90 notecards = 23 pages (4 cards per page)
The pain experience is complex, involving physical, emotional, and ____________ components.
________ converts energy produced by these stimuli into electrical energy.
What is a sensory peripheral pain nerve fiber called?
Cellular damage caused by thermal, mechanical, or chemical stimuli results in the release of excitatory _____________ such as ___________.
Nerve impulses resulting from the painful stimulus travel along _________ peripheral nerve fibers.
Two types of peripheral nerve fibers conduct painful stimuli: the fast, myelinated _________ fibers and the slow, small, unmyelinated _______ fibers.
The _______ fibers send sharp, localized, and distinct sensations that specify the source of the pain and detect its intensity.
The _______ fibers relay impulses that are poorly localized, burning, and persistent.
_______ is the point at which a person is aware of pain.
Are generated from the breakdown of phospholipids in cell membranes and thought to increase sensitivity to pain.
Released from plasma that leaks from surrounding blood vessels at the site of tissue injury. Binds to receptors on peripheral nerves, increasing pain stimuli. Binds to cells that cause the chain reaction producing prostaglandins.
Found in the pain neurons of the dorsal horn (excitatory peptide). Needed to transmit pain impulses from the periphery to higher brain centers. Causes vasodilation and edema.
Produced by mast cells causing capillary dilation and increases capillary permeability.
Released from the brainstem and dorsal horn to inhibit pain transmission.
Are natural supply of morphine-like substances in the body. Activated by stress and pain. Located within the brain, spinal cord, and gastrointestinal tract. Causes analgesia when they attach to opiate receptors in the brain. Present in higher levels in people who have less pain than others with a similar injury.
________ involve transmitter chemicals that signal postsynaptic cells.
Once the brain perceives pain, there is a release of inhibitory neurotransmitters such as endogenous opioids, serotonin, norepinephrine, and gamma aminobutyric (GABA), which work to hinder the transmission of pain and help produce an __________ effect.
The inhibition of the pain impulse is the fourth and last phase of the nociceptive process known as ___________.
The point at which a person feels pain.
The level of pain a person is willing to accept.
Pain of low to moderate intensity and superficial pain. Increased heart rate. Increased muscle tension. Dilation of pupils. Provides increased oxygen intake. Provides additional energy. Prepares muscles for action. Affords better vision. Dilation of pupils.
Severe or deep pain. Muscle tension. Decreased heart rate and blood pressure. Rapid, irregular breathing. Results from fatigue. Causes body defenses to fail under prolonged stress of pain.
_______ is protective, has an identifiable cause, is of short duration, and has limited tissue damage and emotional response.
_______ lasts longer than 6 months and is constant or recurring with a mild to severe intensity. Does not always have an identifiable cause and leads to great personal suffering.
A person with chronic pain who consults with numerous health care providers is labeled a drug seeker, when he or she is actually seeking adequate pain relief. This situation is called_________.
Pain that occurs sporadically over an extended period of time. Pain episodes can last for hours, days, or weeks.
Chronic Episodic Pain
Nociceptive pain includes ___________ and __________ pain.
__________ is chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition.
Studies of nurses' attitudes regarding pain management show that a nurse's personal opinion about a patient's report of pain affects pain assessment and titration of opioid doses.
Pain is a complex process, involving physiological, social, spiritual, psychological, and cultural influences. Thus each individual's pain experience is different. Consider all factors that affect the patient in pain to ensure a holistic approach to the assessment and care of the patient.
Age influences pain, particularly in infants and older adults. Developmental differences found between these age groups influence how children and older adults react to pain.
Toddlers and preschoolers are unable to recall explanations about pain or associate it with experiences that occur in various situations.
_______ heightens the perception of pain and decreases coping abilities. If it occurs along with sleeplessness, the perception of pain is even greater. Pain is often experienced less after a restful sleep than at the end of a long day.
Research on healthy human subjects suggests that ________ passed on by parents possibly increases or decreases the person's sensitivity to pain and determines pain threshold or pain tolerance.
Any factor that interrupts or influences normal pain reception or perception affects the patient's awareness of and response to pain.
Increased _________ is associated with increased pain, whereas distraction is associated with diminished pain response.
Previous frequent episodes of pain without relief or bouts of severe pain cause ________ or fear.
Normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged; usually responsive to nonopioids and or opioids. Includes somatic pain and visceral pain.
Abnormal processing of sensory input by the peripheral or central nervous system; treatment usually includes adjuvant analgesics. Includes sympathetically maintained pain and peripherally generated pain.
People in pain often depend on family or friends for support, assistance, or protection. Although the pain still exists, the presence of family or friends can often make the pain experience less stressful.
Anxiety often increases the perception of pain and pain causes feelings of anxiety. It is difficult to separate the two sensations.
Persons with internal loci of control perceive themselves as having control over events in their life and the outcomes such as pain.
