NUR 355 Exam #2 - Modules 3 & 4 "Pain/Inflamma�on &
Immunity/Infec�on"
Pain / Inflamma�on (Module 3)
General (assessment, priority, evaluation, education, non-pharm etc.) (5 questions)
1. Assess and document pain (5th v/s) according to client condi�on.
2. Nonopioid analgesics including NSAIDs should be considered first-line therapy, administered
on a standing schedule rather than a prn schedule.
3. Assessing Pain in Older Adults With Cogni�ve Impairments: (pain is not a part of aging
process)
a. Observa�onal pain was assessed through the Pain Assessment in Advanced Demen�a
(PAINAD) tool, and cogni�on and mood were evaluated with the Mini-Mental State
Examina�on (MMSE) and the Geriatric Depression Scale (GDS015).
b. Hydromorphone and fentanyl are the preferred opioids in older adults with kidney or
liver impairment, whereas meperidine should be avoided because of the adverse
effects associated with a toxic metabolite, normeperidine.
c. managing pain in cogni�vely impaired adults includes a tailored plan of physical
ac�vity and cogni�ve-behavioral therapy (CBT)
4.
1
, NUR 355 Exam #2 - Modules 3 & 4 "Pain/Inflamma�on &
Immunity/Infec�on"
5. Refusing food, sign of pain. Chronic pain or elevated HR is not reliable pain measurement.
Pain Assessment (9 questions)
1. Focused Pain Assessment:
a. Loca�on- use anatomical terminology/landmarks to describe loca�on. “where is your
pain?” ask pt to point to loca�on.
b. Quality- how the pain feels (sharp, dull, aching, burning etc). “what does it feel like?”
ask if throbbing, burning, stabbing etc.
c. Measures- intensity, strength, and severity. (use visual analog, #scale). “how much
pain do you have?” “rate your pain 0-10”
d. Timing-onset, dura�on, and frequency. “when did it start?” “how o�en does it occur?”
e. Se�ng- how pain affects daily life or ADLs. “what are you doing when symptoms
occur?” “How does pain affect your ability to work?”
f. Associated Manifesta�ons-document manifesta�ons (fa�gue, depression, nausea,
anxiety). “what other symptoms do you have when you are feeling pain?”
g. Aggrava�ng/relieving factors-“What makes the pain beter/worse?” “Are you taking
anything OTC/herbals/Rx?”
h.
2. Joint pain and mobility
a. Joint pain and mobility are indicators of treatment efficacy and disease progression.
3. Temperature
2
, NUR 355 Exam #2 - Modules 3 & 4 "Pain/Inflamma�on &
Immunity/Infec�on"
a. An increase in temperature is an indicator of infec�on.
4. Acute pain- Onset and usually of short dura�on, presen�ng immediately following noxious
s�muli and �ssue damage and con�nuing for several hours to several weeks
a. responsive to common pain management treatments and predictably resolves as
�ssue heals.
6. Chronic pain- Pain that is present for more than 3 to 6 months, with or without an obvious
link to �ssue injury, is considered chronic pain.
a. intensity can vary widely; pa�ents describe pain that is achy, dull, stabbing, burning,
and icy hot. (serves no apparent biological purpose.)
5. Nocicep�ve Pain- s�mula�on of peripheral nerve fibers by noxious s�muli or condi�ons in
superficial skin and �ssues as well as bones, joints, and muscles or in organs. damage to or
inflamma�on of �ssue other than that of the peripheral and central nervous system. (normal
processing of painful s�muli)
a. Cutaneous- Superficial �ssues. (sharp, with intensity varying mild to severe)
b. Soma�c-in bones, joints, muscles, skin, or connec�ve �ssues. (dull, achy, difficult to
localize mild to severe) Ex. Arthri�s, overuse injuries (muscle), trauma, bone
degenera�on.
c. Visceral- internal organs, cause referred pain in other body loca�ons. (sharp, dull-
difficult to localize)
d. managed using opioids and nonopioid meds
6. Referred Pain-nerve fibers from high sensory area (superficial �ssues) and input from low-
sensory area (visceral organs) all converge at similar levels of spinal cord. (Diagnos�c for
serious disorders and should be evaluated thoroughly.)
3
, NUR 355 Exam #2 - Modules 3 & 4 "Pain/Inflamma�on &
Immunity/Infec�on"
7. Neuropathic Pain-abnormal or damaged pain nerves. (most challenging type of pain to assess
and manage. last for months to years.) shoo�ng, s�nging, or “pins and needles”.
a. Peripherally generated neuropathic pain presents in the peripheral �ssues but may
represent injury or dysfunc�on anywhere along the nerve pathway that supports that
region of the body. Ex. Phantom Limb, diabe�c and alcohol-induced neuropathy,
chemotherapy-induced neuropathy, and postherpe�c neuralgia
b. Centrally generated neuropathic pain has its origins in injuries to the spinal cord and
brain structures. (stroke, Parkinson’s disease, or mul�ple sclerosis, damage to neurons,
their suppor�ng myelin, or the nourishing glial cells that surround the brain and spinal
�ssue also disrupt pain processing.)
c. Managed using adjuvant meds (an�depressants, an�spasmodic, skeletal muscle
relaxants)
8.
