feel like)
R: relief measures (what have you taken in the past that relieves pain/what makes
pain go away)
R: region (where is the pain located)
S: severity (pain scale, worst pain v. average pain)
T: timing (is pain constant or transient)
U: effect of pain (ADLs, what can't you do because of pain, do you have anyone
to help when you have pain)
, Reactions to pain Physiologic:
• Sympathetic Stimulation
-Increased respiratory rate
-Increased heart rate
-Increased blood pressure
-Increased blood glucose level
-Diaphoresis
-Increased muscle tension
-Dilation of pupils
-Decreased GI motility
• Parasympathetic Stimulation
-Pallor, Muscle tension, Decreased HR and BP, Irregular breathing, Nausea &
Vomiting
Behavioral:
• Facial expressions
• Restlessness
• Change in activity
• Crying
Pharmacologic Pain Management Opioid: moderate/severe pain
- morphine, oxycodone, codeine, fentanyl
Non-Opioid: moderate/mild pain
- acetaminophen (Tylenol), NSAIDS (aspirin, IB (Advil), naproxen
Adjuvants: meds not specifically designed for pain, but have pain mgt properties -
medications that enhance analgesics or have analgesic properties
- anticonvulsants, antidepressants, antipsychotics, baclofen, benzos
