Care_Man_2_exam_1_study_guide_ Exam 1 Weeks 1&2 Study Guide Most correct

Exam 1 Weeks 1&2 Study Guide
Chapter 4
Assessment and Care of Patients with Pain
Concepts
 The priority concept in this chapter is comfort
 The interrelated concepts in this chapter are cognition sensory Perception
Pain The Scope of the Problem
 Pain is a major economic problem and a leading cause of disability that changes the lives
of many people, especially older adults.
 Chronic non-cancer pain such as osteoarthritis, rheumatoid arthritis, and diabetic
neuropathy is the most common cause of long-term disability, affecting millions of
Americans and others throughout the world.
 Universal, complex personal experience
 Is an impairment in comfort; major economic concern; leading cause of disability
 Failure to manage pain is a worldwide health problem
 Inter-professional pain initiatives help patients receive best treatment
Definitions of Pain
 Unpleasant sensory and emotional experience associated with actual or potential tissue
damage
 Whatever person experiencing it says it is; exists whenever person says it does
 Self-report always most reliable indication of pain
Categorization of Pain by Duration
 Acute pain
- Short-lived
- Results from sudden, accidental trauma; surgery; ischemia; acute inflammation
 Chronic (persistent) pain
- Can last a person’s lifetime
- Chronic cancer pain
- Chronic non-cancer pain
 Pain is treated inadequately in almost all health care settings.
 Populations at the highest risk in medical-surgical nursing are older adults, patients with
substance use disorder, and those whose primary language differs from that of the health
care professional.
 Older adults in nursing homes are at especially high risk because many residents are unable
to report their pain. In addition, there often is a lack of staff members who have been
educated to manage pain in the older-adult population.
Acute Pain
 Acts as warning sign
 Activation of sympathetic nervous system
 “Fight-or-flight” reactions
- Increased vital signs
- Sweating
- Dilated pupils
- Restlessness
- Apprehension
- Distress of varying degrees

,Acute Pain (Cont.)
 Absence of physiologic and behavioral responses does not mean absence of pain
 Usually temporary with sudden onset, and easily localized
 Sensory perception of pain changes as injured area heals
Chronic (Persistent) Pain
 Lasts or recurs for indefinite period (more than 3 months)
 Gradual onset
 Character and quality often change over time
 Serves no biological purpose
 Can result in emotional, financial, and relationship burdens, as well as
depression/hopelessness
Chronic Cancer Pain
 Usually result of tumor growth, nerve compression, tissue invasion, metastasis
 Cancer treatment can also cause acute pain (e.g., procedures, surgery, toxicities from
chemo and radiation)
Chronic Non-Cancer Pain
 Global health issue for people > 65 years old
 Formerly called chronic nonmalignant pain
 Neck, shoulder, low back
 Over half of veterans of recent wars have this condition
- Can cause depression, decreased sense of well-being
Categorization of Pain by Underlying Mechanisms
 Nociceptive pain
- Somatic
- Visceral
 Neuropathic pain
Pain Transmission
 Painful stimuli often originate in extremities
 If pain is not transmitted to the brain, person feels no pain
 Two specific fibers transmit periphery pain:
- A delta fibers
- C fibers
Assessment: Noticing
 Patient’s self-report is “gold standard” for assessment
 Nurse’s role
- Accept patient self-report
- Serve as advocate
- Act promptly to relieve pain
- Respect patient values and preferences
Pain Assessment (Cont.)
 Location
 Intensity
 Quality
 Onset and duration
 Aggravating and relieving factors
 Effect of pain on function and quality of life

,  Comfort-function outcomes
 Other information
Psychosocial Assessment
 Pain holds unique meaning for the person experiencing it.
 Remain objective; advocate for proper pain control
 Refer to resources such as “10-Step Program from Patient to Person” (as needed)
Assessment Challenges
 Patients who cannot self-report pain are at higher risk for under-treated pain
- Hierarchy of Pain Measures
- Checklist of Nonverbal Pain Indicators (CNPI)
- Pain Assessment in Advanced Dementia Scale (PAINAD)
Different Pain Types
 Localized pain is confined to the site of origin.
 Projected pain is diffuse around the site of origin and is not well localized.
 Referred pain is felt in an area distant from the site of painful stimuli.
 Radiating pain is felt along a specific nerve or nerves.
 Intensity: Ask the patient to rate the severity of the pain using a reliable and valid
assessment tool.
 Various self-report scales have been developed to help patients communicate pain
intensity.
Teaching how to respond to a pain scale
 Text book Table 4-4
Analgesic Groups
 Non-opioid analgesics
- Acetaminophen
- NSAIDs
Non-opioid Analgesics
 Monitor patients taking acetaminophen for hepatotoxicity
 Reduced daily dose may be appropriate for older adults on long-term therapy
 Monitor patients taking NSAIDS for gastric side effects
 NSAIDS carry risk for cardiovascular and renal adverse effects through prostaglandin
inhibition
Analgesics by Classification: Opioid Analgesics
 Full or mu agonists
- Morphine, fentanyl, hydromorphone, oxycodone, oxycodone, hydrocodone
 Mixed agonists antagonists
- Butorphanol, nalbuphine
 Partial agonists
- Buprenorphine
Drug Formulation Terminology
 Short acting, fast acting, immediate release (IR), normal release
- Onset in about 30 minutes; short duration of 3 to 4 hours
 Modified-release, extended release (ER), sustained release (SR), controlled release (CR)
- Release over a prolonged period
- Never crush, break, or have patients chew!
Selected Opioid Analgesics

,  Morphine
 Fentanyl
- Teach patients to refrain from applying heat to patches
 Hydromorphone
 Oxycodone
 Hydrocodone
 Methadone
Dual Mechanism Analgesics
 Tramadol (Ultram)
 Tapentadol (Nucynta)
Opioids to Avoid
 Meperidine
 Codeine
Intraspinal Analgesia
 Analgesic administration via a needle or catheter in the epidural or intrathecal space
 Placed by an anesthesia provider
 Side effects depend on drug administered
 Complications are rare but can be life-threatening
Adverse Effects of Opioid Analgesics
 Constipation
 Nausea
 Vomiting
 Pruritus
 Sedation
 Respiratory depression (less common, yet most concerning)
Adjuvant (Co-Analgesic) Analgesics
 Anticonvulsants and antidepressants
- Gabapentin
- Imipramine (Tofranil)
- Clomipramine (Anafranil)
- Doxepin
 Local anesthetics
- Lidocaine
Use of Placebos
 Any medication or procedure (including surgery) which produces an effect because of its
intent
 Used as control in research
 Any other use has ethical and legal implications; violates nurse–patient relationship;
deprives patient of appropriate assessment
Nonpharmacologic Management
 Appropriate for mild- and some moderate-intensity pain
 Should complement, not replace, pharmacologic therapies for more severe pain
- Physical modalities
- Cognitive-behavioral strategies
Physical Interventions (Examples)
 Physical therapy