C H A P T E R
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Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
30 Chapter 9 Pain
7. List in order the nociceptive processes that occur to communicate tissue damage to the CNS. No. 1 is the first process and No. 4 is the last process.
a. Perception b. Modulation c. Transmission d. Transduction
8. Match the following types of pain in the left column with a category of pain from the upper right column and an example of the source of the pain from the lower right column.
Types of Pain
________ a. Pain from loss of afferent input
________ b. Pain persisting from sympathetic nervous system (SNS) activity ________ c. Pain caused by dysfunction in the central nervous system (CNS) ________ d. Pain arising from skin and subcutaneous tissue; well localized ________ e. Pain arising from muscles and bones; localized or diffuse
and radiating
________ f. Pain felt along the distribution of peripheral nerve(s) from nerve damage
________ g. Pain arising from visceral organs; well or poorly localized;
referred cutaneously
9. Amitriptyline (Elavil) is prescribed for a patient with chronic pain from fibromyalgia. When the nurse explains that this drug is an antidepressant, the patient states that she is in pain, not depressed. What is the nurse’s best response to the patient?
a. Antidepressants will improve the patient’s attitude and prevent a negative emotional response to the pain.
b. Chronic pain almost always leads to depression, and the use of this drug will prevent depression from occurring.
c. Some antidepressant drugs relieve pain by releasing neurotransmitters that prevent pain impulses from reaching the brain.
d. Certain antidepressant drugs are metabolized in the liver to substances that numb the ends of nerve fibers, preventing the onset of pain.
10. A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain?
a. Treatment includes the use of adjuvant analgesics b. Will be chronic in nature and require long-term treatment
c. Responds to small to moderate around-the-clock doses of oral opioids
d. Can be well controlled with salicylates or nonsteroidal antiinflammatory drugs (NSAIDs) 11. In the following scenario, identify the elements of a pain assessment that are present.
A 62-year-old male patient is admitted to the medical unit from the emergency department. On arrival he is
trembling and nearly doubled over with severe, cramping abdominal pain. He indicates that he has severe right upper quadrant pain that radiates to his back and he is more comfortable walking bent forward than lying in bed. He notes that he has had several similar bouts of abdominal pain in the last month but “not as bad as this. This is the worst pain I can imagine.” The other episodes lasted only about 2 hours. Today he experienced an acute onset of pain and nausea after eating fish and chips at a fast-food restaurant about 4 hours ago.
a.
b.
c.
d.
e.
f.
g.
Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain
Chapter 9 Pain 31 12. List the 10 basic principles that should guide the treatment of all pain.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
13. A patient with colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications?
a. On an around-the-clock schedule
b. As often as necessary to keep the pain controlled
c. By alternating two different types of drugs to prevent tolerance d. When the pain cannot be controlled with distraction or relaxation
14. A patient who has been taking ibuprofen (Motrin) and imipramine (Tofranil) for control of cancer pain is having increased pain. What would the health care provider recommend as an appropriate change in the medication plan?
a. Add PO oxycodone (Oxycontin) to the other medications
b. Substitute PO propoxyphene (Darvon), a mild opioid, for imipramine c. Add transdermal fentanyl (Duragesic) to the use of the other medications
d. Substitute PO hydrocodone with acetaminophen (Lortab, Vicodin) for the other medications
15. A patient with chronic cancer-related pain has started using MS Contin for pain control and has developed common side effects of the drug. The nurse reassures the patient that tolerance will develop to most of these side effects but that continued treatment will most likely be required for what?
a. Pruritus c. Constipation
b. Dizziness d. Nausea and vomiting
16. A postoperative 68-year-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesic with a basal dose of analgesic as well?
a. Opioid overdose c. Lack of pain control
b. Nausea and itching d. Adverse respiratory outcomes
17. Which measures or drugs may be effective in controlling pain in the physiologic pain process stage of transduction (select all that apply)?
a. Distraction d. Local anesthetics
b. Corticosteroids e. Antiseizure medications
c. Epidural opioids f. Nonsteroidal antiinflammatory drugs (NSAIDs)
18. A patient is receiving a continuous infusion of morphine via an epidural catheter following major abdominal surgery.
Which actions should the nurse include in the plan of care (select all that apply)?
a. Label the catheter as an epidural access.
b. Assess the patient’s pain relief frequently.
c. Use sterile technique when caring for the catheter.
d. Monitor the patient’s level of consciousness (LOC).
e. Monitor patient vital signs (blood pressure, heart rate, respirations).
f. Assess the motor and sensory function of the patient’s lower extremities.
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Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What additional assessment data should the nurse obtain from R.D. before making any decisions about his problem?
2. What data from the nursing assessment are characteristic of the affective, behavioral, and cognitive dimensions of the pain experience?
3. Based on R.D.’s lack of pain control with his current dosage of opioid and his symptoms on arising in the morning, what changes are indicated in his medication regimen?
4. Priority Decision: What are the priority teaching needs that should be included in a teaching plan for R.D. to titrate his analgesic dose effectively?
5. How could the nurse best help R.D. overcome his fear of addiction to opioid drugs?
6. What additional pain therapies could the nurse plan to help R.D. manage his pain?
7. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses? Are there any collaborative problems?
19. A patient with multiple injuries resulting from an automobile accident tells the nurse that he has “bad” pain but that he can “tough it out” and does not require pain medication. To gain the patient’s participation in pain management, what should the nurse explain to the patient?
a. Patients have a responsibility to keep the nurse informed about their pain.
b. Unrelieved pain has many harmful effects on the body that can impair recovery.
c. Using pain medications rarely leads to addiction when they are used for actual pain.
d. Nonpharmacologic therapies can be used to relieve his pain if he is afraid to use pain medications.
20. The patient has chronic pain that is no longer relieved with oral morphine. Which medication would the nurse expect to be ordered to provide better pain relief for this patient?
a. Duragesic b. Oramorph SR c. Hydrocodone
d. Intranasal butorphanol (Stadol)
CASE STUDY Pain
Patient Profile
R.D. is a 62-year-old man being evaluated for a change in his pain therapy for chronic malignant pain from meta- static cancer.
Subjective Data
• Patient desires zero pain but will accept pain level of 3 to 4 on a scale of 0 to 10.
• He has been taking two Percocet tablets q4hr while awake but his pain is now usually at 4 to 5 with the medication.
• Patient reports that pain varies over 24 hours from 5 to 10.
• He always awakens in the morning with pain at 10 with nervousness, nausea, and a runny nose.
• When pain becomes severe he stays in bed and concentrates on blocking the pain by emptying his mind.
• He is worried that increased pain means his disease is worsening.
• He is afraid to take additional doses or other opioids because he fears addiction.
Objective Data
• Height: 6 ft, 0 in (183 cm)
• Weight: 150 lb (68 kg)
• Rigid posturing, slow gait
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Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.