UNIT 10 PAIN Flashcards
1
Q
Pain is:*
A
what ever the experiencing person says it is existing whenever he says it does
2
Q
Name the Five Pain Pathways and Processes*
A
Nociception Transduction Transmission Perception Modulation
3
Q
What is Nociception*
A
Normal processing of painful stimli or The ability to feel pain
4
Q
What is Transduction?*
A
First injury occurs and release substances that activate nociceptors.
5
Q
What are Nociceptors?*
A
Peripheral structures that are specialized receptors in the skin an internal organs that are sensitive to noxious stimuli.
6
Q
Be specific: Where are Nociceptors found and what are the three types?*
A
Found in skin , blood vessels, fascia, internal organs, and joints and other structures. Peripheral nerve cells where nociceptors located.
- Thermoreceptors - temp
- Chemoreceptors - chemical
- Mechanical receptors - pressure
7
Q
First Responder is*
A
A-Delta - Fibers = Sharp well localized pain
8
Q
Second Responder is*
A
C-Fibers = slow responding dull poorly localized and persistent
9
Q
Bradykinin is a powerful ____ that increases ___ ___ and constricts __ ___.
A
a powerful vasodilator that increases capillary permeability and constricts smooth muscle
10
Q
Prostaglandins are important ____-like substances that __ additional ___ stimuli to the ___.
A
Prostaglandins: important hormone-like substances that send additional pain stimuli to the CNS
11
Q
Substance P sensitizes ___ on ___ to feel ___ and also ____ the rate of firing of ___.
A
Substance P: sensitizes receptors on nerves to feel pain and also increases the rate of firing of nerves
12
Q
Seven Steps of Transmission: Stimuli is transmitted from pain receptors by way to sensory nerves…
A
Stimuli is transmitted from pain receptors by way to sensory nerves
- into the dorsal root ganglia
- The impulse enters the spinal cord, and synapses terminate in the dorsal horn of the spinal cord
* 3. Substance P a neurotransmitter assists the impulse to cross the cord and ascend up the spinothalamic tract - And areas of the midbrain
- to the thalamus
- where sensation of heat, cold pain and touch identified
- Location and intensity of pain is perceived in the cortex
13
Q
Specific receptors receive… 3*
A
Endogenous opiods
Endorphins
Enkephalins
14
Q
What are Endogenous opioids*
___ and ___ – made by ___ – produce ___ affect by binding to ___ receptors
A
serotonin and norepinephrine – made by body – produce analgesic affect by binding to opioid receptors
15
Q
Endorphins*
___ ___ ___ and ___ thought to be released with ___ stimulation (___)
A
prolonged pain relief and euphoria thought to be released with skin stimulation (massage)
16
Q
What does Enkephalins* do?
A
inhibits release of substance P at afferent neurons
17
Q
What occurs during pain perception?
A
Spinal reflexes
Muscles near pain site contract
Protective Response
18
Q
Types of Pain*
A
- Acute Pain
- Chronic Pain
- Cancer/Malignant Pain
- Persistent Pain / Central Sensitization
- Long Term Central Sensitization
19
Q
Acute Pain* 1. Cause usually \_\_\_ - follows \_\_\_ \_\_\_ process 2. Intensity usually \_\_\_ with \_\_\_. 3. Is \_\_\_ - \_\_\_ sign 4. May have \_\_\_ signs \_\_\_ and \_\_\_ signs. i.e: increased: \_\_ \_\_\_ \_\_ Facial \_\_\_ & \_\_\_ Lack of _/_ does not mean \_\_\_ pain.
A
- Cause usually known – follows nociceptive pain process
- Intensity usually decreases with healing
- Is protective - warning sign
- May have observable signs behavioral and physical signs
Increased HR, Resp, b/p
Facial grimacing, guarding,
Lack of s/s does not mean no pain
20
Q
Chronic Pain*
- What are the 3 characteristic of pain?
- Serves no ___ ___ – may be difficult to___
- ___ pain signaling both ____ or ___.
- ___ and___ – lasts longer than _ to _ mos.
- ___ & ___ pain responses not present
- ___ and ___.
