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Health Assessment > Pain Assessment > Flashcards

Pain Assessment Flashcards

1
Q

Pain is ……………

A

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage”

whatever the person says it is….. existing whenever the person says it does

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2
Q

Should pain be addressed immediately?

A

Yes, All persons deserve prompt recognition and treatment of pain even when they cannot express their pain verbally

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3
Q

Two classifications of pain ………….

A

Nociceptive and Neuropathic

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4
Q

What are nociceptors?

A

Specialized pain receptors that detect painful sensations from the periphery and transmit them to the CNS

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5
Q

What are the four phases of nociceptive pain?

A

Transduction
Transmission
Perception
Modulation

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6
Q

Nociceptive Pain can be ………..

A

somatic or visceral

Somatic when it arises from the skin, connective tissue, muscle, bones, or joints

Visceral when it arises from internal organs

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7
Q

Nociceptors are activated by

A

noxious stimuli that is either mechanical, thermal, or chemical in nature

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8
Q

Nerve fibers that carry pain impulses ….

A

A delta fibers

C fibers

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9
Q

A delta fibers

A

Large, myelinated fibers
Impulses travel quickly; “fast pain”
Release glutamate at the synapse with the spinal neurons

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10
Q

C fibers

A

small and unmyelinated; impulses travel more slowly

Release glutamate and substance P

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11
Q

What are endogenous opioids?

A

They are neurotransmitters produced by the body that block the transmission of the nerve pathway by binding with specific opioid receptors, reducing pain.

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12
Q

What are the three types of opioid receptors ?

A

Mu, Kappa, Delta

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13
Q

Examples of Endogenous Opioids

A

Enkephalins
Endorphins
Dynorphins
Endomorphins

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14
Q

What do exogenous opioids do ?

A

These are opiate drugs - they relieve pain by attaching to opiate receptors, thus enhancing the natural endogenous opioid response

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15
Q

Neuropathic pain is ………………….

A

an abnormal processing of the pain message from an injury to the nerve fibers.
Neuropathic pain does not follow the typical and rather predictable phases as in nociceptive pain.

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16
Q

True or false. Nociceptive pain can evolve into neuropathic pain.

A

True… this can happen when pain is poorly controlled. The constant irritation and inflammation caused by a pain stimulus can lead to an altered form of the nerve cells, making them more sensitive to any stimulus. This also decreased the number of opioid receptors.

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17
Q

How do First Order Neurons, Second Order Neurons and Third Order Neurons work together to transmit the pain signal to the brain?,

A

First order neurons are the nociceptors that are sensitive to certain substances and different types of noxious stimuli (mechanical, thermal, chemical) and generate the pain signal.
Second order neurons process the nociceptive information within the spinal cord and communicate with various pathways to transmit pain signal up spinal cord and to the thalamus
Third Order Neurons direct nociceptive pain signals to different areas of the brain such as the cerebral cortex where it is perceived

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18
Q

What kind of substances do cells release when they are damaged ? Why does this matter ?

A 
Prostaglandins
Histamine 
Bradykinin
Serotonin
Substance P

This matters because nociceptors are sensitive to these substances. When tissue is damaged and there is inflammation, these substances are released. Nociceptors detect this and generate a pain signal in the process of transduction.

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19
Q

Characteristics of Acute pain

A

Goal is to treat cause to eliminate pain
Sudden, short term and self limiting - example - pulled a hamstring
follows predictable trajectory and dissipates when injury is healed

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20
Q

What is incidence pain ?

A

Expected pain to result upon certain movements - such as shoulder pain when arms are raised

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21
Q

Characteristics of Chronic Pain -

A

Insidious Onset, or follows acute
lasts beyond expected healing period
Goal is to manage pain and maintain function and quality of life

22
Q

Persistent/Chronic pain is diagnosed when the pain ……………..

A

continues for 6 months of longer

23
Q

Chronic pain outlasts its ________________

A

protective purpose

24
Q

Chronic pain originates from __________________ processing of pain fibers from ___________ or _____________ sites.

A

abnormal; peripheral; central

25
Q

Chronic Pain Cycle

A

Increased Pain …….. Increased Anxiety ………………. Sleeping Problems ……………. Not Coping Well ………………. Increased Pain

Chronic pain affects many aspects of a person’s life

26
Q

Pain Tolerance

A

The intensity or duration of painful stimulation one endured before pain responses are initiated

27
Q

Pain Threshold

A

The point at which the stimulus is perceived as pain

28
Q

Different types of sources of pain

A

Deep Somatic
Visceral
Cutaneous
Referred

29
Q

What is referred pain ? What is it the result of ?

