Foundations of Nursing Theory Exam 3

True or false: Pain is an individual and subjective experience that only the patient can describe and feel

True

What step of the pain pathway involves activation of receptors in the periphery and conversion of painful stimuli into electrical impulses?

Transduction

What are the pain receptors that sense mechanical, thermal, and chemical stimuli?

Nociceptors

What is the ability to feel painful stimuli?

Nociception

What step of the pain pathway involves electrochemical signals travelling along the length of a nerve to the dorsal horn of the spinal cord?

Transmission

What fibers are myelinated and larger, transmitting acute, well-localized pain?

A-delta

What fibers are unmyelinated and smaller, transmitting dull, achy, poorly-localized pain?

C

What part of the pain pathway involves the pain stimulus reaching the cerebral and somatosensory cortex?

Perception

What identifies the location and intensity of pain?

Somatosensory cortex

What interprets the quality of pain?

Cerebral cortex

What part of the pain process involves the release of neuromodulators and serves as a protective pain reflex?

Modulation

What are the endogenous, opioid compounds that have an analgesic effect?

Endorphins

What is responsible for withdrawal of an endangered tissue from a damaging stimulus?

Protective pain reflex

What is the model used to describe how pain works?

The Gate Control Theory of Pain

What does the Gate Control Theory of Pain explain?

Painful stimuli can be blocked by non-painful stimuli

What response to pain produces changes in vital signs?

Physiologic

When does a physiologic response to pain often occur?

Acute pain

What pain has a rapid onset and short duration, varying in intensity, with an indentifiable cause?

Acute

What is pain that persists or is recurrent for more than 3-6 months, going through periods of remissions and exacerbations?

Chronic

What kind of pain is poorly localized?

Generalized

What kind of pain can be pinpointed and hurts in one area of the body?

Localized

What kind of pain is short in duration and localized, usually a sharp sensation?

Superficial

What kind of pain originates in bone, joint, muscle, skin or connective tissue, usually aching or throbbing and is well localized?

Somatic

What kind of pain originates in organs that is often the result of a disease process?

Visceral

True or false: If a patient has a past addiction problem, they should not be given addictive medications even if they are in severe pain

False, pain relief should always be provided

What is pain that originates in one part of the body but is felt in an area distant from its point of origin?

Referred

What is pain caused by a lesion or disease of peripheral or central nerves, described as burning, tingling, shooting, or shock-like?

Neuropathic

What term describes a patient experiencing pain in response to a stimulus that isn’t normally painful?

Allodynia

What is the common complication of long term diabetes mellitus with sharp, stabbing pain that is worse at night and is the reduced ability to feel pain or temperature changes in feet?

Diabetic Peripheral Neuropathy

True or false: Pain is a normal part of aging and should be expected

False

What is the ABCDE approach to pain assessment?

Ask about pain regularly

Believe the patient

Choose pain control options appropriate for patient

Deliver interventions in a timely and coordinated fashion

Empower patients

What does the COLDSPA mnemonic for pain assessment mean?

Character: describe the pain

Onset: when did it begin

Location: where is it and does it radiate

Duration: how long does it last and does it recur

Severity: how bad is the pain

Pattern: what makes it better/worse

Associated factors: what other symptoms occur with the pain

What are examples of nonpharmacologic pain relief?

Distraction, acupuncture, massage, guided imagery, heat and ice therapy, meditation

What are the three classes of analgesics?

1. Nonopioid

2. Opioid

3. Adjuvant

What is the most commonly used analgesic?

Acetaminophen

What are the drugs of choice for acute and moderate pain that produce side effects of gastric upset, GI bleeding, and hepatotoxicity?

NSAIDs

What drugs are used to treat moderate to severe pain?

Opioids (narcotics)

What is the main concerning side effect of opioids that may be reason for administering naloxone?

Respiratory depression

What are the common side effects of opioids?

Sedation, nausea, and constipation

What method to maximize pain relief while potentially decreasing opioid use is to administer analgesics at scheduled times rather than prn?

Around the Clock Dosing (ATC)

What is effective in providing pain relief in certain situations that acts on opioid receptors in spinal cord, inserting a catheter and administering opioid medication directly to the receptors?

Epidural

When should the provider be notified during assessment of a patient on opioids?

An increase in sedation or decrease in RR

What is the drug delivery system that allows patients to self-administer opioids with minimal risk of overdose?

Patient controlled analgesia (PCA)

True or false: A nurse should press the button on the PCA if the patient is unable to

False

What is the basic human need that carries out vital functions?

Oxygen

What does the oxygenation of body tissues depend on?

Airway integrity, alveolar integrity, and the functioning of the CV system and blood flow

Where does the airway begin and end?

Begins at the nose, ends at the bronchioles

What are the main functions of the upper respiratory system, consisting of the nose, pharynx, larynx, and epiglottis?

Warm, filter, and humidify inspired air

What is the main function of the lower respiratory system, consisting of the trachea, main stem bronchi, segmental bronchi, and terminal bronchioles?

Conduction of air

What all are essential for ventilation, perfusion, and the exchange of respiratory gases?

Respiratory muscles, pleural space, lungs, and alveoli

Describe mucociliary clearance.

