Excellence in Care:
Pain Management
HPRX 3012
Mary Beth Kean, DNP RN-BC CNS CRRN
Helen Ross Petty
Elizabeth Huss RN, BSN
INDEPENDENT STUDY
Health Professions Institute
for Continuing Education
Austin Community College District
Health Professions Institute, Continuing Education
5930 Middle Fiskville Road, Austin, TX 78752
INDEPENDENT STUDY: HPRX 3012: Managing Pain
Description and Purpose: Mary Beth Kean DNP, RN an expert on pain control from Seaton
Medical Center, and Helen Petty of the Arthritis Foundation appear with Elizabeth Huss RN,
BSN, coordinator with the Health Professions Institute of Austin Community College (ACC), to
discuss the issue of pain management, the impact of pain on the healing process and the issues
important to both practitioner and patient in managing both acute and chronic pain using
pharmacologic and non-pharmacologic strategies .
The purpose of this activity is to enrich the RNs contributions to quality healthcare and his/her
pursuit of professional career goals by providing in-depth information about assisting patients
to deal with both acute and chronic pain. After completing this activity the nurse will be
prepared to engage the patient in managing pain using pharmacologic and non-pharmacologic
methods.
This offering is a learner-paced educational activity developed to meet the individual needs of
nurses, social workers, and emergency medical services personnel requiring continuing
education for re-licensure.
Goals and Objectives: Upon completion of this activity, the student will be able to:
1. Recall definitions of pain, dependence, tolerance, pseudo-addiction, addiction and aberrant
drug related behavior.
2. Describe the types and pathophysiology of pain.
3. Describe the impact of untreated pain and the concept of existential/total pain.
4. Discuss pharmacologic treatment of pain.
5. Discuss non pharmacologic management of pain.
6. Integrate objectives 1-5 into a case study.
7. Explain the difference between acute and chronic pain.
Requirements for Successful Completion: The packet you have received contains a pre-test,
DVD, post-test and a program evaluation. To successfully complete this activity and earn
continuing education the participant must:
1. Complete the pre-test
2. View the DVD
3. Complete the post-test (score an 80 or more)
4. And, complete the evaluation
NOTE: Following the viewing of the DVD and completing the accompanying documents,
questions may be addressed by contacting Elizabeth Huss @ 512-223-7271 or
[email protected]
Submit all of the documents (pre/post-test, evaluation) along with your completed Registration
Form (check or credit card), and payment to:
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
5930 Middle Fiskville Rd.
Austin, TX 78752
Fax: 512-223-7030
Within two business weeks from receipt of your material at ACC, your certificate of completion
will be available to be mailed, e-mailed, faxed to the address you provide or picked up at the
Highland Business Center.
Upon successful completion participants will be awarded a certificate of successful completion
worth 2.00 contact hours.
Austin Community College is an approved provider of continuing nursing education by the
Texas Nurses Association, an accredited approver by the American Nurses Credentialing
Center’s Commission on Accreditation.
Contact hours for programs applicable to social work are approved for CEU’s by the Texas State
Board of Social Worker Examiners. This program is worth 2.00 contact hours or 0.20 continuing
education units (CEU’s).
Continuing education for Emergency Medical Personnel is approved by the Texas Department
of State Health Services. This program is worth 2.0 TDH (P) contact hours.
Conflicts of Interest: A conflict of interest occurs when an individual has an opportunity to
affect or impact educational content with which he or she may have a commercial interest or a
potentially biasing relationship of a financial, professional or personal nature. All planners and
faculty/content specialist(s) must disclose the presence or absence of a conflict of interest
relative to this activity. All potential conflicts are resolved prior to the planning,
implementation, or evaluation of the continuing nursing education activity. All activity planning
committee members and faculty/content specialists have submitted Conflict of Interest
Disclosure forms.
The planning committee members and faculty/content specialists of this CNE activity have
disclosed no relevant professional, personal or financial relationships related to the planning or
implementation of this CNE activity.
Sponsorship or Commercial Support: This CNE activity received no sponsorships or commercial
support.
Non-Endorsement of Products: Approved provider status of Austin Community College refers
only to the continuing nursing education activity and does not imply a real or implied
endorsement by Austin Community College, the American Nurses Credentialing Center (ANCC)
or the Texas Nurses Association (TNA) of any commercial product, service, or company referred
to or displayed in conjunction with this activity, nor any company subsidizing costs related to
this activity.
Off-label Product Use: This CNE activity does not include any information about off-label use of
any product for a purpose other than that for which it is approved by the U.S. Food and Drug
Administration (FDA).
Reporting of Perceived Bias: Bias is defined by the American Nurses Credentialing Center’s
Commission on Accreditation (ANCC COA) as preferential influence that causes a distortion of
opinion or of facts. Commercial bias may occur when a CNE activity promotes one or more
product(s) (drugs, devices, services, software, hardware, etc.). This definition is not all inclusive
and participants may use their own interpretation in deciding if a presentation is biased.
