Podcast
Questions and Answers
Which type of pain is characterized by involvement of internal organs due to obstructions, inflammation, or tumors?
Which type of pain is characterized by involvement of internal organs due to obstructions, inflammation, or tumors?
What is a common characteristic of neuropathic pain?
What is a common characteristic of neuropathic pain?
Which of the following examples best represents somatic pain?
Which of the following examples best represents somatic pain?
What distinguishes phantom limb pain from other types of pain?
What distinguishes phantom limb pain from other types of pain?
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Which of the following best describes visceral pain?
Which of the following best describes visceral pain?
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What does the severity of pain correlate with?
What does the severity of pain correlate with?
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Which factor is NOT considered to influence pain perception?
Which factor is NOT considered to influence pain perception?
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What is meant by nociceptive pain?
What is meant by nociceptive pain?
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What misconception may patients have about post-surgery pain?
What misconception may patients have about post-surgery pain?
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Which type of nociceptive pain is characterized by pelvic discomfort?
Which type of nociceptive pain is characterized by pelvic discomfort?
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Which statement is true about effective pain management?
Which statement is true about effective pain management?
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Which of the following is an example of somatic nociceptive pain?
Which of the following is an example of somatic nociceptive pain?
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What happens to nociceptors during an injury?
What happens to nociceptors during an injury?
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Which statement correctly reflects a fact about infants and pain?
Which statement correctly reflects a fact about infants and pain?
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What is a misconception regarding the visibility of pain?
What is a misconception regarding the visibility of pain?
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Which of the following is true about pain in older adults?
Which of the following is true about pain in older adults?
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What is a fact regarding opioid use in pain management?
What is a fact regarding opioid use in pain management?
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What misconception about pain and aging is incorrect?
What misconception about pain and aging is incorrect?
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Which statement reflects a common misconception about pain assessment?
Which statement reflects a common misconception about pain assessment?
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Why might misconceptions about opioids hinder effective pain management?
Why might misconceptions about opioids hinder effective pain management?
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Which of the following indicates a misunderstanding of how pain can be experienced?
Which of the following indicates a misunderstanding of how pain can be experienced?
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What is the main purpose of the FLACC Scale?
What is the main purpose of the FLACC Scale?
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Which population is most suitable for the use of the PAINAD Scale?
Which population is most suitable for the use of the PAINAD Scale?
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What aspect does the 'Values' section of pain assessment emphasize?
What aspect does the 'Values' section of pain assessment emphasize?
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Which of the following does NOT fall under the 'Pain Assessment Tools' category?
Which of the following does NOT fall under the 'Pain Assessment Tools' category?
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Which behavior is NOT observed by the PAINAD Scale?
Which behavior is NOT observed by the PAINAD Scale?
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What is an important question to ask regarding the impact of pain on a person’s life?
What is an important question to ask regarding the impact of pain on a person’s life?
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What should be considered when discussing goals related to pain management?
What should be considered when discussing goals related to pain management?
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How can fatigue affect pain perception?
How can fatigue affect pain perception?
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Which of the following factors can influence pain sensitivity?
Which of the following factors can influence pain sensitivity?
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What role do neurological conditions play in pain sensitivity?
What role do neurological conditions play in pain sensitivity?
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For patients with pain insensitivity, what care measures are essential?
For patients with pain insensitivity, what care measures are essential?
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How can heredity impact pain medication effectiveness?
How can heredity impact pain medication effectiveness?
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What is the significance of pain being recognized as the 5th vital sign?
What is the significance of pain being recognized as the 5th vital sign?
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When should routine pain screenings be conducted?
When should routine pain screenings be conducted?
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Why is self-report considered the gold standard in pain assessment?
Why is self-report considered the gold standard in pain assessment?
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What approach should nurses take regarding pain assessment?
What approach should nurses take regarding pain assessment?
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What factors might affect how patients disclose their pain?
What factors might affect how patients disclose their pain?
