PAIN MANAGEMENT NURSING Exam 187 Questions with Verified Answers,100% CORRECT

PAIN MANAGEMENT NURSING Exam 187 Questions with Verified Answers Pain - CORRECT ANSWER An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Types of pain - CORRECT ANSWER Acute Pain Chronic Pain Cancer - Related Pain Acute pain - CORRECT ANSWER •Injury - pain(split second to 6 mos.) ,subsides as healing occurs Acute Pain (2) - CORRECT ANSWER REPORTED •TREATMENT NEEDED - crying - rubbing area - holding area - focusing on the pain - guarding the painful part Increased HR, RR, BP Diaphoresis Dilated pupils Chronic pain - CORRECT ANSWER Persists long after injury has healed. lasts 6 months or longer pain often absent and is reported unless asked Appearance of Pt with Acute Pain - CORRECT ANSWER Client's appearance: Anxious Appears restless Appetite is decreased Mobility is decreased Appearance of Pt with Chronic Pain - CORRECT ANSWER Client's appearance: Depressed Fatigue Irritable his weight changes Social withdrawn Quality of Life Activities Affected by Chronic pain - CORRECT ANSWER •Concentrating •Having sex •Exercising •Sleeping •Socializing •Walking •Working around the house •Working a full day at employment •Enjoying hobbies and leisure time •Caring for children •Maintaining relationships with family and friends Cancer Pain - CORRECT ANSWER pain associated with cancer and its treatment which may be acute or chronic. CATEGORIES OF PAIN IN TERMS OF LOCATION - CORRECT ANSWER •VISCERAL PAIN •REFERRED PAIN Visceral Pain - CORRECT ANSWER arises from internal organs that are diseased or injured Compression of an organ (tumor) Contraction (spasm) like in gallbladder or kidney stones, or muscle spasms. Referred Pain - CORRECT ANSWER pain radiates CATEGORIES OF PAIN IN TERMS OF ETIOLOGY - CORRECT ANSWER PHYSIOLOGICAL PAIN NEUROPATHIC PAIN Types of PHYSIOLOGICAL PAIN - CORRECT ANSWER 1.Somatic pain- skin, muscles, bones a. Superficial (Cutaneous) pain b. Deeper somatic pain 2. Visceral pain Types of NEUROPATHIC PAIN - CORRECT ANSWER 1.Peripheral Neuropathic pain 2. Central Neuropathic pain 3. Sympathetically maintained pain Superficial somatic pain (cutaneous pain) - CORRECT ANSWER is perceived as sharp or burning pain Example: •insect bite a paper cut in the finger Deeper somatic pain - CORRECT ANSWER sharp, throbbing and intense Example: •an ankle sprain •a fracture •arthritis Visceral Pain (physiological) - CORRECT ANSWER results from activation of pain receptors in the organs and/or hollow viscera Neuropathic Pain - CORRECT ANSWER damage or malfunctioning nerves •is an inflammatory disorder (repetitive stress, physical injury) Phantom pain - Phantom Limb Pain (PLP) - CORRECT ANSWER 60 to 80% individuals experienced this - breast amputation - extraction of a tooth (phantom tooth pain) - eye removal (phantom eye syndrome) CARPAL TUNNEL SYNDROME - CORRECT ANSWER pain, numbness, paresthesia and weakness of the median nerve Assessment: Phalen's Test- hold the wrist in acute flexion for 60 seconds -Numbness and burning in the fingers(+) TINEL'S TEST Pain, numbness and tingling when percussing lightly over the median nerve is positive for CTS Medical transcriptionist Pianist Secretary Computer programmer Phalen's Test - CORRECT ANSWER hold the wrist in acute flexion for 60 seconds -Numbness and burning in the fingers(+) TINEL'S TEST - CORRECT ANSWER Pain, numbness and tingling when percussing lightly over the median nerve is positive for CTS Central Neurophatic Pain - CORRECT ANSWER results from malfunctioning nerves in the CNS. Examples: a. Spinal cord injury pain b. Post stroke pain c. Multiple sclerosis pain POST STROKE PAIN - Local Pain - CORRECT ANSWER (mechanical) pain is usually felt in the joints. ex,. Shoulder pain POST STROKE PAIN - Central Pain - CORRECT ANSWER is described as constant, moderate, or severe pain caused by damage to the brain Nerve pain (neuropathic pain) - CORRECT ANSWER which is caused by damage to the nerves in the brain and spinal cord. This includes altered sensations such as pins and needles, numbness, crawling or burning feelings. Musculoskeletal (nociceptive) pain - CORRECT ANSWER which is caused by damage to muscles, tendons, ligaments and soft tissue Sympathetically maintained pain - CORRECT ANSWER inflammatory reaction (neurotransmitters) sensitization