(308) Pain management

Health care professionals have the ___________ to accept the __________ report of pain by the pt.

Pain meds should be _______ for the dose of _________ effect while limiting ________ side-effects.

True or false?

There are NO lab studies that can measure the prescence or intensity of pain.
True False

JCAHO requires that we recognize pts right to ___________ and ___________ of pain.

JCAHO requires that we ______ and assess _______ of pain in all pts.

JCAHO requires that we ____________
and _______-__ on all pts pain.

JCAHO requires that the staff be ____________.

JCAHO requires that we follow _______ and _________ for pain management.

JCAHO requires that we __________ pt and family.

JCAHO requires that ________ needs are addressed.

JCAHO requires that pain doees not interfere with _____ or ____, etc.

An unpleasant sensory or emotional experience related to actual or potential tissue damage is known as?

Pain is whatever a person ___ __ __

Pain is a _______ experience.

True or false?

Their is a definitive measurement to asses pain.
True False

what is the single most reliable indicator of pain?

The lowest intensity of pain stumulus that is perceived as pain is?

The amount of pain a person is willing or able to tolerate.

Consequences of unrelieved pain increases _______ demands, leading to _____ breakdown and eventually ____ loss.

Consequences of unrelieved pain can cause _____, poor ________, impaired ______ response.

Consequences of unrelieved pain puts a strain on the Cardiovascular system leading to increased _____, __, ______ oxygen demand, and hyper_________.

Consequences of unrelieved pain can cause what three things?

Consequences of unrelieved pain can cause inhibited ___ motility.

Consequences of unrelieved pain cause development of ______ _____.

Consequences of unrelieved pain can cause sleep ________, ______, _____, _______ thoughts

This type of pain is caused by ongoing responses to noxious stimuli by damage to somatic or visceral stimuli.

This type of pain results from damage to peripheral nerves or CNS.

List 6 causes for Neuropathic pain?

List the 8 ways that Neuropathic pain may be perceived?

List the common classifications of pain:

True or false?

Malignant pain can be successfully treated.
True False

This type of paon is of short duration with a known cause.

This type of pain may have no identifiable pathology to serve to explain the presence or extent of the pain.

This type of pain is usually associated with high levels of pathology or tissue damage and the pain resolves with healing of the underlying injury.

List the 6 signs and symptoms of Acute pain:

List the 4 signs and symptoms of chronic pain:

When assessing pain, minimal expression of pain may be due to _______ or the pt may want to be the "_____" pt.

When assessing pain remember that pain can be __________.

When assessing pain person can _____ even in the presence of severe pain.

If a pt complains of pain, and falls asleep, it is appropriate to do what?

Based on the notes what 3 things can make pain bearable?

True or false?

when assessing pain pts may work while still in pain.
True False

When assessing pain what are some reasons that pts may deny pain?

The nurses role is to have clinical ________ in assessment of pain.

When assessing pain a nurse must use ___________ measurements for pain assessment.

One of the nurses roles is to partner with the physicians in the _________ and effective ________ of pain medications.

One of the nurses role is to _______ pt and family about pain.

One of the nurses roles is to insure access to quality pain ____________ _____ and _____________ ______ for ready use in the clinical area.

One of the nursing roles is to ensure the assessment of pain as the what?

A thorough pain assessment includes what two things?

When doing a thorough pain assessment have the pt describe the pain how?

When doing a thorough pain assessment you want to know what 12 main things?

clue: (paid leaq)

When assessing pain assess the pts ___________ for pain management.

When assessing pain as a nurse you want to know what makes the pain better and what makes the pain worse also known as?

When assessing pain the nurse needs to know about the pt environmental factors such as:

When assessing pain what two stresses does the nurse need to know about?

What does PQRST stand for?

When assessing pain a __ point scale is commonly used.

When assessing pain a ___________ flow sheet allows for consistency in evaluating pain management.

For pts in the home setting, consider use of a pain ____ or ___

When assessing pain on a flow sheet include documentation of _____ of med, _____, _____, _____ of pain med given.

When assessing pain on a flow sheet include documentation of _____ _____ prior to, and 30 min after med is given.

True or false?

