Capital care Review Of Pain Management

1.

Please use the following information for the next four questions…
Mrs. Watson, an 87 year-old woman, lives with her husband Mr. Watson in a suite at Canterbury Court, an assisted living residence affiliated with the Capital Care Home Care program. They have been living at the residence for the last three years ever since Mrs. Watson could no longer care for her husband who requires a wheel chair. Mrs. Watson has osteoporosis and some difficulty ‘getting around’. She is otherwise healthy, cognitively aware, and usually in good spirits. She is happy living at the residence with her husband even if they are no longer at their old home in the country. You are a member of the Watson’s interdisciplinary health team. When you arrive at their room this morning you notice Mrs. Watson is fidgeting, withdrawn, has not touched her breakfast, and wants to go back to sleep.

True or False: All of these signs indicate Mrs. Watson is in pain.

True

False

Signs of pain include:

Body Movements- rigid/tense posture, guarding, fidgeting, increased pacing/rocking, restricted movement, gait or mobility changes

Changes in Activity Patterns or Routines- refused food, appetites change, increase in rest periods, sleep pattern changes, sudden cessation of common routines, increased wandering

Verbalizations/Vocalizations- sighing, moaning, groaning, grunting, chanting, calling out, noisy breathing, asking for help

Changes in Interpersonal Interaction- aggressive, combative, resisting care, decreased social interactions, socially inappropriate, disruptive, and withdrawn

Mental Status Changes- crying, increased confusion, irritability or distress

Explanation

Signs of pain include:

Body Movements- rigid/tense posture, guarding, fidgeting, increased pacing/rocking, restricted movement, gait or mobility changes

Changes in Activity Patterns or Routines- refused food, appetites change, increase in rest periods, sleep pattern changes, sudden cessation of common routines, increased wandering

Verbalizations/Vocalizations- sighing, moaning, groaning, grunting, chanting, calling out, noisy breathing, asking for help

Changes in Interpersonal Interaction- aggressive, combative, resisting care, decreased social interactions, socially inappropriate, disruptive, and withdrawn

Mental Status Changes- crying, increased confusion, irritability or distress

2. Which of the following drug classes are considered as Adjuvant Drugs (Co-Analgesics) for pain therapy?

Anti-depressants

Anti-convulsants

Muscle Relaxants

Membrane-Stabilizing Agents

All of the Above

Adjuvant Drugs, also known as Co-Analgesics, are mainly developed to treat conditions other than pain, but are used in pain management either alone of in supplementation to primary analgesic therapy to decrease the patient's perception of pain and provide analgesic effect in some situations. They may be used to modulate the intensity of somatic and visceral pain, as a main indication for neuropathic pain, and may be used with opioid analgesics to control moderate to severe pain.

Explanation

Adjuvant Drugs, also known as Co-Analgesics, are mainly developed to treat conditions other than pain, but are used in pain management either alone of in supplementation to primary analgesic therapy to decrease the patient's perception of pain and provide analgesic effect in some situations. They may be used to modulate the intensity of somatic and visceral pain, as a main indication for neuropathic pain, and may be used with opioid analgesics to control moderate to severe pain.

3. PainAD is used only for residents who are non-verbal with advanced dementia.

True

False

PainAD is a tool or assessment specifically designed for residents who have advanced dementia and are unable to communicate verbally. This tool helps in identifying and assessing pain in these individuals who cannot express their discomfort through words. Therefore, the statement that PainAD is used only for non-verbal residents with advanced dementia is true.

Explanation

PainAD is a tool or assessment specifically designed for residents who have advanced dementia and are unable to communicate verbally. This tool helps in identifying and assessing pain in these individuals who cannot express their discomfort through words. Therefore, the statement that PainAD is used only for non-verbal residents with advanced dementia is true.

4. Because of the widespread effects of Mr. Jones' disease, proper _____________ in his bed, wheelchair or couch will be necessary to maximize his comfort, thereby helping to reduce his pain.

Proper positioning can help to reduce pressure on a client's joint, while also taking into consideration any pain they may be experiencing due to their skin integrity.

Explanation

Proper positioning can help to reduce pressure on a client's joint, while also taking into consideration any pain they may be experiencing due to their skin integrity.

Submit

5. According to the Capital Care policy manual on pain management, when should residents be observed and questioned for the presence of pain?

A) During each shift by Health Care Workers

B) Every time vital signs are taken

C) Prior to helping the resident to the bathroom

D) Both A & B

Pain can be thoroughly tracked by health care professionals through streamlined assessments. According to the Capital Care policy manual on pain management, pain is continually assessed during each shift and every time vitals are taken. In some settings, the presence or absence of pain holds as much importance as any other vital sign.