The ANCC COA is interested in the opinions and perceptions of participants at approved CNE
activities, especially in the presence of actual or perceived bias in continuing education.
Therefore, ANCC invites participants to access their “ANCC Accreditation Feedback Line” to
report any noted bias or conflict of interest in the educational activity. The toll free number is
1(866) 262-9730.
Expiration: This continuing nursing education activity will expire on September 1, 2014
Pre-test: Pain Management
Name_______________________________________
A. MATCHING: Match the definitions on the right to the terms on the left.
(1) Whatever the person says it is, occurring whenever
the person experiencing it says it does
(
) PSEUDOADDICTION
(2) Evidenced by the person having withdrawal symptoms
when the drug is not available
(
) DEPENDENCE
(3) Evidenced by increasingly higher doses needed to obtain
the same degree of relief
(
) ADDICTION
(4) When healthcare workers make the mistake of
identifying an addiction where one does not exist
(
) ABBERANT DRUG
RELATED BEHAVIOR
(5) A disease of the brain resulting in behavior which
requires extensive treatment for healing
(
) PAIN
(6) Problematic behaviors which mimic disease states related
to the use of therapeutic or street drugs
(
) TOLERANCE
B: MULTIPLE CHOICE: Chose the one most correct answer.
7. Which of the following best describes the difference in acute pain and chronic pain:
a. acute pain has a stimulus which is relatively easy to identify
b. acute pain is greater in intensity that chronic pain
c. acute pain responds better to non-pharmacological methods than does chronic pain
8. Chronic pain is defined by the following characteristic(s):
a. the pain stimulus is no longer present
b. the ascending pathways continue to send pain signals to the brain
c. the clinician’s job is to find a way to block the pain signals rather than eliminate the source of the pain
d. all of the above
9. A recent American Cancer Society Study identified the fact that the following percent of cancer victims had
unresolved issues when dealing with their pain:
a. close to 50%
b. about 20%
c. less than 30%
d. nearly 80%
10. Cancer pain is multi-dimensional and could be caused by many factors including:
a. fear of mutilation or death
b. pain impulses originating in the cancerous site
c. loss of social status
d. all of the above
11. The following medications are the first line of defense for persons with mild to moderate pain:
a. hydrocodone, aspirin
b. tramadol, acetaminophen
c. codeine, Demerol
d. acetominophen , aspirin
12. The following is true about Non-steroidal anti-inflammatory drugs (NSAIDS)
a. ibuprofen belongs to this class
b. they will worsen renal failure
c. they are more effective than acetaminophen
d. all of the above
13. The “gold standard” ( the most effective we have) for treating both intractable chronic pain and severe
acute pain is:
a. hydromorphone
b. fentanyl
c. morphine
d. meperidine/Demerol
14. The one drug which has been found most ineffective to use for pain control and should be used only if all
other options are exhausted is:
a. hydromorphone
b. fentanyl
c. morphine
d. meperidine/Demerol
15. The following are risk factors which need to be considered when managing pain:
a. obstructive sleep apnea
b. liver failure
c. renal failure
d. all of the above
16. The most frequently bothersome side effect of pain medications reported by patients is:
a. diarrhea
b. constipation
c. skin rash
d. dizziness
17. The first and most important thing a nurse needs to do in helping a patient manage pain is:
a. show confidence
b. establish a trusting relationship
c. be empathetic
18. Non-pharmacological approaches to pain management include:
a. acupuncture
b. tens units
c. yoga
d. hypnosis
e. all of the above
Written:
I. Pre-Test
Excellence in Care: Pain Management
Program Outline
DVD Presentation:
II. Definitions
A. Pain
B. Dependence
C. Tolerance
D. Pseudoaddiction
E. Addiction
F. Aberrant Drug Related Behavior
III. Pathophysiology of Pain
A. Physical
B. Emotional
IV. Vicious Cycle of Cancer Pain
V. Chronic Pain versus Acute Pain
VI. The 4 A Approach
VII. Risk Considerations
VIII. Pharmacologic treatment
IX. Non-Pharmacologic treatments
X. Case Study
Written:
IX. Post-Test
X. Evaluation
EVALUATION---PAIN MANAGEMENT
Title of Education Activity: Excellence in Care
Location: DVD Video Format
Participants check out and complete on own time
Purpose of this activity: The purpose of this activity is to enrich the participant’s contribution
to quality healthcare and the pursuit of professional career goals by providing current and
updated information on management of pain.
Directions/Instructions: Please complete this evaluation questionnaire. Your anonymous
responses will be used to revise this activity and to plan future educational activities. Circle
the number that best fits your evaluation of this activity.
1 = Not at all
2 = Somewhat
3 = Almost completely
4 = Completely
1. Recall definitions of pain, dependence, tolerance,
1
pseudo-addiction, addiction and aberrant drug related behavior.
