Pain Management in Nursing
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Questions and Answers

What is a common side effect of opioid use?

  • Pruritus (correct)
  • Hypertension
  • Euphoria
  • Tachycardia

    • Which medication is primarily used to treat seizures but can also help relieve certain types of pain?

  • Lidocaine
  • Duloxetine
  • Nortriptyline
  • Gabapentin (correct)

    • What is the main goal of using co-analgesic agents in pain management?

  • To eliminate the need for pain relievers
  • To replace pain relievers
  • To enhance the effectiveness of pain relievers (correct)
  • To reduce the dosage of pain relievers

    • What is the recommended approach for using NSAIDs in older adults with pain?

    <p>Use NSAIDs for short periods of time only</p> Signup and view all the answers

    What is the benefit of using distraction as a nursing implementation in pain management?

    <p>It helps to divert the patient's attention from the pain</p> Signup and view all the answers

    Why is acetaminophen preferred for older adults with mild pain?

    <p>It has fewer side effects than NSAIDs</p> Signup and view all the answers

    What is the primary concern when using opioids in older adults?

    <p>Risk of sedation and CNS effects</p> Signup and view all the answers

    What is the recommended approach for initiating opioid therapy in older adults?

    <p>Start with a low dose and titrate up</p> Signup and view all the answers

    What is the benefit of using antidepressants as co-analgesic agents in pain management?

    <p>They can help relieve certain types of pain</p> Signup and view all the answers

    What is the recommended reduction in opioid dose for older adults?

    <p>25% to 50%</p> Signup and view all the answers

    What is the main goal of reassessing pain on a regular basis?

    <p>To evaluate the effectiveness of treatment</p> Signup and view all the answers

    What is the primary mechanism of action of non-opioid analgesics such as NSAIDs?

    <p>Inhibiting cyclo-oxygenase</p> Signup and view all the answers

    What is the primary concern when using opioids in pain management?

    <p>Risk of addiction</p> Signup and view all the answers

    What is the primary goal of titration in pharmacologic management of pain?

    <p>Adjusting the dose to find the right amount for each person</p> Signup and view all the answers

    What is the primary characteristic of agonist-antagonist opioids?

    <p>Partial activation and blockade of certain opioid receptors</p> Signup and view all the answers

    What is a primary responsibility of the RN in providing patient care?

    <p>Ensuring the comfort of the patients</p> Signup and view all the answers

    What is the primary focus of the BRN's pain management policy?

    <p>Integrating pain management into nursing programs</p> Signup and view all the answers

    What is the most reliable indicator of pain?

    <p>Patient reports of pain</p> Signup and view all the answers

    What is the purpose of identifying pain assessment and pain management as an organizational priority?

    <p>To enhance the quality of patient care</p> Signup and view all the answers

    What is pain, according to the definition?

    <p>An unpleasant sensory and emotional experience associated with actual or potential tissue damage</p> Signup and view all the answers

    Which type of pain is caused by a problem with the nerves that sense touch and pain?

    <p>Neuropathic</p> Signup and view all the answers

    What is the role of large nerve fibers in the Gate Control Theory of Pain?

    <p>Inhibiting the transmission of pain signals from the spinal cord to the brain</p> Signup and view all the answers

    What is the most reliable measure of pain intensity?

    <p>Self-report</p> Signup and view all the answers

    What is the primary result of unrelieved pain on the endocrine system?

    <p>Increased insulin resistance</p> Signup and view all the answers

    What can shape an individual's perspective on pain and their coping mechanisms?

    <p>All of the above</p> Signup and view all the answers

    What type of pain is associated with tissue damage and has a short duration?

    <p>Acute pain</p> Signup and view all the answers

    What is central sensitization in neuropathic pain?

    <p>The abnormal sensitivity of nerves in the brain and spinal cord to pain</p> Signup and view all the answers

    What is the function of glutamate in the nociception process?

    <p>To carry pain signals from the nociceptors to the spinal cord and brain</p> Signup and view all the answers

    What is the primary role of A-delta fibers in the transmission of pain?

    <p>To quickly localize the source of pain and trigger a rapid reflex withdrawal</p> Signup and view all the answers

    What is the term for the collapse of a lung or part of a lung, which can be a harmful effect of unrelieved pain?

    <p>Atelectasis</p> Signup and view all the answers

    What is postoperative ileus?

    <p>A condition that slows down the movement of the intestines after surgery</p> Signup and view all the answers

    What is the purpose of using local anesthetics as co-analgesic agents?