A
- Persistent, intermittent or limited
- Serves no useful purpose – may be difficult to localize
- Abnormal pain signaling both peripheral or central
- Irreversible and cyclical – lasts longer than 3 to 6 mos
- Physical & behavioral pain responses not present
- Remissions and exacerbations
21
Q
Cancer / Malignant Pain*
- May be __ __that cause seeking ___.
- Associated with what four things?
- Pain related to what three things?
- Cancer pain has what kind of qualities
- Why may pt not want to report their pain?
- With proper interventions what is possible?
A
- May be first symptom that cause seeking treatment
- Associated with chemotherapy, radiation, tissue & organ destruction
- Pain related to hormones, neurotransmitters and enzymes
- Cancer pain has acute and persistent qualities
- Reluctant to report since can indicate progression of disease
- With proper interventions may be relieved
22
Q
Persistent Pain / Central Sensitization
- __ signals bombard ___ and ___ system adaption over time can lead to ___ effects of pain.
- What is it characterized by (give e.x)?*
- What is hyperexcitable?*
A
- Nerve signals bombard CNS
Nervous system adaptation over time – lead to the detrimental effects of pain - Characterized by enhanced pain to mild noxious stimuli ( rheumatoid arthritis inflammation)
- Light touch causes continuous or very frequent input to CNS = hyperexcitable
23
Q
Long Term Central Sensitization*
- What is Allodynia?
- What is Hyperglasia
A
- Allodynia =
abnormal pain signals results in perceived pain with mild, non-painful stimuli
Light touch or blankets on feet = sudden pain - Hyperglasia =
exaggerated response to normal painful stimuli
Lower pain tolerance
Hot liquids on sore throat
24
Q
Source of Pain: Nociceptive Pain
Name and describe the three types?*
A
*1. Somatic - originates in the bone, skin and soft tissue. well localized/easy for the patient to point out location. Characterized by throbbing and aching. Example Sprained ankle and metastatic bone pain
*2. Visceral Pain
Originates internally
Due to stretching, distension inflammation or damage to organs
Described as aching, throbbing, cramping, pressure deep or radiating
Pain diffuse and difficult to locate ( MI pain)
- Referred Pain - Pain that originates in one part of the body but perceived in another area
25
What are the two common responses to pain? *Pg 1157 Box 34-1
1. Physiologic/ Invonluntary
- superficial and moderate
- increased b/p, p and r
- dialated pupils
- muscle tension and rigidity
- pallor
2. Severe and Deep Pain
- n/v
- fainting an unconscious
- Decrease P and b/p , rapid and irregular breathing
- Prostration,
26
Behavioral Signs of Pain and their Affects
Moving away from painful stimuli
Grimacing moaning and crying
Restlessness
Protecting the painful area and refusing to move
Affects
Withdrawal, Anxiety, Depression, Fear, Anger, Anorexia, Fatigue , Hopelessness, Powerlessness
27
```
Possible Signs of Pain in Infant : Behavioral Variables, cont.
Facial expression (most reliable sign):*
```
1. Eyes tightly closed or opened
2. Mouth opened, squarish
3. Furrowing or bulging
of brow
4. Quivering of chin
5. Deepened nasolabial fold
28
School Age Children and Pain
1. Try to be brave when facing a painful procedure
2. May regress to earlier stage of developments
3. Can explain location, intensity, quality and temporal pattern
29
Adolescent and Pain
1. Demonstrate self control / may not admit to pain
2. May be slow to acknowledge pain
3. May consider showing signs of pain and weakness
30
Adult and Pain
1. Fear of pain may prevent seeking care
2. May believe admission of pain is a weakness and inappropriate for age or sex
3. may consider pain an punishment for moral failure
31
Older Adult and Pain
1. May have decreased sensation or perceptions of pain
2. May consider pain and inevitable part of aging
3. Chronic pain may produce anorexia, lethargy and depression
4. Describes pain and hurt or ache
32
Religious Beliefs and Pain*
1. Pain and suffering : lack of___ - means of ___
2. Pain is seen as a ___.
3. What effects does pain have on faith?
1. Pain and suffering : lack of goodness - means of purification
2. Punishment
3. Faith questioned or shaken
33
Anxiety *
1. Creates an ___ perceptions of pain
2. Relationship between pain and ___ and ___ are ___
3. ___ increase pain
Anxiety
Increased perceptions of pain
Relationship between pain and depression and anxiety unclear
Fatigue increase pain
34
What is pain Threshold?*
amount of pain stimulation a person requires before feeling the pain
35
What is pain tolerance?*
| Pg 1169
*is the maximum degree of pain intensity a person is willing to experience/tolerate
Can be increased or decreased by numerous factors
36
What Factors affect pain perception?
