Pain Assessment Flashcards
5th vital sign
pain
the most common reason to seek medical advice
pain
a portective mechanism or a warning to prevent injury
pain
nociceptors also called as
pain receptors
are the nerve endings in the skin that respond only to intense, potentially damaging stimuli
nociceptors
do not contain nerve endings
large intestine organs
______________________________________________________________________________________________ also have nociceptors
joints, skeletal muscle, fascia tendons and cornea
are chemicals that incraese transmission of pain
histamine, bradykinin, acetylcholine, serotonin and substance P
are chemical substances that are believed to increase the sensivity of pain receptors by enhancing the pain provoking effect of bradykinin
Prostaglandins
2 main types of fibers involved in the transmission of nociceptors:
- myelinated, A delta fibers - “first pain”
- Type C fibers - “2nd pain”
chemicals that reduce or inhibit transmission of perception of pain include:
endorphins and enkaphalins
Process of Pain
- Transduction
- Transmission
- Perception
- Modulation
injured tissue releases chemicals that affect nociceptors sending pain messages up/to sensory neuron
Transduction
pain impulse from the nociceptors to the brain
transmission
pain percieved by the brain
Perception
pain message is inhibited by brain stem neuron release of endogenous neurotransmitters
Modulation
Gate Control Theory was proposed by whom and when?
Melzack and Wall, 1965
main part of Gate Control Theory
spinal cord
- stimulation of the skin evokes nervous impulses
- stimulation of the large diameter fibers inhibits the transmission of pain thus, closing the gate
Gate Control Theory
Types of Pain
Classified according to Duration/Etiology
- Acute
- Chronic
- Cancer-related Pain
- usually of recent onset
- commonly associated with specific injury
- lasting from seconds to 6 months
Acute Pain
- constant or intermittent pain that persists beyond the expected healing time
- seldom attributed to a specific injury
- lasts for 6 months or longer
Chronic Pain
Types of Pain
Classified by location/perception
Visceral
Somatic
Cutaneous
Radiating
Referred
Phantom
internal organs (pain)
visceral pain
pain in muscles, joints
somatic pain
pain in skin -> nerve endings (superficial)
cutaneous pain
pain that travels from one body part to another. This pain starts in one place and then spreads into a broader area of the body
radiating pain
occurs when pain receptors in the pelvis, abdomen, chest, or intestines are activated. We experience it when our internal organs and tissues are damaged or injured.
visceral pain
can be deep or superficial, with the deeper pain coming from the skeletal structure, tendons, and muscles.
somatic pain
Pain that arises from the skin and muscles or peripheral nerves themselves
cutaneous pain
when you have an injury in one area of your body but feel pain somewhere else. This happens because all the nerves in your body are part of a huge, connected network.
referred pain
when you feel pain in a body part that you no longer have
phantom pain
Classification of Pain (other categories)
- Neuropathic Pain
- Nociceptive Pain
- Psychogenic Pain
- Intractable Pain
nerves (pain)
Neuropathic Pain
nerve pain that can happen if your nervous system malfunctions or gets damaged
Neuropathic Pain
tissues (pain)
Nociceptive Pain
a type of pain caused by damage to body tissue
Nociceptive Pain
emotional stressors (pain)
Psychogenic Pain
is a pain disorder associated with psychological factors.
Psychogenic Pain
severe and unimaginable (pain)
Intractable Pain
is a severe, constant, relentless, and debilitating pain that is not curable by any known means and which causes a house-bound or bed-bound state and early death if not adequately treate
Intractable Pain
factors influencing pain response
- age
- past experience
- anxiety and depression
- culture
- gender
- genetics
- placebo effect
what are the 4 assessments we can use in assessing pain?
WHAT’S UP
PQRST
OLDCART
COLDSPA
WHAT’S UP
W - where is the pain?
H - How does the pain feel?
