Unit 3 - Pain Flashcards
Pain –
an unpleasant sensory and emotional. experience associated with actual or potential tissue damage
Cutaneous (superficial) –
Deep somatic (5) –
Visceral (3)–
involves skin or
subcutaneous tissue, ex. paper cut, touching a hot
object
pain originates in ligaments,
tendons, bones, blood vessels and nerves, ex. sprain,
fx, arthritis, bone cancer/fracture
Pain originates from internal organs:
thorax, cranium and abdomen, ex. Organ ca,
ischemia, menstrual cramps.
Psychogenic –
the physical cause
for pain can’t be identified. WE CANT SEE. EMOTIONAL PROBLEMS
Acute –
Chronic –
Intractable –
sudden or slow in onset, varies
from mild to severe, may last up to six
months, subsides as healing takes
place, protective, represents potential or
present tissue damage
last 6 months or longer,
limits everyday functioning
highly resistant to
relief, such as in advanced
malignancy
Migrane is an example of what origin of pain?
viseral
Pain is whatever the experiencing person says it is (Believe your client)
T or F
T
Radiating (define & examples)
felt at the source of pain and extends to nearby tissues,
ex., cardiac pain – chest, left
shoulder and down the arm, even
the jaw
Referred –
felt in a part of the. body distant from the tissue
causing the pain.
ex. Kidney pain may be felt along
the thigh, in women a heart attack
may be felt as abdominal/epigastric
d
Etiology of pain examples ( 3)
a. burning pain,
b. post herpetic neuralgia (shingles)
c. phantom pain
Neuropathic Pain ( d/t what ???)
complex and chronic pain, arising from injury to
peripheral or central nervous system d/t ILLNESSS
Peripheral Pain Syndromes ( 3)
Causalgia
Post herpetic neuralgia
Phantom limb pain
Causalgia-
Post herpetic neuralgia-
Phantom limb pain-
persistent, severe, burning sensation of skin (redness, inflamMATION ) eczema
nerve damage from virus causing shingles
post surgical or traumatic amputation.
Diabetes neuropathy is an example of:
Peripheral neuropathy
Central Pain Syndromes ( two names)
Thalamic syndrome
Trigeminal Neuralgia
THALAMIC syndrome- (what kind of pts)
TRIGEMINAL Neuralgia-
neurological disorder that develops when the central
nervous system—the brain and spinal cord—
is damaged (post stroke)
nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face (along trigeminal
nerve).
wheres trigeminal nerve?
along the face
Pain with underlying pathology syndromes ( 6)
Musculoskeletal pain syndrome = osteoporios
Myofascial pain syndrome
Intervetebral disc syndrome = disc degernradting/ ushion is like bone to bone.
Arthritis
Headache
Cancer pain
syndrome
What kind of pain is headache?
viseral
what kind of pain is intervetebral disc syndrome ?
somatic
what kind of pain is myofascial pain syndrome?
Cutaneous
NocicePTION
the process of pain. perception
A. Transduction –
B. Transmisson ( route)
INJURY OCCURS.tissue injury stimulate nerve fibers that signals the brain
THE ACTUAL INJURY PAIN SIGNALS. Transmission of
pain – from peripheral nerves and spinal cord- thalamus-
C. Perception - ( list the double T’s and D)
D. Modulation –
Perception involves the recognition and definition of pain in the frontal cortex. ( threshold/ tolerance/duration )
brain stem sends signals back down spinal cord/ By facilitating or inhibiting pain signals through the endogenous analgesia system and the gate-control mechanism.
Gate control theory describes the:
- NAME FIBERS AND THEIR DUTY
mechanism of pain sensation
Pain is perceived by the interplay between 2 fibers-
those that produce pain (C), and those that inhibit
pain (A Delta)
Gate control explained ( EXAMPLES)
Gate open with body injury/pain
When skin is stimulated (massage) after
pain response, it closes the gate to spinal
cord - decreases number of pain impulses
that reach the brain for perception
Therapy:
Spinal Cord stimulator-
Acupuncture-
Acupressure-
Myofascial release therapy (active release)-
Massage-
Low level laser therapy-
surgically implanted for intractable pain (for pain NOT relieved)
tens (block pain receptors)
stimulates endogenous analgesia
(norepinephrine, serotonin)
firm, gentle pressure, induces relaxation, relieve
pain
manual pressure to
over used/injured muscles and nerves
loosens adhesions/scar tissue
cutaneous stimulation
cold laser (light penetrates deeply into
tissue decreasing inflammation)
Pain sensation –
Pain reaction –
stimuli patient
perceives as pain.
pain stimulates
“fight or flight”, pain fibers
become sensitized that can
intensify and spread
Pain threshold –
Pain tolerance –
Pain threshold LEAST AMOUNT OF STIMULI . is the point at which the brain recognizes and defines a stimulus as pain
the max amount and duration of pain an individual is willing to experience.
