N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
CHAPTER 14 PAIN
Understanding Pain
● Pain is individual and can be very different for different persons with the same disease or injury
● “Whatever the experiencing person says it is, existing whenever he or she says it does”
● “A subjective**, personal, unpleasant experience involving sensations and perceptions that may
or may not relate to bodily or tissue damage” Aronoff (2002)
Pain Classification
● Acute pain: rapid onset**, relatively short duration** and a sign of a new health problem
requiring diagnosis and analgesia
➢ Treat underlying cause—short-term analgesia
● Other types of pain
➢ Conditions such as conversion reaction*** or psychologic disorders***
Pain Assessment
● Cultural pain assessment****
ACUTE PAIN – HIGHER DOSE
CHRONIC – LOW AND SLOW TITRE UP
Pain is an individual experience
Pain intensity and pain distress are related to factors such as culture, past pain experiences, individual
attributes, and pain threshold
History and Physical Examination
Page 1 of 22
N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
,N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
● Address: the onset, location, duration, intensity, characteristics, aggravating and alleviating
factors, and self-treatment or other prescribed treatments that either helped or did not help
● P, Q, R, S, T, U (mnemonic***)
● PROVOKES
● QUALITY
● RADIATION
● SEVERITY
● TIME – HOW LONG?
● U - HOW DO U FEEL?
Additional Evaluations
● Evaluation for depression
● High incidence of depression associated with chronic pain
● Persistent depression** affects person’s ability to cope with pain,
● it must be treated
● Geriatric depression scale
The nurse has just started a hospital job where the majority of her patients are older adults. It is
important that the nurse remember which of the following regarding older adults and pain? (Select all
that apply.)
● a. They may have several chronic illnesses that cause them pain.
● b. They tend to overuse pain mediation.
● c. They believe pain is natural outcome of cancer.
● d. When they are confused, they may not respond pain in the usual way.
● e. They do not understand pain scales.
● Answers are a, c, d
Pharmacologic Treatment
● ***Nurses must be knowledgeable of the physiologic changes of aging that can alter drug
absorption, metabolism, and excretion in the older adult
Non-Opioid Analgesics
● First-line approach to pain management
● Acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve)
● IBUPROFEN = DAMAGE STOMACH**
● ACETAMINOPHEN = DAMAGE LIVER **
● Acetaminophen is drug of choice for musculoskeletal pain; does not affect platelet levels
● Maximum dosage is 4000 mg/24 hours
● **TX: CHARCOAL AND GASTRIC LAVAGE
Opioid Analgesic Side Effects
● Nausea, vomiting, constipation, and urinary retention***
● STOOL SOFTENER, HIGH FIBER DIET, WATER, INCREASE RISK FOR FALLS, CRANBERRY,
Adjuvant Medications
● Anticonvulsants, antidepressants, and some sedatives***
● Alter or modulate the perception of pain
Page 2 of 22
N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
, N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
Complementary and Alternative Medicine (CAM)
● Two subgroups
● Natural products: include herbals and botanicals, as well as vitamins and minerals
● Mind and body practices: include acupuncture, massage therapy, meditation,
movement therapies, relaxation techniques, spinal manipulation, tai chi, healing touch,
and yoga
Other Therapies
● Exercise and physical therapy prevent stiffness, maintain function, relieve muscle spasms, and
increase one’s sense of well-being
● Peripheral nerve stimulation is a chronic pain management technique in which electrical leads
are placed subcutaneously into the area of a person’s pain
● Music therapy
● Hypnosis
● Education
PAIN MEDS – LOOK FOR CONSTIPATION, RESP DEPRESSION, HYDRATION,
ADJUVENT MEDICATION – ADDED TO OTHER MEDS
NON-ANALGESICS USED TO TREAT PAIN, - ANTIDEPRESSANTS/ANTICONVULSANTS***. SOMETIME
SEDATIVES (AND ANTIANXIETY)
CHAPTER 15 – INFECTION
Chain of Infection
s For infection to occur, there must be a
s reservoir of an infectious disease,
s A PORTAL OF ENTRY***
s susceptible HOST**
s NOSOCOMIAL infections: acquired in the hospital
s COMMUNITY ACQUIRED: acquired outside the healthcare facility
Age-Related Changes in the Immune System
s As age increases, so does production of auto antibodies
s Increased auto antibodies causes an increase in autoimmune disease***
s Skin becomes more fragile and prone to breakdown or abrasion***
s INCREASE LIKELIHOOD OF INFECTION
Factors Affecting Immunocompetence
s Protein-energy (caloric) malnutrition***
s Deprivation of protein and energy nutrients*** has been shown to result in alteration
in immune function
s Psychosocial factors***
s Chronic and acute stress, depression, bereavement, and social relationships
s Risks associated with the development of a nosocomial infection include poor nutrition,
unintentional weight loss, low serum albumin levels, decreased fluid intake, poor oral hygiene,
and altered mental status
s Factors contributing to inadequate nutrition include altered taste, social isolation, physical
inability to prepare food, altered absorption, and poverty
Page 3 of 22
N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
CHAPTER 14 PAIN
Understanding Pain
● Pain is individual and can be very different for different persons with the same disease or injury
● “Whatever the experiencing person says it is, existing whenever he or she says it does”
● “A subjective**, personal, unpleasant experience involving sensations and perceptions that may
or may not relate to bodily or tissue damage” Aronoff (2002)
Pain Classification
● Acute pain: rapid onset**, relatively short duration** and a sign of a new health problem
requiring diagnosis and analgesia
➢ Treat underlying cause—short-term analgesia
● Other types of pain
➢ Conditions such as conversion reaction*** or psychologic disorders***
Pain Assessment
● Cultural pain assessment****
ACUTE PAIN – HIGHER DOSE
CHRONIC – LOW AND SLOW TITRE UP
Pain is an individual experience
Pain intensity and pain distress are related to factors such as culture, past pain experiences, individual
attributes, and pain threshold
History and Physical Examination
Page 1 of 22
N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
,N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
● Address: the onset, location, duration, intensity, characteristics, aggravating and alleviating
factors, and self-treatment or other prescribed treatments that either helped or did not help
● P, Q, R, S, T, U (mnemonic***)
● PROVOKES
● QUALITY
● RADIATION
● SEVERITY
● TIME – HOW LONG?
