Pain Assessment Ch 10

Front 1

Visceral Pain

Back 1

originates from larger interior organs (kidneys, gallbladder, etc)

Front 2

Deep Somatic Pain

Back 2

blood vessels, joints, tendons, muscles, & bone

Front 3

Cutaneous Pain

Back 3

skin surface & SQ tissue

Front 4

Referred Pain

Back 4

felt at a particular site & orginates in another

Front 5

Neuropathic Pain

Back 5

doesn't adhere to typical, predictable phases in nociceptive pain; most difficult to assess & treat; often perceived long after injury heals

Front 6

Acute Pain

Back 6

short-term, self limited, lasts the expected recovery time

Front 7

Chronic Pain
-malignant or
-Nonmalignant

Back 7

diagnosed when pain continues for 6+ months
-"intractable" pain, induced by tissue necrosis or stretching of organ by growing tumor (malignant)
-pain becomes a disease in itself, e.g. arthritis, low back pain (nonmalignant)

Front 8

Infant considerations
"CRIES"

Back 8

at 20 weeks gestation, can feel pain
C-crying
R-requires O2 for sat > 95%
I-increased vital signs
E-expression
S-sleepless

Front 9

Gender differences

Back 9

Women 2-3 times more likely to experience migraines during childbearing years
More sensitive to pain during premenstrual period
Women 6x more likely to have fibromyalgia

Front 10

Nociceptors

Back 10

specialized nerve endings, located w/in skin, CT, muscle, thoracic/abd./pelvic viscera, directly stimulated by trauma/injury, indirectly stimulated by chemical mediators released from damaged site; carry pain signal to CNS with A & C fibers

Front 11

A fibers

Back 11

myelinated, larger in diameter, transmit pain signal rapidly to CNS, localized, short-term, sharp sensations

Front 12

C fibers

Back 12

unmyelinated, smaller, transmit pain signal slower, diffuse & aching sensations, persist after initial injury

Front 13

Interneuron

Back 13

fibers synapse, located w/in specific area of cord (substantia gelatinosa)

Front 14

Substantia Gelatinosa

Back 14

Lamina II-layers of nerve cells divided and numbered; receives sensory input from various areas of body

Front 15

Anterolateral Spinothalamic Tract

Back 15

pain signal crosses then ascends to brain (AP tract)

Front 16

Transduction

Back 16

Phase I of nociception; noxious stimuli in periphery, injured tissues release chemicals(prostaglandin, histamine, serotonin, bradykini), these neurotransmitters sent action potential pain message along fibers to spinal cord (dorsal horn), 2nd set of neurotransmitters carry message across synaptic cleft (sub. P, glutamate, ATP)

Front 17

Transmission

Back 17

Phase II of nociception; impulse moves to brain, opioid receptors able to block pain c exogenous/endogenous opioids, if pain's not blocked-impuls moves to brain to end in brainstem & thalamus, dispersed to higher cortical areas

Front 18

Perception

Back 18

Phase III of nociception; awareness of pain sensation, limbic system accounts for emotional responses, somatosensory areas characterize sensation

Front 19

Modulation

Back 19

Phase IV of nociception; pain message inhibited; decending pathways from brain produce 3rd set of neurotransmitters-slow down impulse producing analgesic effect; norepi, neurotensin, GABA & endogenous opioids (endorphins, enkephalins, dynorphins

Front 20

Aging Adult Considerations

Back 20

pain is not part of normal aging process; somatosensory cortex unaffected by dementia, limbic system affected by dementia-may interpret & report pain message differently

Front 21

Initial Pain Assessment Questions

Back 21

Where is your pain?
When did it start?
What does it feel like?
How much pain are you having now?severity scale 0-10
What makes it better or worse?
How does your pain limit your ADLs?
How do you usually behave when in pain?
What does this pain mean to you?

Front 22

Objective data-Joints

Back 22

size & contour, measure circumference, check ROM, normally no pain, tenderness, crepitation (audible/palpable crunch)
abnormal-->swelling, inflammation, deformity, diminished ROM, increased pain on palpation, crepitation

Front 23

Objective data- Muscles and Skin

Back 23

inspect skin/tissues-color, swelling, masses; test ability to perceive sensation
abnormal-->bruising, lesions, open wounds, atrophy, bulging, analgesia(absent pain sensation), hyperalgesia(increased sensation)

Front 24

Objective data- Abdomen

Back 24

observe contour & symmetry, palpate muscle guarding & organ size, note areas of referred pain
abnormal-->swelling, bulging, herniation, inflammation, organ megaly,

Front 25

Acute Pain Behaviors

Back 25

guarding, grimacing, vocalizing, agitation, restless, stillness, diaphoresis, change in vitals

Front 26

Chronic Pain Behaviors

Back 26

Bracing, rubbing, diminished activity, sighing, change in appetitie

Front 27

Acute pain response-Cardiac

Back 27

tachycardia, elevated BP, increased myocardial O2 demand, increased CO

Front 28

Acute pain response-Pulmonary

Back 28

hypoventilation, hypoxia, decreased cough, atelectasis

Front 29

Acute pain response- GI

Back 29

N/V, paralytic illeus

Front 30

Acute pain response-Renal

Back 30

oliguria ( >25cc/hr), urinary retention

Front 31

Acute pain responses- Musculoskeletal

Back 31

spasm, joint stiffness

Front 32

Acute pain response- endocrine

Back 32

increased adrenergic activity

Front 33

Acute pain response- CNS

Back 33

fear, anxiety, fatigue

Front 34

Acute pain response- Immune

Back 34

impaired cellular immunity, impaired wound healing

Front 35

Poorly controlled chronic pain responses

Back 35

depression, isolation, limited mobility/function, confusion, family distress, diminished quality of life