of other pain fibers vasodilation and edema GATE CONTROL THEORY - CORRECT ANSWER the spinal cord contains a neurological "gate" that blocks pain signals or allows them to pass on to the brain CONDITIONS THAT OPEN THE GATE - CORRECT ANSWER Physical conditions: -Extent of injury -Inappropriate activity level Emotional conditions: -Anxiety or worry -Tension -Depression Mental Conditions: -Focusing on pain -Boredom CONDITIONS THAT CLOSE THE GATE - CORRECT ANSWER Physical conditions -Medication -Counter stimulation (e.g., heat and/or massage) Emotional conditions -Positive emotions (e.g., happiness and/or optimism) -Relaxation -Rest Mental conditions -Intense concentration or distraction -Involvement and interest in life activities PHASES OF PAIN TRANSMISSION - CORRECT ANSWER transduction, transmission, perception, modulation transduction of pain - CORRECT ANSWER Noxious stimuli causes cell damage with the release of sensitizing chemicals - Prostaglandins -Bradykinin -Serotonin -Substance P -Histamine These substances activate nociceptors and lead to generation of action potential A-delta fibers - CORRECT ANSWER small myelinated fast pain (0.1 sec.) sharp,pricking,electrical pain C fibers - CORRECT ANSWER large unmyelinated second pain - slowly, burning, aching, throbbing pain Transmission of pain - CORRECT ANSWER Action potential continues from site of injury -- spinal cord -- brainstem & thalamus -- cortex for processing Activates the pain Pain control can be made through - CORRECT ANSWER opioids (narcotic analgesics)- block the release of neurotransmitters, particularly Substance P, which stops the pain at the spinal level Perception of pain - CORRECT ANSWER conscious experience of pain PHYSIOLOGY OF PAIN - CORRECT ANSWER Stimuli → Nerve fibers (nociceptors) → A-delta & C-fibers → Spinal cord (substantia Gelatinosa) → Thalamus (center for awareness of pain) → Cerebral cortex (center for interpretation of pain) → Response → Pain Threshold and Pain Tolerance Modulation of pain - CORRECT ANSWER neurons originating in the brainstem descend to the spinal cord and release substances (endogenous opioids) that inhibit nociceptive impulses HUMOR - CORRECT ANSWER ↑ endogenous opiods (ENDORPHINS) 3 Groups of Endogenous Substances - CORRECT ANSWER enkephalins, endorphins, dynorphins Enkephalins - CORRECT ANSWER stimulates delta receptor Endorphins - CORRECT ANSWER reduces pain & positively affects mood. Dynorphins - CORRECT ANSWER stimulates the kappa- receptor Endogenous Substances - CORRECT ANSWER All 3 have opioid-like action and are found in the body. They are naturally occurring peptides that possess analgesic action and addiction potential Other endogenous opiods - CORRECT ANSWER serotonin epinephrine serotonin - CORRECT ANSWER ("mood neurotransmitter) - maintains the "happy feeling" .It calms anxiety, relieves feelings of depression and helps us to have a good night's sleep epinephrine - CORRECT ANSWER it rapidly prepares the body for action in emergency situations COGNITIVE PROCESSES - CORRECT ANSWER may stimulate endorphin production in the descending control system Massage, Distraction (TV & visitors) and placebo - CORRECT ANSWER increases the activity in the descending system Hyperalgesia - CORRECT ANSWER excessive sensitivity to pain Intractable Pain - CORRECT ANSWER is pain that is highly resistant to relief or cure Examples: pain from trigeminal neuralgia, cervical cancer Psychogenic Pain - CORRECT ANSWER is primarily due to emotional factors, with no physiologic basis. Neuropathic pain (2) - CORRECT ANSWER pain that is related to damage or malfunctioning nervous tissue in the peripheral and/or CNS HERNIATED INTERVERTEBRAL DISK - CORRECT ANSWER •condition in which the central part of the intervertebral disc protrudes into the spinal canal •Compression of spinal nerve roots Causes: •Lifting from a bent over position •Degeneration and dehydration of cartilage with degenerative joint disease •Cumulative effects of years of wear and tear •Falls and motor vehicle accidents are less common causes FACTORS INFLUENCING PAIN - CORRECT ANSWER Past experience Anxiety Depression Culture Age Sex Past pain experience - CORRECT ANSWER previous pain experience alter a client's sensitivity to pain If client refuses pain medication - encourage expression of fears on past experiences