NURS Clinical Science Exam 2 Prep - Pain

What is the most common reason people seek care and take medication?

pain

What is leading cause of disability?

pain

What is pain?

unpleasant sensory and emotional experience associated with acutal or potential tissue damage

What is the most reliable indicator of pain?

self-report

What is persistent (chronic) pain?

lasts beyond expected healing time

What is the most common persistent (chronic) pain?

persistent noncancer

How long is persistent (chronic) pain?

3-6 months

What is acute pain?

short-lived; results from sudden, accidental trauma

What can result in acute pain?

surgery, ,ischemia, acute inflammation

What are resources for acute pain?

physical therapy and pain clinics

What is nociceptive pain?

injury to tissues

What is neuropathic pain?

related to peripheral or central nervous-system dysfunction

What acts as a warning sign?

acute pain

What activates the sympathetic nervous sytem?

acute pain

What are characteristics of acute pain?

usually temporary, sudden onset, procedural pain

What is the result of acute pain?

increased vital signs, sweating, dilating pupils, restlessness, inability to concentrate, apprhension, distress of varying degrees

What is the most common example of acute pain?

post-surgical pain

What are characteristics of persistent (chronic) pain?

last or recurs for indefinitee period (more than 3 months)

What pain has gradual onset?

persisent (chronic) pain

What conditions can results in persistent (chornic) pain?

diabetes, rheumatoid arthritis, chron’s disease, interstitial cystitis

What is usually the result of cancer pain?

tumors, tumor growth, nerve compression, tissue invasion, metastasis

What can cancer treatment result in?

acute pain (ex. repetitive blood draws, procedures, surgery, toxicities from chemotherapy and radiation)

What are types of nociceptor pain?

somatic and visceral

What is somatic pain?

sharp, localized sensation

What is visceral pain?

dull, throbbing, aching pain

What is neuropathic pain?

caused by direct injury to nerves

What is often unsuccessful at treating neuorpathic pain?

analgesic treatment

What is used to treat neuropathic pain?

adjuvant analgesics, antiseizure and antidepressant drugs

What are common descriptors of neuropathic pain?

burning, shooting, tingling, electric shock, pins and needles

What may coexist with nociceptive pain?

neuropathic pain

What diseases result in neuropathic pain?

carpal tunnel syndrome, central pain syndrome, degenerative disk disease, diabetic neuropathy, intractable cancer pain, phantom limb pain, postsurgical pain, sciatica, trigeminal neuralgia

What is the nurse’s role in assessing pain?

serve as adovocate, act promptly to relieve pain, respect patient values and preferences, minimize/remove personal bias

What is the first part of a comprehensive pain assessment?

ask about location, intesnity, quality, onset, and duration

What is the second part of a comprehensive pain assessment?

aggravating and relieving factors

What is the third part of a comprehensive pain assessment?

effect of pain on function and quality of life

What is the fourth part of a comprehensive pain assessment?

comfort-function outcomes; current therapies, medical history, preferences, and goals

What is a psychosocial assessment for pain?

advocate for proper pain control for all patients; explore fear, depression, relationships, and cultural meaning

What are assessment challenges for pain?

patients who cannot self-report pain are at higher risk for undertreated pain

What are neural mechanisms of pain?

multiple targets where medications can act to stop pain transmission

What two major classes of drugs are employed to manage pain?

opioid and nonopioid analgesics

What are kinds of opioids analgesics?

pure opioid agonists (fulll opioid agonists), agonist-antagonist opioids (mixed opioids), opioid antagonists

What class of drug is morphine?

pure opioid agonists (full opioid agonists)

What class of drug is fentanyl?

pure opioid agonists (full opioid agonists)

What class of drug is oxycodone?

pure opioid agonists (full opioid agonists)

What class of drug is oxymorphone?

pure opioid agonists (full opioid agonists)

What class of drug is hydrocodone?

pure opioid agonists (full opioid agonists)

What class of drug is butorphanol?

agonist-antagonist opioid (mixed opioid)

What class of drug is nalbuphine?

agonist-antagonist opioid (mixed opioid)

What class of drug is naloxone?

opioid antagonist

What class of drug is naltrexone?

opioid antagonist

What is the opioid crisis?

declared a national public health emergency in 2017; involves prescription opioid misuse and illicit opioids, including fentanyl and heroin

What is physical dependence?

withdrawal can occur after abrupt cessation

What is tolerance?

diminished effect with repeated exposure

What is addiction?

compuslive use despite harm

What is pseudoaddiction?