Explanation

Pain can be thoroughly tracked by health care professionals through streamlined assessments. According to the Capital Care policy manual on pain management, pain is continually assessed during each shift and every time vitals are taken. In some settings, the presence or absence of pain holds as much importance as any other vital sign.

6. According to the Continuing Care Pain Assessment Tool, each resident should be asked to rate his/her pain using both the ______________ and ______________ scales.

According to the Continuing Care Pain Assessment Tool, each resident should be asked to rate his/her pain using both the medical and scientific scales, as well as the numerical and verbal scales. The use of medical and scientific scales ensures that pain assessment is based on objective criteria and standardized measurements. The numerical and verbal scales provide a more subjective assessment, allowing residents to express their pain in their own words. The inclusion of black and yellow as answer options seems incorrect and irrelevant to pain assessment.

Explanation

According to the Continuing Care Pain Assessment Tool, each resident should be asked to rate his/her pain using both the medical and scientific scales, as well as the numerical and verbal scales. The use of medical and scientific scales ensures that pain assessment is based on objective criteria and standardized measurements. The numerical and verbal scales provide a more subjective assessment, allowing residents to express their pain in their own words. The inclusion of black and yellow as answer options seems incorrect and irrelevant to pain assessment.

Submit

7.

Mrs. Watson is cooperative and eager to help you assess her back pain. You find it easiest to use the numeric rating scale and verbal rating scale because Mrs. Watson is cognitively aware and capable of describing her pain.

Numeric Rating Scale (NMR)

Mrs. Watson describes her pain this morning as distressing and a 7 on the NMR.

What scale could you use if Mrs. Watson was non-verbal or had severe dementia?

Pain Behavior Rating Scale- PAINAD

For residents who are non-verbal or have Advanced Dementia Score, pain is determined by observation of the following items:
- breathing
- negative vocalization
- facial expression
- body language
- consolability

Explanation

Pain Behavior Rating Scale- PAINAD

For residents who are non-verbal or have Advanced Dementia Score, pain is determined by observation of the following items:
- breathing
- negative vocalization
- facial expression
- body language
- consolability

Submit

8. Please use the following information for the next four (4) questions:

Mr. Jones is a client who has been living on your unit for the past two years. He has been diagnosed with rheumatoid arthritis (RA) and experiences frequent flare-ups. Although he is on medication to manage his systemic symptoms, he has been complaining of increasing pain and difficulty in using his hands to complete his activities of daily living.

As a member of Mr. Jones' interdisciplinary team, you might recommend which of the following interventions to help relieve the pressure he is experiencing in his hand and wrist joints:

Pastoral Care

Sensory Stimulation

Referral to a Recreation Therapy program

A splint

Splinting can help to support and/or immobilize a painful joint and to position it to prevent deformity. A splint can be used continuously or be put on periodically to help enhance function during specific tasks.

Splints are most often made and fit to a client by an Occupational Therapist (OT) or a Certified Orthotist.

Explanation

Splinting can help to support and/or immobilize a painful joint and to position it to prevent deformity. A splint can be used continuously or be put on periodically to help enhance function during specific tasks.

Splints are most often made and fit to a client by an Occupational Therapist (OT) or a Certified Orthotist.

9.

Mrs. Lawson comes into the clinic complaining of severe nerve pain in her hands and feet related to her diabetes. She has suffered from similar pain before, but has not previously taken any medication for it. She says that the pain is worsening, and describes it as being "shooting, sudden, and recurring."
What might be the most effective treatment for Mrs. Lawson's neuropathic pain?

Amitriptyline

Gabapentin

Phenytoin

B and C only

All of the Above

Anticonvulsants, such as phenytoin and gabapentin, as well as carbamazepine, topiramate and lamotrigine have been found to be MOST effective when treating neuropathic pain described as being "shooting and paroxysmal," as in the case of Mrs. Lawson's pain.

Amitryptiline, while it is used in neuropathic pain along with other antidepressants, is most effective when used for neuropathic pain described as "constant burning."

Explanation

Anticonvulsants, such as phenytoin and gabapentin, as well as carbamazepine, topiramate and lamotrigine have been found to be MOST effective when treating neuropathic pain described as being "shooting and paroxysmal," as in the case of Mrs. Lawson's pain.

Amitryptiline, while it is used in neuropathic pain along with other antidepressants, is most effective when used for neuropathic pain described as "constant burning."

10.
Use the following information to answer the next 2 questions:
Mr. Kennedy's arthritis pain has been worsening over the past year. Previously, he says he has not taken much for his arthritis other than daily ibuprofen. He says that the doctor mentioned that maybe he should start on something else to help with the pain, such as codeine. Mr. Kennedy explains that he has taken codeine once- 10 years ago when he fell and broke his leg, but had major problems with constipation and stomach upset while he was taking the codeine. He mentions that even the ibuprofen bothers his stomach sometimes. Mr. Kennedy says that he heard something about a patch that could be used to treat his pain, and he is wondering if perhaps a patch might be better for him, so he avoid having more stomach problems.
True or False: Mr. Kennedy should be started on a transdermal slow-release opioid patch (Fentanyl) immediately in order to treat his arthritis pain, and avoid the negative GI side effects associated with oral opiate treatment.