Anxiety - CORRECT ANSWER concerns and fears about the underlying disease Depression - CORRECT ANSWER chronic pain and unrelieved cancer pain Meaning of Pain - CORRECT ANSWER accept pain (circumstances and interpretation of its significance) Positive outcome - may withstand the pain amazingly well. Example: Giving birth to a child Athlete undergoing knee surgery to prolong his career. Ethnic and Cultural Values - CORRECT ANSWER beliefs about pain and how to respond to it differ from one culture to the next •Socially acceptable or unacceptable. Avoid stereotyping ,provide individualized care Puerto Ricans - CORRECT ANSWER loud and spoken in their expression of pain African Americans - CORRECT ANSWER pain & suffering is a part of life and is to be endured. - deny or avoid dealing with pain till it becomes unbearable Mexican Americans - CORRECT ANSWER - pain is a part of life - pain indicates seriousness of an illness. - enduring pain is a sign of strength Chinese culture - CORRECT ANSWER values silence. - Quiet when in pain → do not want to cause dishonour to themselves and their family Japanese - CORRECT ANSWER stoic (minimal and nonverbal expressions) response to pain. May even refuse pain medication Filipino - CORRECT ANSWER believe that pain is " God's will". Some elderly client may refuse pain medication Native Americans - CORRECT ANSWER - Quiet, less expressive, may tolerate high level of pain. - may not request pain medication - may tolerate pain until they are physically disabled. Arab Americans - CORRECT ANSWER Pain responses: - considered private - reserve for immediate family, not with health professionals. Italians - CORRECT ANSWER voicing pain is considered acceptable Gender - women - CORRECT ANSWER have higher pain intensity and fear Placebo Effect - CORRECT ANSWER response to the medication /treatment because of an expectation that the treatment will work uses saline solution or a starch tablet - produces an effect similar to a prescribed drug Environment and Support people - CORRECT ANSWER - hospital, with its noises, lights and activity, can compound pain. - Lonely persons (without a support network) may perceive pain as severe Age (older people) - CORRECT ANSWER small doses of analgesic agents may be sufficient to relieve pain have slower metabolism have a greater ratio of body fat to muscle mass sensitive to drugs - careful assessment Two Major components of pain assessment - CORRECT ANSWER 1. Pain History 2. Direct observation of behaviours, physical signs of tissue damage and secondary physiologic responses of the client. WHY MEASURE PAIN? - CORRECT ANSWER •For documentation •Produces a baseline to assess therapeutic interventions. •Facilitates communication between staff looking at the patient FLACC Scale- - CORRECT ANSWER face, legs, activity, cry, consolability for preverbal or nonverbal children from infancy to 7 years For cognitively impaired person (ICU) BRAILLE ALPHABET - CORRECT ANSWER SENSORY IMPAIRED NON-PHARMACOLOGIC INTERVENTIONS FOR PAIN - CORRECT ANSWER Sleep, Massage, Thermal Therapy, SLEEP - CORRECT ANSWER •Rest increases pain tolerance and improves response to analgesia •Keep sleep interruptions to a minimum THERMAL THERAPY - CORRECT ANSWER •Stimulate the non-pain receptors in the same receptor field as the injury. 1. Ice therapy 2. Heat therapy •As a general rule, apply ice - new injuries heat - older, long-standing problems Ice therapy - CORRECT ANSWER placed in the injury site immediately after injury or surgery. reduces localized swelling through vasoconstriction •Avoid - compromised circulation. •Apply - no longer than 15 to 20 min at a time - no more frequent than once an hour. • Nerve injury and fb may result when used longer. FROSTBITE - CORRECT ANSWER •Prolonged exposure to cold. •Damage to the blood vessels •May necessitate amputation of the affected area. Heat therapy - CORRECT ANSWER •Soothing and promotes vasodilation of the area •Increases the blood flow to an area and helps reduce pain by speeding healing. compress and packs - used in 15 to 20 min. always check temp before application Not used in areas: with impaired circulation with impaired sensation painful area that is the site of acute untreated infection Transcutaneous Electrical Nerve Stimulation - CORRECT ANSWER •Acute pain (e.g. post-op pain) •Chronic