A - Aggravating and alleviating factors
T - Timing
S - Severity
U - Useful other data
P - Perception
PQRST
Provoked
Quality
Region/Radiation
Severity
Timing
OLDCART
Onset
Location
Duration
Characteristics
Aggravating Factors
Radiation
Treatment
COLDSPA
Character
Onset
Location
Duration
Severity
Pattern
Associated Factors (Aggravating Factors)
PAIN ASSESSMENT TOOLS
- Daily Pain Diary
- Visual Analog Scale
- Verbal Description Scale
- Wong-Baker Scale
- McCaffrey Initial Pain Assessment Tool
- Pediatric Assessment Tool
- FLACC Behavioral Scale
- Universal Pain Assessment Tool
- Numerical Pain Rating Scale
- Memorial Pain Assessment Card
for clients who experience chronic pain
Daily Pain Diary
may help the client and identify pain patterns and factors that exacerbate or mediate pain
Daily Pain Diary
the record can include time or onset of pain, activity before pain, pain-related positions or behaviors, pain intensity level, uses of analgesics or other relief measures, duration of pain, time spent in relief activities
Daily Pain Diary
- most commonly used in the hospital
- includes numbers to determine the pain
Numerical Rating Scale
simple descriptive pain intensity scale
Verbal Description Scale
- best for cognitively impaired patients
- for pediatrics
Wong-Baker Scale
- document to remember pain assessment of patient
- detailed
McCaffrey Initial Pain Assessment Tool
- pain assessment tool for cancer patients
Memorial Pain Assessment Card
normal systolic pressure
100-130 mmHg
normal diastolic pressure
60-80 mmHg
- the nurse should ask the client about allergies to medications and the nature of any previous allergic responses
Premedication assessment
- the nurse obtains the client’s medication history, along with a histor of health disorders
Premedication assessment
- refers to the use of more than one form of analgesia concurrently to obtain more pain relief with fewer side effects
Balanced Analgesia
- the nurse waits for the client to complain of pain and then administer analgesia
Pro re nata
in using this approach, the nurse should assess the client for sedation before administering the next dose
Preventive Approach
the goal is to admninister analgesia before pain becomes severe
Preventive Approach
used to manage post-operative pain as well as persistent pain
Patient Controlled Analgesia
allows clients to control the administration of their own medication within predetermined safety limits
Patient Controlled Analgesia
Pharmacologic Therapy
Non opioid
Non-steroidal Anti-inflammatory drugs
Opioids
Morphine
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Normeperidine
Fentanyl (Sublimaze, Duragesic)
Methadone
Opioid Antagonists
Naloxone (Narcan)
Steroids
Tricyclic Anti-depressants (Amitriptyline, Imipramine, Desipramine, and Doxepin)
Anticonvulsants (Carbamazepine (Tegretol) and Gabapentin (Neurontin)
Routes of Drugs Administration
Oral
Rectal
Transdermal Patch
Intramuscular
Subcutaneous
Intravenous
Intraspinal
cutting the nerves in the spinal cord to relieve pain
Cordotomy
sensory nerve roots are destroyed where they enter the spinal cord
Rhizotomy
the spinal roots are divided and banded with a clip to form a lesion and produce subsequent loss of sensation
Rhizotomy
- is a generalized cutaneous stimulation on the back and shoulders
- it promotes comfort through muscle relaxation
Massage
used when a certain are is inflamed
ice compress
warm compress is used when there is
vasodilation, muscle aches, joint aches and for good blood flow
- uses battery operated …. with electrodes applied to the skin to produce a tingling, vibratory or buzzing sensation in the area of pain
Transcutaneous Electrical Nerve Stimulation (TEMS)
decrease pain by stimulating the main pain receptors in the same area as the fibers that transmit pain
Transcutaneous Electrical Nerve Stimulation (TEMS)
focusing the client’s attention or something other than the pain
Distraction/Diversional Activities
belived to reduce pain by relaxing tense muscles that contribute to the pain
Relaxation Techniques
using one’s imagination in a special way to achieve a specific positive effect
guided imagery
is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage
PAIN
Types of Pain
Based on intensity
Mild pain
Moderate pain
Severe pain
Pain is classified
Based on location
Based on intensity
Based on duration
Based on etiology
Types of Chronic Pain
Chronic non cancer pain
Chronic episodic pain
Chronic cancer pain
It usually resolves, with or without treatment, after an
injured area heal
ACUTE PAIN
Unrelieved acute pain can progress to
chronic pain
pain episodes last for hours, days, weeks.
Chronic Episodic pain
effective in relieving or decreasing the amount of analgesic agents required in clients with acute and chronic pain
hynopsis