A patient's self-report of pain is the single most reliable indicator of its existence and intensity.
Patients are better prepared to handle almost any situation when they understand it.
There are three types of analgesics. Nonopioids-acetaminophen and nonsteriodal antiinflammatory drugs (NSAIDs); Opioids- narcotics; and Adjuvants- a variety of medications that enhance analgesics or have properties that were originally unknown.
A drug delivery system called _______ is a safe method for pain management that many patients prefer. It allows patients to self administer opioids with minimal risk of overdose.
_______ is the local infiltration of an anesthetic medication to induce loss of sensation to a body part.
________ is the injection of a local anesthetic to block a group of sensory nerve fibers.
_______ is common for the treatment of acute post-operative pain, labor and delivery pain, and chronic cancer pain.
YOU maintain responsibility for providing emotional support to patients receiving local or regional anesthesia by explaining the insertion technique and warning patients that they will temporarily lose sensory function within minutes of injection.
__________ is a transient flare of moderate to severe pain superimposed on continuous or persistent pain.
A state of adaptation that is manifested by a drug class specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
A primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Behaviors include impaired control over drug use, compulsive use, continued use despite harm, and craving.
A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time.
Medications or procedures that produce positive or negative effects in patients. These effects are not related to the specific physical or chemical properties. If this is ordered, you MUST question the order. It is considered unethical and deceitful to administer them.
Pain is purely a subjective physical and psychosocial experience.
misconceptions about pain often result in doubt about the degree of the patient's suffering and unwillingness to provide relief.
knowledge of the ___________ pain process of the pain experience- transmission, transduction, perception, and modulation- provides guidelines for selecting pain relief measures.
An interaction of psychological and cognitive factors affects pain perception.
A person's cultural background influences the meaning of pain and how it is expressed.
It is common for older patients not to report pain.
Patients who are in _______ are unlikely to show behavioral changes.
The difference between acute and chronic pain involves the concept of harm. Acute pain is protective, thus preventing harm; chronic pain is no longer protective.
Do not collect an in depth pain history when the patient is experiencing severe discomfort.
Pain causes _______ signs and symptoms similar to those of other diseases.
Individualize pain interventions by collaborating closely with the patient, using assessment findings, and trying a variety of interventions.
Eliminating sources of painful stimuli is a basic nursing measure for promoting comfort.
Using a regular schedule _________ for analgesic administration is more effective than an as needed schedule in pain control.
around the clock (ATC)
__________ is an adverse effect of opioids that always precedes respiratory depression (which is rare).
A ______ device gives patients pain control with low risk of overdose.
While caring for a patient who receives local anesthesia, protect him or her from injury.
Nursing implications for administering epidural analgesia include preventing infection and monitoring closely for respiratory depression.
________ rarely occurs in patients who take opioids to relieve pain.
The goal of pain management is to anticipate and prevent pain rather than to treat it.
Pain evaluation includes measuring the changing character of pain, the patient's response to interventions, and the patient's perceptions of the effectiveness of a therapy.
Which of the following signs or symptoms in an opioid-naive patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
B) Difficulty arousing the patient
A health care provider writes the following order for an opioid-naive patient who returned from the operating room following a total hip replacement. "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse takes the following action:
A) Calls the health care provider and questions the order
A patient is being discharged home on an around the clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication?
B) Stimulant laxative
A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question?
B) The time interval
The nurse notices that a patient has received oxycodone/acetaminophen (Percocet) (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?
C) The amount of daily acetaminophen
A patient with chronic low back pain who took an opioid around the clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of:
D) Physical dependence
After having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient's respiratory rate and depth are within normal limits. The nurse now plants to implement the following action:
D) Assess patient's vital signs every 15 minutes for 2 hours
Which one of the following instructions is crucial for the nurse to give both family members and the patient who is about to be started on a patient controlled analgesia (PCA) of morphine?
A) Only the patient should push the button
A patient with a history of a stoke that left her confused and unable to communicate returns from interventional radiology following placement of a gastronomy tube. The health care provider's order reads as follows: "Vicodin 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate?
B) Request to have the order changed to ATC for the first 48 hours
A patient is returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. The nurse's first action is to:
D) Assess the characteristics of the pain
The patient rates his pain as a 6 on a scale of 0-10 with 0 being no pain and 10 being the worst pain. The patient's wife says that he cant be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain?
B) The patient's report of pain is the best method for assessing the pain.
When using ice massage for pain relief, which of the following are correct? (select all that apply)
A) Apply ice using firm pressure over skin
When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include?
D) TENS electrodes are applied near or directly on the site of pain
While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends:
A) Transitioning use of adjuvants with nonsteroidal antiinflammatory drugs (NSAIDs) to opioids
A postoperative patient is currently asleep. Therefore the nurse knows that:
A) The sedative administered may have helped him sleep but the assessment of pain is still needed.