    <p>To numb a specific area of the body, providing localized pain relief</p> Signup and view all the answers

    Why are tricyclic antidepressants (TCAs) used in pain management?

    <p>To manage chronic pain</p> Signup and view all the answers

    What is the purpose of using ketamine as a co-analgesic agent?

    <p>To manage neuropathic pain</p> Signup and view all the answers

    What is the concern when using NSAIDs in older adults with pain?

    <p>Increased risk of NSAID-induced GI toxicity</p> Signup and view all the answers

    What is a common side effect of opioids that can slow down the movement of the intestines after surgery?

    <p>Postoperative ileus</p> Signup and view all the answers

    Which type of medication is used to treat seizures but can also help relieve certain types of pain?

    <p>Anticonvulsants</p> Signup and view all the answers

    What is the primary benefit of using co-analgesic agents in pain management?

    <p>To enhance the effectiveness of pain relievers</p> Signup and view all the answers

    What is the recommended approach for using acetaminophen in older adults with pain?

    <p>Use for mild to moderate pain</p> Signup and view all the answers

    What is the primary concern when using NSAIDs in older adults with pain?

    <p>Increased risk of NSAID-induced GI toxicity</p> Signup and view all the answers

    What is the benefit of using antidepressants as co-analgesic agents in pain management?

    <p>They can help relieve certain types of chronic pain</p> Signup and view all the answers

    What is the recommended approach for initiating opioid therapy in older adults?

    <p>Initiate with a low dose and titrate slowly</p> Signup and view all the answers

    What is the primary benefit of using ketamine as a co-analgesic agent in pain management?

    <p>It can help relieve severe pain, especially in cases of neuropathic pain</p> Signup and view all the answers

    What is the primary concern when using opioids in older adults?

    <p>Sensitive to agents that produce sedation and CNS effects</p> Signup and view all the answers

    What is the recommended reduction in opioid dose for older adults?

    <p>25% to 50%</p> Signup and view all the answers

    What is the primary mechanism by which opioids can cause constipation?

    <p>Slowing down the movement of the intestines</p> Signup and view all the answers

    Which of the following co-analgesic agents is primarily used to treat seizures but can also help relieve certain types of pain?

    <p>Gabapentin (Neurontin)</p> Signup and view all the answers

    What is the primary benefit of using antidepressants as co-analgesic agents in pain management?

    <p>Addressing depression and neuropathic pain</p> Signup and view all the answers

    Which of the following nursing implementations is based on the principle of distraction?

    <p>Employing humor</p> Signup and view all the answers

    What is the primary concern when using opioids in older adults with pain?

    <p>Sensitivity to agents that produce sedation and CNS effects</p> Signup and view all the answers

    What is the recommended approach for using NSAIDs in older adults with pain?

    <p>Use for the shortest period of time possible</p> Signup and view all the answers

    What is the primary benefit of using local anesthetics as co-analgesic agents in pain management?

    <p>Providing localized pain relief</p> Signup and view all the answers

    What is the primary role of ketamine in pain management?

    <p>Managing severe pain, especially in cases of neuropathic pain</p> Signup and view all the answers

    What is the recommended approach for initiating opioid therapy in older adults with pain?

    <p>Initiate with a low dose and titrate up as needed</p> Signup and view all the answers

    What is the primary benefit of using acetaminophen in older adults with mild pain?

    <p>Reducing the risk of NSAID-induced GI toxicity</p> Signup and view all the answers

    Study Notes

    Pain Management

    • The Nurse Practice Act (1997) emphasizes the RN's role in ensuring patient comfort and managing pain as a nursing function.
    • The BRN (Board of Registered Nursing) adopted a pain management policy for RN practice and curriculum guidelines for nursing programs.

    Joint Commission Pain Standards

    • Identify pain assessment and management as an organizational priority.
    • Conduct quality improvement projects.

    Pain Definition

    • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
    • It is a personal and subjective experience, with the patient's report being the most reliable indicator of pain.
    • Pain is a common reason for seeking healthcare.

    Harmful Effects of Unrelieved Pain

    • Endocrine: Increased cortisol, ADH, and epinephrine.
    • Metabolic: Hyperglycemia, insulin resistance.
    • Cardiovascular: Increased heart rate, blood pressure, and cardiac workload.
    • Respiratory: Atelectasis, hypoxia, decreased cough.
    • GU: Decreased urine output, fluid overload, hypokalemia.
    • GI: Decreased gastric and bowel motility (constipation).
    • Musculoskeletal: Muscle spasm, fatigue.
    • Cognitive: Decreased cognition, mental confusion.
    • Immune: Depression of immune response.
    • Developmental: Increased behavioral and physiologic response to pain, addictive behavior.
    • Future pain: Debilitating chronic pain syndrome, phantom pain.
    • Quality of life: Sleeplessness, anxiety, fear, hopelessness, increased thoughts of suicide.

