NS 3205 Study Guide for Exam #1 Chapter #5 Pain 1. Define the concept of pain and its impact.

-Whatever the experiencing person says it is and exists whenever he or she says it does. Most common reason for patient to seek medica care and # reason for a person to take meds. Compromises !"a ity of ife more than any other sing e hea th-re ated pro# em. $nre ieved and "ndertreated pain remains a ma%or& yet avoida# e p"# ic hea th pro# em in $'. (. )dentify * pop" ations at risk for "ndertreatment of pain. 1+ o der ad" ts (+ s"#stance a#"sers *+ those who primary ang"age differs from that of the hea th care professiona s *. Compare and contrast the characteristics of ac"te and chronic pain. - ,c"te Pain- serves a #io ogic p"rpose& activates sympathetic nervo"s system& response simi ar to .fight or f ight. /increased heart rate& increased 0P& increased 11& di ated p"pi s& sweating+& '2' inc "de /rest essness especia y in e der y& ina#i ity to concentrate& apprehension& overa distress+& characteristics /temporary& s"dden onset& easi y oca i3ed+. -Chronic Pain- pain that persists for 4 * months& onset grad"a and !"a ity of pain changes over time& characteristics /poor y oca i3ed and often diffic" t to descri#e #eca"se often invo ves deep tiss"e+. 5. 6xp ain the attit"de and know edge of n"rses& physicians and c ients regarding pain assessment and management. 7egative and mistaken #e iefs a#o"t pain and its treatment are common& witho"t ade!"ate know edge and assessment ski s of pain and ana gesic therapy may not #e a# e to "nderstand patient8s pain and participate in its treatment& witho"t persona experience with pain may not appreciate the magnit"de of painf" conditions associated with diseases and medica s"rgica treatment& may expect patient with chronic paint to react simi ar y to those with ac"te pain& mat ass"me that reactions to pain fa within certain norm #ased on their own c" t"ra va "es& "nder treatment of pain is a serio"s pro# em& * reason n"rse "nder treat 1- negative societa and c" t"ra attit"des (- fear of reg" atory scr"tiny *- ack of know edge a#o"t the effects of ana gesics+ p"# ic needs ed"cation& may #e re "ctant to report pain and when may "nderestimate its severity& may fear #ecoming addicted. 5. Differentiate #etween addiction& to erance and physica dependence. 9. ,ddiction- primary chronic ne"ro#io ogic disease with genetic& psychosocia and environmenta factors inf "encing its deve opment and manifestations& characteri3ed #y #ehavior that inc "des 1 or more of the fo owing /1- impaired contro over dr"g "se (- comp" sive "se *- contin"ed "se 5- craving+& occ"rs over time& rare y the res" t of "sing opioids for pain re ief #"t hea th care professiona s and patients sti fear this. -:o erance- state of adaptation in which expos"re to a dr"g ind"ces change that res" ts in decrease in one or more of dr"g8s effects over time. - Physica dependence- adaptation manifested #y a dr"g-c ass-specific withdrawa syndrome& can #e prod"ced #y /a#r"pt cessation& rapid dose decrease& decreasing # ood eve s of dr"g& administration of antagonist+& occ"rs in everyone who takes opioids over a period of time. ;. Descri#e the components of a comprehensive pain assessment. / C-character& <-onset& =- ocation& Dd"ration& '-severity& P-pattern& ,-associated factors+ >x- ask patient and significant others a#o"t pain experience inc "ding? precipitating and re ieving factors& #e iefs a#o"t ca"se& nat"re of ad%"stments in ife or in fami y& expectations a#o"t what sho" d #e done a#o"t pain& d"ration of pain& onset /s"dden s ow+&

