NUR 170 Exam 4 Study Guide
• What are the different types of pain scale?
The 0 to 10 Numeric Rating Scale (NRS)
Wong-Baker FACES Pain Rating Scale
• What would you expect to see with a patient who has chronic vs acute
pain?
Acute: Sudden onset, short-term
• Usually linked to a specific injury or condition (e.g., surgery, trauma)
↑ heart rate, ↑ blood pressure, ↑ respiratory rate, crying, guarding, moaning,
grimacing avoiding movement, favoring injured area, Chronic:
• Persistent pain lasting more than 3 to 6 months
• May or may not have an identifiable cause (e.g., arthritis, neuropathy, back pain)
• Vital signs often normal (body adapts over time)
• Flat affect or depression, withdrawal, fatigue
• Limited movement or stiffness over time
• Irritability, sleep disturbances
• May appear to function despite pain (e.g., walking, working)
• Pain may be harder to localize or describe clearly
What types of medications are appropriate to administer based on the pain rate?
Mild Pain (1–3/10)
Medication Type:
, • Non-opioid analgesics
Examples:
• Acetaminophen (Tylenol)
• NSAIDs: Ibuprofen, Naproxen (if no contraindications)
Considerations:
• Often first-line treatment
• Monitor for liver (acetaminophen) or kidney/GI effects (NSAIDs)
🔹 Moderate Pain (4–6/10)
Medication Type:
• Weak opioids ± Non-opioid analgesics
• Combination medications
Examples:
• Tramadol
• Hydrocodone/acetaminophen (Norco)
• Oxycodone/acetaminophen (Percocet)
• NSAIDs may be used adjunctively
Considerations:
• Monitor for sedation, constipation, and respiratory effects Combination meds
reduce total opioid dose needed
🔹 Severe Pain (7–10/10)
Medication Type:
• Strong opioids, often IV or oral
Examples:
, • Morphine
• Hydromorphone (Dilaudid)
• Fentanyl
• Oxycodone (higher doses)
Considerations:
• Assess for opioid tolerance, respiratory status
• What are some of the common side effects do pain medications have on
the body? What are the adverse effects? What would you monitor?
Non-Opioid Analgesics (e.g., Acetaminophen, NSAIDs)
• Acetaminophen:
o Side effects: Nausea, rash (rare)
o Monitor: Liver function (ALT, AST), max dose = 4,000 mg/day NSAIDs
(Ibuprofen, Naproxen):
o Side effects: GI upset, dizziness, headache o Monitor: Kidney function (BUN,
creatinine), GI bleeding signs, blood pressure
Opioid Analgesics (e.g., Morphine, Oxycodone, Hydromorphone)
• Common side effects: o Constipation o Sedation o Nausea/Vomiting o Dry mouth
o Itching (pruritus)
• Monitor:
o Respiratory rate o Level of consciousness o Bowel function o Pain score and
relief o Vitals and oxygen saturation
⚠️ Adverse Effects of Pain Medications
Non-Opioids
• Acetaminophen: Hepatotoxicity (especially with overdose or alcohol use)
• NSAIDs:
o GI bleeding/ulcer o Renal failure
o Hypertension
o Cardiovascular risk (MI, stroke with long-term use)
, Opioids
• Respiratory depression (RR <12/min is critical)
• Hypotension
• Severe sedation/unresponsiveness
• Urinary retention
• Allergic reaction or anaphylaxis (rare)
• Physical dependence/tolerance with long-term use
• 🩺 What Would You Monitor?
Assessment Focus What to Monitor
Pain relief Reassess pain score within 30–60 min after admin
Respiratory status RR, SpO₂, sedation level (especially with opioids)
GI function Nausea, vomiting, bowel movements (for constipation)
Vital signs BP, HR, RR before and after admin
LOC/Sedation Alertness, confusion, risk of falls
Liver & kidney labs ALT, AST (acetaminophen); BUN, creatinine (NSAIDs)
Allergic responses Rash, itching, anaphylaxis signs
Nursing Intervention
• Encourage fluid and fiber intake with opioids
• Administer stool softeners (e.g., docusate) or laxatives if needed
• Use lowest effective dose for shortest duration
• Educate patient on reporting dizziness, difficulty breathing, or confusion
What are other methods of treating pain?
• Heat therapy: Improves circulation, reduces stiffness (e.g., heating pad for muscle pain)
• Cold therapy: Reduces inflammation, numbs sharp pain (e.g., ice packs for sprains)
• Massage therapy: Reduces muscle tension and promotes relaxation
• Physical therapy/exercise: Strengthens muscles, improves mobility, and reduces pain
perception
• Positioning: Alleviates pressure and improves comfort, especially for surgical or
bedridden patients
• What are the different types of pain scale?