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What does nurse-initiated pain assessment entail?
What does nurse-initiated pain assessment entail?
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Which of these is true regarding individual pain experiences?
Which of these is true regarding individual pain experiences?
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What might prevent patients from disclosing their pain effectively?
What might prevent patients from disclosing their pain effectively?
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What is the most appropriate way to assess the pain of a patient who is oriented and has
recently had surgery?
What is the most appropriate way to assess the pain of a patient who is oriented and has recently had surgery?
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A nurse is caring for a patient who recently had an abdominal hysterectomy and states that she
is experiencing severe pain. The patient’s blood pressure is 110/60, and her heart rate is 60. In addition, the patient does not appear to be in any distress. Which response by the nurse is most therapeutic?
A nurse is caring for a patient who recently had an abdominal hysterectomy and states that she is experiencing severe pain. The patient’s blood pressure is 110/60, and her heart rate is 60. In addition, the patient does not appear to be in any distress. Which response by the nurse is most therapeutic?
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Which of the following statements made by a patient reflects that the patient understands the
relationship between the gate control theory of pain and the use of meditation to relieve pain?
Which of the following statements made by a patient reflects that the patient understands the relationship between the gate control theory of pain and the use of meditation to relieve pain?
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A nursing student is planning care for an older patient who is experiencing pain. Which of the
following statements made by the nursing student prompts the nursing professor to clarify the
nursing student’s knowledge?
A nursing student is planning care for an older patient who is experiencing pain. Which of the following statements made by the nursing student prompts the nursing professor to clarify the nursing student’s knowledge?
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The nurse is caring for two patients; both are having a hysterectomy. The first patient is
having the hysterectomy after a complicated birth. The second patient has uterine cancer. What will most likely influence the experience of pain for these two patients?
The nurse is caring for two patients; both are having a hysterectomy. The first patient is having the hysterectomy after a complicated birth. The second patient has uterine cancer. What will most likely influence the experience of pain for these two patients?
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The nurse anticipates administering an opioid fentanyl patch to which patient?
The nurse anticipates administering an opioid fentanyl patch to which patient?
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Which of the following statements made by the patient indicates to the nurse that teaching
about a patient-controlled analgesia (PCA) device has been effective?
Which of the following statements made by the patient indicates to the nurse that teaching about a patient-controlled analgesia (PCA) device has been effective?
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A nurse is caring for a patient who is experiencing pain after abdominal surgery. What
information is important for the nurse to tell the patient when providing patient education
about effective pain management?
A nurse is caring for a patient who is experiencing pain after abdominal surgery. What information is important for the nurse to tell the patient when providing patient education about effective pain management?
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nurse is caring for a patient who recently had spinal surgery. The nurse knows that patients
usually experience acute pain after this type of surgery. The patient refuses to get up and walk
and is not moving around in the bed. However, the patient is stoic and denies experiencing
pain at this time. What most likely explains this patient’s behaviour and response to surgery?
nurse is caring for a patient who recently had spinal surgery. The nurse knows that patients usually experience acute pain after this type of surgery. The patient refuses to get up and walk and is not moving around in the bed. However, the patient is stoic and denies experiencing pain at this time. What most likely explains this patient’s behaviour and response to surgery?
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A nurse is providing discharge teaching for a patient with a fractured humerus. The patient is
going home with oxycodone–acetaminophen (Percocet). What important patient education
does the nurse provide?
A nurse is providing discharge teaching for a patient with a fractured humerus. The patient is going home with oxycodone–acetaminophen (Percocet). What important patient education does the nurse provide?
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A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0-to-10 pain scale. What nonpharmacological intervention does the nurse implement for
this patient while awaiting orders for pain medication from the health care provider?
A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0-to-10 pain scale. What nonpharmacological intervention does the nurse implement for this patient while awaiting orders for pain medication from the health care provider?