    Types of Pain (Duration)

    • Acute pain: Short duration, resulting from tissue damage (surgery, trauma, burns).
    • Chronic pain: Persistent pain that can last a lifetime, continuous or intermittent.
    • Breakthrough pain: Chronic pain with intense acute exacerbations.

    Categories of Pain (Pathology)

    • Nociceptive pain: Caused by tissue injury.
    • Neuropathic pain: Caused by damage to the peripheral or central nervous system.
    • Mixed pain: Combination of nociceptive and neuropathic pain.

    Nociception Process

    • Transduction: Involves nociceptors, releasing prostaglandins, enhancing pain signals.
    • Transmission: Glutamate carries pain signals to the spinal cord and brain.
    • Perception: The brain processes and interprets pain signals.
    • Modulation: Neurochemicals in the spinal cord and brain regulate pain signals.

    Transduction and Analgesic Agents

    • Acetaminophen, ibuprofen, local anesthetics, and anticonvulsants are examples of analgesic agents.

    Transmission

    • A-delta fibers: Responsible for detecting thermal and mechanical injuries, quickly transmitting pain signals.
    • C fibers: Slower in conducting impulses, responding to mechanical, thermal, and chemical stimuli.

    Perception

    • Involves higher brain structures, associated with awareness, emotions, and drives.
    • Nonpharmacologic therapies and distraction can help alleviate pain.

    Modulation

    • Pain modulation occurs throughout the body, involving the use of different chemicals to control pain information.
    • Includes serotonin, norepinephrine, and other neurochemicals.

    Neuropathic Pain

    • Caused by a problem with the nerves that sense touch and pain.
    • Can occur without physical injury or inflammation.
    • Involves peripheral and central mechanisms.

    Gate Control Theory of Pain

    • Explains how pain signals are processed by the nervous system.
    • Involves two types of nerve fibers: small and large.
    • Large nerve fibers act as a "gate" to regulate pain signal transmission.

    Factors Affecting the Pain Experience

    • Cultural and ethnicity variables.
    • Family, biological sex, gender, and age.
    • Religious beliefs and spirituality.
    • Environment and support people.
    • Anxiety and other stressors.
    • Past pain experience.

    Components of Pain Assessment

    • Self-report: Most reliable measure of pain.
    • SOCRATES (site, onset, character, radiates, associated system, time/duration, exacerbating, severity).

    Assessing Intensity

    • Pain scales: Numeric Rating Scale (NRS), Wong-Baker FACES Pain Rating Scale, Faces Pain Scale–Revised (FPS-R), Verbal Descriptor Scale (VDS), and Visual Analog Scale (VAS).

    Hierarchy of Pain Measures

    • Attempt to obtain self-report.
    • Consider the patient's condition.
    • Observe behaviors.
    • Evaluate physiologic indicators.
    • Conduct an analgesic trial.

    Pain Management in Specific Populations

    • Nonverbal patients: Use the Hierarchy of Pain Measures.
    • Young children or individuals who are unable to communicate: Use FLACC.
    • Patients with advanced dementia: Use PAINAD.
    • Patients in critical care units: Use CPOT.

    Reassessing Pain

    • Regularly reassess pain to evaluate treatment effectiveness.
    • Depends on the stability of the patient and timing of peak effect of medication.
    • Titration (adjusting) medication.

    Pharmacological Management

    • PCA: Patient Controlled Analgesia, an interactive method of pain management.
    • Closely monitor sedation and respiratory status.

    Analgesic Medications

    • Nonopioids: Decrease pain by inhibiting cyclo-oxygenase.
    • Opioids: Act on the CNS to inhibit activity of ascending nociceptive pathways.
    • Local anesthetics: Block nerve conduction.

    Opioid Analgesic Agents

    • Mu agonists: Directly activate the mu receptors in the brain and spinal cord.
    • Agonist-antagonists: Partially activate certain opioid receptors while blocking others.
    • Antagonists: Block the effects of other opioids.

    Safe Use of Opioids

    • Individualized treatment plan.
    • Route of administration.
    • Titration (adjusting the dose).
    • Equianalgesia (comparing the strength of different opioids).
    • Physical dependence and tolerance.
    • Withdrawal symptoms.

