Pain and Vital Signs (Chapter 6)

Question 1

What structure regulates body temperature? What else is regulated here?

Answer 1

The hypothalamus. It also regulates hunger and thirst, ANS, sleep/wake, emotional responses, and much more.

Question 2

How do fevers come about?

Answer 2

The body recognizes invading pathogens. These pathogens are phagocytized which releases pyrogens that travel to the hypothalamus to reset the thermostat at a higher level, resulting in a fever.

Question 3

What are some ways the body generates heat? What about cooling the body?

Answer 3

Shivering - repetitive muscle contractions generating heat from these contractions.

Vasoconstriction - the blood is pulled away from the surface of the skin allowing less of the heat to escape through the skin.

Contraction of the pilo muscles which decreases the surface area for heat to escape.

The body can be cooled through vasodilation and sweating.

Question 4

What does the systolic blood pressure represent? What about the diastolic?

Answer 4

Systolic - represents the force the ventricles exert on the blood vessels when they contract.
Diastolic - represents the PVR during heart relaxation.

Question 5

Neuropathic pain
1. Patho
2. Subjective data

Answer 5

Longterm chronic pain associated with CNS that persists beyond healing.
1. Trigeminal neuralgia. radiculopathy, diabetic peripheral neuropathy. Caused by damaged peripheral nerves constantly sending impulses to the CNS. Excited dorsal horn.
2. Burning, tingling, numbness, electric shock like. Could worsen at night.

Question 6

Describe the pathway pain takes to get from the site of injury (the foot) to the brain. What fibers are utilized?

Answer 6

1. You step on something sharp. The nociceptors in the foot transmit this painful stimulus along the C fibers (slow, nonmyelinated) and the a-delta fibers (fast, myelinated).
2. These two fibers enter the dorsal horn of the spinal column.
3. The impulse continues along the spinal cord to the brain. Once it enters the brain, different structures can modify the pain sensation.

Question 7

Infants are more susceptible to hypothermia. Why?

Answer 7

1. Surface area - large body surface area to weight ratio
2. Thinner skin
3. Poor stress

Question 8

What is considered a normal temperature?

Answer 8

97.2 - 99.9 (36.2 to 37.7)

Question 9

What is considered a fever?

Answer 9

Temperatures above 100.4

Question 10

0 to 90 days of life fever

Answer 10

Any fever in this age range needs immediate evaluation

Question 11

After 90 days of life with a fever

Answer 11

A fever of 105 degrees needs immediate evaluation

Question 12

Preferred pulse location for infants

Answer 12

Apical

Question 13

Orthostatic hypotension
1. Common causes
2. Subjective findings
3. Assessment

Answer 13

1. Fluid volume deficit, antihypertensive medications
2. Dizziness and lightheadedness upon standing
3. Take the patient’s blood pressure sitting to establish a baseline. Have the patient stand and retake the blood pressure (within 3 minutes). Orthostatic hypotension is present if there is a drop in systolic BP of 20 mmHg or 10 mmHg in diastolic.

Question 14

Normal blood pressure
Prehypertension
Hypertension:
Stage 1
Stage 2

Answer 14

Normal - less than 120/80
Prehypertension - 120-139 / 80-89
Hypertension
Stage 1 - 140-159 / 90-99
Stage 2 - 160 or higher / 100 or higher

Question 15

Prehypertension ranges

Answer 15

120-139 / 80-89

Question 16

Hypertension stage 1 ranges

Answer 16

140-159 / 90-99

Question 17

Hypertension stage 2 ranges

Answer 17

160 or greater / 100 or greater

Question 18

Tender, deep, aching pain

Answer 18

Bone or soft tissue

Question 19

Heavy, throbbing, and aching

Answer 19

Tumor pressing on a cavity

Question 20

Burning or shock like

Answer 20

nerve related

Question 21

Sweaty, grimacing, hand over chest

Answer 21

MI

Question 22

Cramping

Answer 22

Visceral or colic

Question 23

When are children’s reliable reporters of pain?

Answer 23

3 or more

Question 24

FLACC pain assessment

Answer 24

F - face
L - legs
A - activity
C - cry
C - consolability

Question 25

Gestational HTN

Answer 25

140/90 or higher

Question 26

Severe HTN with pregnancy? Associated with?

Answer 26

160/110 or higher. Associated with preeclampsia

Question 27

PAIN AD

Answer 27

Pain assessment in advanced dementia

Question 28

Complex pain syndrome

Answer 28

Chronic condition in which regional pain extends beyond the peripheral nerve injury. Can have subjective and objective changes.

Question 29

Back pain, contraction, round ligament pain - look at the physiologic causes

Question 30

FLACC
1. Used for?
2. Acronym

Answer 30

Used for non-verbal or post surgery patients under the age of 7.
Face - relaxed? Grimace?
Legs - relaxed? Rigid? Flexed?
Activity - moves easily and freely? Fixed position? Rocking?
Cry - no cry? Frequent cry?
Consolability - calm, none needed. Constant?

Question 31

What pain scales are best for children?

Answer 31

1. FLACC
2. OUCHER
3. WONG BAKER

Question 32

Normal vital signs for infants, children, and adults
1. Blood pressure
2. Heart rate
3. RR
4 Temp

Answer 32

Infants:
1. Blood pressure - 72-104 systolic / 37-53 diastolic
2. Heart rate - 100-190
3 RR - 30-50
4. Temp - does not vary with age. 35.5 (95.9) - 38 (100.4)

Children:
1. Blood pressure - 86-115 systolic / 42-76 diastolic
2. Heart rate - 75-140 bpm
3. RR - 18 - 28
4. Temp does not vary with age. 35.5 (95.9) - 38 (100.4)

Adults:
1. Blood pressure - below 120 systolic/ below 80 diastolic
2. Heart rate 60-100 bpm
3. 12-20
4. Temp does not vary with age

Question 33

Complex regional pain syndrome VS Neuropathic pain

Answer 33

CRPS - problem originates in the periphery. The extent of the damage extends beyond the expected time.

Neuropathic pain - problem originates in the CNS. Extends past expected healing time.