The 0 to 10 Numeric Rating Scale (NRS)
Wong-Baker FACES Pain Rating Scale
• What would you expect to see with a patient who has chronic vs acute
pain?
Acute: Sudden onset, short-term
• Usually linked to a specific injury or condition (e.g., surgery, trauma)
↑ heart rate, ↑ blood pressure, ↑ respiratory rate, crying, guarding, moaning,
grimacing avoiding movement, favoring injured area, Chronic:
• Persistent pain lasting more than 3 to 6 months
• May or may not have an identifiable cause (e.g., arthritis, neuropathy, back pain)
• Vital signs often normal (body adapts over time)
• Flat affect or depression, withdrawal, fatigue
• Limited movement or stiffness over time
• Irritability, sleep disturbances
• May appear to function despite pain (e.g., walking, working)
• Pain may be harder to localize or describe clearly
What types of medications are appropriate to administer based on the pain rate?
Mild Pain (1–3/10)
Medication Type:
, • Non-opioid analgesics
Examples:
• Acetaminophen (Tylenol)
• NSAIDs: Ibuprofen, Naproxen (if no contraindications)
Considerations:
• Often first-line treatment
• Monitor for liver (acetaminophen) or kidney/GI effects (NSAIDs)
🔹 Moderate Pain (4–6/10)
Medication Type:
• Weak opioids ± Non-opioid analgesics
• Combination medications
Examples:
• Tramadol
• Hydrocodone/acetaminophen (Norco)
• Oxycodone/acetaminophen (Percocet)
• NSAIDs may be used adjunctively
Considerations:
• Monitor for sedation, constipation, and respiratory effects Combination meds
reduce total opioid dose needed
🔹 Severe Pain (7–10/10)
Medication Type:
• Strong opioids, often IV or oral
Examples:
, • Morphine
• Hydromorphone (Dilaudid)
• Fentanyl
• Oxycodone (higher doses)
Considerations:
• Assess for opioid tolerance, respiratory status
• What are some of the common side effects do pain medications have on
the body? What are the adverse effects? What would you monitor?
Non-Opioid Analgesics (e.g., Acetaminophen, NSAIDs)
• Acetaminophen:
o Side effects: Nausea, rash (rare)
o Monitor: Liver function (ALT, AST), max dose = 4,000 mg/day NSAIDs
(Ibuprofen, Naproxen):
o Side effects: GI upset, dizziness, headache o Monitor: Kidney function (BUN,
creatinine), GI bleeding signs, blood pressure
Opioid Analgesics (e.g., Morphine, Oxycodone, Hydromorphone)
• Common side effects: o Constipation o Sedation o Nausea/Vomiting o Dry mouth
o Itching (pruritus)
• Monitor:
o Respiratory rate o Level of consciousness o Bowel function o Pain score and
relief o Vitals and oxygen saturation
⚠️ Adverse Effects of Pain Medications
Non-Opioids
• Acetaminophen: Hepatotoxicity (especially with overdose or alcohol use)
• NSAIDs:
o GI bleeding/ulcer o Renal failure
o Hypertension
o Cardiovascular risk (MI, stroke with long-term use)
, Opioids
• Respiratory depression (RR <12/min is critical)
• Hypotension
• Severe sedation/unresponsiveness
• Urinary retention
• Allergic reaction or anaphylaxis (rare)
• Physical dependence/tolerance with long-term use
• 🩺 What Would You Monitor?
Assessment Focus What to Monitor
Pain relief Reassess pain score within 30–60 min after admin
Respiratory status RR, SpO₂, sedation level (especially with opioids)
GI function Nausea, vomiting, bowel movements (for constipation)
Vital signs BP, HR, RR before and after admin
LOC/Sedation Alertness, confusion, risk of falls
Liver & kidney labs ALT, AST (acetaminophen); BUN, creatinine (NSAIDs)
Allergic responses Rash, itching, anaphylaxis signs
Nursing Intervention
• Encourage fluid and fiber intake with opioids
• Administer stool softeners (e.g., docusate) or laxatives if needed
• Use lowest effective dose for shortest duration
• Educate patient on reporting dizziness, difficulty breathing, or confusion
What are other methods of treating pain?
• Heat therapy: Improves circulation, reduces stiffness (e.g., heating pad for muscle pain)
• Cold therapy: Reduces inflammation, numbs sharp pain (e.g., ice packs for sprains)
• Massage therapy: Reduces muscle tension and promotes relaxation
• Physical therapy/exercise: Strengthens muscles, improves mobility, and reduces pain
perception
• Positioning: Alleviates pressure and improves comfort, especially for surgical or
bedridden patients