2
3
4
2. Describe the types and pathophysiology of pain.
1
2
3
4
3. Describe the impact of untreated pain
1
2
3
4
4. Discuss pharmacologic treatment of pain.
1
2
3
4
5. Discuss non pharmacologic management of pain.
1
2
3
4
6. Integrate objectives 1-5 into a case study.
1
2
3
4
3. Please evaluate guest speaker- Mary Beth Kean, DNP, RN
a. Knowledge and currency of topic
1
2
3
4
b. Ability to make points clear
1
2
3
4
c. Ability to apply content to practice
1
2
3
4
4. Please evaluate guest speaker- Helen Petty
a. Knowledge and currency of topic
1
2
3
4
b. Ability to make points clear
1
2
3
4
c. Ability to apply content to practice
1
2
3
4
a. Guides the discussion
1
2
3
4
b. Asks pertinent questions
1
2
3
4
c. Fosters clarification of presented information
1
2
3
4
1
2
3
4
5. Please evaluate the moderator- Elizabeth Huss RN, BSN
5. Were the objectives relevant to the overall purpose?
(see above)
5. How long (in minutes) did it take you to complete the entire activity (including taking the
pre-test, watching the video, taking the post-test, and completing this evaluation tool)?
________ Minutes
6. List two (2) ways you will integrate what you learned in this activity into your practice and/or
employment environment.
7. The following were disclosed prior to the beginning of this activity in writing?
a. Requirements for successful completion
b. Conflicts of Interest
c. Commercial Support
d. Non-endorsement of Products
e. Off-label Use
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
8. Did you, as a participant, notice any bias that was not previously disclosed in this
presentation?
Yes
No
If “Yes, please describe who was biased and how.
9. Comments: If you answered (1) to any of the above, please comment.
10. Please list any suggestions or topics for future programming.
To receive continuing education credits please return this completed evaluation, the pre-test and the post-test
along with your completed registration form and payment to
Austin Community College
Health Professions Institute
Attn: Online Nursing Videos
Highland Business Center
5930 Middle Fiskville Rd.
Austin TX 78752
th
If you prefer you may deliver the items to the registration desk on the 4 floor of the Highland Business Center at
the indicated address.
Post-Test: Pain Management
Name:_______________________________
A. MATCHING: Match the definitions on the right to the terms on the left.
(1) Whatever the person says it is, occurring whenever
the person experiencing it says it does
(
) PSEUDOADDICTION
(2) Evidenced by the person having withdrawal symptoms
when the drug is not available
(
) DEPENDENCE
(3) Evidenced by increasingly higher doses needed to obtain
the same degree of relief
(
) ADDICTION
(4) When healthcare workers make the mistake of
identifying an addiction where one does not exist
(
) ABBERANT DRUG
RELATED BEHAVIOR
(5) A disease of the brain resulting in behavior which
requires extensive treatment for healing
(
) PAIN
(6) Problematic behaviors which mimic disease states related
to the use of therapeutic or street drugs
(
) TOLERANCE
B: MULTIPLE CHOICE: Chose the one most correct answer.
7. Which of the following best describes the difference in acute pain and chronic pain:
a. acute pain has a stimulus which is relatively easy to identify
b. acute pain is greater in intensity that chronic pain
c. acute pain responds better to non-pharmacological methods than does chronic pain
8. Chronic pain is defined by the following characteristic(s):
a. the pain stimulus is no longer present
b. the ascending pathways continue to send pain signals to the brain
c. the clinician’s job is to find a way to block the pain signals rather than eliminate the source of the pain
d. all of the above
9. A recent American Cancer Society Study identified the fact that the following percent of cancer victims had
unresolved issues when dealing with their pain:
a. close to 50%
b. about 20%
c. less than 30%
d. nearly 80%
10. Cancer pain is multi-dimensional and could be caused by many factors including:
a. fear of mutilation or death
b. pain impulses originating in the cancerous site
c. loss of social status
d. all of the above
11. The following medications are the first line of defense for persons with mild to moderate pain:
a. hydrocodone, aspirin
b. tramadol, acetaminophen
c. codeine, Demerol
d. acetominophen , aspirin
12. The following is true about Non-steroidal anti-inflammatory drugs (NSAIDS)
a. ibuprofen belongs to this class
b. they will worsen renal failure
c. they are more effective than acetaminophen
d. all of the above
13. The “gold standard” (the most effective we have) for treating both intractable chronic pain and severe
acute pain is:
a. hydromorphone
b. fentanyl
c. morphine
d. meperidine/Demerol
14. The one drug which has been found most ineffective to use for pain control and should be used only if all
other options are exhausted is:
a. hydromorphone
b. fentanyl
c. morphine
d. meperidine/Demerol
15. The following are risk factors which need to be considered when managing pain:
a. obstructive sleep apnea
b. liver failure
c. renal failure
d. all of the above
16. The most frequently bothersome side effect of pain medications reported by patients is:
a. diarrhea
b. constipation
c. skin rash
d. dizziness
17. The first and most important thing a nurse needs to do in helping a patient manage pain is:
a. show confidence
b. establish a trusting relationship
c. be empathetic
18. Non-pharmacological approaches to pain management include:
a. acupuncture
b. tens units
c. yoga
d. hypnosis
e. all of the above