True

False

Mr. Kennedy has not had any treatment with opioids recently, and is thus considered "opioid naive." The use of Fentanyl transdermal patches in opioid naive patients may lead to fatal respiratory depression, and should be avoided.
When switching to Fentanyl patches, the patient must be tolerant to opioid therapy of a comparable potency to that of the intended initiating transdermal dose.

Explanation

Mr. Kennedy has not had any treatment with opioids recently, and is thus considered "opioid naive." The use of Fentanyl transdermal patches in opioid naive patients may lead to fatal respiratory depression, and should be avoided.
When switching to Fentanyl patches, the patient must be tolerant to opioid therapy of a comparable potency to that of the intended initiating transdermal dose.

11. Mr. Jones' rheumatoid arthritis has been progressing over the past year and now affects most of his joints. During a flare-up, Mr. Jones' joints become excessively swollen which not only causes him pain but makes it difficult for him to get around the centre.

True or False: Compression and acupuncture are two interventions that can specifically help to reduce edema.

True

False

Compression wrapping can be used to help reduce edema causing pain, provided that there is adequate circulation prior to applying the compression therapy.

While acupuncture may help to relieve or reduce pain, it does not specifically reduce the swelling in a client's joints.

Explanation

Compression wrapping can be used to help reduce edema causing pain, provided that there is adequate circulation prior to applying the compression therapy.

While acupuncture may help to relieve or reduce pain, it does not specifically reduce the swelling in a client's joints.

12. Mrs. Watson sighs and explains that her back has been 'acting up' lately and this morning it feels especially painful.

As a competent member of the healthcare team you recognize the need to assess Mrs. Watson’s level of pain. You remember this assessment is your responsibility and that there are many consequences for a patient with persistent pain. Which of the following are consequences of persistent pain?

Depression

Anxiety

Decreased Socialization

Suicide

Increased healthcare utilization and cost

All of the above

A, B, and C only

A, B, C, and E (Not D)

It is your responsibility on each shift to ensure that (1) you know which residents have been screened as having pain and (2) that if a resident says they have pain, you assess and document it.

The following are consequences of persistent pain...
- depression
- anxiety
- decreased socialization
- sleep disturbance
- impaired ambulation
- malnutrition
- increased healthcare utilization and costs
- worsening of conditions
- slower rehabilitation
- compromised overall quality of life

Explanation

It is your responsibility on each shift to ensure that (1) you know which residents have been screened as having pain and (2) that if a resident says they have pain, you assess and document it.

The following are consequences of persistent pain...
- depression
- anxiety
- decreased socialization
- sleep disturbance
- impaired ambulation
- malnutrition
- increased healthcare utilization and costs
- worsening of conditions
- slower rehabilitation
- compromised overall quality of life

13. As stated in the Capital Care poilcy manual on pain management, it is the responsibility of the HCA to monitor the effectiveness of the exisiting pain interventions.

True

False

As a nursing team, HCA's, RNs, LPNs, RPNs, CGNs and unit managers are collectively responsible for monitoring the effectiveness of exisiting pain interventions. All nurses involved in the care of a particular resident are to check daily care records, progress notes, MAR/PRN sheets and other information as applicable.

Explanation

As a nursing team, HCA's, RNs, LPNs, RPNs, CGNs and unit managers are collectively responsible for monitoring the effectiveness of exisiting pain interventions. All nurses involved in the care of a particular resident are to check daily care records, progress notes, MAR/PRN sheets and other information as applicable.

14. If Mr. Kennedy is started on an oral codeine therapy, which of the following side effects should he be monitored for potential toxicity?

Nausea

Decreased sensitivity to touch

Excessive Salivation

Hyperactivity

Pruritis / Itching

Hallucination

Diarrhea

Myoclonus

Myoclonus, Nausea, Pruritis and Hallucination are all possible signs of opioid general toxicity and neurotoxicity. Opioid toxicity does not cause a decreased sensitivity to touch, but rather causes hyperalgesia. It also causes DRY mouth, and causes somnolence and sedation, not salivation or hyperactivity.
Opioids frequently cause constipation, not diarrhea.

Explanation

Myoclonus, Nausea, Pruritis and Hallucination are all possible signs of opioid general toxicity and neurotoxicity. Opioid toxicity does not cause a decreased sensitivity to touch, but rather causes hyperalgesia. It also causes DRY mouth, and causes somnolence and sedation, not salivation or hyperactivity.
Opioids frequently cause constipation, not diarrhea.

Submit