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A patient who has had type 2 diabetes for 26 years is beginning to experience peripheral
neuropathy in the feet and lower legs, which is causing the patient to have a decreased ability
to feel pain in the lower extremities. The nurse is providing education to the patient to prevent
injury to the feet. The nurse tells the patient to always wear shoes or slippers when walking.
Which of the following statements made by the nurse best explains the rationale for this
instruction?
A patient who has had type 2 diabetes for 26 years is beginning to experience peripheral neuropathy in the feet and lower legs, which is causing the patient to have a decreased ability to feel pain in the lower extremities. The nurse is providing education to the patient to prevent injury to the feet. The nurse tells the patient to always wear shoes or slippers when walking. Which of the following statements made by the nurse best explains the rationale for this instruction?
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A nurse is assessing a patient who started to have severe pain 3 days ago. When the nurse asks
the patient to describe the pain, the patient states, “The pain feels like it is in my stomach. It is
a burning pain, and it spreads out in a circle around the spot where it hurts the most.” What
type of pain does the nurse document that the patient is having at this time?
A nurse is assessing a patient who started to have severe pain 3 days ago. When the nurse asks the patient to describe the pain, the patient states, “The pain feels like it is in my stomach. It is a burning pain, and it spreads out in a circle around the spot where it hurts the most.” What type of pain does the nurse document that the patient is having at this time?
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A patient who had a motor vehicle accident 2 days ago is experiencing pain and is receiving
patient-controlled analgesia (PCA). How does the nurse know that the patient is experiencing
effective pain management with the PCA?
A patient who had a motor vehicle accident 2 days ago is experiencing pain and is receiving patient-controlled analgesia (PCA). How does the nurse know that the patient is experiencing effective pain management with the PCA?
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The nurse recognizes that which of the following is a modifiable contributor to a patient’s
perception of pain?
The nurse recognizes that which of the following is a modifiable contributor to a patient’s perception of pain?
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The nurse is evaluating the effectiveness of guided imagery for pain management as used for a
patient who has second- and third-degree burns and needs extensive dressing changes. Which
situation best indicates that guided imagery is controlling the patient’s pain effectively during
dressing changes?
The nurse is evaluating the effectiveness of guided imagery for pain management as used for a patient who has second- and third-degree burns and needs extensive dressing changes. Which situation best indicates that guided imagery is controlling the patient’s pain effectively during dressing changes?
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A nurse is providing medication education to a patient who just started taking ibuprofen, a
nonselective nonsteroidal anti-inflammatory drug (NSAID). Which statement made by the
nurse best indicates how ibuprofen works?
A nurse is providing medication education to a patient who just started taking ibuprofen, a nonselective nonsteroidal anti-inflammatory drug (NSAID). Which statement made by the nurse best indicates how ibuprofen works?
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A nurse has brought the patient his scheduled pain medication. The patient asks the nurse to
wait to give pain medication until the time for the dressing change, which is 2 hours away.
Which response by the nurse is most therapeutic?
A nurse has brought the patient his scheduled pain medication. The patient asks the nurse to wait to give pain medication until the time for the dressing change, which is 2 hours away. Which response by the nurse is most therapeutic?
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A nurse receives an order from a health care provider to administer acetaminophen, 500 mg,
to a patient with moderate arthritis pain. The order is to give 2 tablets every 4 hours by mouth
as needed for pain. The patient has a history of gastric ulcer. What is the nurse’s best next
action?
A nurse receives an order from a health care provider to administer acetaminophen, 500 mg, to a patient with moderate arthritis pain. The order is to give 2 tablets every 4 hours by mouth as needed for pain. The patient has a history of gastric ulcer. What is the nurse’s best next action?
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The nurse knows that which technique is best for assessing pain in a child who is 4 years of
age?
The nurse knows that which technique is best for assessing pain in a child who is 4 years of age?
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Which statement made by a nursing educator best explains why it is important for nurses to
determine a patient’s medical history and recent drug use?
Which statement made by a nursing educator best explains why it is important for nurses to determine a patient’s medical history and recent drug use?
