Comprehensive Pain, Pharmacology, and Respiratory Care Review

What is pain defined as?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Why is pain considered subjective?

Because pain is whatever the patient says it is.

Pain is considered what vital sign?

The 5th vital sign.

What organization states nurses have an ethical responsibility to relieve pain?

The American Nurses Association (ANA).

What are the two types of pain based on duration?

Acute pain and chronic pain.

What is acute pain?

Short-term pain usually related to injury or illness.

What is chronic pain?

Long-term persistent pain.

What is idiopathic pain?

Pain with no identifiable cause.

What is intractable pain?

Pain that is difficult or impossible to relieve.

What is referred pain?

Pain felt in a different location from the source.

What is radiating pain?

Pain that spreads from the source to nearby areas.

What are the two main origins of pain?

Nociceptive pain and neuropathic pain.

What is nociceptive pain?

Pain from tissue damage.

What are the types of nociceptive pain?

Cutaneous, visceral, and somatic.

What is cutaneous pain?

Pain from skin or subcutaneous tissue.

What is visceral pain?

Pain from internal organs.

What is somatic pain?

Pain from bones, joints, muscles, or connective tissue.

What is neuropathic pain?

Pain caused by nerve damage.

What are examples of neuropathic pain?

Phantom limb pain and neuropathy.

What is the sympathetic response to acute pain?

Increased BP, HR, RR, and pupil dilation.

What happens if pain remains unrelieved (parasympathetic response)?

Nausea, vomiting, decreased BP and HR, pupil constriction.

What are behavioral responses to pain?

Posture changes, facial expressions, verbalizations, withdrawal.

What are psychological responses to pain?

Anxiety, depression, anger, exhaustion, hopelessness.

What are the effects of untreated pain?

Decline in function, immobility complications, depression, agitation, confusion.

What does the Joint Commission require about pain?

Pain must be regularly assessed.

What pain assessment method is commonly used?

COLDSPA.

What should nurses consider if cognitively impaired patients become agitated?

Pain may be the cause.

What are three nursing diagnoses related to pain?

Impaired comfort, acute pain, chronic pain.

What is a mild pain rating?

1-3

What is a moderate pain rating?

4-7

What is a severe pain rating?

8-10

When should pain interventions be reassessed?

30-60 minutes after intervention.

What are analgesics?

Medications used to relieve pain.

What pain level are nonopioids used for?

Mild to moderate pain.

Are nonopioids addictive?

No.

What are examples of nonopioids?

Acetaminophen, NSAIDs, local anesthetics.

What are opioids?

Controlled substances used for moderate to severe pain.

What routes can opioids be given?

Oral, parenteral, transdermal.

What are examples of opioids?

Oxycodone, hydrocodone, morphine, hydromorphone, fentanyl.

What are the risks of opioids?

Tolerance, physical dependence, addiction.

What are major opioid side effects?

Sedation, respiratory depression, orthostatic hypotension, urinary retention, nausea, constipation, itching.

What medication reverses opioid overdose?

Naloxone (Narcan).

What is PCA?

IV or epidural system allowing patients to administer their own opioid doses.

What are PCA order components?

Bolus dose, lockout time, optional basal rate.

Who should press the PCA button?

ONLY the patient.

What are adjuvant analgesics?

Medications used for other purposes that enhance pain control.

What are examples of adjuvant analgesics?

Antidepressants, anticonvulsants, corticosteroids.

What type of pain are adjuvant analgesics most useful for?

Neuropathic pain.

What are independent nursing pain interventions?

Distraction, massage, positioning, splinting, relaxation.

What are other non-drug therapies?

Heat, cold, TENS, acupuncture.

What are patient barriers to pain control?

Fear of addiction, reluctance to complain, fear of side effects.

What are nurse barriers to pain management?

Not believing patients, poor advocacy, personal attitudes.

What right do patients have regarding pain?

Pain control regardless of severity.

Is using a placebo to test pain ethical?

No.

What is a generic drug name?

The universally accepted name of a drug.

What is a trade name?

Brand name given by the manufacturer.

What is pharmacokinetics?

How a drug moves through the body.

What are the four components of pharmacokinetics?

Absorption, distribution, metabolism, excretion.

What is pharmacotherapeutics?

Desired therapeutic effect.

What is pharmacodynamics?

How the drug works at the cellular level.

What are adverse drug effects?

Undesirable drug effects like allergy, tolerance, toxicity, or interactions.

Pediatric medication dosing is often based on what?

Weight.

Why are infants more sensitive to medications?

Organ immaturity.

Why are older adults at risk for medication problems?

Aging changes and polypharmacy.

What must a medication order include?

Patient name, date/time, medication name, dose, route, frequency, prescriber signature.

What is a standard order?

Regularly scheduled medication.

What is a STAT order?

Immediate one-time dose.

What is a single order?

One-time dose at a specific time.

What is a PRN order?

Given as needed.

When are the 3 medication checks performed?

When retrieving, preparing, and before administering.

What are the 11 rights of medication administration?

Right patient, right medication, right dose, right route, right time, right documentation, right reason, right assessment, right evaluation, right education, right to refuse.

What is the max subcutaneous dose?

1 mL.

What is the needle size for subcutaneous injections?

25-31 gauge, 3/8-5/8 inch.

What is the injection angle for subcutaneous injections?

45-90°.

What is the max IM dose?

3 mL (deltoid max 2 mL).

What is the needle size for intramuscular injections?

21-25 gauge, 1-1½ inch.

What is the injection angle for intramuscular injections?

72-90°.

What is the safest IM injection site?

Ventrogluteal.

What is the site most often used for adults?

Deltoid.

What is the best site for infants?

Vastus lateralis.

What is the purpose of intradermal injections?

Diagnostic testing (TB, allergies).

What is the typical dose for intradermal injections?

0.1 mL.

What is the injection angle for intradermal injections?

5-15°.

What does LOC measure?

Degree of wakefulness.

What are the levels of LOC?

Alert, lethargic, obtunded, stuporous, comatose.

What are dementia characteristics?

Gradual onset, irreversible, progressive.

What is the most common dementia?

Alzheimer's disease.

What is sundowning syndrome?

Increased confusion and agitation in evening.

What are delirium characteristics?

Acute onset, reversible.

What are causes of delirium?

Infection, medications, surgery, metabolic issues, pain.

What does MMSE assess?

Cognitive function.

What are the MMSE scoring ranges?

24-30 = normal, 18-23 = mild impairment, 0-17 = severe impairment.

What is sensory overload?

Excessive stimulation the brain cannot process.

What is sensory deprivation?

Reduced sensory input.

What is presbycusis?

Age-related hearing loss.

What is macular degeneration?

Central vision loss.

What are cataracts?

Clouding of the lens.

What is glaucoma?

Increased intraocular pressure causing peripheral vision loss.

What is pulmonary ventilation?

Movement of air in and out of lungs.

What is respiration?

Gas exchange between alveoli and blood.