Pain in the Older Adult
Pharmacology
Nursing Assessment
More about Pain Meds
Types of Pain
100
These are conditions that are associated with pain in older adults.
What is OA, RA, spinal stenosis, osteoporosis, back pain, peripheral neuropathy, GERD, pressure ulcers, fibromyalgia, and/or post-herpetic neuralgia?
100
Pain medication within this group includes NSAIDs, acetaminophen, and tramadol
What is non-opioid analgesics
100
How do you describe a pain that feels like a sharp point?
What is stabbing pain?
100
These are examples of opioids that should be avoided in the older adult.
What is meperidine and methadone?
100
Nociceptive pain includes two different types of pain, visceral relating to the body's internal organs and somatic which is pain where?
Somatic pain is pain of the muscles, joints, connective tissues and bones that typically is well localized.
200
Pain is often undertreated in the elderly. What is given the most often by healthcare providers for that undertreatment? 1. Pain is merely the absence of the feeling good. 2. Pain is an abstract concept. 3. The elderly frequently complain of pain so it is hard to believe them consistently. 4. Pain is subjective and, therefore, it is hard to communicate its quality.
Pain is often undertreated in the elderly. What is given the most often by healthcare providers for that undertreatment? Feedback for all incorrect answers: Rationale: For any individual, pain is what the client says it is. Items 1 and 2 are incorrect because the intensity, quality, and duration are hard to communicate effectively for anyone. The last response is correct because the nurse should accept the client’s description of their pain and respond appropriately. 1. Pain is merely the absence of the feeling good. Incorrect 2. Pain is an abstract concept. Incorrect 3. The elderly frequently complain of pain so it is hard to believe them consistently. Incorrect 4. Pain is subjective and, therefore, it is hard to communicate its quality. Correct
200
Many opioid analgesics cause constipation. What should the nurse advise the patient to do to help with constipation caused from opioids?
What are stool softeners and bowel stimulants, Senna tea and fruits may also be helpful.
200
The assessment of pain is a single event, it is not an ongoing process. True or false
What is false?
200
Constipation, respiratory depression, pruritis, and N and V are examples of ________
What is adverse effects of opioids?
200
Diabetic neuropathy and post-herpatic neuralgia are examples of this type of pain.
What is neuropathic pain?
300
This is the most reliable indicator of a client's pain.
What is verbal report of pain?
300
A person using a fentanyl patch for the first time should be advised to take an oral medication for the first 24 hours? True or false?
What is true
300
An elderly client has been hospitalized to manage the complications associated with her metastatic breast cancer. The client reports experiencing “breakthrough pain.” What pharmacological action can the nurse reasonably expect will be included in the treatment plan? 1. Initiation of a placebo after every third dose of narcotic. 2. More aggressive use of chemotherapy. 3. Giving narcotics every hour. 4. Increasing the dose of the narcotic.
An elderly client has been hospitalized to manage the complications associated with her metastatic breast cancer. The client reports experiencing “breakthrough pain.” What pharmacological action can the nurse reasonably expect will be included in the treatment plan? 1. Initiation of a placebo after every third dose of narcotic. Incorrect 2. More aggressive use of chemotherapy. Incorrect 3. Giving narcotics every hour. Incorrect 4. Increasing the dose of the narcotic. Correct Rationale: When a client experiences breakthrough pain it is appropriate to increase the dose of the narcotic, following the principle of “starting low and going slow.” Because item 3 suggests hourly doses this is an incorrect response. While chemotherapy might be used to eliminate a source of the pain it would not be used as the primary intervention. Item 1 is not an ethical intervention.
300
This is the maximum amount of acetaminophen an older adult should consume daily from all sources.
What is 3,000mg?
300
These are examples of some of the types of pain behaviors and indicators in older adults with dementia.
What is facial expression, verbalizations/vocalizations, body movements, changes in interpersonal interactions, changes in activity patterns or routines, and/or mental status changes?
400
Non-pharmacological interventions for pain that the nurse might employ for an elderly client with osteoporosis would include: 1. Evening back rubs. 2. Support groups. 3. Daily walks. 4. Increased dairy products in the diet.
Non-pharmacological interventions for pain that the nurse might employ for an elderly client with osteoporosis would include: 1. Evening back rubs. Correct Rationale: Many non-pharmacological interventions, such as a back rub, can be effective in reducing pain. This is the only response listed that includes an intervention that focuses on pain relief. A support group would offer education and emotional support. Items 3 and 4 offer suggestions that could be used as part of the treatment designed to interrupt the disease process. 2. Support groups. Incorrect 3. Daily walks. Incorrect 4. Increased dairy products in the diet. Incorrect
400
A person using a fentanyl patch cannot shower? True or false
What is false They can shower but not put soap over the patch.
