Pain Assessment: Ch. 11 Flashcards
what is Nociceptive pain?
what are examples of nociception?
What are the 4 Phases?
Functioning nerve fibers are stimulated from actual or potential tissue damage
-eg: skinned knee, kidney stones, menstrual cramps, muscle strain, venipuncture, or arthritic joint pain
1-transduction: injured tissues release neurotransmitters (histamine, prostaglandins, serotonin, and bradykinin). They transmit a pain message (action potential) along sensory afferent nerve fibers to the spinal cord. These nerve fibers terminate in the dorsal horn of the spinal cord. Because the initial afferent fibers stop in the dorsal horn, a second set of neurotransmitters (ATP) carries the pain impulse across the synaptic cleft to the dorsal horn neurons.
2-transmission: the pain impulse moves from the level of the spinal cord to the brain.
3-perception: conscious awareness of a painful sensation.
4-modulation: the pain message is inhibited.
To inhibit and block the pain impulse, descending pathways from the brainstem to the spinal cord release neurotransmitters (serotonin, norepinephrine) that produce an analgesic effect.
what is Neuropathic pain
Occurs b/c of abnormal processing of sensory input
- difficult to assess/ treat
- persists long after healing
- eg: pins and needles
Acute Pain
short term and self limiting
Chronic (persistent) pain
pain that continues for >6mo
-can result in depression
Referred Pain
Pain that is felt in a location other than where the injury is
Effects of Pain
- increased catabolic demands
- decreased mobility
- tachypnea
- tachycardia
- impaired sleep
- loss of appetite
- depression w/ chronic pain
What is used to help a patient describe the details of their pain?
OPQRSTU
Onset: when did it start?
Provoking: what makes better/ worse/ start?
Quality: what does it feel like? (stabbing, throbbing, aching)
Radiating: where does it hurt the most, does the pain go anywhere from there?
Severity: 1 to 10 pain scale
Treatment: are you doing anything to treat it?
Understanding: what do you think is causing it?
Diaphoresis
Excessive sweating
Analgesic
Painkiller
Visceral pain
Occurs in larger internal organs (stomach, intestine, gallbladder, pancreas).
Often is described as dull, deep, squeezing, or cramping
Somatic pain
Originates from musculoskeletal tissues or body surface
Deep somatic pain
pain from the blood vessels, joints, tendons, muscles, and bone.
Pain may result from pressure, trauma, or ischemia.
Breakthrough pain
A spike in pain level, moderate to severe in intensity, in an otherwise controlled pain syndrome.
It can result from end-of-dose medication failure. This occurs when a patient taking a long-acting opioid has a recurrence of pain before the next scheduled dose.
Treatment of end-of-dose failure includes shortening the interval between doses or increasing the dose of medication.
what is FPS-R?
when/ who is it used for?
The Faces Pain Scale–Revised
- Used for children 4 to 5y
- has six drawings of faces that show pain intensity
- The FPS-R has realistic facial expressions, with a furrowed brow and horizontal mouth. It avoids smiles or tears so that children will not confuse pain intensity with happiness or sadness
Physical findings that could indicate pain:
- Joints: swelling, inflammation, injury, deformity, decreased ROM, increased pain w/ palpitation, crepitation
- Skin and Muscle: inspect for bruising, swelling, any masses or deformity, lesions, open wounds, tissue damage, atrophy, bulging, change in hair distribution
- Abdomen: Swelling, bulging, herniation, inflammation, organ enlargement
Crepitation
Audible and palpable crunching that accompanies movement
Analgesia
Absent pain sensation when there should be one. Inability to feel pain.
Hyperalgesia
Increased sensitivity to pain. Experience pain when exposed to normal stimuli
Allodynia
Severe pain sensation evoked with a stimulus that does not normally induce pain
-e.g: the blunt end of the tongue blade, cotton ball, clothing
C- Fibers
Nociceptors carry the pain signal to the CNS using A and C sensory fibers.
- unmyelinated, thus transmit the signal more slowly.
- smaller fibers (than A)
- The “secondary” sensations are dull and aching
- pain lasts longer after the initial injury.
A- Fibers
Nociceptors carry the pain signal to the CNS using A and C sensory fibers.
- myelinated thus transmit the signal rapidly to the CNS
- larger in diameter (than C)
- The sensation is localized, short term, and sharp in nature
How does opioid analgesia work?
They activate the opioid receptors in the spinal cord and block the transmission of the pain impulse from the spinal cord to the thalamus.
-this occurs during transmission (pain pathway phase 2)
FLACC scale, and who is it used for?
A nonverbal assessment tool for infants and young children < 3 y
- Face:
- Leg:
- Activity:
- Cry:
- Consolability:
Nonmalignant
Pain often associated with musculoskeletal conditions such as arthritis, low back pain, or fibromyalgia.
CRIES scale, who is it used for?
Pain scale used for infants and neonate
PAINAD scale, who is it used for, what does it evaluate?
Pain scale used for patients with dementia
- evaluates: breathing, vocalization, facial expression, body language, and consolability
- a score of 4 or more indicates a need for pain management
