Summary
Summary NRSG 3320 Exam 1 Study Guide
- Course
- NRSG 3320
- Institution
- Northeastern University
This is a comprehensive and detailed study guide on Exam 1 for NRSG 3320. ***An Essential Study Resource!! All for YOU!!
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MODULE'1-'PAIN:'Chapter!12!
• Pain:!an!unpleasant!sensory!and!emotional!experience!associated!with!actual!or!potential!tissue!
damage,!or!described!in!terms!of!such!damage.!Pain!is!whatever!the!experiencing!person!says!it!is,!
existing!whenever!he!says!it!does.!
o Acute!pain:!shorter!duration;!ex.àtissue!damage!as!a!result!of!surgery,!trauma,!or!burns.!
o Chronic!pain:!being!of!cancer!or!noncancer!origin!and!can!be!time!limited!or!persist!
throughout!the!course!of!a!person’s!life.!Noncancer!pain!include!peripheral!neuropathy!from!
diabetes,!back!or!neck!pain!after!injury,!and!osteoarthritis!pain!from!joint!degeneration.!!
!
! Nociceptive'Pain' Neuropathic'Pain' Mixed'Pain'
Physiologic' Normal!processing!of!stimuli!that! Abnormal!processing!of!sensory!input! Components!of!both!
Processes' damages!tissues!or!has!the!potential!to! by!the!peripheral!or!CNS!or!both.! nociceptive!and!
do!so!if!prolonged;!can!be!somatic!or! Pathophysiologic.!! neuropathic!pain;!poorly!
visceral.!Physiologic.! defined.!
Categories'and' Somatic(Pain:!arises!from!bone!joint,! Centrally(Generated(Pain:! No!identified!categories!
Examples' muscle,!skin,!or!connective!tissue.!It!is! Deafferentation*pain:*injury!to!either! Examples:!fibromyalgia;!
usually!described!as!aching!or! the!PNS!or!CNS;!burning!pain!below!the! some!types!of!neck,!
throbbing!in!quality!and!is!well! level!of!a!spinal!cord!lesion!reflects! shoulder,!and!back!pain;!
localized.!(ex:!surgical,!trauma;!wound! injury!to!the!CNS.!(ex:!phantom!pain!as! some!headaches;!pain!
and!burn!pain;!cancer!pain!(tumor! a!result!of!peripheral!nerve!damage;! associated!with!HIV;!some!
growth)!and!pain!associated!with!bony! post!stroke!pain;!pain!following!spinal! myofascial!pain;!pain!
metastases;!labor!pain!(cervical! cord!injury)! associated!with!Lyme!
changes!and!uterine!contractions);! Sympathetically*maintained*pain:! disease!
osteoarthritis!and!rheumatoid!arthritis! associated!with!dysregulation!of!the!
pain;!etc.)! ANS.!(ex:!complex!regional!pain!
Visceral(Pain:!arises!from!visceral! syndrome)!
organs,!such!as!the!GI!tract!and! Peripherally(Generated(Pain(
pancreas!this!may!be!subdivided:! Painful*polyneuropathies:!pain!is!felt!
tumor!involvement!of!the!organ! along!the!distribution!of!many!
capsule!that!causes!aching!and!fairly! peripheral!nerves.!(ex:!diabetic!
well-localized!pain;!obstruction!of!the! neuropathy)!
hollow!viscus,!which!causes! Painful*mononeuropathies:*usually!
intermittent!cramping!and!poorly! associated!w/a!known!peripheral!nerve!
localized!pain.!(ex:!organ-involved! injury;!pain!is!felt!at!least!partly!along!
cancer!pain;!ulcerative!colitis;!IBS,! the!distribution!of!the!damaged!nerve.!
Crohn’s;!pancreatitis)! (ex:!nerve!root!compression,!nerve!
entrapment)!!
Pharmacologic' Most!responsive!to!nonopioids,! Adjuvant!analgesic!agents!such!as! Same!as!neuropathic!pain!
Treatment' opioids,!and!local!anesthetics! antidepressants,!anticonvulsants,!and!
local!anesthetics,!but!there!is!wide!
variability!in!terms!of!efficacy!and!AE!
profiles.!!
!
• Effects!of!unrelieved!pain!are!multi-systemicà!cardiac!and!respiratory!effects!(increased!HR,!increased!
cardiac!workload,!increased!peripheral!resistance,!increased!myocardial!oxygen!consumption,!
decreased!volume,!atelectasis,!risk!for!infection,!hypoxemia),!endocrine!and!metabolic!systems!(F&F!
response),!GI!and!genitourinary!systems!(decreased!urine!output,!fluid!overload,!hypokalemia,!
decreased!gastric!and!bowel!motility)!
• Long!term!effects!of!unrelieved!pain:!fatigue,!poor!muscle!function,!decreased!cognitive!function,!even!
confusion,!depression,!addictive!behaviors.!
,! 2
PAIN'ASSESSMENT'
Should!be!conducted!during!the!
admission!assessment!or!initial!
interview!with!the!patient,!with!
each!new!report!of!pain,!and!
whenever!indicated!by!changes!in!
the!patient’s!condition!or!
treatment!plan!during!the!course!
of!care.!!