400
An elderly client had abdominal surgery 8 hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is to: 1. Administer a PRN dose of IV pain medication as ordered. 2. Assist the client into a sitting position in preparation for ambulation. 3. Question the client further about discomfort to assess the meaning of pain. 4. Assess the abdominal dressing and consult the surgeon about findings.
An elderly client had abdominal surgery 8 hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is to: Feedback for all incorrect answers: 1. Administer a PRN dose of IV pain medication as ordered. Incorrect 2. Assist the client into a sitting position in preparation for ambulation. Incorrect 3. Question the client further about discomfort to assess the meaning of pain. Correct Rationale: Item 3 is correct because a denial of pain does not mean the client is not experiencing any pain. The client may have a different meaning for the term “pain” so the nurse should explore the situation using a variety of terms like discomfort or aching. Without a careful assessment the first response is inappropriate and a post operative client who had abdominal surgery 6 hrs previously will require medication in preparation for ambulation. While assessing the abdominal dressing is important, unless there are indications of complications the surgeon would not need to be notified. 4. Assess the abdominal dressing and consult the surgeon about findings. Incorrect
400
Patient's with a GI bleed or decreased renal function should not take acetaminophen? true or false
False, they should not take NSAIDs.
400
This type of pain results from harmful or injurious stimulus; the pain is short lived and resolves when the stimulus is removed or the injury has healed.
What is acute pain?
500
Which statements are true? Choose all that apply: 1. Around-the-clock opioids should be used only rarely and with extreme caution in older adults with dementia. 2. Acute post-surgical pain is best treated with prn dosing. 3. There is no reason to believe that an elderly person with a cognitive impairment is less sensitive or feels pain less. 4. The nausea and vomiting that occurs when opioids are first begun usually subsides within a few days. 5. The elderly tend to overreport pain rather than denying that pain is being experienced.
Which statements are true? Choose all that apply: 1. Around-the-clock opioids should be used only rarely and with extreme caution in older adults with dementia. Incorrect 2. Acute post-surgical pain is best treated with prn dosing. Incorrect 3. There is no reason to believe that an elderly person with a cognitive impairment is less sensitive or feels pain less. Correct Rationale: There are no known neurological changes that result in decreased pain sensitivity in the elderly to any significant degree. Any pain that is known or can be anticipated is best managed with around-the-clock treatment for maximal pain relief with the least amount of adverse effects. Opioids are considered safe and effective for anything other than mild pain, including persistent pain in elderly persons with dementia. Any nausea or vomiting that occurs commonly when persons first start taking morphine usually subsides within a few days. Cognition level: Understanding 4. The nausea and vomiting that occurs when opioids are first begun usually subsides within a few days. Correct
500
This is an example of a long-acting benzodiazepine and should be avoided in the elderly if at all possible.
What is Clonazepam, diazepam, and/or chloridazepoxide?
500
The nurse is caring for a patient hospitalized after experiencing a fall down the stairs. The patient has a history of dementia. Which of the following principles should the nurse remember when performing a pain assessment? Choose all that apply. 1. Be aware that episodes of incontinence increase in the presence of pain. 2. Look for signs of increased agitation or restlessness. 3. Screening tools can be used accurately with moderate levels of dementia. 4. Know that only family members could reliably point out pain in their loved one. 5. Aggressiveness can increase in the presence of pain.
Feedback for all incorrect answers: Rationale: Elderly persons with dementia can express their pain up until the time that they have become nonverbal. Therefore, the usual screening tools can still be dependably used. If the dementia is in the latter stages, the nurse may need to rely on nonverbal behaviors such as agitation, moaning, and resisting care as indicators of pain. Unrelieved pain can cause acute confusion and incontinence, but incontinence will not always occur in the presence of pain. Cognition level: Understanding 1. Be aware that episodes of incontinence increase in the presence of pain. Incorrect 2. Look for signs of increased agitation or restlessness. Correct 3. Screening tools can be used accurately with moderate levels of dementia. Correct 4. Know that only family members could reliably point out pain in their loved one. Incorrect 5. Aggressiveness can increase in the presence of pain. Correct
500
This pain medication has a long half-life and may result in toxic accumulation of drug in the person with hepatic or renal impairment.
What is methadone?
500
This type of pain continues over a prolonged period of time.
What is persistent pain?
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