4
Immunity/Infec�on"
Pain / Inflamma�on (Module 3)
General (assessment, priority, evaluation, education, non-pharm etc.) (5 questions)
1. Assess and document pain (5th v/s) according to client condi�on.
2. Nonopioid analgesics including NSAIDs should be considered first-line therapy, administered
on a standing schedule rather than a prn schedule.
3. Assessing Pain in Older Adults With Cogni�ve Impairments: (pain is not a part of aging
process)
a. Observa�onal pain was assessed through the Pain Assessment in Advanced Demen�a
(PAINAD) tool, and cogni�on and mood were evaluated with the Mini-Mental State
Examina�on (MMSE) and the Geriatric Depression Scale (GDS015).
b. Hydromorphone and fentanyl are the preferred opioids in older adults with kidney or
liver impairment, whereas meperidine should be avoided because of the adverse
effects associated with a toxic metabolite, normeperidine.
c. managing pain in cogni�vely impaired adults includes a tailored plan of physical
ac�vity and cogni�ve-behavioral therapy (CBT)
4.
1
, NUR 355 Exam #2 - Modules 3 & 4 "Pain/Inflamma�on &
Immunity/Infec�on"
5. Refusing food, sign of pain. Chronic pain or elevated HR is not reliable pain measurement.
Pain Assessment (9 questions)
1. Focused Pain Assessment:
a. Loca�on- use anatomical terminology/landmarks to describe loca�on. “where is your
pain?” ask pt to point to loca�on.
b. Quality- how the pain feels (sharp, dull, aching, burning etc). “what does it feel like?”
ask if throbbing, burning, stabbing etc.
c. Measures- intensity, strength, and severity. (use visual analog, #scale). “how much
pain do you have?” “rate your pain 0-10”
d. Timing-onset, dura�on, and frequency. “when did it start?” “how o�en does it occur?”
e. Se�ng- how pain affects daily life or ADLs. “what are you doing when symptoms
occur?” “How does pain affect your ability to work?”
f. Associated Manifesta�ons-document manifesta�ons (fa�gue, depression, nausea,
anxiety). “what other symptoms do you have when you are feeling pain?”
g. Aggrava�ng/relieving factors-“What makes the pain beter/worse?” “Are you taking
anything OTC/herbals/Rx?”
h.
2. Joint pain and mobility
a. Joint pain and mobility are indicators of treatment efficacy and disease progression.
3. Temperature
2
, NUR 355 Exam #2 - Modules 3 & 4 "Pain/Inflamma�on &
Immunity/Infec�on"
a. An increase in temperature is an indicator of infec�on.
4. Acute pain- Onset and usually of short dura�on, presen�ng immediately following noxious
s�muli and �ssue damage and con�nuing for several hours to several weeks
a. responsive to common pain management treatments and predictably resolves as
�ssue heals.
6. Chronic pain- Pain that is present for more than 3 to 6 months, with or without an obvious
link to �ssue injury, is considered chronic pain.
a. intensity can vary widely; pa�ents describe pain that is achy, dull, stabbing, burning,
and icy hot. (serves no apparent biological purpose.)
5. Nocicep�ve Pain- s�mula�on of peripheral nerve fibers by noxious s�muli or condi�ons in
superficial skin and �ssues as well as bones, joints, and muscles or in organs. damage to or
inflamma�on of �ssue other than that of the peripheral and central nervous system. (normal
processing of painful s�muli)
a. Cutaneous- Superficial �ssues. (sharp, with intensity varying mild to severe)
b. Soma�c-in bones, joints, muscles, skin, or connec�ve �ssues. (dull, achy, difficult to
localize mild to severe) Ex. Arthri�s, overuse injuries (muscle), trauma, bone
degenera�on.
c. Visceral- internal organs, cause referred pain in other body loca�ons. (sharp, dull-
difficult to localize)
d. managed using opioids and nonopioid meds
6. Referred Pain-nerve fibers from high sensory area (superficial �ssues) and input from low-
sensory area (visceral organs) all converge at similar levels of spinal cord. (Diagnos�c for
serious disorders and should be evaluated thoroughly.)
3
, NUR 355 Exam #2 - Modules 3 & 4 "Pain/Inflamma�on &
Immunity/Infec�on"
7. Neuropathic Pain-abnormal or damaged pain nerves. (most challenging type of pain to assess
and manage. last for months to years.) shoo�ng, s�nging, or “pins and needles”.
a. Peripherally generated neuropathic pain presents in the peripheral �ssues but may
represent injury or dysfunc�on anywhere along the nerve pathway that supports that
region of the body. Ex. Phantom Limb, diabe�c and alcohol-induced neuropathy,
chemotherapy-induced neuropathy, and postherpe�c neuralgia
b. Centrally generated neuropathic pain has its origins in injuries to the spinal cord and
brain structures. (stroke, Parkinson’s disease, or mul�ple sclerosis, damage to neurons,
their suppor�ng myelin, or the nourishing glial cells that surround the brain and spinal
�ssue also disrupt pain processing.)
c. Managed using adjuvant meds (an�depressants, an�spasmodic, skeletal muscle
relaxants)
8.
4
