Critical Care Exam 1 questions with verified
answers
What are some common causes of pain in critically ill patients? Ans✔✔-pain is
very common in critically ill patients; some common causes include:
-preexisting diseases and conditions
- invasive procedures
-trauma
-monitoring devices/tubes (catheters)
-nursing care (dressing changes, repositioning, etc.)
-immobility
What is the nurse's role in pain management? Ans✔✔-nurses have the universal
goal of maintaining a level of comfort for their patients; it's important for nurses
to assess and manage the patients' pain appropriately; end goal is complete
elimination of the pain, though it is not always possible
patients may experience pain differently based on different psychological needs
or cultural values
What can problems can stem from unrelieved pain? Ans✔✔-poor sleep, which
can lead to:
-exhaustion
-disorientation
-anxiety
-agitation
,-PTSD
-PICS (post intensive care syndrome)
What is the definition of pain? Ans✔✔-an unpleasant sensory and emotional
experience associated with actual or potential tissue damage; pain is always what
the patient says it is (it's subjective)
considered the "fifth vital sign"; nursing goal is to maximize patient comfort to
avoid complications such as sleep deprivation, agitation, PTSD; assessment and
treatment plans should include specific goals and outcomes
0-10 pain scale is gold standard when assessing pain; however, there are barriers
to that pain level that doesn't work for all patients such as altered communication
and decreased level of consciousness
What is the definition of anxiety? Ans✔✔-prolonged state of apprehension in
response to fear; marked by apprehension, agitation, and autonomic arousal
like pain, anxiety levels are what the patient says they are; anxiety is not a benign
state, and if left unresolved it can lead to greater morbidity and mortality,
especially in patients with cardiovascular disease due to sympathetic nervous
system arousal and the subsequent release of catecholamines such as
epinephrine and norepinephrine, which spikes vital signs, which can be
detrimental to cardiovascular patients
What is the relationship between pain and anxiety? Ans✔✔-they exacerbate each
other (untreated pain leads to increased anxiety and vice versa); if left
unresolved, the can lead to the patient feeling powerless and displaying agitation
and potentially delirium
,they are interrelated and can be difficult to differentiate; they are also cyclic in
nature
What are some predisposing factors of pain and factors that can influence pain
perception? Ans✔✔-predisposing factors: disease, procedures, monitoring
devices, nursing care, trauma
factors that influence pain perception:
-expectation of pain (as a nurse, be honest about the pain they will experience
and let them know what they expect, ex: "this will hurt for a couple of minutes",
etc.)
-previous pain experiences (can affect their expectation of pain, such as if they
had a previous nurse who took several tries to get their IV)
-emotional state
-cognitive status (can they understand what is happening?)
What are some predisposing factors of anxiety? Ans✔✔-inability to
communicate, noise, light, excess stimulation
examples:
-endotracheal tube
-monitor alarms
-lack of mobility
-unfamiliar surroundings
-uncomfortable room temperatures
, -sleep deprivation
What are some physiological effects of pain and anxiety?* Ans✔✔--raises
catecholamines (epi, norepi, dopamine - can stress the CV system, especially
when patient is critically ill --> vasoconstrictive effects in the alpha portion)
-interference with healing
-increased oxygen consumption (end-organ ischemia)
-increased respiratory effect and hyperventilation (respiratory alkalosis, which
leads to impaired tissue perfusion, which can become cyclic in nature)
-fighting the ventilator/delay in ventilator weaning (can lead to increased feelings
of breathlessness - fighting the ventilator is called desynchrony, which can cause
alveolar damage; the ET tube creates a choking sensation)
-dyspnea (in vented patients and can go unrecognized by providers and nurses;
treating the patient with bronchodilators such as albuterol and adjustments in the
vent settings may improve pain and anxiety)
-constipation
-cool extremities
-diaphoresis
-hypertension (increases myocardial oxygen demand)
-increased cardiac output
-increased glucose production (gluconeogenesis)
-mydriasis (pupillary dilation)
-nausea
-pallor and flushing
-sleep disturbance
-tachycardia
answers
What are some common causes of pain in critically ill patients? Ans✔✔-pain is
very common in critically ill patients; some common causes include:
-preexisting diseases and conditions
- invasive procedures
-trauma
-monitoring devices/tubes (catheters)
-nursing care (dressing changes, repositioning, etc.)
