Study Guide / Exam 5 / Nursing 151

Study online at quizlet.com/_z7rju

1.

What is pain:

The International Association for the Study of

Pain (IASP)
defines pain as "an unpleasant sensory &
emotional experience associated with actual
or potential tissue damage"
Margo McCaffery 1968 ("godmother") states
pain is:
"Whatever the experiencing person says it is,
existing whenever and wherever the person
say it does"

2.

What is pain
good for:

defense mechanism to let you know you are

injured, tissue injury

3.

How often
should pain
be assessed?

every hour

What
information
should be
obtained
during a pain
assessment?

pattern, area, intensity, nature (PAIN),

location, intensity, quality

What is
transmission?

Action potential continues from site of injury

to spinal cord, spinal cord to brainstem and
thalamus, thalamus to cortex for processing

What is
transduction?

Noxious stimuli causes cell damage with the

release of sensitizing chemicals:
prostaglandins, bradykinn, substance P,
serotonin, and histamine. These substances
activate nociceptors and lead to generation of
action potential

4.

5.

6.

7.

What is
perception?

is the point at which a person is aware of pain

8.

What is
modulation?

neurons originating in the brainstem descend

to the spinal cord and release substances
(eg: endogenous opioids) that inhibit
nociceptive impulses

9.

What is the
gate theory?

Mechanisms located along the central

nervous system regulate or even block pain
impulses. Pain impulses pass through when a
gate is open and are blocked when a gate is
closed. Closing the gate is the basis for non
pharmacological pain relief interventions.

10.

How can you

assess pain
in someone
with a
cognitive
impairment?

body movements, facial expressions,

clenched teeth, holding the painful area, bent
posture, and grimacing, moaning, screaming,
guarding.

When should
pain
medications
be held?

sedation, resp. depression, vital signs not

stable, (sedation comes before resp.
depression)

11.

12.

What are
possible
consequences
of unrelieved
pain in a post
op-patient?

prolonged hospitalizations, increased risks of

complications from immobility, and delayed
rehabilitation.

13.

What are
possible
consequences
of unrelieved
pain in
someone with
chronic pain?

threatens physical and psychological well

being, depression, suicide. Job loss, social
isolation, sexual dysfunction, inability to
perform daily activities. Higher risk of
addiction.

14.

What are
different
types of pain?

acute, chronic, nociceptive, neuropathic,

somatic, visceral

15.

Acute vs
Chronic

Chronic: Lasts several months (>3 mo)

beyond expected healing time, serves no
purpose, not protective. May or may not have
identifiable cause
Acute: Lasts as long as to take to heal,
expected outcome of no longer being in pain.

16.

nociceptive
vs
neuropathic

Nociceptive pain is normal pain due to

tissue injury, inflammation / neuropathic

17.

somatic vs
visceral

Somatic pain - skin, bone, joints, muscles

Visceral pain- due to organ damage,
ischemia, obstruction, inflammation, tumor

18.

How might
the elderly
physically
respond
differently to
pain?

muscle mass depletion, body fat increases,

and percentage of water decreases, water
soluble drugs (morphine) concentration can
increase. Low serum albumin levels, which
increases toxicity due to lack of a protein
bond. Decline in liver and renal function,
results in reduced metabolism and excretion
of drugs, a greater peak effect. Thinning skin
affect the absorption of topical meds.

19.

What are the

sx of a
sympathetic
nervous
system
response in
someone with
acute pain?

Dilation of bronchial tubes, and increased

resp. rate. Increased heart rate, Peripheral
vasoconstriction (pallor, elevation in BP),
Increased blood glucose level, Diaphoresis,
Increased muscle tension, Dilation of pupils,
Decreased gastrointestinal motility.

20.

What
education
should be
provided to
the patient
and family
when the
patient is on
a PCA pump?

only the patient controls the pump

21.

What are common

and/or harmful or
life threatening
side effects of
opioids?

nausea, constipation and resp. distress

35.

S/SX of
delirium?

Distracted from tasks, sleep cycle

disturbed, illusions, delusions, memory
recent and immediate impaired, forgetful,
Progression is abrupt,

22.

What adjunct
drugs may help to
control pain due to
inflammation?

ibprofin, motrin, (tylenol has no antiinflammatory effects)

36.

S/SX of
dementia?

Forgetfulness beyond a normal person,

can't recognize numbers, unable to read or
write, delusions, insomnia, ADLs diminish

37.