    Substance Use Disorder (SUD)

    • Chronic and treatable neurological disease.
    • Impaired control over substance use.
    • Compulsive use.
    • Continued use despite harm.
    • Craving for the substance.

    Opioid-Induced Hyperalgesia (OIH)

    • Increasing doses of an opioid result in increasing sensitivity to pain.

    Co-analgesic Agents

    • Local anesthetics.
    • Anticonvulsants.
    • Antidepressants.
    • Ketamine.

    Nursing Implementations

    • Distraction.
    • Humor.
    • Music.
    • Mindfulness practice.
    • Cutaneous stimulation.
    • Acupuncture and dry needling.
    • Hypnosis.
    • Biofeedback.
    • Healing/therapeutic touch.
    • Animal-assisted intervention.

    Pain Management in the Elderly

    • Use acetaminophen for mild to moderate pain.
    • Use NSAIDs when other treatments have failed.
    • Progress to opioids for severe pain.
    • Consider adjuvants that address depression and neuropathic pain.
    • Consider the use of legal cannabis.
    • Sensitive to agents that produce sedation and CNS effects.
    • Initiate with low dose and titrate slowly.
    • Increased risk for NSAID-induced GI toxicity.
    • Acetaminophen preferred for mild pain.
    • Opioid dose should be reduced 25% to 50%.

    Pain Management

    • The Nurse Practice Act (1997) emphasizes the RN's role in ensuring patient comfort and managing pain as a nursing function.
    • The BRN (Board of Registered Nursing) adopted a pain management policy for RN practice and curriculum guidelines for nursing programs.

    Joint Commission Pain Standards

    • Identify pain assessment and management as an organizational priority.
    • Conduct quality improvement projects.

    Pain Definition

    • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
    • It is a personal and subjective experience, with the patient's report being the most reliable indicator of pain.
    • Pain is a common reason for seeking healthcare.

    Harmful Effects of Unrelieved Pain

    • Endocrine: Increased cortisol, ADH, and epinephrine.
    • Metabolic: Hyperglycemia, insulin resistance.
    • Cardiovascular: Increased heart rate, blood pressure, and cardiac workload.
    • Respiratory: Atelectasis, hypoxia, decreased cough.
    • GU: Decreased urine output, fluid overload, hypokalemia.
    • GI: Decreased gastric and bowel motility (constipation).
    • Musculoskeletal: Muscle spasm, fatigue.
    • Cognitive: Decreased cognition, mental confusion.
    • Immune: Depression of immune response.
    • Developmental: Increased behavioral and physiologic response to pain, addictive behavior.
    • Future pain: Debilitating chronic pain syndrome, phantom pain.
    • Quality of life: Sleeplessness, anxiety, fear, hopelessness, increased thoughts of suicide.

    Types of Pain (Duration)

    • Acute pain: Short duration, resulting from tissue damage (surgery, trauma, burns).
    • Chronic pain: Persistent pain that can last a lifetime, continuous or intermittent.
    • Breakthrough pain: Chronic pain with intense acute exacerbations.

    Categories of Pain (Pathology)

    • Nociceptive pain: Caused by tissue injury.
    • Neuropathic pain: Caused by damage to the peripheral or central nervous system.
    • Mixed pain: Combination of nociceptive and neuropathic pain.

    Nociception Process

    • Transduction: Involves nociceptors, releasing prostaglandins, enhancing pain signals.
    • Transmission: Glutamate carries pain signals to the spinal cord and brain.
    • Perception: The brain processes and interprets pain signals.
    • Modulation: Neurochemicals in the spinal cord and brain regulate pain signals.

    Transduction and Analgesic Agents

    • Acetaminophen, ibuprofen, local anesthetics, and anticonvulsants are examples of analgesic agents.

    Transmission

    • A-delta fibers: Responsible for detecting thermal and mechanical injuries, quickly transmitting pain signals.
    • C fibers: Slower in conducting impulses, responding to mechanical, thermal, and chemical stimuli.

    Perception

    • Involves higher brain structures, associated with awareness, emotions, and drives.
    • Nonpharmacologic therapies and distraction can help alleviate pain.

    Modulation

    • Pain modulation occurs throughout the body, involving the use of different chemicals to control pain information.
    • Includes serotonin, norepinephrine, and other neurochemicals.

    Neuropathic Pain

    • Caused by a problem with the nerves that sense touch and pain.
    • Can occur without physical injury or inflammation.
    • Involves peripheral and central mechanisms.