1. Pain Threshold
| 2. Pain tolerance
37
Focused Assessment pg 1162
Tells the ___ of pain.*
There are Three steps*
Characteristics of Pain
1.Onset : When it starts
2. Location
Point to the location – document on a body diagram
Use anatomical landmarks and descriptive terminology
3. Duration : How long it lasts
Continuous = all the time
Breakthrough = pain returns before next scheduled pain med
Incident Related = with a specific movement or procedure
May determine dosing and timing of medication
38
Quality and Intensity
1. What does it indicate*
2. What is used to indicate quality and intensity?
3. What influences this?
1. Indicates the *magnitude or *amount of pain perceived
2. Numeric scale 0-10
3. influenced by past experience, fear of consequences and may change the activity or positioning
39
Quality
1. What do you ask to understand quality?
2. Quality is how the pain __ to the person.
2. What is the terminology?
1. How would you describe your pain?
2. How the pain feels to the person
3. ***Subjective** no common pain terminology but some pain episodes describe in similar terms / everyone describes it differently
40
Noceceptive
aching, sharp, deep gnawing
41
Neuropathic
burning, shocklike
42
Aggravating and Relieving Factors
1. What should be asked about these symptoms?*
2. What are associate symptoms?*
1. 1. What makes the pain better or worse?
Medications
Position Changes
Home Remedies
2. Associate symptoms – symptoms in addition to paing - Do you have any other symptoms in addition to pain?
Nausea Confusion Constipation Itching Fever
Sleepiness Lack of sleep
43
What is the Impact of pain on ability to function and quality of life?*
(7)
```
Sleep
Activity Level
Appetite
Relationships
Ability to work
Quality of life
Mood
```
44
Chronology?
How did it begin and Progress
45
Physical Assessment of Pain? 2*
physiological and behavioral
46
Physiological Variables associated with pain*
| 6
```
increased HR, RR,
shallow respirations
decreased pallor or flushing
diaphoresis, sweating
decreased O2 saturation
Pupil constriction
```
47
Pain Associated Symptoms*
| two
N & V
| Increased blood glucose, ketones
48
Specific Behaviors that Indicate Local Body Pain* (five)