Notify physician when pain relief not achieved.
True False

For the Wong-baker pain rating scale face 0 means

For the Wong-baker pain rating scale face 1 means

For the Wong-baker pain rating scale face 2 means

For the Wong-baker pain rating scale face 3 means

For the Wong-baker pain rating scale face 4 means

For the Wong-baker pain rating scale face 5 means

When assessing pain in Non-verbal pts based on the notes what is #1 pain cues?

When assessing pain in Non-verbal pts based on the notes what is #2 pain cues?

When assessing pain in Non-verbal pts based on the notes what is #3 pain cues?

When assessing pain in Non-verbal pts based on the notes what is #4 pain cues?

When assessing pain in Non-verbal pts based on the notes what is #5 pain cues?

When managing pain in Non-verbal pts consider the ______ or ________ assessment of pt.

When assessing pain you want to check back with the pt within __ minutes of ________ med. administration.

When assessing pain you want to check back with the pt within __ ___ of ___ med. administration.

When assessing pain check back with each report of ___ or _____ pain.

When assessing pain what should pts be coached to do?

True or false?

Pain sensitivity may decrease with age.
True False

Many eldery pts will not do what for themselves?

When dealing with the elderly assess for what types of feelings?
AND
What may these feelings due to?

When assessing pain in the elderly which pain scale is the best to use?

Cognitively impaired pts are at risk for poor what?

True or Fales?

Pain treatment needs to be individualized.
True False

There is never a role for the use of _______ in the assessement or treatment of pain.

A barrier to adequate pain management is that pain is often ____-_____

Barrier's to adequate pain management when dealing with doctors are?
(list 5)

A Barrier to adequate pain management when dealing with nurses is?

Barrier's to adequate pain management when dealing with Pharmacists is?
(list3)

Non-opioids are used for what type of pain?

Non-opioids are also called what?

Opioids are used for what kind of pain?

give 2 example of a NSAID?

Adjuvants are used for what kind of pain?

Which analgesic group when added to primary analgesics, further improve pain control?

Which type of pain is a transient, moderate to severe pain that occurs beyond the pain treated by current analgesics?

Which type of pain is usually rapid in onset and brief in duration with variable intensity and frequency in occurrence?

This method is of adjusting doses or administration interval for safety and effectiveness.

True or false?

titration can be upward or downward.
True False

Titration Goal: is to use the _______ dose to provide desired effective analgesic _______ and with ________ _____-_______.

Titration is a ______________ effort between physician and nurse.

What type of assessment tool is essential for effective titration?

When dealing with titration which route is the preferred route?

When dealing with titration, Nonopioids have a _____ _____ and may cause _________ ________ at high doses.

When dealing with titration, most opioids do not have an _________ ________, so the dosage can be titrated __ until ____ ______ occurs.

____ provide superior pain relidf with fewer side effects, however, a short acting, rapid-onset ____ med should be used to manage _________ ____.

Titrating analgesics should be based upon pt ____, ____, _______, ______ of undesirable or adverse drug effects, measures of __________, _____, _________ states and the pts/________ reports of the impact of the pain on _______ of life.

A dose of one analgesic that is equivalent in pain-relieving effect compaored with another analgesic is know as?

When dealing with equianalgesic dosing _______ doses are given orally to get same iffect as __ doses.

With physician consultation, RN may use a __________ _________ _____ for safe dosing.

If one opioid is not effective after appropriate titration, or it produces significant adverse effects what should be done?

List 6 examples of Adjuvants:

Which adjuvant blocks reuptake of serotonin and norepinephrine in the CNS?

True or false?

Tricyclic anti-depressants are equally effective in depressed and non-depressed pts.
True False

Which Adjuvants are useful in treatment of neuropathic pain states, such as migraines, low back pain, cancer pain, and fibromyalgia?

List two side effects for tricyclic anti-depressants:

list 3 contraindications for tricyclic anti-depressants:

Which adjuvant inhibits prostagandin synthesis and reduce edema?

Which adjuvant is useful in treating neuropathic pain and bone pain?

Which adjuvant is useful in the relief of spasm-associated pain?

Which adjuvant relieves pain by releasing then depleting supplies of "P", a protein released from pain neurons involved in transmission of pain?

