Lomoarcpsd|22896205
EXAM 1 STUDY GUIDE CONCEPTS OF MEDICAL
SURGICAL NURSING (GALEN COLLEGE OF NURSING)
Assessment and Care of Patient Pain
• Pain
o An unpleasant sensory and emotional experience associated
with actual or potential tissue damage.
o The patient is the authority on the pain and the ONLY one who
can describe or experience it.
• What is the most reliable indicator of pain?
O Self report.
Vital signs are the least reliable indicator of pain.
Always attempt self-report.
• Highest Risk of Pain for Inadequate Pain
Management o Older Adults
Pride, altered mental status, cultural background,
metabolism.
They tolerate drugs differently
Should never see an older adult receive a prescription for
Demerol!
O Substance Abusers
Acute hospital setting is not the place to start rehab
treatment or detox treatment.
Cannot detox someone unless they are there for detox.
Give chronic alcoholics a prescription/order of alcohol to
keep baseline.
O Language Differences
Get a interpreter
Language phone call lines
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
, lOMoARcPSD|22896205
We are the patient’s voice & advocates.
• Page 46 Table 4-1 Impact of Unrelieved Pain o
Physiological Impact Prolongs stress response
Increase HR, BP, Oxygen demand. Causes immobility
Caused GI motility
Decrease immune system response
Delays healing
Poorly managed acute pain increases risk for
development of chronic pain
o Quality of Life Impact Interferes with ADL’s
Causes anxiety, depression, hopelessness, fear, anger,
and sleeplessness
Impairs family, work, and social relationships o
Financial Impact
Costs Americans billions of dollars a year
Increases length of hospital stay
Leads to lost income and productivity
• Acute Pain o Usually temporary o Sudden onset o
Easily localized
o Experience fight or flight response
Increased vital signs, sweating and dilated pupils o
Highly individualized and humans quickly adapt
physiologically and behaviorally to pain.
o DO NOT EXPECT OR ASSUME TO FIND CERTAIN
RESPONSES WHEN ASSESSING A PATIENT.
o The absence of the physiologic and behavioral responses does
not mean the absence of pain.
• Chronic Pain o Persistent pain
o Often described as pain that lasts or recurs for an indefinite
period, usually 3 months or more.
o Onset is gradual
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
, o Quality of pain usually changes over time
o Causes emotional and financial burdens, depression, and
hopelessness
o Body adapts to persistent pain and thus vital signs will often be
lower than normal.
o NO BIOLOGIC PURPOSE
o Although many characteristics of chronic pain are similar in
different patients, be aware that each patient is unique and
requires a highly individualized plan of care.
• Page 46 Table 4-2 Characteristics of Acute &
Chronic Pain o Acute
Short duration
Well-defined cause
Decreases with healing
Usually reversible
Initially serves a biologic purpose (warning sign to
withdraw from painful stimuli or seek help)
When prolonged, serves no useful purpose
Ranges from mild to severe
May be accompanied by anxiety & restlessness
When unrelieved can increase morbidity and mortality
and prolong length of hospital stay
o Chronic
Lasts longer than 3 months
May or may not have well defined cause
Usually begins gradually and persists
Serves no useful purpose
Ranges from mild to severe
Often accompanied by multiple quality of life and
functional adverse effects including depression, fatigue,
financial burden, increased dependence on family,
friends and health care system
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
, lOMoARcPSD|22896205
Can impact quality of life of family and friends.
• Pain Assessment o Assess
Location, intensity, quality and duration, aggravating and
relieving factors, effects of pain on QOL.
o Pain Scales
Numeric Rating Scales (NRS)
0-10 pain scale verbalized by patient
Wong-Baker FACES Pain Rating Scale
6 cartoon faces with word descriptors
Faces Pain Scales
Revised (FPS-R) 7 faces patient picks face that best
depicts pain
Verbal Descriptor Scale (VDS)
Words or phrases that describe intensity of pain
o Vital signs are the least reliable indicator of pain o Ask where
they are hurting and how does it feel.
o If we didn’t have pain receptors how would we know if
something was wrong?
o Is it under control or is it any different?
o Cannot prevent pain but can manage pain, hospital is not a pain
free experience
o Intensity = severity o Quality = what does it feel like, pins &
needles/aching etc. O Subjective descriptions are more
accurate than observable indicators.
• Assessment Challenges
o Patients who are unable to self report their pain are high risk for
untreated pain management
Cognitively Impaired
Not understanding may need another tool
Family can help use baseline behavior
Behaviors, squeeze fingers when broken are and
they grimace.
