Week 3 - pain

Question 1

transduction

Answer 1

a noxious stimuli is inflicted upon the individual.

Question 2

Transmission

Answer 2

the impulse moves along the spinal cord to the brain, if not interrupted by the opioid receptors.

Question 3

Perception

Answer 3

the noxious stimuli is interpreted as pain.

Question 4

Modulation

Answer 4

the pain impulse may be slowed down by neurotransmitters that act like analgesia (ie. Serotonin, norepinephrine, endorphins, etc).

Question 5

nocioceptive

Answer 5

caused by tissue injury, often describes as “aching” or “throbbing”
- somatic = superficial (skin) or deep (muscles/ tendons)
- visceral = internal organs

Question 6

Neuropathic

Answer 6

often results from damage or disease of the somatosensory nervous system
- spinal cord injury, infectious or metabolic diseases, medication-induced
“shooting” or “burning” pain

Question 7

referred pain

Answer 7

originates in one location but is experienced in other locations
chest pain = immediate action

Question 8

acute pain

Answer 8

Short-term
Self-limiting
Follows a predictable trajectory
Dissipates after injury heals
- typically you know the source
pain 6 and above = immediate treatment

Question 9

persistent (chronic) pain

Answer 9

Continues for 3 months or longer
Malignant (cancer-related) or nonmalignant
Does not stop even after tissue has healed
- pain needs to be treated immediately to avoid chronic pain

Question 10

developmental considerations - infants and young children

Answer 10

higher risk for undertreatment
words children may use to report pain
fear of injections

Question 11

developmental considerations - older adults

Answer 11

pain not a normal process of aging
higher incidence related to chronic conditions
- osteoarthritis, surgery…

Question 12

developmental considerations - gender

Answer 12

differences in prevalence rates of painful conditions
genetic differences may account for differences in pain perception
- stereotypical gender roles

Question 13

subjective data

Answer 13

Self-report is the most reliable indicator of a patient’s experience of pain.
Need to take into account patients’ understanding and beliefs about pain
Examples of question to assess pain beliefs:
- Do you use traditional remedies?
- How do others know you are in pain?
- How do you usually describe your pain?
- What does your pain mean to you?
- How do family and friends help you?

Question 14

OPQRSTUV

Answer 14

• Where is the pain?
• When did the pain start?
• Severity of pain?
• what makes your pain better/worse?
• What do you do at home for your pain?
  Onset: When did the pain start? not very useful…
  Provocative or palliative: What makes your pain worse? Does anything make it better/ relieved?
  Quality of pain: Words to describe pain?
  Region of body: Where? Does it radiate or move to other areas?
  Severity: How do you rate the pain on an intensity scale?
  Treatment and Timing of pain: What treatments have worked for you? Is it a constant, dull, or intermittent pain? Pain-free periods or changed over time?
  Understanding of pain: What do you believe is causing the pain? Goal for comfort?
  Values. Acceptable level of pain? Any other stressors or spiritual pain?

Question 15

pain assessment tool

Answer 15

• adult non-verbal pain scale
• brief pain inventory: rates the pain within the previous 24 hours
• pain is a stress: brain detects it
  C6H12O6 (glucose) + O2 = energy –> 6CO2 +6H2O
  need heart and lungs
  under stress HR goes up
  respiration goes up
• need slow and deep breaths

Question 16

pain rating scales

Answer 16

Visual Analogue Scale or Numeric rating scale (0-10)
Descriptor Scale (no, mild, mod, severe)
Faces Pain Scale – Revised. Great for children!

Question 17

objective data

Answer 17

use a pain assessment tool to help classify the type of pain the patient experiences:
- acute, persistent/chronic, or neuropathic

Question 18

nonverbal/behavioral assessment

Answer 18

acute pain behaviors
- at high risk of undertreatment if unable to report pain
- if nonverbal but cognitively intact, intensity may be indicated by numerical rating scale, written description, or pointing to location

persistent (chronic) pain behaviors
- adapt over time
- may give little indication of pain
- higher risk for under-detection
- ask patient how they behave when in pain

the unconscious individual
- grimacing, wincing, moaning, rigidity, arching, restlessness, shaking, pushing to indicate pain
- critical-care pain observation tool

Question 19

which type of pain would cholecystitis (gallbladder disease) cause?

Answer 19

visceral pain

Question 20

which anticipated persistent pain finding should guide a nurse’s care planning?

Answer 20

patients w/ persistent pain may show few or no outward signs of pain

Question 21

a crying patient says, “please, get me something to relieve this pain.” what should the nurse do next?

Answer 21

Assess the level of pain and ask the patient what usually works for his or her pain; administer pain medication as needed, and then reassess pain level.
Pain management should be collaborative and ongoing, and this response includes the patient as part of the decision-making process.

Question 22

re-cap

Answer 22

initial assessment
- appearance
-work of breathing
- circulation (color)

primary survey
-ABCDEF
-vital signs

focused physical examination
- Body system(s)
- subjective & objective data