Topic 9 Flashcards
transduction
conversion of one form of energy into another. In sensation, the transforming of stimulus energies, such as sights, sounds, and smells, into neural impulses our brains can interpret.
transmission
Sending of impulse across a sensory pain nerve fiber (nociceptor)
nerve impulses
Excitatory neurotransmitters send electrical impulses across the synaptic cleft between two nerve fibers, enhancing transmission of the pain impulse.
pain impulses
These pain-sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response.
A fibers
fast, myelinated
-Send sharp, localized, and distinct sensations that specify the source of the pain and detect its intensity
C fibers
the very small, slow, unmyelinated
-Relay impulses that are poorly localized, visceral, and persistent
perception
the point at which a person is aware of pain
modulation
Inhibits pain impulse
-Once the brain perceives pain, there is a release of inhibitory neurotransmitters such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), which hinder the transmission of pain and help produce an analgesic effect.
gate-control theory
the theory that the spinal cord contains a neurological “gate” that blocks pain signals or allows them to pass on to the brain. The “gate” is opened by the activity of pain signals traveling up small nerve fibers and is closed by activity in larger fibers or by information coming from the brain.
pain threshold
the point at which a person feels pain
the stress respond of pain stimulates the…
autonomic nervous system
Continuous, severe, or deep pain typically involving the visceral organs activates the
parasympathetic nervous system
what are common behavior al responses of acute pain?
Clenching the teeth, facial grimacing, holding or guarding the painful part, and bent posture
chronic pain can affect a patients…
-activity (eating, sleeping, socialization)
-thinking (confusion, forgetfulness)
-emotions (anger, depression, irritability)
-quality of life and productivity.
pain tolerance
level of pain a person is willing to accept
Acute/transient pain
Protective, identifiable, short duration; limited emotional response
what is a primary nursing goal for individuals with acute/transient pain?
to provide pain relief that allows patients to participate in their recovery, prevent complications, and improve functional status
Chronic/persistent noncancer pain
Is not protective, has no purpose, may or may not have an identifiable cause
what are some things that are considered chronic noncancerous pain?
arthritis, headache, low back pain, or peripheral neuropathy
chronic episodic pain
Occurs sporadically over an extended duration
cancer pain
is normal (nociceptive), resulting from stimulus of an undamaged nerve and/or neuropathic, arising from abnormal or damaged pain nerves. Can be acute or chronic.
referred pain
pain that is felt in a location other than where the pain originates
idiopathic pain
Chronic pain without identifiable physical or psychological cause
factors influencing pain
-physiological (age, fatigue, genes, neurological functions)
-social factors
-spiritual factors
-psychological factors (anxiety/coping style)
-cultural factors
how does fatigue affect pain
Fatigue increases the perception of pain and can cause problems with sleep and rest
how does anxiety affect pain
Anxiety often increases the perception of pain, and pain causes feelings of anxiety. It is difficult to separate the two sensations.
ABCDEs of pain management: A
A: Ask about pain regularly. Assess pain systematically.
ABCDEs of pain management: B
B: Believe the patient and family in their report of pain and what relieves it.
ABCDEs of pain management: C
C: Choose pain control options appropriate for the patient, family, and setting
ABCDEs of pain management: D
D: Deliver interventions in a timely, logical, and coordinated fashion.
ABCDEs of pain management: E
E: Empower patients and their families. Enable them to control their course to the greatest extent possible
PQRSTU of Pain
P: Palliative or Provocative factors
Q: Quality:
R: Region/Relief measure
S: Severity
T: Timing
U: Effect of Pain
P: Palliative or Provocative factors questions
What makes pain better/worse?
Q: Quality questions
Describe your pain
R: Region/Relief measure questions
Show me where, what gives you relief?
S: Severity questions
on a scale from 1-10
T: Timing questions
Do you have pain all the time or only at certain times.
U: Effect of Pain questions
What are you not able to do because of pain?
what is the single most reliable report for pain
patients self report
if a patients is unable to communicate pain; what should the nurse pay attention to during the assessment
Vocal response, facial movements (e.g. grimacing, clenched teeth) and body movements (e.g., restlessness, pacing). Social interaction, does the patient avoid conversation?
characteristics of pain
Timing
Location
Severity
Quality
Aggravating and precipitating factors
Relief measures
what is the nurses job related to pain relief?
Administering and monitoring therapies ordered by health care providers for pain relief and independently providing pain-relief measures that complement those prescribed.
what are the common holistic health approaches
wellness education, regular exercise, rest, attention to good hygiene practices and nutrition, and management of interpersonal relationships.
when should nonpharmacologic measures never be used in place of pharmacologic therapies
in the ace of acute pain
Nonpharmacological pain-relief interventions
-Cognitive and behavioral approach
-Relaxation and guided imagery
-Distraction
-Music
-Cutaneous stimulation
-Cold and heat application
-Transcutaneous electrical nerve stimulator (TENS)
-Herbals
-Reducing pain perception and reception
guided imagery allows
patients to alter affective-motivational and cognitive pain perception
relaxation
mental and physical freedom from tension or stress that provides individuals a sense of self-control.
Distraction
directs a patient’s attention to something other than pain and thus reduces awareness of it
Cutaneous stimulation
Stimulation of the skin through a massage, warm bath, cold application, and TENS may be helpful in reducing pain perception.
Transcutaneous electrical nerve stimulator (TENS)
Involving stimulation of the skin with a mild electrical current passed through external electrodes.
Herbals for Pain
echinacea, ginseng, ginkgo biloba, and garlic despite conflicting research evidence supporting their use in pain relief.