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
EXAM 1 STUDY GUIDE CONCEPTS OF MEDICAL
SURGICAL NURSING (GALEN COLLEGE OF NURSING)
Assessment and Care of Patient Pain
• Pain
o An unpleasant sensory and emotional experience associated
with actual or potential tissue damage.
o The patient is the authority on the pain and the ONLY one who
can describe or experience it.
• What is the most reliable indicator of pain?
O Self report.
Vital signs are the least reliable indicator of pain.
Always attempt self-report.
• Highest Risk of Pain for Inadequate Pain
Management o Older Adults
Pride, altered mental status, cultural background,
metabolism.
They tolerate drugs differently
Should never see an older adult receive a prescription for
Demerol!
O Substance Abusers
Acute hospital setting is not the place to start rehab
treatment or detox treatment.
Cannot detox someone unless they are there for detox.
Give chronic alcoholics a prescription/order of alcohol to
keep baseline.
O Language Differences
Get a interpreter
Language phone call lines
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
, lOMoARcPSD|22896205
We are the patient’s voice & advocates.
• Page 46 Table 4-1 Impact of Unrelieved Pain o
Physiological Impact Prolongs stress response
Increase HR, BP, Oxygen demand. Causes immobility
Caused GI motility
Decrease immune system response
Delays healing
Poorly managed acute pain increases risk for
development of chronic pain
o Quality of Life Impact Interferes with ADL’s
Causes anxiety, depression, hopelessness, fear, anger,
and sleeplessness
Impairs family, work, and social relationships o
Financial Impact
Costs Americans billions of dollars a year
Increases length of hospital stay
Leads to lost income and productivity
• Acute Pain o Usually temporary o Sudden onset o
Easily localized
o Experience fight or flight response
Increased vital signs, sweating and dilated pupils o
Highly individualized and humans quickly adapt
physiologically and behaviorally to pain.
o DO NOT EXPECT OR ASSUME TO FIND CERTAIN
RESPONSES WHEN ASSESSING A PATIENT.
o The absence of the physiologic and behavioral responses does
not mean the absence of pain.
• Chronic Pain o Persistent pain
o Often described as pain that lasts or recurs for an indefinite
period, usually 3 months or more.
o Onset is gradual
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
, o Quality of pain usually changes over time
o Causes emotional and financial burdens, depression, and
hopelessness
o Body adapts to persistent pain and thus vital signs will often be
lower than normal.
o NO BIOLOGIC PURPOSE
o Although many characteristics of chronic pain are similar in
different patients, be aware that each patient is unique and
requires a highly individualized plan of care.
• Page 46 Table 4-2 Characteristics of Acute &
Chronic Pain o Acute
Short duration
Well-defined cause
Decreases with healing
Usually reversible
Initially serves a biologic purpose (warning sign to
withdraw from painful stimuli or seek help)
When prolonged, serves no useful purpose
Ranges from mild to severe
May be accompanied by anxiety & restlessness
When unrelieved can increase morbidity and mortality
and prolong length of hospital stay
o Chronic
Lasts longer than 3 months
May or may not have well defined cause
Usually begins gradually and persists
Serves no useful purpose
Ranges from mild to severe
Often accompanied by multiple quality of life and
functional adverse effects including depression, fatigue,
financial burden, increased dependence on family,
friends and health care system
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
, lOMoARcPSD|22896205
Can impact quality of life of family and friends.
• Pain Assessment o Assess
Location, intensity, quality and duration, aggravating and
relieving factors, effects of pain on QOL.
o Pain Scales
Numeric Rating Scales (NRS)
0-10 pain scale verbalized by patient
Wong-Baker FACES Pain Rating Scale
6 cartoon faces with word descriptors
Faces Pain Scales
Revised (FPS-R) 7 faces patient picks face that best
depicts pain
Verbal Descriptor Scale (VDS)
Words or phrases that describe intensity of pain
o Vital signs are the least reliable indicator of pain o Ask where
they are hurting and how does it feel.
o If we didn’t have pain receptors how would we know if
something was wrong?
o Is it under control or is it any different?
o Cannot prevent pain but can manage pain, hospital is not a pain
free experience
o Intensity = severity o Quality = what does it feel like, pins &
needles/aching etc. O Subjective descriptions are more
accurate than observable indicators.
• Assessment Challenges
o Patients who are unable to self report their pain are high risk for
untreated pain management
Cognitively Impaired
Not understanding may need another tool
Family can help use baseline behavior
Behaviors, squeeze fingers when broken are and
they grimace.
EXAM #1 STUDY GUIDE CONCEPTS OF MEDICAL SURGICAL
NURSING (GALEN COLLEGE OF NURSING)
