NUR170 Exam 1 Study Guide
Concepts of Medical Surgical Nursing (Galen College of
Nursing)
, EXAM 1 STUDY GUIDE
Pain The 5th Vital Sign
Characteristics of Acute and Chronic Pain
▪ Acute Pain (sudden onset, trauma, accident) – usually hours to days
o Increased Heart Rate Blood Pressure and Respiratory Rate
o Dilated Pupils and Sweating
o Results from sudden, accidental trauma, surgery; ischemia, inflammation
▪ Chronic Pain (persistent long term) – usually longer than 3 months
o Dull, Burning Sensation
Types of Pain
▪ Nociceptive Pain (normal pain)
o Somatic Pain – Superficial or Subcutaneous Tissue felt by sharp, burning.
o Deep Somatic – Bone, Muscle, Blood Vessel, Connective Tissues.
o Visceral Pain – Organs and Linings of Body Cavities felt by deep cramping,
splitting, sharp.
▪ Neuropathic Pain (abnormal pain) Give Gabapentin
o Nerve Fibers, Spinal Cord, Central Nervous system felt by shooting, fiery,
burning, sharp,
numbness.
o DM, phantom limb pain, HIV
neuropathies How to assess pain
• Wong-Baker faces pain rating scale – 0-10 uses visual appearance of face to determine
pain
• Pain scales – 1. Numerical, 2. Descriptive, 3. Visual analog scale
• Non-verbal indicators of pain – moaning, crying, irritability, restlessness, grimacing
or frowning, inability to sleep, rigid posture, increased BP/HR/RR, nausea,
diaphoresis
Considerations for Older Adults
o Pain is relative to the person, and it is what they say it is. Always take patients self-
report
o Pain is not a part of getting older.
o Never give your patient a placebo.
o Start dose low and titrate slowly.
o Avoid Meperidine (Demerol) because it can cause nephron toxicity and chronic
delirium.
o Home safety assessment and teach caregivers to help reduce falls and accidents.
o Do not use an older adults hand for IV’s. A nice plump vein in a younger adult is best.
PQRST Acronym
o Precipitates – what triggers the pain?
o Quality – what does it feel like?
o Radiate – is the pain localized or referred?
o Severity – how intense is the pain on a scale of 1-10?
o Treatment – what helps it go away and how long?
Non-Opioid Analgesics
o The first-line therapy for mild to moderate pain.
, o Acetaminoph – Max dose 4G q24h, can hepatotoxici and nephrotoxicity. Antidote
cause
en Mucomyst (Acetylcysteine) ty is
o NSAID (nonselective cox-1-inhibitors) can cause stomach upset and worsen peptic
ulcer disease.
o Aspirin / Ibuprofen / Naproxen ^
NSAID (selective cox-2-inhibitor) doesn’t affect platelet aggregation(clumping) in stomach and
won’t worsen gastric ulcers
o Celecoxib / Meloxicam ^
o Lidocaine – patch and topical cream
Nonpharmacologic
interventions
o Elevation of affected body part
o RICE acronym
o Relaxation
o Distraction
o Heat/cold – do not apply directly to skin, use barrier. No more than 15-30 minutes
o NEVER okay to deliver a placebo
Complementary and alternative therapies – acupuncture/acupressure, chiropractor manipulation,
guided imagery/meditation techniques, herbal therapies, massage, laughter/humor, repositioning,
relaxation, therapeutic
touch
Pharmacologic management of pain:
o Basic principle – prevent and control pain
o Multimodal analgesia – using two or more classes of analgesia to target
different pain mechanisms
o Post op pain – combination therapy
o Pre-medicate before procedures/activity
o Oral route is preferred, IV can be used if patient is NPO or nauseated, or if pain is
severe or escalating
Opioids (Block the release of neurotransmitters in the brain and spinal cord) – mainstay in
management of moderate to severe nociceptive types of pain
o Codeine – short-acting weak drug
o Hydrocodone – like codeine and is available as a combination with Tylenol.
o Oxycodone – recommended for both acute and chronic pain, available as IR and ER.
o Morphine – the gold standard for both acute and chronic pain.
o Hydromorphone – synthetic version of morphine and is 8 times stronger.
o Fentanyl – good for chronic pain and available as a patch also in PCA.
o Methadone – the only full opioid agonist with dual mechanism on mu and NMDA.
Meperidine – not recommended for any type of pain, in older adult can cause acute delirium,
seizures, and psychosis
Older adults – start low and go slow – starting dose should be 25-50% lower
Side effects of Opioids
• Constipation and/or urinary retention
o Assess previous bowel sounds, and movements, administer stool softeners /
Nausea and Vomiting
Treat with antiemetic (Zofran / Reglan) prophylactically and prn.
laxatives.
