Pain Management, Sleep, and Rest

Comprehensive vocabulary flashcards covering Chapter 28 (Pain) and Chapter 31 (Sleep & Rest) from Wilkinson's Fundamentals of Nursing.

Pain

A personally defined, subjective experience described as whatever the experiencing person says it is; recognized as the most common reason individuals seek medical care in the United States.

• affects quality of life

• classified by type, origin, onset, duration, quality

Cutaneous Pain

Superficial pain that originates in the skin or the subcutaneous tissue layer.

Visceral Pain

Poorly localized pain originating from internal organs within the abdominal cavity, cranium, or thorax; frequently described as a tight, pressure, or crampy sensation.

Deep Somatic Pain

Localized pain originating in deeper structures such as ligaments, tendons, nerves, and bones.

Radiating Pain

Pain that originates at a specific site and extends or travels outward to adjacent or distant areas.

Referred Pain

Pain perceived at an anatomical site that is distant from its actual point of origin, such as left arm pain triggered by a myocardial infarction (heart attack).

Phantom Pain

Painful sensations perceived in an anatomical area or extremity that has been surgically amputated or is physically missing.

Psychogenic Pain

Pain experienced in the absence of an identifiable physical etiology, believed to be generated or perceived through psychological processes.

Nociceptive Pain

The most common category of pain, occurring when nociceptive pain receptors respond to pain stimuli; typically characterized as "achy."

Neuropathic Pain

Pain resulting from damaged nerves that transmit pain signals, characteristic of chronic pain states and described as "pins and needles," burning, or numbness.

Acute Pain

Pain with an anticipated or sudden onset that lasts for a duration of less than 6 months.

Chronic Pain

Persistent or recurring pain lasting for a duration greater than 6 months.

Intractable Pain

Severe, persistent pain that is resistant or refractory to standard medical and relief interventions.

quality of pain

how the person describes pain… can be sharp, dull, stabbing, aching, throbbing

frequency of pain

What part of pain are they describing when pts say “episodic, intermittent, or constant”

intensity of pain

What part of pain are pts describing when they say “mild, distracting, moderate, severe”

Pain Modulation

The physiological process of altering pain perception by blocking receptor sites with pharmacologic agents (e.g., opioids) or targeting small, slow and large, fast fibers using non-pharmacologic modalities (heat, ice, massage, etc)

pain

What are grimacing, frowning, moaning, irritability, agitation, pacing, rocking, body posture, profanity, increase BP/HR/RR, and self harm indications of?

P: what provokes pain (cause)

Q: quality

R: region (location) and does it radiate

S: severity

T: when did the pain start; anything make it better or worse?

What does the PQRST Pain Assessment stand for?

Patient Self-Report

The most reliable clinical indicator and standard measure of the presence and intensity of pain.

1. admission

2. before/after painful procedures/ treatments

3. at rest

4. before & after administering pain meds

5. with VS

6. change in condition

7. complaints of pain

When should you assess pain? 7

FACES Pain Rating Scale

A visual pain assessment scale featuring illustrated facial expressions representing varying degrees of distress from 0 ("no hurt") to 10 ("hurts worst"), used for children and non-verbal patients.

PAINAD Tool (Pain Assessment IN Advanced Dementia)

an observational scoring tool that evaluates breathing, negative vocalization, facial expression, body language, and consolability for patients with dimentia

CPOT (Critical Care Pain Observation Tool)

a validated observational scale utilized to assess pain cues in sedated, intubated, or anesthetized patients unable to self-report.

• repositioning

• oral care

• dimming lights

• talking to pt

UAP Pain Management Delegation actions 4

Non-Opioid Analgesics

A class of analgesics used for mild to moderate pain, most commonly exemplified by acetaminophen.

NSAIDs

Nonsteroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen, naproxen) that must be taken with food to reduce GI bleeding, require caution with anticoagulants, and necessitate reporting abnormal bleeding from gums, urine, stool, or vomitus.

Adjuvant Analgesics

Medication classes including topical anesthetics, muscle relaxants, and corticosteroids that are co-administered with opioids to decrease the total opioid dose required for pain relief.

Opioid Analgesics

Controlled narcotic medications (e.g., Morphine, Hydrocodone, Oxycodone) indicated for moderate to severe pain that carry the potential to depress respiratory drive.

What do you need to teach pt when admin opiods?

• constipation is a side effect, so increase water, fiber, stool softeners

• N/V is a SE, take medication w small snack

• drowsiness is a SE, fall risk, no driving

Patient-Controlled anesthesia (PCA)

med administered through IV pump with set controls; pt presses button when they are in pain

Sleep

A cyclical state of altered consciousness characterized by decreased motor activity and perception, accompanied by a selective response to external environmental stimuli.

Rest

A state involving mild to no physical activity that provides relaxation, relief from stress, and leaves the individual feeling refreshed.

• mental performance (learning, long term memory)

• energy

• ability to cope

• immune system

Benefits of Sleep

Circadian Rhythm

An internal clock operating on a 24-hour day-night sleep/wake pattern that affects an individual's overall level of functioning.

Reticular Activating System (RAS)

A brainstem neural network that relays sensory tracts through the thalamus and projects radiations to the cerebral cortex to modulate arousal and maintain sleep-wake transitions.

NREM Sleep (Non-Rapid Eye Movement)

a recurring division of the sleep cycle characterized by progressive physiological slowing and absence of rapid eye movements.

REM Sleep (Rapid Eye Movement)

a stage of sleep featuring heightened brain activity, vivid dreaming, and rapid bilateral ocular movement.

• age

• lifestyle (activity, food/alc, meds etc)

• illness

• environment (temp, noise/light, comfort)

Factors Affecting Sleep 4

Insomnia

A common sleep disorder defined as the inability to fall asleep, maintain sleep, or go back to sleep after awakening.

Circadian Disorders

Sleep disruptions stemming from an abnormality in sleep/wake timing cycles, frequently induced by jet lag, night shift work, or rotating work schedules.

Restless Legs Syndrome (RLS)

A neurological sensory-motor disorder manifested by an uncontrollable urge to move the legs during periods of rest or sleep.

Hypersomnia

A condition characterized by excessive sleeping, particularly during daytime hours, which may be sleep-related, disease-related, or linked to depression.

Sleep Apnea

A sleep-related breathing disorder characterized by periodic cessation of breathing lasting for at least 10 seconds during sleep.

Narcolepsy

A chronic central nervous system disorder caused by the brain's inability to properly regulate sleep-wake cycles, resulting in sudden, uncontrollable daytime sleep episodes.

Parasomnias

A clinical category of disruptive sleep-related disorders that include sleepwalking, sleeptalking, bruxism, night terrors, REM sleep disturbances, and enuresis.

• cluster/schedule nursing care to avoid interrupting sleep

• create a comfortable/restful environment

• promote comfort/relaxation

• support bedtime rituals/routines

• offer food that help promote sleep

• teach about sleep hygeine

What are 6 nursing interventions for promoting sleep?