Ch. 10 :pain assessment

Question 1

Classic definition of pain

Answer 1

“whatever the experiencing person says it is, existing whenever he says it does.”

Question 2

Structure and function

Answer 2

\+neuroanatomic pathway
  -high complex that originates from the cns or pns or both
\+nociception
  -divided into 4 phases
\+neuropathic pain
  - type of pain that is not typical or predictable 
\+ sources of pain
  - based upon their origin
\+types of pain
  -classified by its duration

Question 3

Neuroanatomic pathway

Answer 3

+nociceptors:
-specialized nerve endings designed to detect painful sensations from the periphery and transmit them to the CNS

+interneurons
-peripheral sensory fibers synapse with interneurons located within a specified are in the spinal cord

+anterolateral spinothalamic tract
-the pain signals then cross over to the other side of spinal cord and ascend to the brain via this tract

Question 4

Nociception

Answer 4

+1st phse:TRANSDUCTION
-some form of traumatic injury occurs, injurred tissue releases chemicals that propagate pain message. the pain message travels along sensory afferent nerve fibers to the spinal cord.

+2nd phase:TRANSMISSION
- the pain impulse moves from the level of the spinal cord to the brain

+3rd phase:PERCEPTION
- conscious awareness of a painful sensation

+4th phase: MODULATION
-neurons from brain stem releases neurotransmitters that block the pain impulse

Question 5

Neuropathic pain

Answer 5

• most diff. pain to assess and treat
• abnormal processing pain message
• neurochemical level

Question 6

Sources of pain

Answer 6

+visceral pain: large interior organs

+deep somatic pain: blood vessels, joints, tendons, muscles

+cutaneous pain:skin surface

+referred pain: felt in one area but originates in another area

Question 7

Types of pain

Answer 7

+acute pain
-short-term, self-timing, follows a predictable trajectory, dissipates after injury heals

+chronic or persistent pain
-continues for 6 month or longer, types or malignant (cancer related) and nonmalignant

+breakthrough pain
-pain occurs again or escalates before the next schedules analgesic dose.

Question 8

Pain assessment tools

Answer 8

+initial pain assessment

+brief pain inventory

+short-form Mcgill pain questionnaire

+pain rating scales

• Numeric rating scales
• descriptor scale

Question 9

Objective data- physical exam

Answer 9

+joints-note

• size/contour/circumference
• AROM/PROM

+Muscles/skin- Inspect

• color/swelling
• masses/deformity
• sensation changes

+abdomen- inspect and palpate

• contours/symmetry
• guarding/organ size

+pain behavior-inspect

• nonverbal cues
• acute pain behavior
• chronic pain behavior

Question 10

Acute pain behaviors

Answer 10

• guarding
• grimacing
• vocalization such as moaning
• agitation, restlessness
• stillness
• diaphoresis
• change in vital signs

Question 11

Chronic Pain behaviors

Answer 11

• bracing
• rubbing
• diminished activity
• sighing
• change in appetite
• being with other people
• movement
• exercise
• prayer
• sleeping

Question 12

REFLEXIVE SYMPATHETIC DYSTROHPY

Answer 12

• AKA (RSD)
• chronic, progressive nerve condition
• burning pain, swelling, stiffness, and discoloration of the affected extremity
• follows trauma to the nerve
• most commonly appears in 40-60 year old men and women
• the key feature: simple touch or brush of cotton ball or clothing can create sever, intense painful response