Ch 35: Comfort And pain management Flashcards
What are 2 ways to define pain
- Pain is whatever the patient says whenever the patient says pain is present
- Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage
Give the categories of pain classification
Give the difference between acute and chronic pain
What is a common misconception about pain meds
Categories of pain:
- Duration
- localization/location (generalized the local)
- etiology (cause)
Acute: -RAPID onset autonomic response (f v f) -protective and nature warns of tissue damage • MI • appendicitis •ectopic pregnancy •AAA
Chronic:
- Limited, intermittent, or persistent
- last beyond normal healing period (1-6 months)
- periods of remission or exacerbation (reappearance)
Common misconception:
-pain meds do not take away pain🚫
allow patient to tolerate and manage pain✅
Give the sources (types) of pain
- Nociceptive
-define

2.Cutaneous
-A.k.a.
-where is pain
-sensation - Somatic
- where is pain - Visceral
- Most what?
- What is it based on
- Poorly what? - Neuropathic pain
- I.E.
- describe the pain
1.Nociceptive: peripheral nerve fibers
- Cutaneous: “ superficial pain”
- skin and subcutaneous tissue
- Sharp pain with burning sensation - Somatic:
- in BONES, tendons, ligaments, blood vessels ,nerves - Visceral: “ splecanic pain”
- MOST COMMON AS ORGANS BECOME DISTENDED, ISCHEMIC, INFLAMM
- of the abdominal ORGANS
- poorly localized - Neuropathic pain: phantom pain
-Injury or lesion to nerve causing abnormal peripheral function
-
 describe the Origins of pain
Physical
psychogenic
referred pain
-Give examples of referred pain
Physical: identified cause
Psychogenic: unidentified cause
Referred pain: pain perceived in area away from origin
- MI: jaw, neck, left arm
- gallbladder: right shoulder
- Liver: right chest/older
- bladder: rectal area
Give the 4 physiologic pain process steps
1.
- definition
- activation
- directional process
- 
- definition
- two fibers involved - Definition
4.
- definition
- Who is involved
1. Transduction
: activation of pain receptors
(with injury, chemical is released and activate/exciting nerve endings)
-Painful stimuli turns into electrical impulses starting with nociceptors in the periphery going to the cord

2. Transmission
: conduction of pain along pathways to spinal cord By afferent pathway
-involves A delta and C fibers

3. Perception of pain
: awareness of pain characteristics
- Modulation
: inhibition or modification of pain
 Inhibited by Nero modulators (endorphins, and enkephalins)

Under transmission
-differentiate A delta V C fibers
Under modulation:
-what are neuromodulators
-give the 3 types and their slight differences

A delta: larger fibers
-Acute well localized pain
C fibers: smaller
-diffuse, longer-lasting
Modulation: Nuromodulators are natural hormones and chemicals that alter pain and block pain releasing substances 1. endorphins: most potent 2. enkephalins: less potent 3. Dynorphin‘s
What are the substances released that stimulate nociceptors (pain receptors)
Bradykinin:
-powerful vasodilator that ⬆️ capillary permeability and constrict smooth muscle
Prostaglandins:
-Hormone like substance that since additional pain stimuli to CNS
Substance P:
-sensitizers receptors of nerves to feel pain and increases firing of nerves
What does a gate control theory of pain describe and recogn
What does a gating mechanism determine
What conducts and inhibits pain stimuli to brain
Can you control theory describes the transmission of painful stimuli
-recognizes relationship between pain and emotions
Getting mechanism determines the impulse that reaches the brain
Small and large diameter nerve fibers conduct and inhibit pain stimuli to brain

Describe nociceptors
Describe paint threshold
Describe pain tolerance
Describe adaptation
Specifically what do the three Nuro modulators inhibit and from where

Nociceptors:
-Peripheral nerves the transmit pain

Pain threshold:
-The point at which you feel pain
• lowest intensity
Pain tolerance:
-Maximum level patient can tolerate
Adaptation:
-⬆️ in tolerance by regular exposure to paint
The 3 Nuro modulators inhibit substance P from the afferent neuron (especially enkephalins)
Briefly describe the pain sensation and relief process
- Pain path begins in the nerve ending
- Electrical chemicals impulse goes to the dorsal horn
-  impulse Travels to Hypothalamus: sensory Center
- Impulse goes to cerebral cortex where intensity and location is perceived
- Pain relief signal goes to the dorsal horn
- Endorphins released
Common response is the pain:
Give physiologic responses to pain
Give behavioral responses to pain
Give affective responses to pain
Physiologic: involuntary response
- ⬆️BP AND PULSE
- ⬆️ in glucose
- pupils dilate
- muscles tense
- sweating
- N/V
Behavioral :
- Grimacing
- moaning/crying
- guarding
- flinching
- restless
- Gross motor activities
Affective: person becomes withdrawal from pain
- Anxious
- depressed
- fear/anger
- stoic
- pain in way of ADL
- perception/ meaning of pain
- treatment at home
What is pain regardless of what
- What must nurse due to patient’s pain
- As a nurse what must we do to be able to manage patient’s pain
Pain is whatever the patient says it is regardless of actions
- Nurses must believe patients about pain
- nurses must be able to be aware of their own feelings to pain and Factors that affect pain to be able to manage patient pain

If physiologic pain is severe and deep what may it lead to and what does it mean
What pain is not exhibited in chronic pain What is exhibited
If physiologic pain is severe and deep
-person may have N/V, fainting
Which is a sign they cannot tolerate the pain
In chronic pain physiologic pain may be decreased or not exhibited
✅ so you may see you affective (anxious)
What are considerations to have for older adults and addressing age and comfort with pain
- issues with what (what do you want to do)
-  Who do you want to include
- Monitor what after medications
- How may pain be affected
- what do you want the patient to do regarding the assessment and what do you want to evaluate
- Term, not normal
- What do you want to ensure and why
- what are we monitoring what are we discouraging

-older may have issues communicating
• observe behaviors carefully
-Include family and caregiver when gathering information
• how older has dealt with pain
- Monitor behavior and confusion after medications
- consider pain perception is affected by boredom and depression
- Ask &involve patient in the pain assessment and evaluate their willingness to help and get help
Use a different term to pain and explain pain is not normal with aging
Ensure dose and frequency to avoid over sedation and toxicity
Monitor for respiratory depression and discourage driving and self-medicating after medications

What are manifestations of pain you will see in your elder
Manifestations of pain for older:
- change an activity level
- don’t wanna do anything
- grimacing