A

Pain perceived at a different location other than the site of the painful stimulus/origin. It is the result of interconnecting sensory nerves

30
Q

Sympathetic response to low to moderate pain ………….

A 
Bronchial dilation
Increased HR
Peripheral vasoconstriction
Hypertension
Diaphoresis
Increased muscle tension
Dilated pupils
Decreased GI motility
31
Q

Parasympathetic response to severe or deep nerve pain

A 
Pallor
Muscle Tension
Decreased Heart Rate
N/V
Rapid, irregular breathing
32
Q

Pain Related Assessment Questions

A 
Location 
Quality 
Chronology
Setting
Associated manifestation
Alleviating factors
Aggravating factors
Meaning
33
Q

The major cause of chronic pain in the elderly has to do with ………….

A

musculoskeletal problems - bones, joints, muscles

34
Q

When to assess and document pain ……..

A 
admission
Regular intervals
New pain
Exacerbations
Uncontrolled pain
New therapy (new meds, increased doses)

Pain assessment needs to occur regularly and frequently – at admission to a facility or service; every month, week or shift, depending on the resident situation; whenever there is a new pain reported or observed; every time pain gets worse or is uncontrolled; and re-assess needs to happen with a new medication or other therapy is tried or when the dosage is increased.

35
Q

How to look for pain ?

A

Patient’s report of pain
Body movements and facial expressions -including withdrawal, fatigue, grimaces, moans, and irritability,
Sympathetic response
Interest in usual events
Ability to participate in usual activities
Interference in life

36
Q

Pharmacologic Interventions for Pain

A

Non-opioid medications
Opioid medications
Adjuvant medications

37
Q

Nonpharmacologic interventions for pain

A

Cognitive Behavioral Therapies (CBT)
Physical comfort measures
Complementary/Alternative therapies

38
Q

Some people, especially older adults, may not use the word “pain.” They may talk about how sore they are but not say they are in pain. For this reason it is important to …………………

A

be creative with the questions you ask to explore the presence of pain.

…… any discomfort, achiness, soreness, heaviness, burning sensations

Once you know how a person refers to his pain, be sure to use that term consistently when assessing pain.

39
Q

Examples of Non physical pain ………….

A 
Existential distress
Grief-anticipatory, complicated…
Fear-uncertainty
Dependency-helplessness
Social Isolation-Loneliness
Boredom
40
Q

Points to Remember about pain in nonverbal patients and those with dementia

A

Tolerance to acute pain possibly increases but pain threshold does not appear to change
Dementia may blunt response to acute pain
Cognitive impairment may decrease the perceived analgesic effectiveness
Pain can negatively affect cognitive function

41
Q

Behaviors Related to Pain

A 
More Obvious 
Grimacing or wincing
Bracing
Guarding
Rubbing
Less Obvious:
Changes in activity level
Sleeplessness, restlessness
Resistance to movement
Withdrawal/apathy 
Increased agitation, anger, etc.
Decreased appetite
Vocalizations
42
Q

Causes of Physical Pain in Patients with Dementia

A 
Constipation or diarrhea
Lodged food particles
Contractures
Ill fitting dentures 
Pressure ulcers
UTI
43
Q

Things affecting perception of pain

A 
Fatigue
Anxiety
Past experience
Coping style
Culture
44
Q

Different Perceptions of Pain

A

Punishment
Threat
loss
Challenge

45
Q

Use of Pain Scales - what is important to assess?

A

Ask the patients individual “acceptable” pain score

Using Faces rating scale, numeric scale, Oucher Scale

46
Q

Hierarchy of Data Sources

A 
Patient’s report (if possible)
Prior pain history
Painful diagnoses
Behavioral indicators
Observer assessment
Response to empirical therapy
47
Q

There is no pain __________________ when there is no pain _________________.

A

relief; assessment

48
Q

Why is it important to distinguish between nociceptive and neuropathic pain in the pain assessment?

A

Because neuropathic pain requires different types of pain medications than nociceptive pain

49
Q

characteristics of nociceptive pain

A

Dull, aching, pressure, tender

50
Q

characteristics of neuropathic pain

A

shooting, burning, electric shock, tingling

51
Q

Nociceptive pain responds to …………..

A

traditional pain medicines and therapies

Health Assessment (11 decks)

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