Nonopioid analgesics
analgesics that are not classified as opioids, these include acetaminophen, and NSAIDS
Opioids (narcotics)
are prescribed for moderate to severe pain. They are associated with respiratory depression and adverse effects of nausea, vomiting, constipation, itching, urinary retention, and altered mental processes. Sedation is an adverse effect of opioids that always precedes respiratory depression.
physical dependence
A state of adaptation that is manifested by a drug class-specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist
addiction
A physiological or psychological dependence on a drug Þ primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations
drug tolerance
A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time
placebos
are pharmacologically inactive preparations or procedures that produce no beneficial or therapeutic effect.
Adjuvants/co-analgesics
drugs used to treat other conditions, but they also have analgesic qualities (tricyclic antidepressants and anticonvulsants).
Patient-controlled analgesia (PCA)
a drug delivery system that uses a computerized pump with a button the patient can press to deliver a dose of an analgesic keeping constant plasma level (minimal risk of overdose)
what are the safety guidelines for the PCA
-The patient is the only person who should press the button to administer the pain medication
-Monitor the patient for signs and symptoms of oversedation and respiratory depression.
-Monitor for potential side effects of opioid analgesics.
Topical analgesics
Creams, ointments, patches
Local anesthesia
Local infiltration of an anesthetic medication to induce loss of sensation to a small area, like an inscison site for example
Regional anesthesia
the injection or infusion of local anesthetics to block a group of sensory nerve fibers.
*for a whole body part
Perineural local anesthetic infusion
a surgeon places the tip of an unsutured catheter near a nerve or groups of nerves and the catheter exits from the surgical wound.
Nursing implications for local and regional anesthesia
Provide emotional support
Protect patient from injury
providing emotional support: local and regional anesthesia
Explaining the insertion technique and warning patients that they will temporarily lose sensory function within minutes of injection.
protect patient from injury: local and regional anesthesia
-Protect the patient from injury until full sensory and motor function return. Patients are at risk for injuring an anesthetized body part without knowing it.
-When patients receive epidural analgesia, initially monitor them as often as every 15 minutes, including assessment of vital signs, respiratory effort, and skin color.
-Once stabilized, monitoring occurs every hour in the first 12 to 24 hours and then with less frequency if the patient is stable.
WHO analgesic ladder
Recommended guidelines for prescribing, based on pain level (0-10, 10 = severe pain)
Level 1 (1-3 rating)—Use non-opioids
Level 2 (4-6 rating)—Use weak opioids alone or with adjuvant drug
Level 3 (7-10 rating)—Use strong opioids
Level 4- nerve block, epidural, PCA pump
pain centers
treat patients on an inpatient or outpatient basis
What is the goal of palliative care?
to learn how to live life fully with an incurable condition
what kind of program is hospice
end of life care; helps terminally ill patients continue to live at home or in a health care setting in comfort and privacy.
olfactory
smell
gustatory
taste
kinesthetic
position and motion
Stereognosis
a sense that allows a person to recognize the size, shape, and texture of an object.
Reception
stimulation of a receptor such as light, touch, or sound
Perception
integration and interpretation of stimuli
Reaction
only the most important stimuli will elicit a reaction
what can losing visual and hearing acuity cause…
the person to withdraw by avoiding communication or socialization with others in an attempt to cope with the sensory loss
what are the three types of sensory deprivation
-reduced sensory input
-elimination of patterns or meaning from input
-restrictive environments that produce monotony and boredom
Reduced sensory input
sensory deficit from visual or hearing loss
Elimination of patterns or meaning from input
e.g., exposure to strange environments
Restrictive environments that produce monotony and boredom.
e.g., bed rest
sensory deprivation
Inadequate quality or quantity of stimulation
sensory deficits
Deficit in the normal function of sensory reception and perception
Sensory overload
Reception of multiple sensory stimuli
factors affecting sensory function
Age
Meaningful Stimuli
Amount of Stimuli
Social Interaction
Environmental Factors
Cultural Factors
Visual changes occur during adulthood that result in the need for glasses around what age
40 to 50 years old
Glaucoma
increased intraocular pressure results in damage to the retina and optic nerve with loss of vision
Hearing loss usually begins around…
30 years of age
Smell and taste changes usually begin around…
around 50 years
meaningful stimuli
Reduce the incidence of sensory deprivation
Meaningful stimuli include those activities and people who have…
a positive influence on the patient, such as pets, music, TV, movies, family, clock, and calendar.
amount of stimuli
Can cause sensory overload
Social interaction
The amount and quality of social contact with supportive family members and significant others influence sensory function. The absence of visitors during hospitalization or residency in an extended care facility influences the degree of isolation a patient feels.
Environmental factors
Occupation, recreation, and sports activities
audiologist or otolaryngologist
specialist in the ear and throat
expressive aphasia
A motor type of aphasia, is the inability to name common objects or express simple ideas in words or writing. For example, a patient understands a question but is unable to express an answer.
receptive aphasia
Is the inability to understand written or spoken language. A patient is able to express words but is unable to understand questions or comments of others.
global aphasia
The inability to understand language or communicate orally.
when do individuals need to have hearing screenings
at least every decade through age 50 and every 3 years thereafter
what is important to remember in patients using assistive devices
Patients who wear corrective contact lenses, eyeglasses, or hearing aids need to make sure that they are clean, accessible, and functional.
what are some ways to promote meaningful stimuli
Take measures to improve lighting, hearing, and tactile, taste, and smell sensations. If a patient is overly sensitive to tactile stimuli (hyperesthesia), minimize irritating stimuli.
what are ways a nurse can control sensory stimuli
Combining activities such as dressing changes, bathing, and vital sign measurement in one visit prevents the patient from becoming overly fatigued. Try to control extraneous noise in and around a patient’s room.