pain (e.g. chronic low back pain) • Battery operated • Electrodes applied to the skin •Client can adjust both voltage and pulsation TENS - CORRECT ANSWER •Mechanism based on GATE CONTROL THEORY: •Electric signals: -block pain signals before they reach the brain TENS Nursing Responsibilities - CORRECT ANSWER Do not place electrodes over Broken skin - hemorrhage Incision site - hemorrhage Carotid sinus - cardiac problems Eyes - increase intraocular pressure Pharyngeal or laryngeal muscles - laryngeal spasm Uterus of pregnant women - uterine contraction Skin with diminished sensation - skin irritation Do not use in client with cardiac pacemaker. Check for redness (more than 30 minutes) - reposition DISTRACTION - CORRECT ANSWER •Any activity that takes a person attention away from the pain VISUAL - CORRECT ANSWER Watching a basketball game or a boxing match •TACTILE - CORRECT ANSWER Massage Holding or stroking a pet or toy Intellectual - CORRECT ANSWER Hobbies -story writing Card games Crossword puzzles Sudoku Scrabble Word factory Chess Relaxation Techniques - CORRECT ANSWER •a.k.a "tension release" •Conscious relaxation of muscle groups. •Abdominal breathing at a slow, rhythmic rate. Guided imagery - CORRECT ANSWER It is a combination of slow, rhythmic breathing with a mental image of relaxation and comfort. FAVORITE VACATION SETTING HYPNOSIS - CORRECT ANSWER •During hypnosis, your body relaxes and your thoughts become more focused. • It lowers blood pressure and heart rate, and changes certain types of brain wave activity. Music therapy - CORRECT ANSWER reduces pain and anxiety AROMATHERAPY - CORRECT ANSWER means "treatment using scents". Essential oils - CORRECT ANSWER •added to the bath or massaged into the skin, inhaled directly or diffused to scent an entire room. alleviate tension and fatigue invigorate the entire body Thai Massage - CORRECT ANSWER (lazy man's yoga) - incorporates stretching and smooth flowing massage strokes to stimulate circulation and flexibility ACUPRESSURE - CORRECT ANSWER Finger pressure is applied on different 'pressure points' on the body, stimulating the corresponding glands of the body. Seated Acupressure Massage - CORRECT ANSWER is based on a traditional form of Japanese massage call "ANMA", which means press and rub. It works on the muscular, circulation and nervous systems, stimulating over 60 specific pressure points on the head, neck, shoulders, back and arms Acupuncture - CORRECT ANSWER A Chinese technique of pain control by insertion of fine needles at specific points on the body . Needle insertion activates production of endorphins. Biofeedback - CORRECT ANSWER •Uses a machine that uses electrodes attached to the skin to measure the degree of muscular tension The machine has • color lights that change (red to yellow to green) - VISUAL DISPLAY •Audible tone that change from high pitch to lower as the patient relaxes - AUDITORY DISPLAY Magnetic therapy - CORRECT ANSWER when placed on or near the body to relieve pain and facilitate healing PHARMACOLOGIC INTERVENTIONS - CORRECT ANSWER ANESTHETIC AGENTS NONOPIOID ANALGESICS OPIOID ANALGESICS Regional anesthesia - CORRECT ANSWER •Depresses superficial nerves and interfere with the conduction of pain impulses from certain area or region. •The patient remains conscious. Topical anesthesia - CORRECT ANSWER blocks the peripheral nerves Uses: •Respiratory passages - eliminates laryngeal reflexes and cough. •Technique : spray, instillation- cream, jelly, eye drop Examples : • Xylocaine, Pontocaine, •EMLA- emulsion of local anesthetics- lumbar puncture/ IV insertion, preprocedure (applied 60-90 min ) Simple local infiltration - CORRECT ANSWER the agent is injected into the tissue •Around the incisional area. •Example: Xylocaine 1-2% Intraspinal Narcotic Infusion - CORRECT ANSWER Uses narcotics or local anesthetic agents for relief of acute or chronic pain. Catheter placed in the subarachnoid (intrathecal) or epidural space in the thoracic or lumbar area - infuse medications EPIDURAL ANESTHESIA - CORRECT ANSWER Respiratory depression generally peaks 6 -12 hours after ______ administration of opioids Implantable infusion device or pump - CORRECT ANSWER deliver an active drug to a target organ or body compartment for prolonged periods of time. The pump is surgically implanted