MEDRADSC 3LA3 - Pt Assessment Tools

In the OPQRSTUV assessment acronym, what does the 'O' represent?

Onset (When it began, frequency, and duration).

Which component of OPQRSTUV asks what brings on or improves the symptom?

Provoking/Palliating.

How is the 'Quality' of nociceptive pain typically described?

Sharp, aching, or throbbing.

What descriptors are characteristic of neuropathic pain 'Quality'?

Shooting, burning, tingling, or painfully numb.

The 'R' in the adapted pain assessment acronym stands for _.

Region/Radiation.

What four specific intensity levels should be assessed under 'Severity' in OPQRSTUV?

Right now, at best, at worst, and on average.

What does the 'T' in OPQRSTUV evaluate regarding medications?

Current and past treatments, effectiveness, and side effects.

The 'U' in the pain assessment acronym stands for Understanding/Impact, which includes what patient belief?

What the patient believes is causing the symptom.

In OPQRSTUV, the 'V' stands for _, which identifies the patient's comfort goal.

Values.

What screening tool is used to identify a patient's pain level on a scale from $0$ to $10$?

ESASr.

According to ESASr scoring, what range represents 'Mild Pain'?

$1-3$.

What ESASr score range is categorized as 'Moderate Pain'?

$4-6$.

An ESASr score between $7$ and $10$ is classified as _.

Severe Pain.

How is 'Mild Pain' defined regarding its impact on activities of daily living (ADLs)?

It generally does not interfere with ADLs.

Which level of pain is characterized by a patient feeling it is difficult to concentrate and hard to be distracted?

Moderate Pain.

What is the primary focus of a patient experiencing 'Severe Pain'?

The patient is completely focused on the pain.

What is the recommended first-line pharmacological treatment class for neuropathic pain?

Tricyclic antidepressants, anticonvulsants, or duloxetine.

Which specific medication class should be avoided when treating neuropathic pain in the elderly?

Tricyclic antidepressants (TCAs).

List three specific examples of tricyclic antidepressants mentioned for neuropathic pain.

Amitriptyline, desipramine, nortriptyline, or imipramine.

What two anticonvulsants are suggested as initial treatment options for neuropathic pain?

Gabapentin or pregabalin.

Nociceptive pain typically arises from stimuli from _.

Damaged tissue (inflammatory pain).

What two medication types are most effective for responding to nociceptive pain?

Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids.

What is the recommended maximum daily dose of dexamethasone for symptomatic patients with increased intracranial pressure?

$16$ mg daily.

How should dexamethasone be administered for intracranial pressure management following surgery?

In four equal daily doses.

What is the recommended radiotherapy dose for uncomplicated bone metastases?

A single $8$ Gy fraction.

What is the immediate pharmacological treatment for suspected metastatic spinal cord compression?

High-dose dexamethasone.

As a general guide, what percentage of the total daily opioid dose should the breakthrough dose be?

Approximately $10$ %.

What is the standard frequency for oral breakthrough opioid dosing?

Every $1$ to $2$ hours as needed (prn).

For what patient population should fentanyl transdermal patches never be initiated?

Opioid-naïve patients or patients with uncontrolled pain.

Which organ dysfunction requires cautious use of opioids and potential frequency alterations?

Liver or kidney dysfunction.

How long does it typically take for tolerance to develop for opioid-induced nausea and drowsiness?

$5-10$ days.

What is the most common prophylactic treatment for preventing opioid-induced constipation?

A combination of a stimulant (senna/bisacodyl) and an osmotic laxative (lactulose/PEG).

Define 'Tolerance' in the context of opioid use.

A state of adaptation where drug exposure results in diminished effects over time.

What is 'Dependence' as manifested by a drug class?

A state of adaptation manifested by a specific withdrawal syndrome upon abrupt cessation.

List the four behavioral characteristics that define 'Addiction'.

Impaired control, compulsive use, continued use despite harm, and craving.

What are three risk factors that place a patient in a 'high risk' category for addiction?

History of alcohol/drug misuse, major psychiatric disorder, or young age.

What tool is recommended for physicians to use when initiating opioid therapy for high-risk patients?

A Written Care Treatment Agreement.

Which two specific analgesics should not be used for mild cancer pain treatment?

Meperidine and pentazocine.