    Gate Control Theory of Pain

    • Explains how pain signals are processed by the nervous system.
    • Involves two types of nerve fibers: small and large.
    • Large nerve fibers act as a "gate" to regulate pain signal transmission.

    Factors Affecting the Pain Experience

    • Cultural and ethnicity variables.
    • Family, biological sex, gender, and age.
    • Religious beliefs and spirituality.
    • Environment and support people.
    • Anxiety and other stressors.
    • Past pain experience.

    Components of Pain Assessment

    • Self-report: Most reliable measure of pain.
    • SOCRATES (site, onset, character, radiates, associated system, time/duration, exacerbating, severity).

    Assessing Intensity

    • Pain scales: Numeric Rating Scale (NRS), Wong-Baker FACES Pain Rating Scale, Faces Pain Scale–Revised (FPS-R), Verbal Descriptor Scale (VDS), and Visual Analog Scale (VAS).

    Hierarchy of Pain Measures

    • Attempt to obtain self-report.
    • Consider the patient's condition.
    • Observe behaviors.
    • Evaluate physiologic indicators.
    • Conduct an analgesic trial.

    Pain Management in Specific Populations

    • Nonverbal patients: Use the Hierarchy of Pain Measures.
    • Young children or individuals who are unable to communicate: Use FLACC.
    • Patients with advanced dementia: Use PAINAD.
    • Patients in critical care units: Use CPOT.

    Reassessing Pain

    • Regularly reassess pain to evaluate treatment effectiveness.
    • Depends on the stability of the patient and timing of peak effect of medication.
    • Titration (adjusting) medication.

    Pharmacological Management

    • PCA: Patient Controlled Analgesia, an interactive method of pain management.
    • Closely monitor sedation and respiratory status.

    Analgesic Medications

    • Nonopioids: Decrease pain by inhibiting cyclo-oxygenase.
    • Opioids: Act on the CNS to inhibit activity of ascending nociceptive pathways.
    • Local anesthetics: Block nerve conduction.

    Opioid Analgesic Agents

    • Mu agonists: Directly activate the mu receptors in the brain and spinal cord.
    • Agonist-antagonists: Partially activate certain opioid receptors while blocking others.
    • Antagonists: Block the effects of other opioids.

    Safe Use of Opioids

    • Individualized treatment plan.
    • Route of administration.
    • Titration (adjusting the dose).
    • Equianalgesia (comparing the strength of different opioids).
    • Physical dependence and tolerance.
    • Withdrawal symptoms.

    Substance Use Disorder (SUD)

    • Chronic and treatable neurological disease.
    • Impaired control over substance use.
    • Compulsive use.
    • Continued use despite harm.
    • Craving for the substance.

    Opioid-Induced Hyperalgesia (OIH)

    • Increasing doses of an opioid result in increasing sensitivity to pain.

    Co-analgesic Agents

    • Local anesthetics.
    • Anticonvulsants.
    • Antidepressants.
    • Ketamine.

    Nursing Implementations

    • Distraction.
    • Humor.
    • Music.
    • Mindfulness practice.
    • Cutaneous stimulation.
    • Acupuncture and dry needling.
    • Hypnosis.
    • Biofeedback.
    • Healing/therapeutic touch.
    • Animal-assisted intervention.

    Pain Management in the Elderly

    • Use acetaminophen for mild to moderate pain.
    • Use NSAIDs when other treatments have failed.
    • Progress to opioids for severe pain.
    • Consider adjuvants that address depression and neuropathic pain.
    • Consider the use of legal cannabis.
    • Sensitive to agents that produce sedation and CNS effects.
    • Initiate with low dose and titrate slowly.
    • Increased risk for NSAID-induced GI toxicity.
    • Acetaminophen preferred for mild pain.
    • Opioid dose should be reduced 25% to 50%.

    Pain Management

    • The Nurse Practice Act (1997) emphasizes the RN's role in ensuring patient comfort and managing pain as a nursing function.
    • The BRN (Board of Registered Nursing) adopted a pain management policy for RN practice and curriculum guidelines for nursing programs.

    Joint Commission Pain Standards

    • Identify pain assessment and management as an organizational priority.
    • Conduct quality improvement projects.

    Pain Definition

    • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
    • It is a personal and subjective experience, with the patient's report being the most reliable indicator of pain.
    • Pain is a common reason for seeking healthcare.