The airways are lined with mucus and cilia that are hair-like projections that trap particles and push them with the mucus up toward the upper airway so they can be removed by coughing and sneezing

What is surfactant?

A phospholipid that covers alveoli and reduces the surface tension between the moist mucous membranes of alveoli that supports gas exchange

True or false: The lungs remain partially expanded at all times due to the pressure difference between the pleural space and atmospheric pressure

True

Is intrapleural pressure negative or positive in relation to atmospheric pressure?

Negative

Which lung has 3 lobes?

Right

Which lung has 2 lobes?

Left

What are small air sacs that are responsible for gas exchange?

Alveoli

What branches to each lungs from the trachea?

Main bronchus

What prevents alveoli from collapsing?

Surfactant

Each alveoli is made of a what kind of tissue, allowing for gas exchange?

Simple squamous epithelium

What is the lining of the lungs?

Visceral pleura

What is the lining of the thoracic cavity?

Parietal pleura

What holds the lungs in an expanded position and acts as a lubricant that allows the lungs to expand and contract easily along the chest wall?

Pleural fluid

What defines the movement of gases into and out of the lungs?

Ventilation

What defines the gas exchange between air and blood in the alveoli?

Diffusion

What defines the ability of the CV system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs?

Perfusion

What innervates the diaphragm?

Phrenic nerve

What can disruptions in ventilation include?

Edema of respiratory tract, poor neck positioning, asthma, obstruction by food, foreign object, water, or thickened mucus

What defines the ease with which the lungs can be filled with air/the ability of the lungs to expand in response to increased intraalveolar pressure?

Compliance

What conditions can decrease lung compliance?

Pulmonary edema and cystic fibrosis

What is a condition created when there is an obstruction in the airway / any condition that decreases the diameter of airways such as asthma, tracheal edema, or COPD?

Increased airway resistance

What are factors that affect diffusion?

Changes in surface area available at alveolar/capillary membrane

What controls involuntary respiration?

Medulla (part of the brainstem)

What responds to changes in arterial blood gas levels which stimulates neural regulators to adjust the rate and depth of ventilation to maintain normal ABG levels?

Chemoreceptors in the medulla, aortic, and carotid bodies

What is the response when chemoreceptors in the medulla are stimulated?

An increase in rate and depth of ventilation

True or false: A blood pH out of range is critical and can very quickly lead to death

True

What is the primary stimulus for breathing?

Increased blood CO2

What pumps deoxygenated blood through pulmonary circulation?

Right ventricle

What pumps oxygenated blood through systemic circulation?

Left ventricle

Where does the exchange of O2 and CO2 take place?

Capillaries

What could anemia lead to that would affect oxygenation?

Decreased oxygen carrying capacity

How could a chronic lung disease like COPD affect oxygenation?

Change in the anteroposterior diameter of the chest wall due to overuse of accessory muscles to breath leading to dyspnea/tachypnea

What can hypovolemia lead to that affects oxygenation?

Shock and severe dehydration (reduced blood volume) resulting in hypoxia

How can pregnancy lead to dyspnea?

Changes in uterine size push abdominal contents upward against the diaphragm causing inspiratory capacity to decline

True or false: Older adults have diminished respiratory muscle strength and decrease in cough effectiveness, increasing the risk for respiratory infections

True

What occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or to eliminate sufficient carbon dioxide?

Hypoventilation

What is the stimulus to breathe for COPD patients?

Decreased PaO2

True or false: Administration of oxygen greater than 1-3 L/min prevents the PaO2 from falling to a level that stimulates peripheral chemoreceptors, thus destroying the stimulus to breathe in a patient with COPD

True

What are the signs and symptoms of hypoventilation?

Mental status change, dysrhythmias, and potential cardiac arrest

What is the condition in which an inadequate amount of oxygen is available to cells?

Hypoxia

What are early signs of hypoxia?

Restlessness, anxiety, inability to concentrate, decreased LOC, dizziness, behavioral changes, increased pulse and depth of respiration

What is the main concerning late sign of hypoxia?

Cyanosis

What symptom can occur in chronic hypoxia?

Clubbing of the nails

What are the signs and symptoms of dyspnea?

Increased HR, RR, and BP, pallor/cyanosis, anxiety, use of accessory muscles

What advice should be given a patient with dyspnea?

Pursed-lip breathing and a position that reduces breathlessness

How can orthopnea be improved?

Patient sitting up or in tripod position, multiple pillow use when reclined to alleviate shortness of breath

What should be inspected during the nursing assessment of respiratory system?

1. Chest contour and shape (barrel, kyphosis, AP>transverse, rate and rhythm of respirations)

2. Cough (productive?)

3. Clubbing of nails, pallor, cyanosis, edema, capillary refill

4. Appearance (LOC/orientation)

What should be palpated during the nursing assessment of respiratory system?

Tracheal deviation (pneumothorax), tactile fremitus / thrills, pulses, skin temp, color, peripheral edema,

What sounds are the soft, whooshing, low pitched expirations heard over most of the lung?

Vesicular

What sounds are high pitched during expiration heard over trachea?

Bronchial