aggravating factors& where is radiates& character and !"a ity of pain& intensity& associated s2s& when patient in pain keep >x short. Physica assessment- ac"te pain may ca"se severa physio ogic symptoms d"e to '7' stim" ation /e.g. increased >1 and 0P+& physio ogic changes in response to chronic pain are "s"a y adapted to so often have deve oped coping ski s and may appear we . Psychosocia assessment- ac"te pain ho ds significant meaning for patient& chronic pain is inf "enced #y psychosocia factors /anxiety fear re ated to meaning of pain& ong d"ration& power ess angry+ @. Descri#e the action of nonopioids& opioids and ad%"vant medications in pain management. -7on-opioid- first ine therapy for mi d to moderate pain& two most common aspirin and :y eno & these dr"gs have a cei ing at 1AAAmg& aspirin and 7',)D' good for inf ammatory pain /rhe"matoid arthritis& mi d-moderate post-op pain& menstr"a pain& migraines& m"sc e pain+& i#"profen and naproxen ca"se east B) pro# ems of 7',)D'& :y eno has no B) effects and no # eeding effects good for post-op patients& #"t may ca"se nephrotoxicity. - <pioids- there is no cei ing for opioids& most opioids are meas"red against 1Amg morphine& agonist are the most potent of a ana gesics& #e caref" of opioids mixed with acetaminophen #eca"se of the 5g imit on the dr"g& opioids that attach to the M" receptors and # ock the re ease of s"#stance P an red"ce pain ca"se /constipation& 7CD& "rinary retention& pr"rit"s& sedation& resp. depression+& 7CD treated with antiemetic pro# em "s"a y goes away on its own in a week& patients #ecome deve op to erance to the respiratory depression whi e at the same time #ecome to erant to the ana gesic effects& if resp. depression severe yo" can administer an opioid antagonist ike 7arcan. -,d%"vant meds- "sef" for comp ex or chronic pain& not tr"e ana gesics #"t either re ive pain a one or in com#ination with ana gesics& can potentiate the effectiveness of ana gesics and can he p contro other discomforts associated with pain& examp es inc "de topamax /#e s"re to monitor e ectro ytes #eca"se tricyc ic antidepressants ca"se hyponatremia& contraindicated with sei3"res and cardiac disease+ he ps with ne"ropathic pain& antianxiety dr"gs can #e "sed& other <:C dr"gs. E. )dentify the n"rseFs ro e in the "se of patient contro ed ana gesia and epid"ra ana gesia for pain management. PC,,+ ( n"rses program the p"mp 0+ sign on p"mp reads& .<n y patient is to administer medication.. C+ PC, #y proxy may #e "sed in rare cases& consider a different way to medicate D+ teach patient how to "se PC, p"mp 6+ te patient to report side effects /di33iness& na"sea& vomiting& and ina#i ity to void+ G+ Monitor vita s especia y respiration B+ check sedation eve very ( ho"rs per hospita po icy >+ teach patient they wi not overdose on p"mp )+ teach patient to p"sh #ottom on first sign of pain. 6pid"ra ana gesia,+ "sed in patients predisposed to respiratory comp ications /thoracic& orthopedic& a#domina s"rgery& preexisting respiratory disease and the o#ese+ 0+ ow-mec" ar weight heparin is he d on the day the epid"ra is removed C+ "sed post-op most often D+ tape catheter in ( p aces 6+ p aced in "m#ar or thoracic /#e ow 9th verte#ra+ 6+ maintain aseptic techni!"e d"ring catheters p acement& direct dr"g insti ation& inf"sion so "tion and t"#ing change G+ maintain occ "sive steri e dressing over site. B+ 7CD treated with antiemetic& pr"ritis treated with 7arcan not 0enadry >+ monitor vita s& resp. and sedation eve & every ho"r )+ ower motor weakness is common when "sed in con%"nction with opioids& assist patient to get o"t of #ed and assess eve of weakness do not de egate

