Sensory/Perception: Pain Flashcards
What is part of external stimuli?
Visual Auditory Olfactory Tactile Gustatory
What is part of internal stimuli?
Gustatory
Visceral
Kinesthetic
What are the components of pain?
Reception (receiving of stimuli or data)
Perception (translation of the stimuli/data into meaningful information)
Reaction (response of the stimuli)
S/S of sensory deprivation
Yawning Drowsy, sleepy Decreased attention span Disorientation Nocturnal confusion (sun downing) Apathy Hallucinations, delusions
What is sensory deprivation?
Decrease or lack of meaningful stimuli
What happens with patients with sensory deprivation?
Become more aware of remaining stimuli
Alters perception, cognition, and emotion
What is sensory overload?
Inability to process or manage the amount or intensity of sensory stimuli
What are the three factors of sensory overload?
Internal
External
Inability to disregard stimuli selectively
S/S of sensory overload
Irritability Disorientation Fatigue, sleeplessness Reduced problem solving ability Scattered attention Increased muscle tension
Who are more at risk for sensory deprivation?
Patients who:
- are in confinement in nonstimulating environment (home or facility)
- have impaired vision or hearing
- have mobility restrictions
- have communicable diseases (AIDS)
Who are more at risk for sensory overload?
Patients:
- with pain/discomfort
- in ICU with IV’s, tubes, and machines
What factors influence sensory function?
Developmental (age) Medications Cultural Stress Preexisting illnesses Lifestyle and personality Smoking
What are some consequences of untreated pain?
Unnecessary suffering Physical and psychosocial dysfunction Increased respiratory and cardiac workload Impaired recovery Immunosuppression Sleep disturbances Decreased GI motility Increased catabolism Increased morbidity
What are nociceptors?
Primary neurons
Detect tissue injury and damage
What sensations does nociceptors evoke?
Touch Heat Cold Pain Pressure
What does the process of nociception consist of ?
Transduction (conversion of stimulus into neural action potential)
Transmission (movement of impulse to brain (substance P))
Perception (pain recognized, defined, and responded)
Modulation (“descending system”)
What are the type of nerve fibers?
‘A’
‘C’
What are ‘A’ fibers?
And what type of pain do they sense?
Myelinated
- Fatty covering
- Sharp, prickling, localized pain
What are ‘C’ fibers?
And what type of pain do they sense?
Unmyelinated
- No fatty sheath
- Dull, burning, diffuse pain, aching
What are some interactional responses to pain?
Physiologic (transmission)
Sensory (recognition, patten, area, intensity)
Affective (motivational, fear, anger, depression)
Behavioral (observable: facial expressions)
Cognitive (beliefs, attitudes, memories)
What are some sources of pain?
Mechanical (tearing, pressure, muscle spasm, infection)
Thermal (electrical current, sunburn, lightning)
Chemical (histamines, enzymes, caustic agents)
What are some physiological effects of pain?
Dilation of bronchi Increase RR and HR Peripheral vasoconstriction Elevated glucose Diaphoresis Increased muscle tension Decreased GI motility
Environmental variable: Night vs Day?
Night increases pain perception
Daytime decreases pain perception
What are some sociocultural variables?
Demographics Support systems Social roles Culture - Pain expression - Drug use - Pain related beliefs - Coping
How does each of these affect pain?
- Culture
- Attitude&Value
- Sex
- Birth order
- Affects attitude and beliefs
- Gives meaning to pain
- Females are more expressive
- First born usually less tolerant of pain
What are endorphins?
Natural supply of opium like substances
“morphine within”
Produces analgesia
Where are endorphins located?
Brain
Spinal cord
GI tract
Endorphins are activated by what?
Pain and stress
What is the gate control theory ?
Peripheral nerve fibers can be altered at the spinal cord level
Gate Control Theory: What can be used to “close” the gates?