Factors Affecting the Pain
Experience (6)
- Fear
- Fatigue
3.Lack of knowledge
4.Culture/Ethnic
5.Developmental (adaptive/learned behavior)
6.previous pain experience
Developmental Factors of pain
Newborn
Toddler/Preschooler
School Age Child
Adolescents
Adult
Older Adult
Newborn ( cry)
Toddler/Preschooler (verbally/pointing)
School Age Child ( able to speak)
Adolescents ( sometimes reluctance)
Adult ( vary may be related to childhood/ gender based/ seen as weakness)
Older Adult ( may be unable to speak bc cognitive impairment/ atypical ways/ nonverbal /social isolation/depression/sleep disturbances/ impaired mobility)
Assessment of Pain(Fifth Vital Sign) * 5*
- Location – where is your pain?,
external? internal?, ask to point to
painful area, especially children - Onset and duration – how long have
you had this pain? How long has it
lasted? - Intensity/severity
– how would you
describe the pain?
*Use of scale from 0-10
with “0” = no pain
* Mild, moderate,
severe…\ - Quality – ask patient to describe
what pain feels like
Example:
Crushing, burning, constant,
dull, sharp, pounding, etc - Associated characteristics : ask
patient:
Any visual disturbances?
Nausea? Anorexia?
Depression?, muscle spasms,
anger, etc
four pain scale
interferes with task, moderate pain/tooth ache
two pain is …
mild pain, can be ignored
eight pain is …
interferes with basic needs/severe pain
six pain is …
moderate/interferes with concentration
ten pain is…
worst pain/ requires bedrest
Behavioral responses –
does
the patient rub or support the
area, need to make frequent
position changes, walk, pace
Facial expressions –
grimaces
Verbal expression
Affective responses – how does it
make you feel?
How does pain interfere with
the client’s life.
PQRST ( explain each letter)
P : provocative: (What causes. pain? What makes it better?)
Q – quality: (What does it feel like?)
R – region/radiation: (Where does the pain
radiate?)
S- severity: How severe is the pain on a
scale of 1 - 10?
T - time ( when did the pain start)
Nursing interventions:
(Independent)
(Dependent)):
Therapeutic touch,
massage, quiet room, darkened room,
music, imagery, distractions (video
games, reading, TV)
NEED A DOCTORS ORDER Medications,
acupressure, acupuncture, TENS unit, heat and ice pack/BRACES.
Opioid (narcotic)
Action – ____________
Uses: __________
Side effects –_____________
acts in CNS
mod-severe pain/most common is
CONSTIPATION , most dangerous is
respiratory depression
Non opioid – Acetaminophen (Tylenol)
Classification:
Side effects________
Uses-
Analgesic & Antipyretic
both side effects: hepatotoxicity
mild to moderate pain
NSAID’s - ___________ ( we love this)
Classification:
Used for ________
Side effects –
(ibpro)
non-steroidal anti inflammatory non-opiod
Anti-inflammatory Analgesic Antipyretic
Fever and musculoskeletal pain.
Can cause GI bleeding, No ASA while taking this med, can cause kidney damage.
Opioid and nonopioid combination
Example: _________________
Uses- ___________
Effects -_________
Lortab, Norco, Vicodin/ ibuprofen
Treats moderate to severe pain
Effects CNS and peripheral nerve
pathways
Adjuvant Analgesics
Example:
is a medication that is not primarily designed to control pain but can be used for this purpose
valium, vistaril
A client is being discharged home on an
opioid for chronic back pain. Which
medication should the nurse also request?
A. Stool softener
B. Allergy
medication
C. Pain reliever
D. Anti-ulcer
medication
A. STOOL softener
The pain experience can significantly interfere with a person’s quality of life and affect nearly every aspect of daily living.
T or F
T
Pain is NOT a subjective experience.
T OR F
F . it can be
A fracture or sprain, arthritis, and bone cancer can cause___________ type of pain
deep somatic pain.
Menstrual cramps, labor pain, gastrointestinal (GI) infections, bowel disorders, and organ cancers all produce_______ pain.
visceral
A patient who just had their leg amputated but feels as though the leg is still there
Phantom pain
chest pain experienced during a myocardial infarction (heart attack) is caused by ____________- stimuli, specifically the changes that result from tissue ischemia.
by internal chemical stimuli,
NONOPIOID analgesics include a variety of medications that relieve
mild to moderate pain
Acetaminophen vs NSAIDS ( 3 POINTS )
-Has analgesic and fever-reducing properties.
-Has fewer side effects and is probably the safest of the nonopioids.
-Does not affect platelet function