What are
possible
reversible
causes of
delirium?

===

23.

What adjunct
drugs may help to
control pain due to
neuropathic pain?

Tricyclic antidepressants, SNRI's,

seizure meds

24.

What drugs may

be used for mild to
moderate pain?

acetaminophen, NSAIDS, non-opioids

38.

How can you

promote safety
in a client who
is confused?

===

25.

What drugs may

be used for severe
pain?

opioids

39.

no, currently no treatment to stop

deterioration of brain cells

Nonpharmacological
methods to reduce
pain?

relaxation, guided imagery, distraction,

cutaneous stimulation, herbals, reducing
pain perception.

Can you reduce

the risk of
developing
dementia?

26.

40.

Cholinesterase inhibitors/ aricept, exelon,

razadyne, (block enzyme which breaks
down acetylcholine at the nerve synapse.

27.

When is TENS
used?

To stimulate the skin to reduce pain

perception. release endorphin's, thus
blocking the transmission of painful
stimuli.

What
medications are
used to treat
Alzheimer's
dementia and
how effective
are they?

28.

How do you know

if pain relief was
effective?

patient is optimizing on their level of

mobility

41.

denial=forgetful,

29.

What should you

do if a client
refuses pain
meds?

ask the patient why they are refusing

Defense
mechanisms
used by
Alzheimer's
patients?

42.

===

What are
nursing/physician
biases that may
inhibit adequate
pain control?

addiction, do not believe patient is in

pain, drug seeking

Pathology of
Alzheimer's
patients?

43.

Progression of
Alzheimer's?

===

44.

===

What is agesim?

discrimination against people because of

increasing in age

Care of
Alzheimer's
patients?

45.

What are s/sx of

depression?

Not a normal part of aging, depression may

co-exist with dementia, loss of health and
function, death of spouse or family
member, no one set cause, sleep
abnormalities, depressed mood, loss of
pleasure, more than 2 weeks

46.

S/SX of suicidal
tendencies?

plan on suicide,

47.

Types of meds
to treat
depression?

SSRI, Tricyclics, MAOIs, SNRIs

30.

31.

32.

Normal
physiological
changes with
aging?

arthritis, back/spine problems, heart

problems, resp. illness, hearing deficits,
extremity stiffness, mental/emotional
issues, DM, blindness, CVA

33.

Normal cognitive
changes with
aging?

it is a misconception, they often fear that

they are or soon will be impaired.

34.

What is difference
between delirium
and dementia?

Onset: Sudden vs slow

Course: short vs long
delirum is reversible, IWATCHDEATH+(
Infection, withdrawl, trauma, cns patho,
hypoxia, deficencies, endocrine pathos,
acute vascular pathos, toxins, heavy
metals)

Advantages
and
disadvantages
of taking
depression
meds?

it is beleived that depressive disorders are a

result of imbalances of monoamine
neurotransmitters including serotonin,
dopamine and norepinephrine. Increase
serotonin, dopamine, and norepinephrine in
some way. Blocking serotongenic receptors
can cause adverse effect.

49.

What are the

stages of
GAS?

===

50.

What are the

symptoms of
GAS?

===

51.

How can you

assess stress
levels?

===

52.

How can you

help patients
reduce their
stress?

===

53.

What are
priorities for
someone in
crisis?

===

54.

How do you
know if
someone is
harmful to
themselves or
others?

===

55.

What kind of
abuse may
the elderly
experience?

===

56.

S/SX of abuse
in the
elderly?

===

57.

Which elderly
patients are
at greatest
risk of abuse?

===

58.

What are your

obligations as
a Nurse if you
suspect
abuse?

===

59.

How do antiinfectives
work?

destroy or interfere with proliferation of

various types of living organisms

60.

Empiric
therapy:

treatment of infection based on most likely

organism before culture report is back.

61.

Prophylactic
therapy:

used to prevent infection if pt. has scheduled

procedure w/ risk of microorganism
contamination

48.

62.

Super-infection:

overgrowth of non-susceptible
organisms due to reduction of normal
bacterial flora, or secondary infection
occurring due to weakening of immune
system by primary infection

63.

Drug resistance:

over prescription, failure to complete

prescribed meds, use of broad
spectrum antibiotics, used for viral
infections

64.

Geriatric and
immunocompromised
patients may not
exhibit obvious S/SX
of infection why?

====

65.

How to give pain

meds?

ATC not prn