Questions and Answers
What is the primary reason for undertreatment of pain by nurses?
Which type of pain is often characterized by allodynia and hyperalgesia?
What is the process of converting a stimulus into electrical energy in pain mechanisms?
What is the term for pain that is caused by a primary lesion or dysfunction in the nervous system?
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What is the process of sending an impulse across a sensory pain nerve fiber in pain mechanisms?
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What is the term for pain that is caused by activity in neural pathways in response to potentially tissue-damaging stimuli?
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What is the primary source of somatic pain?
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What is the characteristic of breakthrough pain in terms of its duration?
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What is the primary reason why nurses give PRN in addition to regular pain meds?
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What is a common characteristic of visceral pain?
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What is a key aspect of the nature of pain?
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What is the term for pain that is felt in a different location from its origin?
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What is a key factor that contributes to the experience of pain?
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What is a key aspect of the description of pain?
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What is a key aspect of pain treatment principles?
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What is an example of an associated feature or secondary sign/symptom of pain?
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What is the significance of associated factors in pain assessment?
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What is the relationship between depression and pain, according to studies?
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Which dimension of pain is concerned with the emotional response to pain?
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Which of the following is an example of an alternative and complementary practice used to control pain?
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The cultural dimensions of pain include cognitive beliefs, attitudes, memories, and meanings attributed to pain.
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Pain is a subjective experience that can be directly observed and measured.
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Only nurses are responsible for administering medications for pain management.
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Pain assessment includes evaluating the patient's mood and emotional distress.
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The primary goal of pain treatment is to eliminate pain completely.
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Infants in pain exhibit distinctive crying patterns that can be observed by caregivers.
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What is the approximate normal intake of fluids in 24 hours?
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What is the term for a urinary output of less than 400 mL in 24 hours?
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What is the primary concern for geriatric patients in terms of urinary elimination?
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What is the purpose of palpation in urinary system assessment?
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What is the normal pH range for urine?
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What is the term for urination at night?
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What is the term for the inability to urinate?
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What is a common symptom of UTI in geriatric patients?
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What is a late symptom of BPH?
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What is a nursing intervention to promote continence?
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What is the purpose of monitoring serum creatinine levels?
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What is a common cause of UTI?
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What is the significance of KUB in diagnostic exams?
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What is the purpose of pushing fluids after a diagnostic exam using iodine-based contrast?
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What is the risk associated with iodine-based contrast in diagnostic exams?
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What is the purpose of continuous bladder irrigation after a surgical procedure?
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What is the significance of using a stat lock in catheterization?
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What is the recommended frequency for catheter care in nursing practice?
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What is the term for an infection caused by a catheter?
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What is the term for the temporary or permanent surgical bypass of the bladder and urethra?
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What is the primary reason for ensuring adequate fluid intake in clients with urinary diversions?
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Suprapubic catheters are used to drain the urinary bladder through the abdominal wall
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Nursing diagnoses for clients with urinary diversions include risk for impaired skin integrity, disturbed body image, acute pain, and risk for infection.
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Suprapubic catheters are only used for clients with urinary retention
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Study Notes
Student Learning Outcomes
- Explain how physiology of pain relates to selection of interventions for pain relief
- Describe guidelines for selecting and individualizing comfort and pain interventions
- Describe non-pharmacological measures for pain relief and supportive comfort measures
- Describe implications for opioid analgesics, nonopioids, and NSAIDS use
- Utilize nursing process in care of client experiencing discomfort or pain
- Explain how cultural factors influence the pain experience
Nursing Roles
- Assess pain and communicate with other healthcare providers
- Ensure initiation of adequate pain relief measures
- Evaluate effectiveness of interventions
- Advocate for those in pain
Magnitude of the Pain Problem
- Acute pain: most common reason for healthcare visits (25 million Americans)
- Chronic pain: 50 million Americans suffer from persistent pain, 25 million from migraine headaches
- Inadequate pain management across care settings and patient populations
Definition of Pain