```
Pulling ears
Rolling head from side to side
Lying on side with legs flexed on abdomen
Limping
Refusing to move a body part
```
49
What does not indicate lack of pain?*
Lack of symptoms and pain expression does not mean lack of pain
50
Physical Expressions of Pain*
1. Facial:
2. Body Movements:
3. Emotional
1. Facial expressions: frowning, wincing, lack of expression
2. Body movements: frequent position changes, guarding, immobilization (can be detrimental)
3. Emotional: depression, anger, fear, regression
Unrelieved pain = confusion, disorientation
51
Verbal Responses to Pain
Moaning, crying, grunting
Groaning
Report of pain –
52
Nonverbal Responses to Pain
```
Facial Expressions
Grimace, Clenched teeth
Wrinkled forehead
tightly closed or widely opened eye or mouth
lip biting
```
```
Body Movement
Restlessness
Immobilization
Muscle tension
Increased hand and finger movements
Pacing activities
Rhythmic or rubbing motions
Guarding
```
53
Affective pg 1163
Effects of pain on activities of daily living and lifestyle
Anxiety
Depression
Interactions with others
Interference with sleep, work, diversional activities, eating
May need several weeks of data – journaling
Perception and meaning of pain
Coping mechanism used
Outcomes – what would you do if pain better what is pain goal
54
Risk Identification
1. Tolerance*
2. Physical Dependence*
3. Addiction*
1. Tolerance- Neuroadaptive response requiring a larger dose of drug to reduce persistent pain
2. Physical dependence- physiologic adaptation characterized by withdrawal symptoms when drug is abruptly withdrawn
3. Addiction – chronic neurobiologic disease – impaired control over drug use compulsive use or continued use
55
Nursing Diagnosis: Acute Pain pg 1167
1. Definition
2. Related factors
3. ___ pain
4. r/t
5. m/b
1. Definition: an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
2. Related factors: biologic, chemical , physical and psychological agents or injury
3. **Acute Pain
4. r/t Tissue pressure, Inflammation, trauma, surgery
5. m/b: Rates pain 8 on scale of 1-10 with 10 being worst pain
56
Nursing Diagnosis: Chronic Pain
1. Definition of chronic pain*
2. related to
3. P:*
4. r/t
5. m/b
1. An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage a duration of greater than six months
2. Related to :
Chronic physical or psychosocial disability
3. P: Chronic pain
4. r/t degenerative changes ( osteoarthritis ) of the right kinee
5. m/b Stiffness, unable to get full ROM
57
Implementation: Health Promotion
1. What should be anticipated?
2. What should be prepared?
3. What should be done when dealing with persistent pain?
1. Anticipating Painful Experiences
2. Pre-procedural pain preparation EMLA cream
3. Persistent Pain :
Patient sets pain control goal
Quality of live goal
Personal pain diary to identify aggravating and alleviating factors
58
How do you apply EMLA Cream?
1. Area application condition?
2. what doe sit need
3. when you apply rest of cream what should be done?
4. how long should it be left on?
Area should not be "cleaned" first; lipids on skin assist in activation.
ELA-Max needs to be "SET" by rubbing 1/3 of cream on treated area for 40-60 seconds.
Apply rest of cream, preferably covered with transparent dressing.
Leave on for up to 2 hr.
59
Implementation: Basic comfort measures
```
Positioning and hygiene
Clean bed and skin – backrubs
Position changes – limb elevation
Comfortable environment
Massage ( cutaneous stimulation)
Relax muscles and reduce
tension
Use of lotions or menthol (warmth)
Contraindicated with impaired skin
Heat & Cold Therapy
```
60
Contralateral stimulation
stimulation applied directly to the painful area, proximal to pain or distal to pain and to contralateral ( exact location on opposite side)
Used in Phantom limb pain
61
TENS:*
1. what does TENS stand for
2. what happens?
3. What does high frequency do
4. What does low frequency activity do?
5. What patients should not use TENS?
1. Transcutaneous Electrical Nerve Stimulation
2. Electrodes are placed on or near the site of pain and stimulated
3. High Frequency: blocks the pain signal to the brain
4. Low Frequency activity: causes body to release its own pain endorphins
5. NO: Pacemakers, arrythmias, – 1st trimester of pregnancy
62
Cognitive & Behavioral *
Change the way pain is interpreted and experienced by modifying thoughts and behaviors
Provides client with a sense of control
Tailored to patients wishes and skills
63
Distractions*
: draws attention away from situation
useful for short procedures,dressing changes, lumbar punctures, childbirth ( Lamaze)
Reading, music, stroking, visual distraction ( TV, movie)
Best of client enjoys distraction works only while client interested
64
Relaxation*
decreases the effects of stress
More than getting client to relax – structured techniques designed to focus mind and relax muscle group
Involve quiet environment, comfortable position, passive attitude
Rhythmic breathing, progressive muscle relaxation
Meditation
65
Guided Imagery*
Focus on a pleasant relaxed mental image as a way to decrease the intensity of pain – better with chronic pain
Guiding light
66
Biofeedback
voluntary control over autonomic functions
electrodes placed on body and feedback to
the patient about relaxation is given – decreases anxiety
Goal: Client can relax at will using breathing techniques other relaxation techniques
67
Pain Evaluation
Sample Client Goal: The client will report a reduced pain intensity level that is at or less than he or she states is tolerable.
Sample Outcome: At the time of therapy onset, client calls the pain intensity a lower number than that reported when the therapy was administered.
Use previously developed goals and outcomes to evaluate client responses to nursing interventions.