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A nurse is supervising a student who is caring for a patient with chronic pain. Which
statement by the student indicates an understanding of pain management?
A nurse is supervising a student who is caring for a patient with chronic pain. Which statement by the student indicates an understanding of pain management?
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The nurse is assessing how a patient’s pain is affecting mobility. Which assessment question
is most appropriate?
The nurse is assessing how a patient’s pain is affecting mobility. Which assessment question is most appropriate?
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The nurse is teaching a student nurse about pain assessment scales. Which statement by the
student indicates correct understanding?
The nurse is teaching a student nurse about pain assessment scales. Which statement by the student indicates correct understanding?
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The nurse is administering pain medication for several patients. Which patient does the nurse
administer medication to first?
The nurse is administering pain medication for several patients. Which patient does the nurse administer medication to first?
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The nurse is assessing a patient for opioid tolerance. Which finding supports the such a
finding?
The nurse is assessing a patient for opioid tolerance. Which finding supports the such a finding?
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A nurse is caring for a patient with rheumatoid arthritis who is now going to be taking 2
acetaminophen (Tylenol) tablets every 6 hours to control pain. Which part of the patient’s
social history is the nurse most concerned about?
A nurse is caring for a patient with rheumatoid arthritis who is now going to be taking 2 acetaminophen (Tylenol) tablets every 6 hours to control pain. Which part of the patient’s social history is the nurse most concerned about?
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The nurse is caring for a patient who suddenly experiences chest pain. What is the nurse’s first
priority?
The nurse is caring for a patient who suddenly experiences chest pain. What is the nurse’s first priority?
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The nurse is caring for a patient who recently had surgery to repair a hernia. The patient’s pain
was rated 7 on a scale of 0 to 10 before pain medication was administered. One hour after
receiving an oral opioid, the patient ranks his pain at 3. The patient asks the nurse why he isn’t
receiving more pain medication. Which is the nurse’s best response?
The nurse is caring for a patient who recently had surgery to repair a hernia. The patient’s pain was rated 7 on a scale of 0 to 10 before pain medication was administered. One hour after receiving an oral opioid, the patient ranks his pain at 3. The patient asks the nurse why he isn’t receiving more pain medication. Which is the nurse’s best response?
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Which of the following is the best way for the nurse to manage pain for a patient with chronic
pain from arthritis?
Which of the following is the best way for the nurse to manage pain for a patient with chronic pain from arthritis?
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A nurse is caring for a patient who fell on the ice and has connective tissue damage in the
wrist and hand. What type of pain is the patient experiencing?
A nurse is caring for a patient who fell on the ice and has connective tissue damage in the wrist and hand. What type of pain is the patient experiencing?
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The nurse is caring for an infant in the pediatric unit. Which of the following is the most
accurate description of factors that will influence the perception and management of pain for
this patient?
The nurse is caring for an infant in the pediatric unit. Which of the following is the most accurate description of factors that will influence the perception and management of pain for this patient?
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The nurse is administering iburpofen (Advil) to an older patient. Which of the following
assessment data would cause the nurse to withhold the medication?
The nurse is administering iburpofen (Advil) to an older patient. Which of the following assessment data would cause the nurse to withhold the medication?
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What is the primary focus of fall prevention strategies in healthcare settings?
What is the primary focus of fall prevention strategies in healthcare settings?
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Which tool is specifically designed to quantify the risk of falling?
Which tool is specifically designed to quantify the risk of falling?
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What is a significant legal consideration related to the use of restraints?
What is a significant legal consideration related to the use of restraints?
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Which of the following is NOT a component of an effective fall prevention program?
Which of the following is NOT a component of an effective fall prevention program?
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Which patient characteristic is most crucial in assessing the risk of falls?
Which patient characteristic is most crucial in assessing the risk of falls?
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What is an essential practice when educating patients about fall prevention strategies?
What is an essential practice when educating patients about fall prevention strategies?
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How should environmental modifications contribute to fall prevention?