underneath the skin, operates by battery, and connects to a tube or catheter that is placed in the appropriate body area. Refill every 1-2 mos Morphine pump implantation - CORRECT ANSWER is a surgical procedure performed to permanently implant a pump that delivers morphine to the spinal fluid to treat chronic pain Intrathecal Pump Implant ("Spinal Pain Pump") - CORRECT ANSWER The medication contained within the pump will last about 1 to 6 months depending upon the concentration and amount infused DepoDur - CORRECT ANSWER •is a morphine sulfate •It is a one-time injection (during or shortly after surgery) that maintains a therapeutically effective level of morphine in the patient's bloodstream for 48 hours. SPINAL ANESTHESIA - CORRECT ANSWER •injection of a local anaesthetic into the subarachnoid space, generally through a fine needle. PAIN LADDER - CORRECT ANSWER step one: non-opioid, (+)(-) adjuvant step two: Opioid for mild to moderate pain , (+) nonopioid, (+)(-) adjuvant step three: Opioid for moderate to severe pain (+)(-) nonopioid, (+) (-) adjuvant SALICYLATES - CORRECT ANSWER •ANALGESIA •ANTIPYRETIC •ANTI-INFLAMMATORY •ANTIPLATELET - M.I. ACETAMINOPHEN - CORRECT ANSWER Analgesic Antipyretic Nursing considerations: ØDo not exceed the recommended dose - 4 grams daily( maximum) ØAntidote- acetylcysteine ( Mucomyst) ØNot used more than 5 days(child), adult(10 days) SIDE EFFECTS OF ACETAMINOPHEN - CORRECT ANSWER GI irritation, occult bleeding, tinnitus, dizziness, confusion, LIVER TOXICITY NSAIDs (Non-steroidal Anti-inflammatory drugs) - CORRECT ANSWER Prevents prostaglandin synthesis. Use : v Rheumatoid arthritis v Osteoarthritis v Mild to moderate pain v Primary dysmenorrhoea Fever Iburpofen,(Advil, Motrin) Naproxen(Naprosyn) Ketorolac tromethamine(Toradol) COX- 2 inhibitors - OSTEOARTHRITIS Celocoxib(Celebrex) •COX-2 reduces the risk of peptic ulceration SIDE EFFECTS OF NSAIDS - CORRECT ANSWER • Allergic reaction: varies from rash to anaphylaxis. • Anemia, decreased platelet aggregation, prolonged bleeding time • N&V, gastritis, occult GI bleeding • Renal failure with high doses • Toxicity: tinnitus, visual changes, alterations in mental changes COX-2 inhibitors (coxibs) - CORRECT ANSWER •are a type of nonsteroidal anti-inflammatory drug (NSAID) that directly target cyclooxygenase-2, an enzyme responsible for inflammation and pain. • Targeting selectivity reduces the risk of peptic ulceration ex. Celecoxib (Celebrex) NSAID Nursing Interventions - CORRECT ANSWER •Give with food, milk, full glass of water or antacid to decrease GI irritation •Check auditory and visual status periodically. •Instruct client to observe for any signs of bleeding. •Monitor liver and renal function test in clients •Avoid use of alcohol or aspirin when taking other NSAIDs •Caution client that drowsiness and dizziness may occur and may impair ability to perform mechanical tasks. Opioid analgesics - CORRECT ANSWER §Produces analgesia by acting on the CNS receptor cell §Moderate - Severe pain, cancer pain §Can suppress respiration and coughing - acts on the respiratory and cough center in the medulla §Produces euphoria, sedation, physical dependence FULL AGONISTS- - CORRECT ANSWER pure opioid drugs, that bind tightly to receptor sites producing maximum pain inhibition. USE: for mild to moderate pain, severe pain, premedication Examples: -Morphine-produce analgesia, euphoria & sedation -Codeine - analgesia, euphoria, sedation & is also an antitussive. -Meperidine(Demerol)- analgesia, euphoria, sedation .Short acting than morphine. Meperidine (Demerol) - CORRECT ANSWER preoperative and postoperative medicaton v does not decrease uterine contractions v has less depressive effect on neonatal respiration than morphine. - Duration of action: 2-3 hours Partial agonist - CORRECT ANSWER have only partial efficacy Ex. Buspirone, Aripiprazole, Buprenorphine AGONIST- ANTAGONIST ANALGESIC - CORRECT ANSWER It can block other opioid analgesics when given to a patient who has been taking pure opioids (antagonist effect) Examples: 1. Nalbuphine (Nubain) 2. Pentazocine (Talwin) 3.Butorphanol (Stadol) 4.Buprenornorphine (Buprenex) COMMON OPIOID SIDE EFFECTS - CORRECT ANSWER Respiratory depression Nausea and Vomiting Constipation Pruritus Urinary retention Sedation Respiratory depression - CORRECT ANSWER • most serious S.E. Nursing Actions: -Use with caution especially in elderly, very ill patients, asthma and those with respiratory depression. -Administer an opioid antagonist,such as NARCAN until respirations return to an acceptable rate. -slowly by IV route with 10ml of saline. -Monitor the client and repeat the procedure as required. -If the client is receiving IV PCA, stop or slow the infusion. Nausea and Vomiting - CORRECT ANSWER Nursing Actions: -Inform patient - Tolerance to this emetic effect generally develops after several days of opiate therapy. -Provide an antiemetic as required. -Changed the analgesic as indicated. -Adequately hydrate patient and change his position slowly Constipation - CORRECT ANSWER Nursing Actions: -Increase fluid intake (e.g.6-8 glasses daily). -Increase fiber and bulk- forming agents to the diet.(e.g. fresh fruits and vegetables) -Increase exercise regimen. -Administer stool softeners and if necessary provide a laxative. Pruritus - CORRECT ANSWER Nursing Actions: -Apply cool packs, lotion, and diversional activity. -Administer an antihistamine( Benadryl). -Inform the client that tolerance also develops to pruritus. Urinary retention - CORRECT ANSWER Nursing Actions: -May need to catheterize the patient. -Administer narcotic antagonist: Naloxone Hydrochloride (Narcan). Sedation - CORRECT ANSWER Nursing Actions: -Inform client that tolerance usually develops over 3-5 days. -Administer a stimulant - Dexedrine or Ritalin each morning ADDICTION - CORRECT ANSWER compulsion to take the substance primarily to experience its psychic effects TOLERANCE - CORRECT ANSWER need for increasing or more frequent/larger doses of the medication to achieve the initial effects of the drug - varies from individual to individual PHYSICAL DEPENDENCE - CORRECT ANSWER abrupt cessation of the opiod, or administration of an opioid antagonist, results in a WITHDRAWAL SYNDROME Parenteral (IM, IV or SC) - CORRECT ANSWER - for NPO and vomiting patients - produces effects more rapidly than oral administration. - IV dose is smaller & prescribed at shorter intervals (peaks rapidly [usually within minutes]and metabolized quickly) - slow IV push (over a 5-10 min period) or by continuos infusion (PCA) - preferred parenteral route in most acute care situations Oral - CORRECT ANSWER - if patient can tolerate medication by mouth - easy to administer and is less invasive - opioids relieve severe pain if the doses are high enough Rectal - CORRECT ANSWER - for patient who cannot take medications by any other route - indicated for patients with bleeding problems (hemophilia), dying Transdermal route - CORRECT ANSWER - used to achieve consistent opioid serum level through absorption of the medication via the skin. - most often used in the home or hospice care settings for cancer patients Transdermal opiods - CORRECT ANSWER - fentanyl (Duragesic) - buprenorphine (Buprenex) Transmucosal route - CORRECT ANSWER FOR BREAKTHROUGH PAIN Breakthrough pain - CORRECT ANSWER a sudden and temporary increase in pain occuring in a patient being managed with opioid analgesia Nasal sprays - CORRECT ANSWER butorphanol ( Stadol ) fentanyl (Duragesic) Sufentanil (Sufenta) Morphine - analgesia Patient-Controlled Analgesia (PCA) - CORRECT ANSWER Type of intravenous pump that allows the client to administer narcotic analgesic (e.g., morphine) on demand within preset dose & frequency limits Lockout interval - CORRECT ANSWER The time interval before the pump can provide the next dose. It is a safety feature. For example 'morphine 2 mg every 10 minutes' means that 10 minutes should pass before the pump can provide another dose of morphine. If the pain is not well controlled then the lockout interval may be decreased. Patient-Controlled Analgesia (PCA) (2) - CORRECT ANSWER Goal is to achieve more constant level of analgesia as compared to prn IM injections Causes less sedation & lower risk of respiratory depression For postoperative pain management; also used for intractable pain in terminal illness. Nursing Interventions (PCA) - CORRECT ANSWER Instruct client in use of PCA pump -Demonstrate how to push control button (10 - 15 min) -Explain concept of client- controlled analgesia Assess client's level of consciousness, respiratory rate, & degree of pain relief frequently Keep control button