Week 3 - pain Flashcards
transduction
a noxious stimuli is inflicted upon the individual.
Transmission
the impulse moves along the spinal cord to the brain, if not interrupted by the opioid receptors.
Perception
the noxious stimuli is interpreted as pain.
Modulation
the pain impulse may be slowed down by neurotransmitters that act like analgesia (ie. Serotonin, norepinephrine, endorphins, etc).
nocioceptive
caused by tissue injury, often describes as “aching” or “throbbing”
- somatic = superficial (skin) or deep (muscles/ tendons)
- visceral = internal organs
Neuropathic
often results from damage or disease of the somatosensory nervous system
- spinal cord injury, infectious or metabolic diseases, medication-induced
“shooting” or “burning” pain
referred pain
originates in one location but is experienced in other locations
chest pain = immediate action
acute pain
Short-term
Self-limiting
Follows a predictable trajectory
Dissipates after injury heals
- typically you know the source
pain 6 and above = immediate treatment
persistent (chronic) pain
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
developmental considerations - infants and young children
higher risk for undertreatment
words children may use to report pain
fear of injections
developmental considerations - older adults
pain not a normal process of aging
higher incidence related to chronic conditions
- osteoarthritis, surgery…
developmental considerations - gender
differences in prevalence rates of painful conditions
genetic differences may account for differences in pain perception
- stereotypical gender roles
subjective data
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?
OPQRSTUV
- 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?
pain assessment tool
- 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
pain rating scales
Visual Analogue Scale or Numeric rating scale (0-10)
Descriptor Scale (no, mild, mod, severe)
Faces Pain Scale – Revised. Great for children!
objective data
use a pain assessment tool to help classify the type of pain the patient experiences:
- acute, persistent/chronic, or neuropathic
nonverbal/behavioral assessment
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
which type of pain would cholecystitis (gallbladder disease) cause?
visceral pain
which anticipated persistent pain finding should guide a nurse’s care planning?
patients w/ persistent pain may show few or no outward signs of pain
a crying patient says, “please, get me something to relieve this pain.” what should the nurse do next?
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.
re-cap
initial assessment
- appearance
-work of breathing
- circulation (color)
primary survey
-ABCDEF
-vital signs
focused physical examination
- Body system(s)
- subjective & objective data