    Harmful Effects of Unrelieved Pain

    • Endocrine: Increased cortisol, ADH, and epinephrine.
    • Metabolic: Hyperglycemia, insulin resistance.
    • Cardiovascular: Increased heart rate, blood pressure, and cardiac workload.
    • Respiratory: Atelectasis, hypoxia, decreased cough.
    • GU: Decreased urine output, fluid overload, hypokalemia.
    • GI: Decreased gastric and bowel motility (constipation).
    • Musculoskeletal: Muscle spasm, fatigue.
    • Cognitive: Decreased cognition, mental confusion.
    • Immune: Depression of immune response.
    • Developmental: Increased behavioral and physiologic response to pain, addictive behavior.
    • Future pain: Debilitating chronic pain syndrome, phantom pain.
    • Quality of life: Sleeplessness, anxiety, fear, hopelessness, increased thoughts of suicide.

    Types of Pain (Duration)

    • Acute pain: Short duration, resulting from tissue damage (surgery, trauma, burns).
    • Chronic pain: Persistent pain that can last a lifetime, continuous or intermittent.
    • Breakthrough pain: Chronic pain with intense acute exacerbations.

    Categories of Pain (Pathology)

    • Nociceptive pain: Caused by tissue injury.
    • Neuropathic pain: Caused by damage to the peripheral or central nervous system.
    • Mixed pain: Combination of nociceptive and neuropathic pain.

    Nociception Process

    • Transduction: Involves nociceptors, releasing prostaglandins, enhancing pain signals.
    • Transmission: Glutamate carries pain signals to the spinal cord and brain.
    • Perception: The brain processes and interprets pain signals.
    • Modulation: Neurochemicals in the spinal cord and brain regulate pain signals.

    Transduction and Analgesic Agents

    • Acetaminophen, ibuprofen, local anesthetics, and anticonvulsants are examples of analgesic agents.

    Transmission

    • A-delta fibers: Responsible for detecting thermal and mechanical injuries, quickly transmitting pain signals.
    • C fibers: Slower in conducting impulses, responding to mechanical, thermal, and chemical stimuli.

    Perception

    • Involves higher brain structures, associated with awareness, emotions, and drives.
    • Nonpharmacologic therapies and distraction can help alleviate pain.

    Modulation

    • Pain modulation occurs throughout the body, involving the use of different chemicals to control pain information.
    • Includes serotonin, norepinephrine, and other neurochemicals.

    Neuropathic Pain

    • Caused by a problem with the nerves that sense touch and pain.
    • Can occur without physical injury or inflammation.
    • Involves peripheral and central mechanisms.

    Gate Control Theory of Pain

    • Explains how pain signals are processed by the nervous system.
    • Involves two types of nerve fibers: small and large.
    • Large nerve fibers act as a "gate" to regulate pain signal transmission.

    Factors Affecting the Pain Experience

    • Cultural and ethnicity variables.
    • Family, biological sex, gender, and age.
    • Religious beliefs and spirituality.
    • Environment and support people.
    • Anxiety and other stressors.
    • Past pain experience.

    Components of Pain Assessment

    • Self-report: Most reliable measure of pain.
    • SOCRATES (site, onset, character, radiates, associated system, time/duration, exacerbating, severity).

    Assessing Intensity

    • Pain scales: Numeric Rating Scale (NRS), Wong-Baker FACES Pain Rating Scale, Faces Pain Scale–Revised (FPS-R), Verbal Descriptor Scale (VDS), and Visual Analog Scale (VAS).

    Hierarchy of Pain Measures

    • Attempt to obtain self-report.
    • Consider the patient's condition.
    • Observe behaviors.
    • Evaluate physiologic indicators.
    • Conduct an analgesic trial.

    Pain Management in Specific Populations

    • Nonverbal patients: Use the Hierarchy of Pain Measures.
    • Young children or individuals who are unable to communicate: Use FLACC.
    • Patients with advanced dementia: Use PAINAD.
    • Patients in critical care units: Use CPOT.

    Reassessing Pain

    • Regularly reassess pain to evaluate treatment effectiveness.
    • Depends on the stability of the patient and timing of peak effect of medication.
    • Titration (adjusting) medication.

    Pharmacological Management

    • PCA: Patient Controlled Analgesia, an interactive method of pain management.
    • Closely monitor sedation and respiratory status.

    Analgesic Medications

    • Nonopioids: Decrease pain by inhibiting cyclo-oxygenase.
    • Opioids: Act on the CNS to inhibit activity of ascending nociceptive pathways.
    • Local anesthetics: Block nerve conduction.