What is the typical starting dose of oral Morphine for an opioid-naïve patient with moderate pain?

$5$ mg PO every $4$ hours.

For elderly or frail patients, what is the suggested starting dose of oral Morphine for moderate pain?

$2.5$ mg PO every $4$ hours.

What is the starting dose of oral Hydromorphone for an opioid-naïve patient with moderate pain?

$1$ mg PO every $4$ hours.

If pain is uncontrolled on an immediate-release opioid, by what percentage should the dose be increased every $24-48$ hours?

$25$ %.

What is the breakthrough dose frequency for a patient on a sustained-release opioid via the subcutaneous route?

Every $30$ minutes as needed (prn).

In a severe pain crisis for an opioid-naïve patient with IV access, what is the 'stat' dose of morphine?

$5-10$ mg IV every $10$ minutes until relief.

Should long-acting opioids be used to manage a severe pain crisis?

No.

List the five steps of the Patient Assessment Process in order.

Assessment, Diagnosis, Planning, Implementation, Evaluation.

How does a 'Medical Diagnosis' differ from a 'Nursing Diagnosis'?

Medical identifies a specific disease/pathology; Nursing identifies responses to health problems.

Give an example of a Nursing Diagnosis related to cancer care.

Pain, body image issues, or ineffective breathing patterns.

What does the 'B' in the BATHE assessment tool stand for?

Background.

In the BATHE tool, what does the 'A' (Affect) help the clinician understand?

How the patient feels about their situation and their individual experience.

Which part of the BATHE tool confirms what is bothering the patient the most?

T (Trouble).

What is the purpose of the 'H' (Handling) step in the BATHE tool?

To assess how the patient is managing the problem and their compliance.

What does the 'E' in BATHE stand for, and what is its goal?

Empathy; to provide reassurance and normalize the patient's experience.

Which tool is a communication technique used to share information within the interprofessional team?

SBAR.

What do the letters in SBAR stand for?

Situation, Background, Assessment, and Recommendation/Request.

In the Triage system, what physical signs are associated with 'Severe' pain ($8-10$)?

Agitation, frequent position changes, muscle trembling, or clenching.

What are the four dimensions of cancer pain that must be addressed for quality of life?

Physical, psychological, social, and spiritual.

Why is 'self-reporting' considered the most reliable method of pain assessment?

Because pain is a subjective experience unique to the individual.

In the Planning phase of assessment, what three areas are addressed?

Interventions, strategies, and side effect management.

According to the SBAR paper, what is the primary cause of the majority of reported sentinel events?

Communication errors.

What is 'Allodynia' in the context of neuropathic pain?

Pain caused by a stimulus that does not normally provoke pain.

Deep somatic pain is usually described as _.

Dull, aching, or cramping.

What are the common potential stimuli for visceral pain?

Organ distension, muscle spasm, traction, ischemia, or inflammation.

Name one clinical example of Deafferentation Pain.

Phantom limb pain or Post-mastectomy pain.

Which non-pharmacological physical therapy is NOT advisable for areas receiving radiation therapy?

Applying hot or cold packs.

What is the benefit of a patient keeping a 'pain diary'?

It shows patterns of occurrence, frequency, and intensity to help communicate needs.

When should 'breakthrough medication' be taken relative to radiation treatment to ease the setup process?

$1$ hour prior to treatment.

Define 'Abuse' in the context of substance use.

Recurrent use causing clinically significant impairment or failure to meet major responsibilities.

What is the recommended starting dose for oral Oxycodone in an opioid-naïve patient with moderate pain?

$2.5$ mg PO every $4$ hours.

In patients with reduced kidney or liver function, which specialist should be consulted for opioid advice?

A palliative care specialist.

What is the primary goal of the 'Evaluation' phase in the patient assessment process?

Analysis (of the effectiveness of interventions).

What is the starting SC/IV dose of Morphine for an opioid-naïve patient with severe pain?

$2.5$ to $5$ mg SC/IV every $4$ hours.

How often should regular and breakthrough opioid doses be adjusted based on the previous 24h total dose?

Every $24$ to $48$ hours.

What procedure should be considered if oral neuropathic pain agents are ineffective?

A neuroablative procedure.

Mixed pain refers to the presence of both and elements.

Nociceptive; neuropathic.