drug-seeking behaviors (such as asking for early refills or higher doses) that look like an opioid addiction, but are actually caused by undertreated pain

What is opioid naive?

person who has not recently taken enough opioid on a regular basis to become tolerant to the effects

What is opioid tolerant?

person who has taken an opioid long enough at doses high enough to develop tolerance to many of the effects

What is opioid use disorder?

dependence on opioids

What is the MAT program?

methadone, combo. of buprenorphine plus naloxone, naltrexone

When is the MAT program used?

treatment for opioid dependence

What are kinds of non-opioid analgesics?

acetaminophen and NSAIDs

What is assessed with acetaminophen?

total daily exposure and liver risk

What are NSAIDs?

monitor GI bleeding, renal and cardiovascular risk

What should be evaluated after non-opioid analgesic admin.?

pain relief and function

What must be monitored when taking acetaminophen?

hepatotoxicity; ALT and AST

What must be monitored when taking NSAIDs?

gastric side effects

What are adverse effects of NSAIDs?

risk for CV and renal through prostaglandin inhibition

What is the MOA of NSAIDs?

inhibit cyclooxygenase (COX), an enzyme responsible for the formation of prostaglandins

What is the result of NSAIDs?

reduce fever, inflammation and pain

What are NSAIDs used for?

mild to moderate pain

What are common kinds of NSAIDs?

aspirin, ibuprofen, COX-2 inhibitors (Celebrex), naproxen

What is the pharmacological class of acetaminophen?

para-amninophenol derivative

What is the action and therapeutic use of acetaminophen?

produces analgesia through central mechanisms involvign prostaglandin activity; acts on the hypothalamus to reduce fever

What is acetaminophen used for?

mild to moderate pain and fever

What are adverse effects of acetaminopehn?

nausea, rash, or hypersensitivity reactions, elevate liver enzymes, severe hepatoctoxciity and acute liver failure with overdose

What are priority nursing considerations for acetmainophen?

assess pain or temperature before and after admin., assess for liver disease, malnutrition, and alcohol use

What is priority safety for acetaminophen?

adult maximum is generally 4,000 mg/24 hours from ALL sources under appropriate supervision; product-specific and patient-specific limits may be lower

What are kinds of non-steroidal anti-inflammatory drugs (NSAIDs)?

nonopioid analgesics, anti-inflammatory agents, antipyretics

What is the action of non-steroidal anti-inflammatory drugs (NSAIDs)?

inhibit COX enzymes, decreasing prostaglandin synthesis

What is the use of non-steroidal anti-inflammatory drugs (NSAIDs)?

reduce painn, inflammation, and fever

What are major adverse effects of NSAIDs?

GI irritation, peptic ulcers, and GI bleeding; acute kidney injury; increased BP, fluid retention, and cardiovascular events; increased bleeding risk

What are priority nursing considerations with NSAIDs?

assess pain and inflammation before and after admin., review hisotry of GI bleeding, kidney disease, heart disease, and hypertension

What must be monitored when taking NSAIDs?

renal function, BP, edema, and signs of bleeding

What is priority safety for NSAIDs?

use the lowest effective dose for the shorted necessary dureation

What is true of enteric-coated aspirin?

must be swalloed whole—never crush, chew or split

What are analgesics?

medications used to relieve pain

What are opioid analgesics?

natureal or synthetic morphine-like substance responsible for reducing moderate to severe pain

What are narcotic substances?

can produce numbness or stupor-like symptoms

What are opioids?

milky extract from the unripe seeds of the poppy plant

What are opiates?

chemicals contained within having pharmacological activity

What is the primary use of opioid agonists?

relieve moderate to severe pain; some used for anesthesia

What is morphine?

prototype drug by whcih all other opioids effectiveness is compared

What is patient-controlled analgesia (PCA)?

patients are able to self-medicate by pressin a limited rate-controlled button

What are combination analgesics?

opioid combine with nonnarcotic analgesic

What is the result of combination analgesics?

work together to relieve pain in an attempt to avoid narcotic related-side effects

What are types of combination analgesics?

anexsia, fioricet, percocet, oxtecet, percodan, tylenol with codiene

What are types of selected opioid analgesics?

morphine, fentanyl, hydromorphone, oxycodone, hydrocodone, methadone

What are adverse effects of opioid analgesics?

respiratory depression, constipation, nausea, comiting, pruritus, sedation, orthostatic hypotension

What is the action of morphine?

acts on CNS opioid receptors to alter pain perception

What is the therapeutic use of morphine?

moderate to severe pain when opioid therapy is indicated