within client reach. "PCA by proxy" - trained family member, name must be noted in the medical order ADJUVANT MEDICATIONS - CORRECT ANSWER Drugs - specific uses that can provide analgesia Anticonvulsants - CORRECT ANSWER •nerve injury - trigeminal neuralgia Examples: Carbamazepine (Tegretol), Phenytoin (Dilantin) Antidepressants - CORRECT ANSWER •promote normal sleeping patterns in clients with chronic pain Examples: Amytriptyline (Elavil), Doxepin (Sinequan) Local anesthetics - CORRECT ANSWER •used for a nerve block or given via a spinal route Example: lidocaine, EMLA,Bupivacaine Corticosteroids - CORRECT ANSWER •for metastatic bone cancer Examples: Dexamethasone (Decadron), Prednisone (Deltasone) Muscle Relaxants - CORRECT ANSWER •for muscle spasms and anxiety Examples: Methocarbamol (Robaxin), Cyclobenzaprine (Flexeril) Benzodiazepines - CORRECT ANSWER •for muscle spasm and anxiety Examples: Alprazolam (Xanax), Lorazepam (Ativan) Antihistamines - CORRECT ANSWER •for nausea and anxiety Examples: Hydroxyzine ( Vistaril, Atarax) Psychostimulants - CORRECT ANSWER •analgesic effect, cancer pain Examples: Dextroamphetamine,Methyphenidate (Ritalin) Clonidine - CORRECT ANSWER pain from spinal cord injury, phantom limb pain, peripheral nerve injury Approaches for using Analgesic agents - CORRECT ANSWER •Balance Analgesia •Pro Re Nata •Preventive Approach Balance analgesia - CORRECT ANSWER •Use of more than 1 form of analgesia concurrently to obtain more pain relief with fewer side effects. •It minimizes the potentially toxic effects of any one agent •To relieve a certain pain When used alone - morphine 15 mg When combined - morphine 8 mg and 30 mg of ketorolac (Toradol) Pro Re Nata - CORRECT ANSWER •Waits for the patient to complain of pain and then administer analgesia. •Effect- it leaves the patient sedated or in pain •Opioid analgesia - the serum level of opioids must be maintained at a minimum therapeutic level Preventive approach to pain - CORRECT ANSWER Analgesics - given at set intervals, •to act before the pain becomes severe •before the serum opioid level decreases to a subtherapeutic level. GOAL- to provide analgesia before the pain gets severe •Smaller doses - pain does not escalate to a level of severe intensity. •Less medication, tolerance prevented and side effects (sedation, constipation) of analgesic decreased Spinal cord stimulation - CORRECT ANSWER •A surgically implanted device allows the patient to apply pulsed electrical stimulation to the dorsal aspect of the spinal cord to block pain impulses. Deep brain stimulation - CORRECT ANSWER •a surgical treatment involving the implantation of a medical device called a brain pacemaker which sends electrical impulses to specific parts of the brain. •Electrode - connected to a radiofrequency device or pulse generator system operated by external telemetry. •For neuropathic pain - stroke, brain or spinal cord injuries, phantom limb pain Neurosurgical Procedures For Pain Control - CORRECT ANSWER Performed for persistent intractable pain of high intensity Involves surgical destruction of nerve pathways to block transmission of pain Neurectomy - CORRECT ANSWER Interruption of cranial or peripheral nerves by incision or injection to alleviate localized pain GLOSSOPHARYNGEAL NEURALGIA - CORRECT ANSWER EXTREME PAIN IN THE BACK OF THE THROAT, TONGUE AND EAR. ATTACKS OF INTENSE, ELECTRIC SHOCK-LIKE PAIN CAN OCCUR WITHOUT WARNING OR CAN BE TRIGGERED BY SWALLOWING Laparoscopic Presacral Neurectomy(LPSN) - CORRECT ANSWER •is the surgical removal of the presacral plexus - the group of nerves that conducts the pain signal from the uterus to the brain. •Indicated for the treatment central dysmenorrheal (painful periods), adenomyosis, and endometriosis RHIZOTOMY - CORRECT ANSWER surgical procedure to sever nerve roots in the spinal cord •Laminectomy is necessary •Interruption of posterior nerve root close to the spinal cord •Results in permanent loss of sensation •Performed to alleviate pain of the head and neck from cancer or neuralgia Trigeminal neuralgia - CORRECT ANSWER is an inflammation of the trigeminal nerve, causing extreme pain and muscle spasms in the face. - electric shock-like facial pain can occur without warning or be triggered by touching specific areas of the face motor root - CORRECT ANSWER controls the