True or false?

Topical capsaicin (zostrix) may cause pain then will relieve pain.
True False

When dealing with topical capsaicin (zostrix) what is a problem for many pts who have tried the med?

Acetaminophen's mechanism of action is ________.

Acetaminophen has minimal ___-________ effect.

True or false?
Increasing dose of NSAIDS deyond a pint will not increase relief.
True False

What may need to be used to minimize GI effects, especially those with a history of gastric bleeding?
AND
Give example of drug?

If coagulation is impaired, _______ may be cantraindicated.

When dealing with NSAIDS what 2 things to you what to ensure to minimixe risk of renal impairment?

NSAID, including ____, are good Step __ analgesics.

NSAIDS, including ASA, work in part by inhibiting ____-________, the enzyme that converts ________ acid to prostaglandins.

True or false?

NSAIDS can have significant adverse effects.
True False

Opioids produce ________.

Opioids _____ perception of and _________ responses to pain.

Opioids reach ______ concentration approximately ___-___ minutes after oral (including _____-____) or rectal administration, ___ minutes after subcutaneous or ___ administration and __ minutes after IV injection.

List 8 commonly used opioids:

List the 9 routes for opioids:

This type of Opioid is used to manage intermittent pain and breakthrough pain.

Long acting and sustained release varieties of Opioids are used for what 2 reasons?

Expected physiologic phenomenon in which the effects of a drug become less with repeated use.

Expected physiologic respinse manifested vy a withdrawal syndrome that occurs when blood levels of the drug are abruptly decreased.

A complex neurobiologic condition characterized by a drive to obtain and take substances for other than the prescribed, therapeutic value.

A syndrome of poorly or under-treated pain.

Addiction is a clinical problem in pts with moderate to severe pain treated with opioids is a common what?

True or false?

Addiction risk is high when opioids are dosed propperly.
True False

What 2 routes are preferred with chronic treatment?

Opioids do not have what type of effect?

What kind of effect has a dose beyond which no additional analgesia is achieved?

Opioids tend to have what kind of side effects? (list 8)

When giving Opioids you should be cautions with pts with what kind of conditions?

Which Opioid is not indicated in long term treatment of pain?

Meperidine (Demerol) is metabolized in the _____, and excreted through the _______. In renal dysfunction, normeperidine is not _______ and accumulates in the ______ ______.

Normeperidine is toxic to the ____ and pts are at risk for _______.

___________, the active incredient in Darvocet/ Darvon, is converted to ___________ which can accumulate with renal __________ and can cause ______

True or false?

Opioids depress respiratory function and are therefore too dangerous to be used safely.
True False

Respiratory depression is often cited as a factor for what main reason?

Respiratory depression is usually _____-______, and generally occurs in ____-_____ pts (pts who are receiving opioids for the first time).

Respiratory depression is anatagonized by what?

Withholding appropriate use of opioids on the basis of respiratory concerns is __________. Concerns about respiatory depression do not apply to pts who receive _____-____ opioid therapy.

When a pt is a naive pt monitor ______ and __________ status during ___ 24 hours.

Use ________ for opioid reversal

Use ________ for respiratory depression assessment.

True or False?

Unacceptable sedation and confusion are a frequent side-effect in opioid pts.
True False

When managing sedation as an opioid side-effect you want to assess for concurrent ______ _____.

When managing sedation as an opioid side-effect you want consider use of ____ ________ during the day.

When managing sedation as an opioid side-effect, if persistent, consider what?

When managing confusion as an opioid side-effect you want assess for pre-existing ____ ________.

________ is an opioid with antagonist activity that is useful in treating ________ and __________ pain. It appears to be ___ times as potent as high doses of morphine.

Population at risk for undertreated pain are?
clue (I.C.O.S)

List 5 Side-effects for opioids:

Which drug obtained approval from the FDA as abuse-resistant pain-killer?

When opioids are used always use preventative regimen such as?

list 5

When a pt is suffering from pruritis you want to consider what 2 drugs?

If a pts gastric motility is slowed, use what?

If a pt is suffering from Nausea and avomiting use what?

Urinary retention is common in what kind of pts?