Signs & Symptoms; OPQRST Flashcards
nociception=
-pain sensation
nociceptors=
-pain receptors
tissue damage results in release of __, __ P, histamine & __ __ (all nociceptive substances).
these substances __ pain signals by acting on __ nerve endings.
- serotonin; substance; kinin peptides
- activate; free
__ pain conveyed by thin, __, type A __ fibers.
__, achy, hurting pain via __, slow type __ fibers.
- sharp; myelinated; delta
- dull; unmyelinated; C
skin, joints, arterial walls & periosteum have a lot of=
-nociceptors
most important for patient to:
-identify where is the pain
aching=
muscle, tendon, ligament
bounding=
vascular, circulation
burning=
nerve root, arterial
cramp=
muscle
boring deep pain=
cancer, bone pain
unrelenting deep pain=
cancer, visceral
dull=
musculoskeletal, visceral
gnawing=
ulcer
radiating (well delineated)=
nerve (causalgia-burning pain from peripheral nerve)
radiating (diffuse)=
sclerotogenous or myogenous
sharp/localized=
facet, visceral referred
stabbing=
visceral
shooting=
nerve root, entrapement
tearing=
anuerysm or severe pain
throbbing=
vascular, circulation
tingling (segmental)=
nerve root, peripheral nerve
tingling (non-segmental)=
- if bilateral: cord compression, MS, diabetes
- if unilateral: plexus
(pain pattern)
dermatogenous=
- pain along the sensory distribution of a nerve root
- sharp, stabbing, well demarcated
(pain pattern)
myogenous=
- pain referral within muscular or fascial tissue
- trigger points within the muscle will refer pain to a distant site
- myofacial
(pain pattern)
scleratogenous=
- pain referred from somatic structures (cartilage, ligament, joint capsule or bone)
- typically will not follow dermatome
- dull, achy, diffuse, difficult to pinpoint
(timing of pain)
with use, better with rest=
-mechanical
(timing of pain)
night pain=
- serious (cancer)
- if aggravated by motion= mechanical
(timing of pain)
pain at rest & worse w/ beginning of use=
-inflammatory
(timing of pain)
constant=
-cancer, visceral
(referred pain)
Site of referral: right shoulder inferior scapula
Organ?
-right lung, liver, gallbladder
(referred pain)
Site of referral: left shoulder
Organ?
-left lung, stomach, spleen
(referred pain)
Site of referral: jaw, neck, left shoulder & arm
Organ?
-heart
(referred pain)
Site of referral: either shoulder
Organ?
-diaphragm
(referred pain)
Site of referral: flank
Organ?
-kidney
(referred pain)
Site of referral: substernal
Organ?
-esophagus, heart, lung
(referred pain)
Site of referral: spine at T10
Organ?
-pancreas
(referred pain)
Site of referral: suprapubic
Organ?
-bladder
(referred pain)
Site of referral: occiput, forehead
Organ?
-eye
(referred pain)
Site of referral: temporal HA
Organ?
-TMJ
O=
- Onset
- WHEN did this problem occur?
- if traumatic, ask the MOI
- if chronic, ask prior episodes
P=
- Provocative/Palliative
- WHAT makes it WORSE or BETTER?
- does the problem interfere with daily living activities?
Q=
- Quality
- DESCRIPTION of Pain (what kind of pain?)
- bright, pricking, sharp, cutting, knifelike, lightning like
- burning, hot, stinging
- deep, aching, boring, pounding, sore, heavy, constricting, gnawing
R=
- Radiating
- WHERE else?
- does the pain stay in one place?
- does the pain encompass a large area?
- does the pain move from one location to another location?
S=
- Site/Severity
- WHERE & HOW BAD?
- can you show specifically where?
- what other feelings occur at this site?
- have pt rate the intensity (0-10 pain scale)
T=
- Timing
- HOW OFTEN does it hurt?
- is it all the time? come & go?
- if intermittent: ask about frequency & duration of episodes
- constant or occasiona? seasonal? certain time of day?
