1. The most accurate information concerning a client’s pain comesfrom the nurse’s assessment or the client? Information from the client Is objective orsubjective data more important? Subjective When objective and subjective data about a client’s pain are in conflict, which report should the nurse consider as the primary source? Pain is always subjective “subject says”. 2. When administering pain medication, is it the most appropriate to administer the minimum dose and reevaluate the client’s pain after 30 minutes or administer the highest pain medication dosage to ensure the client’s pain is relieved? If BP is slow,start low. If patient comes out ofsurgery and pain is an 8 pushing the max dose is at the nurses discretion. 3. What physiological changes can occur when a client is in acute pain? - BP, Resp Rate, Pulse - Dilated Pupils - Perspiration (Diaphoresis/sweating) - Pallor (pale skin) How can a nurse assess a non-verbal client for pain? Wong Baker Face Scale, or non-verbal cues (grimacing, rolling on bed, fetal position). What isthe difference between pain quality and intensity? Quality = Type (sharp, dull, stabbing, numb) Intensity = How bad it hurts (scale of 1-10) 4. What are the signs of a client in chronic pain? - Lasts over 6 months - Persistent - Constant/recurrent - Produces negative changesin life (withdrawn, frail) - Body adapts (moves slowly to avoid movement of painful areas) - Needs reg assessment & diff approach to treatment 5. What is the gate control theory? Things other than medications can help relief pain (communication ie. Saying someone will be okay and rubbing their backs, therapy, acupuncture) 6. Review hypertension stepped-care approach, food with elevated sodium levels, know which ethnic group tends to develop hypertension earlier in life. African Americans are higher risk, change in lifestyle & diet first, then diuretics (which eliminate water from the body by passing urine more frequently). 7. Review the difference between primary (essential) hypertension and secondary hypertension. PN1 Test 2 Review (Cont.) 2 - Primary Hypertension: More common, is the in BP due to unknown causes - Secondary Hypertension: Rarer, renal or endocrine disease process that results in BP Which type is rarer? Secondary 8. What mm/hg is normal for blood pressure? 120/80 What are palpitations? Heart is racing, pounding, fluttering, skipping a beat often, bothersome but rarely a sign of heart attack. What is the “fifth” vitalsign? - Body temperature - Pulse - Respirations - Blood Pressure - Pain 9. Review the Joint Commissionsstandards related to pain management. Each client’s pain must be treated individually due to different interpretations of pain and different goals of pain relief. Do previous experiences, cultures, age, poverty level, or educational level affect a client’s pain experience? (Which ones do not?) Education level & poverty level do not. 10. Do older clients fear being labeled as “complainers” and avoid requesting medications? They often live with the pain in fear of being labeled as a complainer or a bother, nurse should encourage to request pain relief when needed. 11. Know about the normal vital signs and morphine dosage range. Normal= 12 RR Below 8-10 they will get Narcan (reverses) Be able to decide if a pain medication can be given based upon the client’s vital signs and physicians order. Always by Physicians order Would breathing changes,such as Cheyne-Stokes pattern prevent you from administering the client’s pain medication if their vital signs are normal? Cheyne-Stokes-> increase, decrease, then temporary stop in breathing (ie. Sleep apnea) Probably not but monitor closely. 12. Are clients who are able to gain pain relief able to function normally and comfortably? Yes, don’t chase the pain. 13. When using the SBAR technique for telephone communication, information in the S (situation) should include the nurse’s name, the client name, the circumstances leading up to the call.