Components'of'a'Pain'Assessment:''
1. Location(s)(of(pain:!ask!the!patient!to!state!or!point!to!the!area(s)!of!pain!on!the!body.!
2. Intensity:!ask!the!patient!to!rate!the!severity!of!the!pain!using!a!reliable!and!valid!assessment!tool.!
3. Quality:!ask!the!patient!to!describe!how!the!pain!feels.!Descriptors!such!as!sharp,!shooting,!or!burning!
may!help!identify!the!presence!of!neuropathic!pain.!
4. Onset(and(duration:!ask!the!patient!when!the!pain!started!and!whether!it!is!constant!or!intermittent.!
5. Aggravating(and(relieving(
factors:!ask!the!patient!what!
makes!the!paint!worse!and!
what!makes!it!better.!
6. Effect(of(pain(on(function(
and(quality(of(life:!the!effect!
of!pain!on!the!abiity!to!
perform!recovery!activities!
should!be!regularly!
evaluated!in!the!patient!with!
acute!pain.!Important!to!ask!
patients!with!persistent!pain!
about!how!pain!has!affected!
ther!lives.!
7. Comfort-function((pain(
intensity)(goal:*for!patients!
with!acute!pain,!identify!
short-term!functional!goals!
and!reinforce!to!the!patient!
that!good!pain!control!will!
more!likely!lead!to!successful!
achievement!of!the!goals.!!
8. Other(information:!the!
patient’s!culture,!past!pain!
experience,!and!pertinent!
medical!history!such!as!
comorbidities,!lab!tests,!and!
diagnositc!studies!are!
considred!when!making!a!
treatment!plan.!!
!
ASSESSàINTERVENE àREASSES/EVALUATE'
'
'
'
, ! 3
CHOOSING'A'METHOD'
Nonopiod'Analgesic'Agents'
• Acetaminophen!and!NSAIDs!
• Appropriate!alone!for!mild!to!some!moderate!nociceptive!pain!and!are!added!to!opiods,!local!anesthetic,!
and/or!anticonvulsants!as!part!of!a!multimodal!analgesic!regimen!
• Often!combined!with!opiods,!such!as!oxycodone!or!hydrocodone!
• Acetaminophen:!versatile!in!that!it!can!be!given!by!multiple!routes!of!administration,!oral,!rectal,!and!IV.!!
• NSAID:!availability!of!a!wide!variety!of!agents!for!administration!via!noninvasive!routes.!Ibuprofen,!
naproxen,!and!celecoxib!are!most!widely!used!oral!NSAIDs!
Adverse(effects(of(nonopiod(analgesic(agents:!
• *Acetaminophen!considered!one!of!the!safest!and!best!tolerated!analgesic!agents.!Most!serious!
complication!is!hepatotoxicity!(liver!damage).!Does!not!increase!bleeding!time!and!has!a!low!incidence!of!
GI!AEs.!
• NSAIDs*have!more!AEs,!with!gastric!toxicity!and!ulceration!being!the!most!common.!Risk!factors!include!
advanced!age!(>60),!presence!of!prior!ulcer!disease,!and!CV!disease!and!other!comorbidities.!GI!AEs!also!
related!to!the!dose!and!duration!of!NSAID!therapy.!Have!increased!bleeding!time!and!possible!renal!
toxicity.!Administer!with!food!and!plenty!of!water!to!decrease!risks.!!
Opioid'Analgesic'Agents'
• Mu(agonist(opioids('
o Larger!of!the!two!groups!and!include!morphine,!hydromorphone,!hydrocodone,!fentanyl,!
oxycodone,!and!methadone,!amonng!others!
• Agonist-antagonist(opioids'
o Include!buprenorphine!(Buprenex,!Butrans),!nalbuphine!(Nubain),!and!butorphanol!(Stadol)!
• Opioid!analgesic!agents!exert!their!effects!by!interacting!with!opioid!receptor!sites!located!throughout!the!
body!
• Titration!of!the!opioid!dose!is!usually!required!at!the!start!and!throughout!the!course!of!the!treatment!
when!opioids!are!administered.!The!goal!of!titration=!use!of!the!smallest!dose!that!provides!satisfactory!
pain!relief!with!the!fewest!adverse!effects!!
• Antagonists((ex:!naloxone,!naltrexone)!are!drugs!that!also!bind!to!opioid!receptors!but!produce!no!
analgesia.!Most!often!used!to!reverse!AEs,!such!as!respiratory!depression.!*
• Determining(appropriate(opioid(analgesic(agent:(consider!pain!intesnsity,!age,!coexisting!diseae,!current!
drug!regimen!and!potential!drug!interactions,!prior!treatment!outcomes,!and!patient!preference.*
• Consider!least!invasive!route!and!convenience!of!adherence!to!medication!regimen;!consider!dosing!
schdeule!and!do!what’s!best!to!keep!set!goals!and!what!will!work!best!for!patient.!*
• Treatment(of(adverse(effects:(
o Be!aware!of!the!prevalence!and!impact!of!opioid!adverse!effects.!
o Remember!that!most!opioid!adverse!
effects!are!dose!dependent;!always!
consider!decreasing!the!opioid!dose!as!a!
method!of!treating!or!eliminating!an!
adverse!effect;!adding!nonopioid!
analgesic!agents!for!additive!analgesia!
facilitates!this!approach.!
o Use!a!preventive!approach!in!the!
management!of!constipation,!including!
for!patients!receiving!short-term!opioid!
treatment.!
o Prevent!respiratory!depression!by!
monitoring!sedation!levels!and!
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