-immobility
What is the nurse's role in pain management? Ans✔✔-nurses have the universal
goal of maintaining a level of comfort for their patients; it's important for nurses
to assess and manage the patients' pain appropriately; end goal is complete
elimination of the pain, though it is not always possible
patients may experience pain differently based on different psychological needs
or cultural values
What can problems can stem from unrelieved pain? Ans✔✔-poor sleep, which
can lead to:
-exhaustion
-disorientation
-anxiety
-agitation
,-PTSD
-PICS (post intensive care syndrome)
What is the definition of pain? Ans✔✔-an unpleasant sensory and emotional
experience associated with actual or potential tissue damage; pain is always what
the patient says it is (it's subjective)
considered the "fifth vital sign"; nursing goal is to maximize patient comfort to
avoid complications such as sleep deprivation, agitation, PTSD; assessment and
treatment plans should include specific goals and outcomes
0-10 pain scale is gold standard when assessing pain; however, there are barriers
to that pain level that doesn't work for all patients such as altered communication
and decreased level of consciousness
What is the definition of anxiety? Ans✔✔-prolonged state of apprehension in
response to fear; marked by apprehension, agitation, and autonomic arousal
like pain, anxiety levels are what the patient says they are; anxiety is not a benign
state, and if left unresolved it can lead to greater morbidity and mortality,
especially in patients with cardiovascular disease due to sympathetic nervous
system arousal and the subsequent release of catecholamines such as
epinephrine and norepinephrine, which spikes vital signs, which can be
detrimental to cardiovascular patients
What is the relationship between pain and anxiety? Ans✔✔-they exacerbate each
other (untreated pain leads to increased anxiety and vice versa); if left
unresolved, the can lead to the patient feeling powerless and displaying agitation
and potentially delirium
,they are interrelated and can be difficult to differentiate; they are also cyclic in
nature
What are some predisposing factors of pain and factors that can influence pain
perception? Ans✔✔-predisposing factors: disease, procedures, monitoring
devices, nursing care, trauma
factors that influence pain perception:
-expectation of pain (as a nurse, be honest about the pain they will experience
and let them know what they expect, ex: "this will hurt for a couple of minutes",
etc.)
-previous pain experiences (can affect their expectation of pain, such as if they
had a previous nurse who took several tries to get their IV)
-emotional state
-cognitive status (can they understand what is happening?)
What are some predisposing factors of anxiety? Ans✔✔-inability to
communicate, noise, light, excess stimulation
examples:
-endotracheal tube
-monitor alarms
-lack of mobility
-unfamiliar surroundings
-uncomfortable room temperatures
, -sleep deprivation
What are some physiological effects of pain and anxiety?* Ans✔✔--raises
catecholamines (epi, norepi, dopamine - can stress the CV system, especially
when patient is critically ill --> vasoconstrictive effects in the alpha portion)
-interference with healing
-increased oxygen consumption (end-organ ischemia)
-increased respiratory effect and hyperventilation (respiratory alkalosis, which
leads to impaired tissue perfusion, which can become cyclic in nature)
-fighting the ventilator/delay in ventilator weaning (can lead to increased feelings
of breathlessness - fighting the ventilator is called desynchrony, which can cause
alveolar damage; the ET tube creates a choking sensation)
-dyspnea (in vented patients and can go unrecognized by providers and nurses;
treating the patient with bronchodilators such as albuterol and adjustments in the
vent settings may improve pain and anxiety)
-constipation
-cool extremities
-diaphoresis
-hypertension (increases myocardial oxygen demand)
-increased cardiac output
-increased glucose production (gluconeogenesis)
-mydriasis (pupillary dilation)
-nausea
-pallor and flushing
-sleep disturbance
-tachycardia
