pain management week 9

What is the most important principle of pain assessment?

Pain is subjective; the patient's self-report is the most reliable indicator.

What is the nurse's responsibility when a patient reports pain?

Accept the patient's report and assess and manage the pain without requiring proof.

What factors influence a patient's perception of pain?

Age, culture, genetics, emotions, past experiences, social support, and neurological status.

What is acute pain?

Pain with a sudden or gradual onset that is generally associated with an injury or illness.

What is chronic pain?

Pain that persists for 3 months or longer.

What is referred pain?

Pain perceived in a location different from its actual source.

What is visceral pain?

Pain originating from internal organs.

What is somatic pain?

Pain originating from skin, muscles, bones, or connective tissues.

What is nociceptive pain?

Pain resulting from activation of pain receptors by actual or potential tissue damage.

What is neuropathic pain?

Pain caused by nerve damage or dysfunction, often described as burning, tingling, or pins and needles.

A patient with diabetes reports burning and tingling in the legs. What type of pain is suspected?

Neuropathic pain.

What is gate control theory?

A theory that a neurological gate in the spinal cord regulates pain signals traveling to the brain.

How does stimulation of large nerve fibers affect pain transmission?

Large nerve fiber activity can inhibit pain transmission through the spinal cord.

What physiological changes can occur during pain?

Increased blood pressure, heart rate, respiratory rate, and neuroendocrine activity.

What are common nonverbal manifestations of pain?

Grimacing, guarding, clenched teeth, restlessness, and changes in posture.

What are common verbal manifestations of pain?

Moaning, crying, and verbally reporting discomfort.

How can pain affect activities of daily living (ADLs)?

Pain can interfere with normal daily activities and physical functioning.

How does distraction influence pain perception?

Distraction redirects attention away from pain and can reduce perceived intensity.

What does PQRST stand for in pain assessment?

Provokes, Quality, Radiates, Severity, and Time.

What does OLDCART stand for in pain assessment?

Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, and Treatments.

What does the P in PQRST assess?

What provokes, worsens, or relieves the pain.

What does the Q in PQRST assess?

Pain quality, such as sharp, dull, stabbing, or burning.

What does the R in PQRST assess?

Whether pain radiates or spreads to another location.

What does the S in PQRST assess?

Pain severity using an appropriate pain rating scale.

What does the T in PQRST assess?

When pain began and how long it lasts.

What does a pain rating of 0 indicate?

No pain.

What does a pain rating of 10 indicate?

The worst pain possible.

What is the Wong-Baker FACES Pain Scale used for?

Helping children and patients who can select facial expressions communicate pain intensity.

Which patients may have difficulty verbally reporting pain?

Young children, cognitively impaired patients, critically ill patients, and comatose patients.

How should nurses assess pain in patients unable to communicate?

Observe facial expressions, guarding, body movements, and behavioral changes.

Does the absence of verbal pain complaints indicate that a patient is pain-free?

No. Patients may experience pain without being able to express it verbally.

What are basic nonpharmacological interventions for pain?

Repositioning, hygiene, a calm environment, heat, cold, and massage.

What is transcutaneous electrical nerve stimulation (TENS)?

A nonpharmacological technique that uses electrical stimulation to help manage pain.

What is guided imagery?

Using mental visualization to promote relaxation and reduce pain.

What is biofeedback?

Using physiological feedback to help patients control their responses to pain.

What is mindfulness in pain management?

Present-focused awareness that helps modify the experience of pain.

What are the three major categories of analgesics?

Nonopioid analgesics, opioid analgesics, and adjuvant analgesics.

What are examples of nonopioid analgesics?

Acetaminophen (APAP) and nonsteroidal anti-inflammatory drugs (NSAIDs).

What is the primary purpose of NSAIDs?

Reduce pain and inflammation by suppressing part of the inflammatory pathway.

What are major adverse effects of NSAIDs?

GI irritation, reduced clotting, decreased renal blood flow, kidney injury, and increased blood pressure.

Which NSAID is especially associated with reduced platelet clotting and salicylate poisoning?

Aspirin.

What is the major toxicity associated with excessive acetaminophen use?

Hepatotoxicity (liver damage).

What is the maximum daily acetaminophen dose identified in the lecture?

4,000 mg (4 g) in 24 hours; lower limits may apply to certain patients.

Why must nurses check OTC medications before administering acetaminophen?

Many cold, headache, allergy, and sleep products contain acetaminophen, increasing overdose risk.

How do opioid analgesics relieve pain?

They bind to opioid receptors in the brain and alter pain perception.

What medication is considered the prototype opioid analgesic?

Morphine.

What are common opioid analgesics?

Morphine, fentanyl, hydrocodone, hydromorphone, and oxycodone.

What is the most common adverse effect of opioid analgesics?

Constipation caused by decreased intestinal peristalsis.

What is the most serious life-threatening adverse effect of opioids?

Respiratory depression.

What should the nurse assess before administering an opioid?

Pain intensity, respiratory rate, oxygen saturation, medication, dose, and previous administration time.

What should the nurse monitor after opioid administration?

Respiratory rate, oxygen saturation, sedation, pain relief, and bowel function.