Backrubs
Warm compresses
TENS
Distraction
What are some common biases and misconceptions?
- Pts with minor illnesses have less pain than those with severe illnesses
- Giving analgesics regularly will lead to drug addiction
- Amount of tissue damage in an injury accurately indicates the amount of pain
- Psychogenic pain is not real
- Drug abusers and alcoholics over react to pain
- Health care personnel are the best authorities on the nature of the client’s health
What is pain threshold?
Point at which a person first perceives the pain
Who is at risk for pain?
Pre-op patients
Clients preparing for childbirth
Clients with altered internal or external integrity
Clients with localized area of inflammation
What is the most important part of nursing assessment?
Client interview
What do you want the client to answer about pain?
Full description of characteristics of pain
Pain trajectory
Clients response to pain
Variables affecting pain
Assessment of previous records regarding pain
What should be included in the physical assessment when dealing with pain?
Location Type Intensity (0-10) Quality Duration (how long?) Control (what can client do to minimize pain) Nonverbal and physiological expressions Verbalization of fears and expectations
What different scales can be used to measure pain intensity?
0-10 Scale
Wong-Baker Faces rating scale (children)
Adult Non-Verbal Pain Scale (ANVPS) (18+ who cant communicate)
Defense and Veterans Pain Rating Scale (DVPRS)
Richmond Agitation Sedation Scale (RASS) (ICU)
What are the different types of chronic pain?
Intractable (having no relief)
Benign (no known disease or injury)
Persistent (does not subside after injury heals)
What can be part of chronic pain management?
Nerve blocks (epidurals)
Acupuncture
Biofeedback (alteration of body function through mental concentration)
TENS (Transcutaneous Electrical Nerve Stimulation)
Hypnosis
Neurosurgery
- Neurectomy (removal of nerve)
- Rhizotomy (removal of root nerve)
- Chordotomy (cut pathway at spinal column)
Operant conditioning
What is TENS?
Stimulates endorphin production
Battery transmitter, wires, electrodes attached to skin at pain point
Produces buzzing/tingling sensation
Nerve function not damaged
What is the best indicator for evaluation of a client’s pain?
Client’s verbal report of pain
What are some techniques for pain control?
- Distraction
- Progressive relaxation techniques (contraction and relaxation of muscle groups)
- Promote rest (cluster care, mild sedation)
- Cutaneous stimulation (lightly rubbing affected area)
- Guided imagery
- Therapeutic touch
The Analgesic Ladder:
What is included in Step 1?
For what pain intensity ?
ASA (acetylsalicylic acid)
Acetaminophen
NSAID’s
1-3/10
“Ceiling effect”
OTC
Do not produce tolerance/dependence
The Analgesic Ladder:
What is included in Step 2?
For what pain intensity ?
Codeine
Oxycodone
Hydrocodone
4-6/10
Common opioids combined with nonopioid
Persistent pain despite nonopioid therapy
The Analgesic Ladder:
What is included in Step 3?
For what pain intensity ?
Morphine Fentanyl Hydromorphone Methadone Oxycodone
7-10/10
No “ceiling effect”
What is adjuvant therapy used for?
Enhance pain therapy
- Enhance effects of opioid and non-opioids
- Possess analgesic properties
- Counteracts side effects of analgesics
Used at all steps of the analgesia ladder
What are some drugs used with adjuvant therapy?
Antidepressants Anti-seizure a2 Adrenergic agonists Corticosteroids Local anesthetics
What is the route of choice?
Oral
What is the most effective route of administration for pain medication?
IV
What are the routes of administration?
Oral SL/Buccal Intranasal Rectal Transdermal Parenteral Intraspinal
What are some intraspinal complications?
Catheter dislodgment/migration
Neurtoxicity
Infection
Advantages of PCA
Fewer post op complication
Less total analgesic
Great sense of control for patient
Earlier ambulation
What is a basal rate?
PCA run as a continuous infusion