How should environmental modifications contribute to fall prevention?
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What documentation is vital in addressing the use of restraints in patient care?
What documentation is vital in addressing the use of restraints in patient care?
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Study Notes
Common Misconceptions About Pain (Infants and Children)
- Infants have fully developed nervous systems and are capable of feeling pain.
- Pain in infants can have lasting effects if not managed properly.
- Pain may not always show physical signs. Self-report is the gold standard for assessing pain in infants.
- Infants and young children are not capable of expressing pain.
- Older adults may experience higher pain levels due to chronic conditions.
- Age does not lessen the intensity of pain.
Common Misconceptions About Pain (Adults and Older Persons)
- People will express their pain explicitly and utilize the word "pain".
- Pain levels are not always directly proportional to tissue injury.
- Pain is not always directly observable.
- People who use opioids for pain are not necessarily addicts.
- Pain is a normal part of aging, but can still be intense.
- Pain can not be reliably assessed in people with cognitive impairment.
Different Physiology and Types of Pain
- Nociceptive Pain: Occurs in response to tissue damage or injury, activating pain receptors. This includes somatic (bones, joints, muscles, skin) and visceral (internal organs) types.
- Neuropathic Pain: Arises from damage to the somatosensory nervous system. This pain can be described as burning, tingling, or numbness.
- Acute Pain: Short-term pain with an identifiable cause, usually resolves as the injury heals. Typically lasts less than six months.
- Chronic Pain: Long-term pain lasting for more than six months, often difficult to treat. It may occur without a readily identifiable cause.
- Cancer Pain: A form of pain associated with cancer presence in the body, with various pain types (acute, chronic, nociceptive, neuropathic).
- Breakthrough Pain: Sudden, intense spikes in pain.
Factors Affecting Pain Experience
- Age: Younger people have higher pain tolerance; older adults may experience heightened pain sensitivity.
- Fatigue: Tiredness can lower pain tolerance.
- Heredity: Genetic factors can impact pain tolerance and sensitivity.
- Neurological Function: Conditions like multiple sclerosis or diabetic neuropathy can increase or decrease pain sensitivity.
- Attention: Increased focus on pain can increase its intensity.
- Previous experiences: Can impact how pain is experienced.
- Family Support: Emotional support from family can lower perceived pain intensity.
- Spiritual beliefs: Patients' beliefs, faith, and spirituality can affect pain tolerance.
- Anxiety and Fear: Anxiety and fear can heighten pain perception.
- Meaning of Pain: The patient's perspective on the meaning of pain can influence pain intensity.
- Cultural differences: Different cultures have different expectations and expressions of pain.
Potential Complications Related to Pain
- Chronic pain can lead to or worsen conditions like depression, anxiety, and mood disorders.
- Chronic pain can impact quality of life by limiting daily activities, sleep, and social interaction.
- Unmanaged pain can delay recovery and rehabilitation.
- Chronic pain can impose a significant economic burden due to lost productivity and increased healthcare costs.
Nursing Assessments for Clients Experiencing Pain
- Pain should be considered the 5th vital sign.
- Routine pain assessments are essential.
- Self-report is the most reliable measure of pain, although nurses should also assess non-verbal cues.
Pain Assessment Tools
- FLACC Scale: Used for infants and children to assess pain levels based on facial expression, legs, activity, cry, and consolability (nonverbal cues).
- PAINAD Scale: Assesses pain levels in non-verbal patients (e.g., those with cognitive impairment) based on breathing, vocalization, facial expression, body language, and consolability.
- Faces Pain Scale-Revised: Uses faces to depict different pain intensities.
- Numeric Rating Scale (NRS) Measures pain intensity on a 0-10 scale.
- Categorical Scale: Descriptive words to describe pain (e.g., mild, moderate, severe).
- Brief Pain Inventory (BPI): Assesses pain intensity, its impact on daily functions, and the effectiveness of pain management.
