Ch 7 Pain Flashcards
How do we deal with pain?
we assess and treat all patients
What is this:
sudden onset
short duration
associated w/ injury?
acute pain
What does acute pain travel on?
a-delta fibers
What fibers send sharp pain info, have quick transmission, large fibers, and are myelinated?
a-delta fibers
What is this:
persistent pain greater than 6 months and associated with long disease processes.
chronic pain
What does chronic pain travel on?
C-polymodal fibers
What fibers send dull pain info, have slow transmission, small fibers and are unmyelinated?
C-fibers
What does bradykinin, substance P, prostaglandins, leukotriens, seritonine, histamine and catecholamines do in terms of pain?
help move pain impulse from pain receptors to dorsal horn up to the anterolateral spinothalamic tract up to the cerebral cortex
Do neonates feel pain?
yes, process pain early in life
In neonates, how does pain travel?
typically on C-fibers w/ short transmission distance and inability to process pain resulting in increased sensitivity to pain stimulus, due to developmental immaturity
Who are more likely to be more sensitive to pain, preterm and full term newborns, or infants and children.
preterm and newborns
Why might pregnant women experience back pain?
lax ligaments, weight gain, anterior tilt of pelvis, hyperlordosis
Why might pregnant women experience epigastric pain?
gravid uterus
What kind of pain might pregnant women feel if their ligaments are stretched due to enlarged uterus?
round ligament pain
What are the causes of labor pain?
dilation of cervix
stretching of uterus
pressure on structures
hypoxia of uterine muscle cells
Do older adults have diminished perception of pain?
no evidence to support this
What kind of pain do elderly feel?
osteoporosis, arthritis, diabetic neuropathy, fractures
Why dont the elderly tell people they are hurting?
stigmas
think its normal part of aging, dont want to bother you, dont want to pay for tests, dont want to take meds
If elderly individual is cognitively impaired how do you assess pain?
ask family member, use nonverbal pain indicators, ask them
What takes precedent, subjective or objective pain assessment?
SUBJECTIVE!
How do you rate a patients pain?
you ask them, then you make that level of pain the gold standard for that patient to compare against for other visits
What is the fifth vital sign?
Why is it so important?
pain
can assess tissue damage, assess emotional state of mind, and pathophysiological effect of pain on body
How to choose the correct pain scale?
continuity is key
If you have large change in vital signs what kind of pain are you showing?
few changes?
acute
chronic
What are some behavioral signs of pain?
distorted face inability to sit still clenched eyes silence in a talkative patient groaning
What kind of pain is this associated with:
tender, deep, aching
bone and soft tissue pain
What kind of pain is this:
heavy, throbbing, and aching pain
tumor pressing on a cavity
What kind of pain is this:
burning, shocklike
nerve tissue damage
What is this a sign of:
clenched fist over chest with diaphoresis and grimacing
myocardial infarction
What is this a sign of:
cramping or spasm
visceral or colic pain
How do you assess pain in neonates (28-40 weeks)?
PIPP (premature Infant Pain Profile)
uses gestational age, behavioral state, heart rate, oxygen saturation, brow bulge, eye squeeze, nasolabial furrow
How do you assess pain in infants?
facial expressions, cries, breathing patterns, extremeties, state of arousal in procedural pain
The (blank) scale uses crying, oxygen saturation, heart rate, blood pressure, expression, and sleeplessness to assess procedure and surgical pain in newborns and infants
CRIES
Physiological measures and behaviors are combined for pain behavior scales that dont rate pain but are used for ….?
identify presence of pain and treatment
How do you reduce pain in neonates?
give them sugar water -> it promotes opoids :)
At what age do kids start being able to verbalize pain levels? What pain scale should you use?
3
Wong/Baker FACES rating scale (the ones with the sad to happy face) and Oucher scale (different faces too)
Should you look at a childs facial expression and use an oucher scale or a wong/baker faces scale and figure out for yourself what they are feeling?
NOOOOOOO
Following the surgery of 2months-7 year olds, what pain scale is good to assess pain in nonverbal patients?
FLACC
face, legs, activity, cry and consolability
Explain the FLACC pain scale?
0 is no problem, 2 is the greatest problem
For the FLACC scale, After scoring all the points tell me what they mean?
0=relaxed
1-3=mild discomfort
4-6=moderate pain
7-10= severe pain/discomfort
Why can FLACC be useful for parents to use?
for cognitively impaired children
What is a good predictor of amount of pain a particular woman may experience in labor?
socioeconomic status and prior menstrual difficulties
If patients have dementia or cognitive impairment can you still give them a pain scale?
if they can verbalize then yes
if not, use the Checklist of Nonverbal Indicators
Explain how the Checklist of Nonverbal Indicators works
Gives a sign, if observed, then 1 point, if not observed then no points.
Total score 0-5
What are the signs in the Checklist of Nonverbal Indicators?
Vocal complaints (moans, grunts) Facial Grimaces/Winces Bracing Restlessness Rubbing Vocal complaints(ouch, that hurts, curse words)
What is a form of chronic pain caused by a primary lesion or dysfunction of the CNS that persists beyond expected healing?
Neuropathic pain
What is the presence of regional pain (beyond site of nerve damage) with motor, sensory, and autonomic changes following a predominantly traumatic noxious event with or without specific nerve injury?
Complex regional pain syndrome
What all goes into sensing pain?
behavior, physiology, and emotion
State the key components of the history when pain is part of the present problem
Onset, Quality, Intensity, Location, Associated symptoms, What the patient thinks is causing the pain, Effect of pain on daily activities, Effect of pain on psyche, Pain control measures, Medications
