Module 25 pain Flashcards
assessing pain
subjective symptom of many conditions and injuries
- characteristics and intensity are unique for each person
acute pain
sudden and of short duration
- associated with surgery, injury, acute illness
chronic pain
persistent, lasting at least weeks or months
- associated with prolonged disease
nociception
transmission of pain impulses form site of injury to the dorsal horn of the spinal cord and brain
myelinated A-delta fibers
large
cary sharp, well-localized pain, quickly transmitted
unmyelinated C-polymodal fibers
small
carry dull, burning, diffuse, and chronic pain which is slowly transmitted
pain nerve tract
A/C fiber
- > dorsal horn of spinal cord
- > anterolateral spinothalamic tract
- > medulla
- > thalamus
- > cerebral cortex
responses to pain
emotions, cultural backgrounds, sleep deprivation, previous pain experience, and age all impact the perception and interpretation of pain
how infants feel pain
differences in nociceptive processing due to neurophysiologic and cognitive immaturity
- less able to modify pain impulses
- newborns more sensitive to pain stimuli than older infants and children
pain in children
what words to they use what does child tell parents when hurt? What does child want parent to do? pain behaviors? - facial expressions - grimacing - protective posture
pain in older adults
no evidence older adults have a diminished perception of pain
May not report pain because
- believe to be nml part of aging
- do not want to be a nuisance
- are afraid of expensive testing of hospitalization
- are hesitant to take pain meds
Review Hx onset
date of onset sudden or gradual time of day duration precipitating factors variation
review hx quality
throbbing shooting stabbing sharp cramping gnawing not or burning aching heavy
review hx intensity
slight to severe
pain scale 0-10
review hx location
identifying all sites
point to it
radiation
review hx assoc. symptoms
nausea fatigue behavior change irritability distress
review hx origin
what pt thinks is causing pain
review hx effect on ADL
limited activity
sleep disruption
need for inc. rest
appetite change
review hx effect on psyche
change in mood or social interactions
poor concentration
thinking only about pain
irritability
review hx pain control measures
distraction relaxation ice/heat massage electrical stimulation acupuncture
review hx personal and social hx
previous experiences with pain
coping strategies
family’s concerns and cultural beliefs about pain
expectations to tolerate pain
attitudes towards use of meds
current or past use of illicit substances
pain and cognitively impaired
have a family member describe cues to their expression of pain
guarding
hands over painful area
protective behavior
distorted posture
irritability
pain behaviors
facial mask of pain vocalizations: groaning, crying, becomes quiet body movements: head rocking, pacing, inability to keep hands still changes in vitals pallor, diaphoresis pupil dilation dry mouth dec. attention span, confusion
bone and tissue pain
tender
deep
aching
tumor or pressure on cavity pain
heavy
throbbing
aching
nerve tissue damage pain
burning
shock-like
MI pain
clenched fist over chest with diaphoresis and grimacing
visceral or colic pain
cramping spasms
Infant pain assessment tools
premature infant pain profile (PIPP)
neonatal infant pain score (NIPS)
neonatal facial coding system (NFCS)
neonatal pain, agitation, and sedation scale (N-PASS)
cry, requires O2, inc. vitals, expression, sleepless (CRIES)
COMFORT scale
children pain assessment tools
oucher scale
wong-baker faces pain scale
FLACC
painometer
multidemensional measure of pain
allows for a measure of intensity and quality and an opportunity for localization
includes sensory and affective word descriptors of pain
FACES pain scale revised
useful for older adults including those with mild moderate cognitive impairment