● U - HOW DO U FEEL?
Additional Evaluations
● Evaluation for depression
● High incidence of depression associated with chronic pain
● Persistent depression** affects person’s ability to cope with pain,
● it must be treated
● Geriatric depression scale
The nurse has just started a hospital job where the majority of her patients are older adults. It is
important that the nurse remember which of the following regarding older adults and pain? (Select all
that apply.)
● a. They may have several chronic illnesses that cause them pain.
● b. They tend to overuse pain mediation.
● c. They believe pain is natural outcome of cancer.
● d. When they are confused, they may not respond pain in the usual way.
● e. They do not understand pain scales.
● Answers are a, c, d
Pharmacologic Treatment
● ***Nurses must be knowledgeable of the physiologic changes of aging that can alter drug
absorption, metabolism, and excretion in the older adult
Non-Opioid Analgesics
● First-line approach to pain management
● Acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve)
● IBUPROFEN = DAMAGE STOMACH**
● ACETAMINOPHEN = DAMAGE LIVER **
● Acetaminophen is drug of choice for musculoskeletal pain; does not affect platelet levels
● Maximum dosage is 4000 mg/24 hours
● **TX: CHARCOAL AND GASTRIC LAVAGE
Opioid Analgesic Side Effects
● Nausea, vomiting, constipation, and urinary retention***
● STOOL SOFTENER, HIGH FIBER DIET, WATER, INCREASE RISK FOR FALLS, CRANBERRY,
Adjuvant Medications
● Anticonvulsants, antidepressants, and some sedatives***
● Alter or modulate the perception of pain
Page 2 of 22
N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
, N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
Complementary and Alternative Medicine (CAM)
● Two subgroups
● Natural products: include herbals and botanicals, as well as vitamins and minerals
● Mind and body practices: include acupuncture, massage therapy, meditation,
movement therapies, relaxation techniques, spinal manipulation, tai chi, healing touch,
and yoga
Other Therapies
● Exercise and physical therapy prevent stiffness, maintain function, relieve muscle spasms, and
increase one’s sense of well-being
● Peripheral nerve stimulation is a chronic pain management technique in which electrical leads
are placed subcutaneously into the area of a person’s pain
● Music therapy
● Hypnosis
● Education
PAIN MEDS – LOOK FOR CONSTIPATION, RESP DEPRESSION, HYDRATION,
ADJUVENT MEDICATION – ADDED TO OTHER MEDS
NON-ANALGESICS USED TO TREAT PAIN, - ANTIDEPRESSANTS/ANTICONVULSANTS***. SOMETIME
SEDATIVES (AND ANTIANXIETY)
CHAPTER 15 – INFECTION
Chain of Infection
s For infection to occur, there must be a
s reservoir of an infectious disease,
s A PORTAL OF ENTRY***
s susceptible HOST**
s NOSOCOMIAL infections: acquired in the hospital
s COMMUNITY ACQUIRED: acquired outside the healthcare facility
Age-Related Changes in the Immune System
s As age increases, so does production of auto antibodies
s Increased auto antibodies causes an increase in autoimmune disease***
s Skin becomes more fragile and prone to breakdown or abrasion***
s INCREASE LIKELIHOOD OF INFECTION
Factors Affecting Immunocompetence
s Protein-energy (caloric) malnutrition***
s Deprivation of protein and energy nutrients*** has been shown to result in alteration
in immune function
s Psychosocial factors***
s Chronic and acute stress, depression, bereavement, and social relationships
s Risks associated with the development of a nosocomial infection include poor nutrition,
unintentional weight loss, low serum albumin levels, decreased fluid intake, poor oral hygiene,
and altered mental status
s Factors contributing to inadequate nutrition include altered taste, social isolation, physical
inability to prepare food, altered absorption, and poverty
Page 3 of 22
N212 GERO Final Exam Study Guide: Key Concepts in Pain Management