1A. Descri#e physica and cognitive #ehaviora therapies for patients experiencing pain. -Physica meas"res- C"taneo"s stim" ation /app ication of heat& co d& and press"re? therape"tic to"ch& massage& vi#ration+& consider /#enefits vary from app ication to app ication& pain re ief on y ast as ong as the app ication& m" tip e tria s may need to #e done to o#tain effects& stim" ation may aggravate pain or prod"ce new pain+& this has #oth physica and psycho ogica effects on the patient& patient can participate in pain managment& :67' may #e "sed as ad%"nctive therapy for pain& fee s ike .pins and need es. & #e s"re to rotate e ectrode sights& can sti perform ,D=s -Cognitive-0ehaviora meas"res- Distraction? a ters the perception of pain #"t does not inf "ence the ca"se or periphera mechanism of pain. )magery? g"ided imagery& "sef" for chronic pain& if agitated "se distraction first& n"rse m"st decided if patient can concentrate for 5-9A min"tes then assist them in foc"sing on a tho"ght& may not work for a . 1e axation techni!"es? can decrease anxiety& emotiona stress and tension& physica examp es- receiving a #ody message& #ack r"#& or warm2hot #ath& modifying the environment to red"ce distraction& moving into a comforta# e position. psycho ogica examp es- p easant conversation& m"sic& re axation tapes. >ypnosis? n"rses ro e- c arify misconceptions& instr"ct patients a#o"t re axation and distraction& enco"rage patient to practice se f-hypnosis 11. Descri#e the ro e of the n"rse as an advocate in pain management. -#e ieve patient8s reports of pain and treat it ade!"ate y or ta k to MD if pain is "nre ieved& a ow patient to participate active y in decisions a#o"t how to manage pain. Chapter #19 )nterventions for Preoperative C ients 1. Differentiate among the vario"s types and p"rposes of s"rgery. -Diagnostic- performed to determine the origin and ca"se of disorder or the ce type for cancer. - C"rative- performed to reso ve a hea th pro# em #y repairing or removing the ca"se. -1estorative- performed to improve a patient8s f"nctiona a#i ity. Pa iative- performed to re ieve symptoms of a disease process& #"t does not c"re. - Cosmetic- performed primari y to a ter or enhance persona appearance. - 6 ective- p anned for correction of a nonac"te pro# em. -$rgent- re!"ires prompt intervention? may #e ife threatening i treatment is de ayed more than (5 to 5@ ho"rs. - 6mergent- re!"ires immediate intervention #eca"se of ife-threatening conse!"ences. -Minor- proced"re witho"t significant risk? often done with oca anesthesia. - Ma%or- proced"re of greater risk? "s"a y onger and more extensive than a minor proced"re. -'imp e- on y the most overt y affected areas invo ved in the s"rgery. -1adica - extensive s"rgery #eyond the area o#vio"s y invo ved? is directed in finding a root ca"se. -Minima y invasive s"rgery- performed in a #ody cavity or #ody area thro"gh one or more endoscopes? can correct pro# ems& remove organs& take tiss"e for #iopsy& re-ro"te # ood vesse s and drainage systems? is fastgrowing and ever-changing type of s"rgery. (. )dentify persona factors that increase the c ientFs risk for comp ications d"ring and immediate y fo owing s"rgery. -,ge- 495 -Medications- antihypertensive& trycyc ic antidepressants& anticoag" ants& 7',)Ds -Medica >x- decreased imm"nity& dia#etes& p" monary disease& cardiac disease& hemodynamic insta#i ity& m" tisystem disease& coag" ation defects or disorder& anemia& dehydration& infection& hypertension& hypotension& any chronic disease. -Prior s"rgica experiences- ess-than-optima emotiona reaction& anesthesia reactions or comp ications& postoperative comp ications ->ea th >istory- ma n"trition& cancer& # eeding disorder. -:ype of s"rgica proced"re p anned- neck& ora & facia /airway comp ications+& chest or high a#domina proced"res /p" monary comp ications+& a#domina s"rgery /para ytic i ie"s& veno"s throm#oem#o ism+.