• Sedation and Confusion
Concepts of Medical Surgical Nursing (Galen College of
Nursing)
, EXAM 1 STUDY GUIDE
Pain The 5th Vital Sign
Characteristics of Acute and Chronic Pain
▪ Acute Pain (sudden onset, trauma, accident) – usually hours to days
o Increased Heart Rate Blood Pressure and Respiratory Rate
o Dilated Pupils and Sweating
o Results from sudden, accidental trauma, surgery; ischemia, inflammation
▪ Chronic Pain (persistent long term) – usually longer than 3 months
o Dull, Burning Sensation
Types of Pain
▪ Nociceptive Pain (normal pain)
o Somatic Pain – Superficial or Subcutaneous Tissue felt by sharp, burning.
o Deep Somatic – Bone, Muscle, Blood Vessel, Connective Tissues.
o Visceral Pain – Organs and Linings of Body Cavities felt by deep cramping,
splitting, sharp.
▪ Neuropathic Pain (abnormal pain) Give Gabapentin
o Nerve Fibers, Spinal Cord, Central Nervous system felt by shooting, fiery,
burning, sharp,
numbness.
o DM, phantom limb pain, HIV
neuropathies How to assess pain
• Wong-Baker faces pain rating scale – 0-10 uses visual appearance of face to determine
pain
• Pain scales – 1. Numerical, 2. Descriptive, 3. Visual analog scale
• Non-verbal indicators of pain – moaning, crying, irritability, restlessness, grimacing
or frowning, inability to sleep, rigid posture, increased BP/HR/RR, nausea,
diaphoresis
Considerations for Older Adults
o Pain is relative to the person, and it is what they say it is. Always take patients self-
report
o Pain is not a part of getting older.
o Never give your patient a placebo.
o Start dose low and titrate slowly.
o Avoid Meperidine (Demerol) because it can cause nephron toxicity and chronic
delirium.
o Home safety assessment and teach caregivers to help reduce falls and accidents.
o Do not use an older adults hand for IV’s. A nice plump vein in a younger adult is best.
PQRST Acronym
o Precipitates – what triggers the pain?
o Quality – what does it feel like?
o Radiate – is the pain localized or referred?
o Severity – how intense is the pain on a scale of 1-10?
o Treatment – what helps it go away and how long?
Non-Opioid Analgesics
o The first-line therapy for mild to moderate pain.
, o Acetaminoph – Max dose 4G q24h, can hepatotoxici and nephrotoxicity. Antidote
cause
en Mucomyst (Acetylcysteine) ty is
o NSAID (nonselective cox-1-inhibitors) can cause stomach upset and worsen peptic
ulcer disease.
o Aspirin / Ibuprofen / Naproxen ^
NSAID (selective cox-2-inhibitor) doesn’t affect platelet aggregation(clumping) in stomach and
won’t worsen gastric ulcers
o Celecoxib / Meloxicam ^
o Lidocaine – patch and topical cream
Nonpharmacologic
interventions
o Elevation of affected body part
o RICE acronym
o Relaxation
o Distraction
o Heat/cold – do not apply directly to skin, use barrier. No more than 15-30 minutes
o NEVER okay to deliver a placebo
Complementary and alternative therapies – acupuncture/acupressure, chiropractor manipulation,
guided imagery/meditation techniques, herbal therapies, massage, laughter/humor, repositioning,
relaxation, therapeutic
touch
Pharmacologic management of pain:
o Basic principle – prevent and control pain
o Multimodal analgesia – using two or more classes of analgesia to target
different pain mechanisms
o Post op pain – combination therapy
o Pre-medicate before procedures/activity
o Oral route is preferred, IV can be used if patient is NPO or nauseated, or if pain is
severe or escalating
Opioids (Block the release of neurotransmitters in the brain and spinal cord) – mainstay in
management of moderate to severe nociceptive types of pain
o Codeine – short-acting weak drug
o Hydrocodone – like codeine and is available as a combination with Tylenol.
o Oxycodone – recommended for both acute and chronic pain, available as IR and ER.
o Morphine – the gold standard for both acute and chronic pain.
o Hydromorphone – synthetic version of morphine and is 8 times stronger.
o Fentanyl – good for chronic pain and available as a patch also in PCA.
o Methadone – the only full opioid agonist with dual mechanism on mu and NMDA.
Meperidine – not recommended for any type of pain, in older adult can cause acute delirium,
seizures, and psychosis
Older adults – start low and go slow – starting dose should be 25-50% lower
Side effects of Opioids
• Constipation and/or urinary retention
o Assess previous bowel sounds, and movements, administer stool softeners /
Nausea and Vomiting
Treat with antiemetic (Zofran / Reglan) prophylactically and prn.
laxatives.
• Sedation and Confusion