    Opioid Analgesic Agents

    • Mu agonists: Directly activate the mu receptors in the brain and spinal cord.
    • Agonist-antagonists: Partially activate certain opioid receptors while blocking others.
    • Antagonists: Block the effects of other opioids.

    Safe Use of Opioids

    • Individualized treatment plan.
    • Route of administration.
    • Titration (adjusting the dose).
    • Equianalgesia (comparing the strength of different opioids).
    • Physical dependence and tolerance.
    • Withdrawal symptoms.

    Substance Use Disorder (SUD)

    • Chronic and treatable neurological disease.
    • Impaired control over substance use.
    • Compulsive use.
    • Continued use despite harm.
    • Craving for the substance.

    Opioid-Induced Hyperalgesia (OIH)

    • Increasing doses of an opioid result in increasing sensitivity to pain.

    Co-analgesic Agents

    • Local anesthetics.
    • Anticonvulsants.
    • Antidepressants.
    • Ketamine.

    Nursing Implementations

    • Distraction.
    • Humor.
    • Music.
    • Mindfulness practice.
    • Cutaneous stimulation.
    • Acupuncture and dry needling.
    • Hypnosis.
    • Biofeedback.
    • Healing/therapeutic touch.
    • Animal-assisted intervention.

    Pain Management in the Elderly

    • Use acetaminophen for mild to moderate pain.
    • Use NSAIDs when other treatments have failed.
    • Progress to opioids for severe pain.
    • Consider adjuvants that address depression and neuropathic pain.
    • Consider the use of legal cannabis.
    • Sensitive to agents that produce sedation and CNS effects.
    • Initiate with low dose and titrate slowly.
    • Increased risk for NSAID-induced GI toxicity.
    • Acetaminophen preferred for mild pain.
    • Opioid dose should be reduced 25% to 50%.

    Pain Management

    • The Nurse Practice Act (1997) emphasizes the RN's role in ensuring patient comfort and managing pain as a nursing function.
    • The BRN (Board of Registered Nursing) adopted a pain management policy for RN practice and curriculum guidelines for nursing programs.

    Joint Commission Pain Standards

    • Identify pain assessment and management as an organizational priority.
    • Conduct quality improvement projects.

    Pain Definition

    • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
    • It is a personal and subjective experience, with the patient's report being the most reliable indicator of pain.
    • Pain is a common reason for seeking healthcare.

    Harmful Effects of Unrelieved Pain

    • Endocrine: Increased cortisol, ADH, and epinephrine.
    • Metabolic: Hyperglycemia, insulin resistance.
    • Cardiovascular: Increased heart rate, blood pressure, and cardiac workload.
    • Respiratory: Atelectasis, hypoxia, decreased cough.
    • GU: Decreased urine output, fluid overload, hypokalemia.
    • GI: Decreased gastric and bowel motility (constipation).
    • Musculoskeletal: Muscle spasm, fatigue.
    • Cognitive: Decreased cognition, mental confusion.
    • Immune: Depression of immune response.
    • Developmental: Increased behavioral and physiologic response to pain, addictive behavior.
    • Future pain: Debilitating chronic pain syndrome, phantom pain.
    • Quality of life: Sleeplessness, anxiety, fear, hopelessness, increased thoughts of suicide.

    Types of Pain (Duration)

    • Acute pain: Short duration, resulting from tissue damage (surgery, trauma, burns).
    • Chronic pain: Persistent pain that can last a lifetime, continuous or intermittent.
    • Breakthrough pain: Chronic pain with intense acute exacerbations.

    Categories of Pain (Pathology)

    • Nociceptive pain: Caused by tissue injury.
    • Neuropathic pain: Caused by damage to the peripheral or central nervous system.
    • Mixed pain: Combination of nociceptive and neuropathic pain.

    Nociception Process

    • Transduction: Involves nociceptors, releasing prostaglandins, enhancing pain signals.
    • Transmission: Glutamate carries pain signals to the spinal cord and brain.
    • Perception: The brain processes and interprets pain signals.
    • Modulation: Neurochemicals in the spinal cord and brain regulate pain signals.

    Transduction and Analgesic Agents

    • Acetaminophen, ibuprofen, local anesthetics, and anticonvulsants are examples of analgesic agents.

    Transmission

    • A-delta fibers: Responsible for detecting thermal and mechanical injuries, quickly transmitting pain signals.
    • C fibers: Slower in conducting impulses, responding to mechanical, thermal, and chemical stimuli.

