Chapter 10 - Pain Assessment Flashcards
How are white individuals different regarding cultural/racial differences in the treatment of pain?
White individuals receive more analgesic therapy than black or Hispanic individuals with similar symptoms
Neuropathic pain implies an abnormal…
processing of the pain message
An older adult patient with dementia has a pain rating of 5 on the Pain Assessment in Advanced Dementia (PAINAD) Scale. The nurse should
administer the prescribed pain medication
two main processes for pain assessment:
nociceptive and/or neuropathic processing
nociceptive processing (nociceptor)
designed to detect painful sensations from the periphery and transmit them to the CNS.
Nociceptors are located within the skin, connective tissue, muscle, and the thoracic, abdominal, and pelvic viscera.
can be stimulated directly by trauma or injury or secondarily by chemical mediators that are released from the site of tissue damage
analgesic
pain killer
Pain
is a highly complex and subjective experience that originates from the central nervous system (CNS) or peripheral nervous system (PNS), or both
Nociceptors carry the pain signal to the central nervous system by
two primary sensory (or afferent) fibers: Aδ and C fibers
Aδ fibers
myelinated and larger in diameter, so they transmit the pain signal rapidly to the CNS. The sensation is very localized, short-term, and sharp in nature because of the Aδ fiber stimulation
C fibers
are unmyelinated and smaller and they transmit the signal more slowly. The “secondary” sensations are diffuse and aching, and they last longer after the initial injury
substantia gelatinosa.
interneurons located within a specified area of the cord called the
anterolateral spinothalamic tract
structure and pathway that transmits pain signals to the brain
Nociceptive pain
develops when nerve fibers in the periphery and in the central nervous system are functioning and intact.
described as aching pain
starts outside of the nervous system from actual or potential tissue damage.
can be divided into four phases:
(1) transduction
(2) transmission
(3) perception
(4) modulation
transduction
occurs when a noxious stimulus in the form of traumatic or chemical injury, burn, incision, or tumor takes place in the periphery
transmission
the pain impulse moves from the level of the spinal cord to the brain
perception
indicates the conscious awareness of a painful sensation
modulation
pain message is inhibited
Neuropathic pain
implies an abnormal processing of the pain message from an injury to the nerve fibers.
described as burning, shooting, and tingling
most difficult to assess and treat.
Pain is often perceived long after the site of injury heals and can start 2 to 3 years after an initial injury.
Visceral pain
originates from the larger interior organs
Deep somatic pain
comes from sources such as the blood vessels, joints, tendons, muscles, and bone
referred pain
Pain that is felt at a particular site but originates from another location
Acute pain
short-term and self-limiting, often follows a predictable trajectory, and dissipates after an injury heals
persistent (or chronic) pain
diagnosed when the pain continues for 6 months or longer.
can be further divided into malignant (cancer-related) and nonmalignant
breakthrough pain
pain that starts again or escalates before the next scheduled analgesic dose
Pain is ALWAYS…
subjective
In the Initial Pain Assessment, the clinician asks the patient to answer eight questions concerning …
location, duration, quality, intensity, and aggravating/relieving factors
The Brief Pain Inventory, asks the patient…
to rate the pain within the past 24 hours using graduated scales (0-10) with respect to its impact on areas such as mood, walking ability, and sleep
The short-form McGill Pain Questionnaire, asks the patient to
rank a list of descriptors in terms of their intensity and to give an overall intensity rating to his or her pain.
Crepitation
an audible and palpable crunching that accompanies movement
allodynia
pain sensation is evoked with a stimulus that does not normally induce pain
Diaphoresis
the state of perspiring profusely
PAINAD
“Pain Assessment In Advanced Dementia” Scale
-a score of 4 or greater should be reported for pain mngmt purposes
Reflexive Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS)
RSD/CRPS is a chronic progressive nerve condition, characterized by burning pain, swelling, stiffness, and discoloration of the affected extremity. It affects both men and women, usually around 40 to 60 years old, and occurs weeks to months after a nerve injury (e.g., carpal tunnel syndrome, broken leg, cerebral lesions)
Intractable Pain
pain not relieved with typical measures
Cholecystitis causes which type of pain?
Inflammation in the gallbladder
