at the gate, certain cells in the spinal cord are
believed to interrupt the signal, closing the gate.- a.Acute pain: Generally rapid in onset, varying in
intensity from mild to severe, and lasting from a
brief period up to 6 months (e.g., surgery pain)
b.Chronic pain: May be limited, intermittent, or
persistent, but lasts for 6 months or longer and
interferes with normal functioning (e.g., arthri-
tis pain)
c. Intractable pain: Pain that is resistant to therapy
and persists despite a variety of interventions
6.Sample answers:
a.Culture: In one culture, it may be acceptable to
express pain vocally, whereas in another
culture, such vocal expressions of pain are
unacceptable.
b.Ethnicity: An Italian man may respond to pain
with cries, moans, complaints, and so on,
whereas an Irish man may be calm and unemo-
tional about his pain.
c. Family, gender, or age: Spouses may reinforce
pain behavior in their partners.
d.Religious beliefs: In some religions, pain is
viewed as suffering and as a means of purifica-
tion to make up for individual or community
sin.
e.Environment and support people: Caring sup-
port people can help a patient cope with the
strangeness of the healthcare environment.
f. Anxiety and other stressors: Fear of the unknown
may compound anxiety and aggravate pain.
g.Past pain experience: A child may have no fear
of pain because he has never experienced pain.
7.Answers will vary with student’s experiences.
8.Sample answers:
a.“You are the authority on your pain experience,
and you must let your nurse know when you
are in pain or when the medication isn’t work-
ing anymore.”
b.“Physical addiction may occur with chronic
opioid use, but this is not the same as the psy-
chological dependence of addiction. Studies
suggest that only half of 1% of all individuals
with cancer pain and other severe types of pain
will become addicted to opioids.”
c. “Opioid drugs can be used to manage your pain
safely as long as we take the appropriate precau-
tions and conscientiously assess any side effects.”
9.Sample answers:
a.Duration of pain: “For how long have you been
experiencing this pain?”
b.Quantity and intensity of pain: “How frequently
do you get these attacks? On a scale of 1 to 10,
how would you rate the intensity of this pain?”
c. Quality of pain: “How would you describe the
pain (sharp, intense, dull, throbbing, etc.)?”
d.Physiologic indicators of pain: “Have you
noticed any physical changes since you’ve been
experiencing this pain?”
10.Answers will vary with the student’s experiences
and may include the following: If a patient
suspects a plot to trick him/her into feeling better,
the patient is unlikely to respect or appreciate the
good intentions of the physicians and nurses
involved.- a.A patient with a cognitive impairment: Many
cognitively impaired patients cannot verbally
report their pain or express concepts; therefore,
nurses must rely on their own careful assess-
ments, their empathetic qualities, and the
expectation that this patient will experience
pain if a verbal patient usually reports this
event as painful.
b.A 5-year-old patient: Children cannot always
express their pain; the nurse must observe facial
expressions, body positions, crying, and physio-
logic responses. Communication with parents
or guardians is vital for accurate pain
assessment.
c. An older patient: Nurses should be aware that
older patients fear that admitting pain may
limit their independence; boredom, loneliness,
and depression may affect an older person’s per-
ception of pain and willingness to report it.
Also, their choice of terms in describing pain
may be deceptive.
APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What nursing interventions might the nurse use to
help minimize the effects of premenstrual
syndrome on Ms. Potter?
The nurse should investigate Ms. Potter’s symptoms
and pain history to determine what pharmaceutical
or CAM measures might help relieve the pain and
anxiety she is experiencing.
The nurse should also keep in mind that stress and
fatigue intensify the effects of pain.
2.What would be a successful outcome for this
patient?
By next visit, Ms. Potter vocalizes pain relief related
to learned relaxation measures
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of the pain experience, pain
process, and factors influencing the pain
experience, such as stress and fatigue
Interpersonal: ability to communicate and interact
effectively with patients experiencing pain
4.What resources might be helpful for Ms. Potter?
Consultation with an experienced CAM
practitioner, printed materials on PMS and relief
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