Fundamentals of Nursing

Question 1

Four specific processes of nociception

Answer 1

Transduction - tissue damaged by thermal, mechanical, or chemical stimuli activate nociciptors
Transmission - pain-sensitizing substances surround pain fibres in the extracellular fluid, creating the spread of the pain message via afferent peripheral nerve fibres to the spinal cord.
Perception - conscious awareness of pain
Modulation - Increase, decrease in pain signal intensity that can occur before, during and after pain is perceived - inhibitory transmitters

Question 2

Substances released by damaged tissue

Answer 2

Prostaglandins, bradykinin, histamine, prostaglandins, serotonin, and substance P

Question 3

Two types of afferent peripheral nerve fibres that conduct painful stimuli

Answer 3

Fast, myelinated A-delta fibres - sharp, localized, distinct sensation, source and intensity
Small, slow, unmyelinated C fibres - poorly localized, burning, and persistent.

Question 4

Substance P

Answer 4

Excitatory peptide, needed to transmit pain impulses from the periphery to the higher brain centre, causes vasodilation and edema

Question 5

Serotonin

Answer 5

released from brain stem and dorsal horn, inhibits pain transmission

Question 6

Prostaglandins

Answer 6

Generated from breakdown of phospholipids in cell membrane, believed to increase sensitivity to pain

Question 7

Endorphins and Dynorphins

Answer 7

Neuromodulator - body’s natural supply of morphine-like substances
Activated by stress and pain
Located in the brain, spinal cord, and GI tract
Attach to opiate receptors in brain

Question 8

Bradykinin

Answer 8

Released from plasma that leaks from surrounding blood vessels
Binds to receptors in peripheral nerves, increases pain stimuli
Binds to cells that cause the chain reaction-producing prostaglandins

Question 9

Factors involved in perception of pain

Answer 9

Brain interprets intensity, quality, character, info from past experience, psychological, social, spiritual and cultural associations

Question 10

Examples of inhibitory transmittors

Answer 10

Endogenous opioids (endorphins and enkephalins), serotonin, norepinephrine, and gamma amino butyric acid

Question 11

Substantia gelatinosa

Answer 11

Gatekeeping cells within the dorsal horn of the spinal cord, thalamus and limbic system - physiological, emotional and cognitive processes can influence these gates

Question 12

Factors that increase release of endorphins

Answer 12

Stress, exercise

Question 13

Psychological conditions that accompany pain

Answer 13

Exhaustion, anxiety, depression, irritability

Question 14

Sympathetic Stimulation in reaction to pain

Answer 14

Dilation of bronchial tubes
Increased respiratory rate
Increased heart rate
Vasoconstriction - elevated blood pressure, pallor
Increased blood glucose
Diaphoresis
Increased muscle tension
Dilation of pupils
Decreased GI motility

Question 15

Parasympathetic Stimulation in response to pain

Answer 15

Pallor
Muscle tension
Decreased heart rate and blood pressure
Rapid, irregular breathing
Weakness and exhaustion

Question 16

Superficial or Cutaneous pain characteristics

Answer 16

Pain resulting from stimulation of skin

Pain is localized and of short duration, usually sharp sensation

Question 17

Deep or Visceral pain

Answer 17

Pain resulting from stimulation of internal organs
Pain is diffuse and may radiate in several directions, duration varies, lasts longer than superficial pain, sharp, dull or unique to organ

Question 18

Referred pain

Answer 18

Common in visceral pain because many organs have no pain receptors, entrance of sensory neurons from affected organ into same spinal cord segment as neurons from areas where pain is felt, perception of pain is in unaffected areas.
Pain is felt in a part of the body separate from the source.

Question 19

Radiating pain

Answer 19

Sensation extends from initial site to another body part
Pain feels as though it travels
Intermittent or constant

Question 20

Neuropathic pain

Answer 20

From abnormal or damaged pain nerves as a result of prior injury or disease, certain nerves may continue to send pain messages to brain even though no ongoing tissue damage is present
Pain described as burning, shooting, numbing
Consequence of disease or prior injury to peripheral or central nervous system

Question 21

Examples of conditions that cause neuropathic pain

Answer 21

Stroke
Spinal cord injury
MS
Diabetic neuropathy
Alcohol-nutritional neuropathy
Guillain-Barre
Nerve root compression
Nerve entrapment
Trigeminal neuralgia
Herpes zoster

Question 22

Behavioural Indications of Pain

Answer 22

Vocalizations - moaning, crying, gasping, grunting
Facial Expression - grimacing, clenched teeth, wrinkled forehead, tightly closed or wide open eyes, lip biting
Body Movement - restlessness, immobilization, muscle tension, increased hand and finger movements, pacing activities, rhythmic or rubbing motions, protective movement of body parts
Social interaction - avoidance of conversation, focused only on pain relief, avoidance of social contacts, reduced attention span, despondent

Question 23

Three types of analgesics

Answer 23

Nonsteroidal antinflammatory drugs (NSAIDs) and nonopiods
Opiods
Coanalgesics - enhance analgesics, have analgesic properties

Question 24

Acetaminophen (Tylenol)

Answer 24

No anti-inflammatory effects
Action unknown
Adverse effect - hepatotoxicity
No effect on platelet function
Minimal GI effect

Question 25

Nonselective NSAIDs

Answer 25

Aspirin and Ibuprofen
Provide relief for mild to moderate acute pain resulting from trauma or inflammatory processes
Inhibit synthesis of prostaglandins
Act of peripheral nerve receptors to reduce transmission of pain stimuli

Question 26

Adjuvants

Answer 26

Drugs originally developed to treat conditions other than pain but have been shown to have analgesic properties
E.g. anticonvulsants, antidepressants, cannabinoids