What nursing intervention is important during IV opioid administration?

Monitor oxygen saturation and respiratory status for opioid-induced respiratory depression.

What medication reverses opioid-induced respiratory depression?

Naloxone (Narcan), an opioid antagonist.

What patient teaching helps prevent opioid-related constipation?

Increase fluids, dietary fiber, and activity as appropriate; use prescribed stool softeners or laxatives.

What safety instructions should nurses provide to patients taking opioids?

Avoid driving or heavy machinery and change positions slowly to prevent dizziness and falls.

How soon should pain be reassessed after IV analgesic administration?

30 minutes after administration, followed by ongoing reassessment.

How soon should pain be reassessed after oral analgesic administration?

60 minutes after administration, followed by ongoing reassessment.

What is patient-controlled analgesia (PCA)?

A method allowing patients to self-administer prescribed analgesic doses through a delivery system.

What are the common routes for PCA and intraspinal analgesia?

PCA may use IV, subcutaneous, or epidural routes; intraspinal analgesia includes epidural and intrathecal routes.

What is the difference between opioid tolerance, physical dependence, and addiction?

Tolerance is reduced drug response; dependence causes withdrawal if abruptly stopped; addiction involves compulsive use despite harm.

What are adjuvant analgesics, and when are they useful?

Medications primarily used for other conditions that help treat neuropathic or persistent pain.

Which anticonvulsants are commonly prescribed for neuropathic pain?

Gabapentin (Neurontin) and pregabalin (Lyrica).

What adverse effects should nurses monitor with gabapentin and pregabalin?

Drowsiness, confusion, blurred vision, clumsiness, muscle aches, and weakness.

How long may antidepressants take to relieve chronic or cancer-related pain?

Approximately 1–2 weeks.

Which patients are at increased risk for opioid-induced respiratory depression, hypotension, and confusion?

Older adults, particularly elderly postoperative patients.

What is the difference between acute and chronic pain?

Acute pain has a sudden or gradual onset and is generally associated with injury or illness; chronic pain persists for 3 months or longer.

What is the difference between nociceptive and neuropathic pain?

Nociceptive pain results from tissue damage activating pain receptors; neuropathic pain results from nerve damage or dysfunction and often causes burning or tingling.

What is the difference between somatic and visceral pain?

Somatic pain originates in skin, muscles, bones, or connective tissues; visceral pain originates in internal organs.

What is the pathway of pain transmission?

Painful stimulus activates sensory nerve endings → signals travel through sensory nerves and spinal cord → brain interprets pain.

What is gate control theory in pain management?

A neurological gate in the spinal cord modulates pain transmission; large nerve fiber activity can inhibit pain signals reaching the brain.

What factors influence pain perception and modulation?

Age, genetics, neurological status, emotions, past experiences, attention, culture, spirituality, and social support.

What is the most reliable indicator of a patient's pain?

The patient's self-report because pain is subjective; nurses must accept the patient's report.

What does PQRST stand for in pain assessment?

Provokes, Quality, Radiates, Severity, and Time.

What subjective information should nurses collect during pain assessment?

Patient-reported location, intensity, quality, onset, duration, radiation, and aggravating or relieving factors.

What objective findings may indicate pain?

Grimacing, guarding, restlessness, increased heart rate, increased blood pressure, and increased respiratory rate.

How should nurses assess pain in cognitively impaired or nonverbal patients?

Observe facial expressions, guarding, body movements, and behavioral changes; absence of verbal complaints does not mean absence of pain.

What is the difference between opioids, acetaminophen, and NSAIDs?

Opioids alter pain perception through opioid receptors; acetaminophen relieves pain without significant anti-inflammatory effects; NSAIDs reduce pain and inflammation.

What are the most important adverse effects of opioid analgesics?

Constipation is the most common; respiratory depression is the most serious. Also monitor sedation, nausea, and dizziness.

What must the nurse assess before and after administering opioids?

Before: pain, respiratory rate, oxygen saturation, and previous dose. After: pain relief, respiratory status, sedation, and bowel function.

What medication reverses opioid-induced respiratory depression?

Naloxone (Narcan), an opioid antagonist used for opioid overdose.

What are the major safety concerns with acetaminophen and NSAIDs?

Acetaminophen can cause hepatotoxicity; NSAIDs can cause GI irritation, bleeding, decreased renal blood flow, and kidney injury.

What nonpharmacological techniques help manage pain?

Relaxation, distraction, guided imagery, mindfulness, biofeedback, massage, positioning, heat, cold, and TENS.

How do cognitive-behavioral pain management strategies reduce pain?

They modify attention and responses to pain through distraction, relaxation, guided imagery, mindfulness, and biofeedback.

What are the nurse's ethical responsibilities and patient education priorities in pain management?

Believe patient reports, assess regularly, avoid deceptive placebo use, educate about medication safety and adverse effects, and reassess treatment effectiveness.

What is patient-controlled analgesia (PCA), and what are the nurse's responsibilities?

PCA allows patients to self-administer prescribed analgesic doses. Assess pain, respiratory rate, oxygen saturation, sedation, and medication effectiveness; only the patient should activate the PCA button.