CH 11: Pain Assessment Flashcards
pain is always?
subjective
what is pain assessment?
interpretation of scale number and critical thinking about influencing factors
signs of pain?
facial expression
guarding
moaning
vital changes
what can hypoventilation lead to?
hypoxia
collapsed alveoli
pain requires attention to what?
response to relief methods
medication side effects
what else can be done?
why is pain assessment important?
to develop non-pharmacological and pharmacological strategies to improve clinical results
-important for treatments, diagnoses, etc
pain assessment details?
intensity
location
onset (acute more emergent, chronic harder to treat)
referred or radiating
limitations of ADL
duration
alleviating and aggravating
what is holistic?
non pharma
holistic method examples?
distraction: music, relaxation, massage, acupuncture
tubes: decompress and relieve pressure
anxiolytics
improve breathing and oxygenation
positioning
heat/cold (good for musculoskeletal)
psychological support, palliative care, conflict resolution
what is nocioreception?
describes noxious stimuli perceived as pain
originates from CNS or PNS
nocireceptors?
specialized nerve endings that detect pain
transmit signals to sensory fibers: A (rapid signal, shorter term) and C (slower signal, persist after injury)
nociception concepts: transduction?
stimulus in periphery (cut or burn felt at peripheral level)
- mediators released: substance P, histamine, prostaglandins, serotonin, bradykinin
nociception concepts: transmission?
pain moves from spinal cord to brain (enacts reflexes to feel pain faster)
nociception concepts: perception?
conscious awareness of pain sensation (brain is aware)
-cortical structures (limbic system=emotional response)
only perceived as pain when reaches cortical structures
nociception concepts: modulation?
inhibition of pain sensation (how body reacts to pain - endogenous relievers)
-body’s built in mechanism to slow/stop pain stimulus
-analgesic effects (serotonin, norepi, neurotensin, GABA)
pain treatment approaches?
modify source
alter central perception
modulate transmission of pain in CNS (alter pain signal)
block transmission of pain in CNS (nerve blocks, anesthesia)
what is neuropathic pain?
abnormal processing of pain messaging
*signal mixup/nerve dysfunction
does not follow predictable phase
MOST DIFFICULT to assess/treat
perceived long after healing
ex. diabetes, herpes zoster, HIV, sciatica, chemo, phantom limb pain
what is visceral pain?
originates from large organs
-stems from direct injury to organ
-autonomic responses (N/V, pallor, diaphoresis) bc transmitted by ascending nerve fibers
ex. appendicitis, ulcer pain, cholecystitis
what is deep somatic pain?
from blood, vessels, joints, tendons, muscles, bone
-from pressure, trauma, ischemia
-described as aching/throbbing, usually localized
-nausea, sweating, tachycardia, HTN
what is cutaneous pain?
from skin or SUBQ
-superficial with sharp, burning sensation
what is referred pain?
felt at specific site but originates in diff location
both sites innervated by same spinal nerve
what is acute pain?
short term
self limiting
predictable
dissipates after healing
protective quality
vital signs indications bc ANS
what is chronic pain?
continues beyond expected time
malignant and non
in cancer: increase pain=increase disease
does not stop when healed
no protective qualities
pain level may not correspond with physical findings
acute pain symptoms?
protective responses
diaphoresis
anxiety
restlessness or stillness
moaning
chronic pain symptoms?
normal VS
skin warm and dry
depressed/withdrawn
anxiety
anger/irritability
substance abuse
no protective
bracing/rubbing
sighing
appetite change
reduced activity
aging adult?
pain not normal process, indicates pathology or injury
what is PAINAD?
scale for dementia patients
0-2 (0 being normal)
measures:
breathing
vocalization
facial expression
body language
consolability
what makes up PAINAD?
breathing
negative vocals
face expression
body language
consolability
0 (normal) to 2 (not)
what is PQRST?
provocation
quality
region/radiation
severity
time
what should you ask?
where?
started?
feels like?
how much now?
what makes it better or worse?
limit ADLs?
how do you know?
how do others know?
types of pain assessment?
numeric: 0-10
verbal descriptor: use words
visual analog: mark on line none - worst
descriptor: select pain term words
don’t assume patients know what?
0 - 10 scale
AA pain beliefs?
illness sign
no pain= may affect treatment compliance
inevitable/endured
high tolerance
spiritual/religious beliefs
praying
mexican beliefs?
accepted as necessary
consequence of behavior
restores balance
delay treatment seeking
divinely predetermined
objective assessment?
joints- ROM
muscle/skin- color, swelling, deformity
abdomen- contour and symmetry