chewing muscles is preserved sensory root fibers - CORRECT ANSWER transmit the pain signals to the brain, are severed CORDOTOMY - CORRECT ANSWER Interruption of pain-conducting pathways with the spinal cord -Laminectomy usually required. -May be done by percutaneous needle insertion. -Interrupts conduction of pain and temperature sense in affected parts. -Done for pain felt in the legs and trunk •severing the nerve fibers on one or both sides of the spinal cord that travel the express routes to the brain. • affects the sense of temperature as well as pain, since the fibers travel together in the express route. •C1-C2 Sympathectomy - CORRECT ANSWER Pathways of the sympathetic division of the autonomic nervous system are severed. It eliminates vasopasm, improves peripheral blood supply and is effective in the treatment of painful vascular disorders such as angina pectoris. SYMPATHECTOMY Nursing Responsibilities - CORRECT ANSWER -Provide pre and post-op care for a laminectomy - Assess extremities for sensation (ex. Touch, pain, temperature,) and movement. - Monitor skin for signs of damage or pressure - Teach client ways to compensate for loss of sensation in affected parts Visually inspect skin for signs of injury or pressure Check temperature of bath water Avoid use of hot water bottles, heating pads Avoid extremes of temperature Surgical procedures for chronic back pain relief - CORRECT ANSWER Kyphoplasty Vertebroplasty Kyphoplasty - CORRECT ANSWER is a procedure whereby a balloon is inserted through a needle to the fractured vertebra Vertebroplasty - CORRECT ANSWER is a similar procedure; it also involves the injection of cement but without the use of balloon. More than one vertebral fracture can be treated at a time. Note:Both procedures can be done under local anesthesia and in an outpatient basis •Using a special x-ray machine, a bone needle is guided through the skin and into the fractured vertebra. •A cement-like material called polymethylmethacrylate acrylic cement (PMMA) is injected into the vertebra. The needle is removed and the cement hardens, stabilizing the vertebra GENERAL NURSING INTERVENTIONS - CORRECT ANSWER Establish nurse - client relationship. Let the client know that you believe that his pain is real. Respect the client's attitudes and behavioural responses to pain using a standardized pain scale appropriate to age and condition. Document effectiveness of interventions in a timely manner. Assess characteristics of pain and evaluate client's response to interventions. Promote rest and relaxation. Prevent fatigue. Teach relaxation techniques, e.g. slow, rhythmic breathing, guided imagery. Institute comfort measures. Positioning: support body parts. Decrease noxious stimuli such as noise or bright lights. Provide cutaneous stimulation: massage, pressre, baths, vibration, heat,cold packs Relieved anxiety and fears. Spend time with the client. Offer reassurance, explanations. Provide distraction and diversion, e.g. music, puzzles Administer pain medication as needed - CORRECT ANSWER §Administer pain medication in early stages before the pain becomes severe. §Administer pain medication prior to procedure that produces discomfort. §If pain is present most of the day, a preventative approach may be used, e.g. an around the clock schedule may be ordered in place of a prn schedule. §Document effectiveness of intervention. Relief of pain - CORRECT ANSWER evidenced when the patient Rates pain at a lower intensity(on a scale of 0 to 10) after intervention. Rates pain at a lower intensity for longer period Correct administration of prescribed analgesic medications - CORRECT ANSWER evidenced when the patient or family States correct dose of the medication. Administers correct dose using correct procedure. Identifies side effects of medication Describes actions taken to prevent or correct side effects Use of nonpharmacologic pain strategies as recommended - CORRECT ANSWER evidenced when the patient: Reports practice of nonpharmacologic strategies. Describes expected outcomes of nonpharmacologic strategies. Minimal effects of pain and minimal S.E. of interventions - CORRECT ANSWER evidenced when the patient: 1.Participates in activities important to: - recovery - self and family activities 2. Reports adequate sleep and absence of fatigue and constipation.