Combined Exam Review bundle for NUR2356 / NUR 2356 Multidimensional Care I / MDC 1. |Contains Exam 1 Review, Exam 2 Review and Exam 3 (Final Exam) Review.|
NUR 2356 Multidimensional Care I
MDC 1 Exam 1 Review
NUR 2356 Multidimensional Care I
MDC 1 Exam 2 Review
Pain
● Will be subjective and individualized per patient. May be unpleasant to various degrees.
● Different patients may need different treatments
● Many units will use the same classes of pain medications and methods to manage, but
the patient’s goal for pain relief may be different.
● Always respect one’s pain level! 5th vital sign!
○ Types of Pain:
■ Acute Pain: associated w/ injury, medical condition, surgery. Lasts hours
to a few days, but not longer than 6 months.
■ Chronic Pain: associated w/ long term or chronic illnesses, can continue
for months or years and may go into positions of exacerbations and
remission.
■ Cancer Pain: caused from
■ tumor progression, pathological processes,
■ invasive procedures, chemotherapy and drug toxicities, infection and
physical limitations.
■ Idiopathic Pain: chronic or acute pain without an identifiable cause. Take
this pain seriously!
■ Somatic Pain: From ligaments, tendons, nerves, blood vessels and
bones, often from fractures or sprains that cause the pain.
■ Visceral Pain: From deep internal disorders or diseases such as in the GI
system like cramps and stomach pain.
■ Cutaneous/ Burning Pain: from damage or pain or inflammation on the
skin surface. Can be intense with movement and when completing ADLs,
often from touching a hot surface.
■ Radiating Pain: pain that starts at an origin and can extend or move to
other locations.
■ Referred Pain: pain that occurs in another area that is distal from the true
site of pain origin. Like Jaw pain with a patient with an MI.
■ Phantom Pain: AMPUTATIONS! Pain perceived from an area that is
surgically or tragically removed. It WILL be REAL! Often in the person’s
brain, so we need to give pain medications and
■ non-pharmacological interventions to keep the patient comfortable.
■ Neuropathic Pain: From an injury that impairs the nerve messaging
system to multiple nerves. Often results in numbness and tingling.
■ Intractable Pain: pain that cannot be relieved.
● Assessment
■ Remember: to always note the client’s developmental level, cognitive
disabilities, culture, and gender when assessing pain.
■ Always try to ask the patient about their pain and their goals for pain.
More information= better result.
■ GOAL: treat the pain before it becomes severe
■ Ask the client to describe the pain in terms of timing, location, severity,
quality, aggravating and precipitating factors, and relief measures, that
affect their life.
● PQRST
○ P= Provoking Factors: what makes the pain worse, what
makes the pain better. What causes the pain.
○ Q= Quality: how the pain feels (sharp, dull, stabbing,
throbbing)
○ R=Region/ Radiate: where is the pain located and/or does
it move or expand to other tissues.
○ S=Severity: how intense is the pain (0-10)
○ T=Time: when did the pain start, how long have you had it,
intermittent or constant.
■ Use a numeric scale, faces scale, visuals to assess.
■ If not able to tell you about pain: use FLACC Scale, CRIES
■ Look at nonverbal behaviors like grimacing, positioning, guarding,
movement in the bed, arms and limbs, etc.
● Interventions
● Non-pharmacological
● Hot/ Cold Therapy: helps to constrict and dilate blood vessels,
reduce swelling and inflammation, and soothe pain.
○ May need an order for use
○ Includes warm compresses, warm water, heated blankets,
thermal pads, hot tubs, and whirlpool baths. Cold packs,
ice bags.
○ Monitor temp to prevent skin from burning.
○ Keep on for a certain amount of time.
○ Remove the source if one has problems with sensation or
discomfort.
● Cutaneous Stimulation: refocuses the attention to tactile stimuli
rather than pain.
○ Reduces muscle pain
○ Acupressure
○ Uses hot and cold therapy, therapeutic touch.
○ May need an order.
○ Massage: helps to decrease pain in the back, shoulder,
hands and feet.
■ Do not use one who has PVD or calf swelling, or in
the neck.
● TENS: the application of a device that gives a mild electric current
over areas of pain to block the impulses.
○ Do not use this with a client with a pacemaker
● Binders, slings and supportive devices:
○ Various objects that can ease the pain when there is
musculoskeletal injury, pain or other process where one is
immobile.
○ Includes elevation to reduce swelling by using pillows to
relieve pain.
○ Teach patients how to use it.
● Relaxation: use of different strategies to decrease tension, anxiety,
increase sleep and control.
○ Use of breathing techniques, yoga, etc
○ Teach to use before pain is severe.
● Distraction: takes the patients mind off of the pain with sensory
engagement
○ TV, books, newspaper, coloring
○ Muscle Therapy and pet therapy are often ordered to help
someone relax and reduce pain.
● Guided Imagery: using the imagination to create a relaxing effect
with deep breathing.
○ Usually of places the person loves
● Biofeedback: involves adjusting and controlling the body’s
feelings, thoughts and responses from stimuli.
● Pharmacological
● Non-Opioids
○ NSAIDS
■ Ex: aspirin, ibuprofen.
■ Helps to relieve minor aches, pains, fevers.
■ Contraindicated w/ gastric irritation or PUD or
allergy
■ Bleeding is a big concern- have to report if vomiting
or pooping blood.
■ Take these meds w/ food to reduce gastric or
stomach irritation.
■ Can amplify effects of anticoagulants
■ Hypoglycemia if used with a oral antidiabetic
■ Toxicity w/ CCB
■ Adverse effect: gi upset and bleeding
○ Acetaminophen
■ Ex: tylenol
■ Helps to relieve minor aches, pains, fevers.
■ Do not use w/ hepatic or renal disease clients,
alcoholism, or hypersensitive (allergy).
■ Assess for liver dysfunction
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Monitor for hepatic damage such as N,V,D, ABD
pain.
Monitor liver function labs
Teach clients that self medication should not be
used 10 days post d/t hepatotoxicity.
Antidote is acetylcysteine!
Adverse effect: liver damage (hepatotoxicity)
These medications suppress pain but can also
suppress respiration and coughing as they act on
the respiratory systems.
Tolerate low doses first before advancing to higher
doses. IV best route.
Administer before pain gets bad.
Teach about physical dependence.
Take BP, RR,HR, do not use low RR, low HR and
Low BP.
LIsten to the lungs and monitor LOC.
Safety precautions: falls.
Monitor I/O and take medication with a snack.
Do not do activities like driving if taking the
medication.
Assess for its effect after given.
Opioid antidote is naloxone and it should be on
hand.
○ Codeine:
■ Used as a cough suppressant
■ Can cause constipation
■ Ex: hydrocodone/ oxycodone
○ Hydromorphone:
■ Concern: respiratory depression
■ Can make one drowsy, dizzy, and have orthostatic
hypotension
■ Monitor vital and RR
■ Assist the client when getting up, get up slowly to
prevent one from falling.
○ Morphine
■ Used to ease moderate to severe pain
■ Concern: respiratory depression
■ Adverse effects: orthostatic hypotension, urinary
retention, constipation, pupil constriction, N,V.
■ Do not use it with patients with severe respiratory
disorders, head injuries, renal disease, seizure
activity, increased ICP.