- "Whatever the person experiencing pain says it is" - Margo McCaffery
- Unpleasant sensory and emotional experience associated with actual or potential tissue damage (Perry, Potter pg. 962)
Pain Mechanisms
- Nociception: physiologic process that communicates tissue damage to CNS
- Transduction: conversion of stimulus into electrical energy
- Transmission: sending of impulse across a sensory pain nerve fiber (nociceptor)
- Perception: patient's experience of pain
- Modulation: activation of descending pathways that exert inhibitory or facilitatory effects on transmission of pain
Categorizing Pain
- Acute vs. Chronic Pain
- Nociceptive vs. Neuropathic Pain
- Cancer Pain: related to tumor progression, invasive procedures, toxicity of treatment, infection, and physical limitation
- Somatic Pain (body pain): aching or throbbing, localized, arises from bone, joint, muscle, skin, or connective tissue
- Visceral Pain: tumor involvement or obstruction, arises from internal organs
Breakthrough Pain
- Transient, moderate to severe
- Occurs beyond treated pain
- Rapid onset and brief duration with variable frequency and intensity
Nature of Pain
- Involves physical, emotional, and cognitive components
- Physical and/or mental stimulus
- Exhausting and demands energy
- Interferes with relationships
Dimensions of Pain
- Physiologic: genetic, anatomic, and physical determinants
- Affective: emotional response to pain experience (anger, fear, depression, anxiety)
- Behavioral: observable actions used to express and control pain (facial expressions, socially withdrawn, less physically active, guarding, crying)
- Cognitive: beliefs, attitudes, memories, and meaning attributed to pain
Pain Assessment
- Gather and document data
- Make collaborative decisions with patient and other healthcare providers
- Onset and duration
- Location/distribution
- Quality
- Intensity
- Aggravating/relieving factors
- Associated features or secondary signs/symptoms
- Associated factors (mood/emotional distress, functional activities)
- Treatment response### Pain Management
- Student Learning Outcomes:
- Explain the physiology of pain and its relation to intervention selection
- Describe guidelines for selecting and individualizing comfort and pain interventions
- Describe non-pharmacological measures for pain relief and supportive comfort measures
- Describe the implications of opioid analgesics, non-opioids, and NSAIDs use
Nursing Roles
- Assess pain and communicate with other healthcare providers
- Ensure initiation of adequate pain relief measures
- Evaluate the effectiveness of interventions
- Advocate for those in pain
Magnitude of the Pain Problem
- Acute pain is the most common reason for healthcare visits
- 25 million Americans have acute pain caused by injury or surgery
- 50 million Americans suffer from persistent or chronic pain, such as arthritis
- Over 25 million suffer from migraine headaches
- Despite the prevalence of pain, many studies document inadequate pain management across care settings and patient populations
Consequences of Untreated Pain
- Unnecessary suffering
- Physical and psychosocial dysfunction
- Impaired recovery from acute illness and surgery
- Immunosuppression
- Sleep disturbances
Definition of Pain
- "Whatever the person experiencing pain says it is" - Margo McCaffery
- Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Pain Mechanisms
- Nociception: physiologic process that communicates tissue damage to the CNS
- Involves four processes:
- Transduction: conversion of stimulus into electrical energy
- Transmission: sending of impulse across a sensory pain nerve fiber
- Perception: the patient's experience of pain
- Modulation: activation of descending pathways that exert inhibitory or facilitatory effects on the transmission of pain
- Involves four processes:
Types of Pain
- Nociceptive pain: caused by activity in neural pathways in response to potentially tissue-damaging stimuli
- Neuropathic pain: caused by a lesion or dysfunction in the nervous system
- Somatic pain: aching or throbbing pain from bone, joint, muscle, skin, or connective tissue
- Visceral pain: pain from internal organs
- Breakthrough pain: transient, moderate to severe pain that occurs beyond treated pain
- Referred pain: pain that is felt at a site distant from the origin of the pain
Dimensions of Pain
- Physiologic: genetic, anatomic, and physical determinants of pain
- Affective: emotional response to pain experience
- Behavioral: observable actions used to express and control pain
- Cognitive: beliefs, attitudes, memories, and meaning attributed to pain
Assessing the Patient with Pain
- Onset and duration of pain
- Location and distribution of pain
- Quality of pain
- Intensity of pain
- Aggravating and relieving factors
- Associated features or secondary signs/symptoms
- Associated factors: mood, emotional distress, functional activities, treatment response### Radiologic Studies of Urinary System: CT and IVP
- Common GU conditions: incontinence, urinary retention, urinary retention with overflow, stress incontinence, and benign prostatic hypertrophy
- Incontinence types: transient, functional, associated with retention (overflow urinary incontinence), stress, urge, and reflex
Stress Incontinence
- Involuntary loss of urine during physical exertion or upon coughing, sneezing, or laughing
- Caused by pelvic floor weakness, detrusor overactivity, and estrogen depletion
- Not automatically due to aging
Urinary Retention
- Accumulation of urine due to the inability of the bladder to empty
- Suspected when patient has large amounts of voided cloudy urine, pain in the suprapubic region, spasms and difficulty during urination, or incontinence
Nursing Diagnoses
- Urinary incontinence (functional, reflex, stress, urge)
- Infection
- Self-care deficit, toileting
- Impaired skin integrity
- Urinary retention
Nursing Actions
- Bladder training
- Pelvic floor muscle exercises (teaching)
- Health promotion/teaching clients non-surgical options
- Importance of fluid intake
- Proper cleaning technique
- UTI prevention
- Bowel elimination measures
- Medication use
- Catheterization if necessary (including teaching)
- Pre and post-diagnostic exam care
Catheterization
- Insertion of sterile tube via sterile technique into the bladder
- Document cath size, amount obtained, and appearance
- Indwelling (foley) or straight catheter (one-time use)
- Catheter care at least once a shift
Nursing Measures (Lab)
- Promote fluid intake (2000 to 2500 mL per day)
- Foley bag must remain below the bladder/free of kinks
- Prevent infection
- Bag must not touch floor
- Keep system sterile
- Empty QS
Condom Catheters
- Change daily – q shift optimal
- Caution with kinks
- Do not use masking tape
- Caution with application – might cut off circulation
Urinary Diversion
- Temporarily or permanently bypasses the bladder and urethra
- The bladder is removed, and the outlets of the ureters are placed inserted into openings made in the abdominal wall
NANDAs for Clients with Urinary Diversions
- Risk for impaired skin integrity
- Disturbed body image
- Acute pain
- Risk for infection
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