- McGill Pain Questionnaire: Evaluates different aspects of pain (sensory, affective, evaluative).
- Pain Quality: Describes how the pain feels.
- Onset: When the pain started.
- Provoking factors: What triggers or worsens the pain.
- Quality: Describing the pain
- Region/Radiation: Where the pain is located.
- Severity: Intensity of the pain
- Timing/Treatment: How long the pain lasts.
- Understanding/Impact: Questions about how the pain affects the individual or family.
- Values: Beliefs / views on pain (cultural, spiritual, familial)
Nursing Diagnoses and Expected Outcomes for Pain
- Acute pain can be related to procedures or injuries. The Expected outcome/goal is a pain level decrease, usually by 50%, within 1 hour after medication; Client will identify and use non-drug techniques for pain management (e.g., relaxation, heat).
- Chronic pain is persistent pain lasting over six months.
- Impaired physical mobility due to pain in both procedures and injuries. The expected outcome is increased range of motion within two weeks of treatment.
Nursing, Medical and Alternative Interventions for Pain Management
- Assess and monitor pain regularly.
- Provide support for Activities of Daily Living (ADLs).
- Address anxiety related to pain.
- Advocate for effective pain management.
- Consult with a pain management team.
- Administer medications before pain becomes severe.
Role of Interprofessional Team Members
- Physicians/Onocologists: Diagnose, determine pain management plans, and adjust medications as needed.
- Pain team: Individuals specialized in advanced pain management strategies.
- Registered Nurses & Registered Practical Nurses: Assess pain, administer medications, monitor responses, and educate clients/families.
- Personal Support Workers: Assist with daily tasks and provide comfort measures to clients experiencing pain.
- Physiotherapists: Help with movement, mobility, and exercises to manage pain/improve function.
- Occupational Therapists: Support patients with daily activities and improve quality of life.
Nursing Interventions to Reduce the Risk of Falls
- Fall risk assessments are conducted regularly, including history, gait, balance, and medication review.
- Environment modifications are made by removing obstacles, securing carpets, and adjusting bed heights.
- Assistive devices, such as walkers and canes, are used to support mobility.
- Education on fall risks, and safety measures provided.
- Supervision and assistance particularly for high-risk clients is provided.
- Appropriate footwear and clothing are provided.
- Medication review helps determine if medications contribute to falling.
- Collaboration with healthcare professionals is needed.
Clients at Increased Risk of Falls
- Age.
- History of falls.
- Issues with mobility and balance.
- Cognitive impairments.
- Medication effects.
- Sensory impairments in vision and hearing.
- Chronic illnesses.
Negative Outcomes Related to Falls
- Psychological effects (decreased esteem, confidence, anxiety, depression).
- Decreased quality of life (loss of independence, work, and overall wellbeing).
- Reduced mobility.
- Physical injury (fractures, bruises, head injuries).
- Increased healthcare costs.
Screening for Falls
- Nurses routinely screen all adults to identify those at risk for falls (through history, gait, balance, mobility difficulties and clinical judgment).
- Screening determines if additional interventions are required.
Procedure if a Client Falls
- Assess for injuries.
- Provide immediate care, including stopping any injuries.
- Notify and notify appropriate healthcare providers.
- Conduct a thorough post-fall assessment.
- Monitor and implement preventive measures.
Types of Restraints
- Physical restraints: Limit the client's ability to move (e.g., bed rails).
- Environmental restraints: Control where a client can go, (e.g., seclusion rooms).
- Chemical restraints: Use medications to calm agitated behavior (e.g., benzodiazepines).
Least Restraint Approach
- Prioritizing client safety through alternative strategies.
- Using the least restrictive type of restraint only when necessary.
Alternative Approaches to Restraints
- Increased supervision and monitoring.
- Distraction and diversion strategies.
- Placement near nursing stations.
- Removing stimuli, especially risky behaviors
- Communication.
- Medication review and adjustments.
- Pain management strategies.
- Concealment of medical equipment.
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