*. Descri#e effective comm"nication techni!"es when teaching c ients and fami y mem#ers a#o"t what to expect d"ring the s"rgica experience. ,+ exp aining in his or her own words the p"rpose and expected res" ts of p anned s"rgery 0+asking !"estions when something is not known C+ adhering to 7P< re!"irements D+stating an "nderstanding of preoperative preparations /e.g. skin prep& #owe prep+ 6+ demonstrate correct "se of exercises and techni!"es to #e "sed after s"rgery for the prevention of comp ications /e.g. sp inting the incision& co"ghing2deep #reathing+& G+ if patient does not know this ask them .What do yo" know and what wo" d yo" ike to knowH.& te what yo" are doing and why yo" are doing it& give patient time to "nderstand and ask !"estions. 5. )dentify appropriate preoperative assessments of the c ient inc "ding diagnostic tests and the significance of these assessments. ->x-age& "se of to#acco& a coho & or i icit s"#stances& inc "ding mari%"ana& c"rrent dr"gs& "se of comp imentary or a ternative practices& s"ch as her#a therapies& fo k remedies& or ac"p"nct"re& medica history& prior s"rgica proced"res and how these were to erated& prior experience with anesthesia& pain contro and management of na"sea or vomiting& a"to ogo"s or direct # ood donations& a ergies& genera hea th& type of s"rgery p anned& know edge a#o"t and "nderstanding of events d"ring the preoperative period& ade!"acy of the patientFs s"pport system. -o#%ective data- physica assessment/resp& cardio& rena & m"sc" oske eta & ne"ro& integ"mentary& n"tritiona & hydration& psychosocia + - a# tests- "rina ysis& # ood type and screen& comp ete # ood co"nt or hemog o#in eve & c otting st"dies& e ectro yte eve s& ser"m creatinine and # ood "rea nitrogen eve s& depending on a fema e patients age and the nat"re of the p anned proced"re& a pregnancy test. , IC im#a ance needs to #e corrected #efore s"rgery. ,n x-ray is often cond"cted to have a #ase ine. 6CB is common among 5A-55 year o ds. 5. Descri#e the ega imp ications and proper proced"res when o#taining informed consent. :he s"rgeon is responsi# e fore having the consent form signed #y the patient& n"rse is not responsi# e for providing detai s a#o"t s"rgery& ro e is to c arify facts& n"rse acts as a witness to signat"re 7<: to the fact the patient is informed. J)f yo" think patient is "ninformed contact doc and chart it. ) iterateH sign K w2 ( witnesses& emergency w2 no g"ardianH consent of ( physicians& # indH ( witnesses& hearing impaired2 6'=H trans ator ( witnesses& te ephone consentH ok w2 fo ow "p and ( witnesses. 'pecific sight s"rgeries need to #e verified #y patient #efore hand /mark spot+. 9. )dentify appropriate preoperative n"rsing diagnoses and expected o"tcomes. Inow edge deficient and anxiety. 6xpected o"tcomes inc "de- patient exp ain expected res" ts& adheres to 7P<& demonstrates correct "se of exercise for after s"rgery. ;. 6xp ain the p"rposes and techni!"es common y "sed for c ient preoperative preparation. May need intestina prep with a#domina s"rgery& may need a sedative the night #efore& shower 1-( days #efore or morning with antiseptic& don8t shave& 7P< /stop so ids 9 ho"rs #efore and c ear i!"ids ( ho"rs #efore+& an 1@-(A ga"ge need e is p aced& "s"a dr"g sched" e may #e a tered /dr"gs for cardiac disease& respiratory disease& sei3"res& and hypertension are common y a owed with a sip of water #efore s"rgery+& void& advance directives&