    Perception

    • Involves higher brain structures, associated with awareness, emotions, and drives.
    • Nonpharmacologic therapies and distraction can help alleviate pain.

    Modulation

    • Pain modulation occurs throughout the body, involving the use of different chemicals to control pain information.
    • Includes serotonin, norepinephrine, and other neurochemicals.

    Neuropathic Pain

    • Caused by a problem with the nerves that sense touch and pain.
    • Can occur without physical injury or inflammation.
    • Involves peripheral and central mechanisms.

    Gate Control Theory of Pain

    • Explains how pain signals are processed by the nervous system.
    • Involves two types of nerve fibers: small and large.
    • Large nerve fibers act as a "gate" to regulate pain signal transmission.

    Factors Affecting the Pain Experience

    • Cultural and ethnicity variables.
    • Family, biological sex, gender, and age.
    • Religious beliefs and spirituality.
    • Environment and support people.
    • Anxiety and other stressors.
    • Past pain experience.

    Components of Pain Assessment

    • Self-report: Most reliable measure of pain.
    • SOCRATES (site, onset, character, radiates, associated system, time/duration, exacerbating, severity).

    Assessing Intensity

    • Pain scales: Numeric Rating Scale (NRS), Wong-Baker FACES Pain Rating Scale, Faces Pain Scale–Revised (FPS-R), Verbal Descriptor Scale (VDS), and Visual Analog Scale (VAS).

    Hierarchy of Pain Measures

    • Attempt to obtain self-report.
    • Consider the patient's condition.
    • Observe behaviors.
    • Evaluate physiologic indicators.
    • Conduct an analgesic trial.

    Pain Management in Specific Populations

    • Nonverbal patients: Use the Hierarchy of Pain Measures.
    • Young children or individuals who are unable to communicate: Use FLACC.
    • Patients with advanced dementia: Use PAINAD.
    • Patients in critical care units: Use CPOT.

    Reassessing Pain

    • Regularly reassess pain to evaluate treatment effectiveness.
    • Depends on the stability of the patient and timing of peak effect of medication.
    • Titration (adjusting) medication.

    Pharmacological Management

    • PCA: Patient Controlled Analgesia, an interactive method of pain management.
    • Closely monitor sedation and respiratory status.

    Analgesic Medications

    • Nonopioids: Decrease pain by inhibiting cyclo-oxygenase.
    • Opioids: Act on the CNS to inhibit activity of ascending nociceptive pathways.
    • Local anesthetics: Block nerve conduction.

    Opioid Analgesic Agents

    • Mu agonists: Directly activate the mu receptors in the brain and spinal cord.
    • Agonist-antagonists: Partially activate certain opioid receptors while blocking others.
    • Antagonists: Block the effects of other opioids.

    Safe Use of Opioids

    • Individualized treatment plan.
    • Route of administration.
    • Titration (adjusting the dose).
    • Equianalgesia (comparing the strength of different opioids).
    • Physical dependence and tolerance.
    • Withdrawal symptoms.

    Substance Use Disorder (SUD)

    • Chronic and treatable neurological disease.
    • Impaired control over substance use.
    • Compulsive use.
    • Continued use despite harm.
    • Craving for the substance.

    Opioid-Induced Hyperalgesia (OIH)

    • Increasing doses of an opioid result in increasing sensitivity to pain.

    Co-analgesic Agents

    • Local anesthetics.
    • Anticonvulsants.
    • Antidepressants.
    • Ketamine.

    Nursing Implementations

    • Distraction.
    • Humor.
    • Music.
    • Mindfulness practice.
    • Cutaneous stimulation.
    • Acupuncture and dry needling.
    • Hypnosis.
    • Biofeedback.
    • Healing/therapeutic touch.
    • Animal-assisted intervention.

    Pain Management in the Elderly

    • Use acetaminophen for mild to moderate pain.
    • Use NSAIDs when other treatments have failed.
    • Progress to opioids for severe pain.
    • Consider adjuvants that address depression and neuropathic pain.
    • Consider the use of legal cannabis.
    • Sensitive to agents that produce sedation and CNS effects.
    • Initiate with low dose and titrate slowly.
    • Increased risk for NSAID-induced GI toxicity.
    • Acetaminophen preferred for mild pain.
    • Opioid dose should be reduced 25% to 50%.

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    Description

    This quiz covers the role of registered nurses in ensuring patient comfort and managing pain, as well as the Joint Commission's pain standards and the definition of pain. Knowledge of pain management policies and guidelines is crucial for nursing practice.

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