Capital care Review Of Pain Management
Review of Pain Management for Capital Care Employees:� focusing on�Pain Assessment,�Non-Pharmacological and Pharmacological Interventions, and the Policies and Procedures of Capital Care encompassing pain. �
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Questions and Answers
- 1.
After assessing Mrs. Watson's pain you decide it's time to develop a care plan with the interdisciplinary team at Canterbury Court. What is the goal of the care plan? What else needs to be addressed to ensure Mrs. Watson is receiving optimal care for her pain?Please write a couple sentences or point-form notes to answer the questions.
- 2.
While Mr. Jones is living in the centre, his pain can fluctuate from week to week, depending on his current symptoms. Use the space below to list some of the non-pharmacological interventions that you can use to educate Mr. Jones so that he can learn how to self-manage and minimize the pain he experiences on a day to day basis.
- 3.
According to the Verbal Pain Rating scale, identify the words (6) that are used to assess and measure the resident's pain; starting with no pain at all.
- 4.
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 Watson is fidgeting, withdrawn, has not touched her breakfast, and wants to go back to sleep.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.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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 distressRate this question:
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- 5.
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?
- A.
Depression
- B.
Anxiety
- C.
Decreased Socialization
- D.
Suicide
- E.
Increased healthcare utilization and cost
- F.
All of the above
- G.
A, B, and C only
- H.
A, B, C, and E (Not D)
Correct Answer
H. A, B, C, and E (Not D)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 lifeRate this question:
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- 6.
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?
Correct Answer
Pain Behavior Rating Scale
PAINAD
Pain and Behavior rating scale
Pain and Behavior Scale
Pain Behavior ScaleExplanation
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
- consolabilityRate this question:
- 7.
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:
- A.
Pastoral Care
- B.
Sensory Stimulation
- C.
Referral to a Recreation Therapy program
- D.
A splint
Correct Answer
D. A splintExplanation
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.Rate this question:
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- 8.
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.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 9.
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.
Correct Answer
positioningExplanation
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.Rate this question:
- 10.
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.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 11.
Which of the following drug classes are considered as Adjuvant Drugs (Co-Analgesics) for pain therapy?
- A.
Anti-depressants
- B.
Anti-convulsants
- C.
Muscle Relaxants
- D.
Membrane-Stabilizing Agents
- E.
All of the Above
Correct Answer
E. All of the AboveExplanation
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.Rate this question:
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- 12.
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?
- A.
Amitriptyline
- B.
Gabapentin
- C.
Phenytoin
- D.
B and C only
- E.
All of the Above
Correct Answer
D. B and C onlyExplanation
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."Rate this question:
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- 13.
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.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 14.
If Mr. Kennedy is started on an oral codeine therapy, which of the following side effects should he be monitored for potential toxicity?
- A.
Nausea
- B.
Decreased sensitivity to touch
- C.
Excessive Salivation
- D.
Hyperactivity
- E.
Pruritis / Itching
- F.
Hallucination
- G.
Diarrhea
- H.
Myoclonus
Correct Answer(s)
A. Nausea
E. Pruritis / Itching
F. Hallucination
H. MyoclonusExplanation
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.Rate this question:
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- 15.
According to the Capital Care policy manual on pain management, when should residents be observed and questioned for the presence of pain?
- A.
A) During each shift by Health Care Workers
- B.
B) Every time vital signs are taken
- C.
C) Prior to helping the resident to the bathroom
- D.
D) Both A & B
Correct Answer
D. D) Both A & BExplanation
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.Rate this question:
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- 16.
According to the Continuing Care Pain Assessment Tool, each resident should be asked to rate his/her pain using both the ______________ and ______________ scales.
Correct Answer
medical, scientific
numerical, verbal
black, yellowExplanation
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.Rate this question:
- 17.
PainAD is used only for residents who are non-verbal with advanced dementia.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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Mar 21, 2023Quiz Edited by
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