@. )dentify appropriate teaching for the c ient preparing for s"rgery. ,+ #egin ear y pre-op 0+inform patient a#o"t what to expect C+ teach D0LC exercise D+:each incentive spirometer 6+ teach sp inting G+ teach eg exercises B+promote mo#i ity post-op B+ have them wear :6Ds or 'CDs >+ inform a#o"t drains /Go ey& 7B+ E. 1ecogni3e c ient conditions or iss"es that need to #e comm"nicated to the s"rgica team. , ergies& Medications given preoperative y& if they are wearing hearing aids& advance directives& =a#2:est res" ts Chapter #1@ )nterventions for Postoperative C ients 1. Descri#e appropriate assessments of the postoperative c ient and the significance of these assessments. -1espiratory stat"s is the # n"rsing assessment when ret"rning from s"rgery& assess "ngs at east every 5 ho"rs for (5 ho"rs then every @ ho"rs. -,ssess cardiovasc" ar system& vita s every 15 min"ets "nti patient is sta# e& report (5M or higher changes in 0P /15-(A points+& cardiac monitoring is contin"ed "nti sta# e "n ess they have cardiac disease then to te emetry f oor& periphera vasc" ar assessment needs to #e performed /check for DD:& P6+. -7e"ro ogic 'ystem- =<C needs to #e assessed& compare =<C with #ase ine& motor and sensory assessment are D61N important after epid"ra or spina anesthesia. -G "id& 6 ectro yte& and ,cid-0ase #a ance- s"rgery ca"ses f "id oss and a ters #a ance& meas"re )C<& assess hydration stat"s& monitor )D f "ids c ose y. -Iidney2$rinary system- assess fo ey or need for one. -Bastrointestina system- 7CD are the most common post-op reaction. perista sis is norma for (5 ho"rs /severa days for B) s"rgery+& constipation may occ"r after s"rgery from opioids. -'kin assessment- sho" d hea at skin eve in ( weeks& deep tiss"e wo"nds can take 9 months to ( years& head and facia wo"nds hea faster #eca"se of #etter # ood f ow& assess incision every @ ho"rs& assess drains ever @ ho"rs or when vita s are done. -,ssess pain2discomfort- assess for ac"te signs of pain and if possi# e ask to rate A-1A pain on pain sca e. -Psychosocia assessment- check for anxiety. -=a# assessment- check a# tests for infection& (5& 5@ and ;( ho"rs. (. )dentify and prioriti3e n"rsing interventions for the c ient recovering from s"rgery and anesthesia. 1. ,irway Maintenance (. Monitor A( with p" se oximetry at east every ( ho"rs *. Positioning& patient sho" d #e in semi-fow ers "n ess contraindicated then side ying position or head to side to prevent aspiration. 5. oxygen therapy- may #e prescri#ed to treat hypoxemia. 5. 0reathing exercise- #egins after patient regains gag and co"gh ref ex and2or remova of 6: airway. 1emind them to do the exercises ever 1-( ho"rs. )f "na# e to remove m"co"s or sp"t"m re!"ire ora or nasa s"ctioning. 9. Movement- assist patient o"t of #ed as soon as possi# e to promote "ng expansion. )f not possi# e to get o"t of #ed assist to t"rn every ( ho"rs. Make s"re #reathing and eg exercises are #eing performed. <ffer pain meds *A-5A min"tes #efore getting o"t of #ed. *. )dentify factors that inf "ence wo"nd hea ing after s"rgery. 'moking& e der y& o#ese& dia#etics& infection& distention from edema& or para ytic i e"s& stress at s"rgica site& ma no"rished patients& steroid "se

5. Descri#e appropriate assessments and interventions for a c ient who has a postoperative wo"nd comp ication. 6xpected <"tcomes- wo"nd edges remaining together& no p"r" ent drainage& ind"ration& or redness in& form& or aro"nd the incision. When drainage or # eeding occ"rs? sma amo"nt /o"t ine and check every 1A-15 min"tes+ arge amo"nt /notify MD+ prof"se # eeding /notify MD& press"re dressing& fre!"ent vita signs& ca m environment& increased )D rate& :LCM& shock treatment& prep for s"rgery+ )nfection /monitor '2' of infection& CL' of wo"nd #efore anti#iotics started& steri e dressing change& maintain wo"nd drainage& anti#iotic+ Dihiscence /notify MD& stay with patient& ow fow ers& decrease movement& moist steri e dressing& check D'& 7P< "nti seen #y MD& s"pport and reass"re& 7B as ordered& prep for c os"re+ 5. Descri#e appropriate interventions for the re ief of postoperative pain. :he "se of opioids or other ana gesics for pain management may mask or increase the severity of symptoms of an anesthesia reaction. <ften patients get the #est pain re ief from a com#ination opioids& non-opioids& and a ternative therapies. 9. )dentify postoperative n"rsing care to prevent potentia comp ications. ear y post-op am#" ation& eg exercises& enco"rage ,D=s2 se f t"rning& ade!"ate rest& P: referra prn& administer pain meds