it is generally rapid in onset, varies in intensity from mild to severe. It is protective in nature; that is it warns the individual of tissue damage or organic disease. After underlying cause is resolved, it disappears. It should end once healing occurs. Causes include a pricked finger, sore throat, or surgery. Last less than 6 months.
acute pain
it is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Patients have difficulty describing _____ _____ because it may be poorly localized. Perceived as meaningless and may lead to withdrawal, depression, anger, frustration, and dependency. last 6 month +++, no protective purpose
chronic pain
Commonly people with ________experience periods of ________ (when the disease is present but the person does not experience symptoms)
chronic pain.
remission
_______ are the symtoms that reappear
exacerbation
pain associated with cancer or other progressive disorders is termed ______ _______ _______
chronic malignant pain
pain in people whose tissue injury is nonprogressive or healed is termed ______ ______ ______
example: arthritis, lower back
chronic nonmalignant pain
Pain can also be categorized according to its location. Which pain involves the skin or subcutaneous tissue? Example a paper cut that produces sharp pain with a burning sensation is an example of what location of pain?
cutaneous (or superfical pain)
Deep ______ ____ is diffused or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep _____ _____
Somatic pain
this is poorly localized and originates in body organs in the thorax, cranium and abdomen. This pain occurs as organs stretch abnormally and become distended, ischemic, or inflamed.
guarding maybe the protective response present .
Visceral pain
Pain also can be classified based on its mode of transmission. Pain can originate in one part of the body but be perceived in an area distant from its point of origin. This is known as _____ _____
Example pain associated with myocardial infarction, or heart attack, is frequently referred to the neck, shoulder, or arms (often the left arm).
referred pain.
This results from an injury to or abdnormal functioning of peripheral nerves or the CNS. The exact cause of neuropathic pain is unknown and it can occur in many forms. This can be of short duration or lingering and is often described as burning or stabing.
e.g. neuropathy
neuropathic pain
______ a characteristic feature of neuropathic pain is pain that occurs after a normally weak or nonpainful stimuli, such as a light touch or a cold drink
allodynia
When pain is resistant to therapy and persists despite variety of interventions, it is referred to as _______
intractable
The pain that is often referred to an amputated leg when receptors and nerves are clearly absent is a real experience for the patient. This type of pain is called ________
sensory misrep
Phantonm pain or phantom limb pain
______physical cause for the pain cannot be identified.
no defined reason, can not find a physical reason for the pain to occur
psychogenic pain
Pain may be classified into 5 parts. What are the 5 parts?
1. duration
2. location
3. source
4. mode of transmission
5. its etiology
what are the 3 types of responses to pain?
1. physiologic
a. parasympathetic
b. sympathetic
2. behavioral
3. affective
The mechanism or process of pain is believed to involve four stages. What are the 4 stages?
1.transduction
2.transmission
3.perception
4.modulation of pain
The activation of pain receptors is referred to as....
it involves conversion of painful stimuli into electircal impulses that travel from the periphery to the spinal cord at the dorsal horn.
transduction
The peripheral nerve fibers that transmit pain are called....
nerve receptor that is responsible for the transmission of pain
nociceptors
What are prostaglandis (hormone-like substances that send additional pain stimuli to the CNS), substance P (sensitizes receptors on the nerves to feel pain and also increases the rate of firing of nerves), and serotonin (a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vasoconstriction)
neurotransmitters or pain receptors
Pain sensation from the site of an injury or inflammation are conducted along pathways that have been rather clearly defined in certain areas but are still somewhat unclear in other areas to the spinal cord and then on to higher centers. This process is known as
conduction along pathways (a-delta & C-delta fibers)
transmission
The _________ of pain involves the sensory process that occurs when a stimuli for pain is present. It includes the person's interpretation of the pain.
perception
the thresold of perception, the _________, is the lowest intensity of a stimulus that causes the subject to recognize pain.
pain threshold
what is considered the 5th vital sign?
pain
Migraines, malignant last long periods -- maybe intracetable.
intermittent chronic pain
A patient who has bone cancer is most likely experiencing which of the following types of pain?
a.cutaneous
b. somatic
c. visceral
d.referred
somatic -- deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels and nerves
_____ pain can be identified
physical pain
The process where sensation of pain is inhibited or modified is referred to as....
(initiation of the protective reflex response_
modulation
Relationship between pain and emotions. Small and large diameter nerve fibers conduct and inhibit pain stimuli. Gating mechanism determine impulses that reach the brain. What theory is this?
Gate Control Theory of Pain
this is the amount of pain the client is willing to endure
pain tolerance
this is the compulsive use of substance even when you know that this is harmful and is affecting life, physical and other
addiction
a biologic need for a substance, if they do not have they will go through withdrawl
this is what the body requires a progressivley greater amount of a drug to achieve the same results
drug tolerance
Which of the following modulators of pain is thought to reduce pain sensation by inhibiting the release of substance P from the terminals of afferent neurons?
B. enkephalins are thought to reduce pain by inhibiting the release of substance P from the terminals of afferent neurons
_____ & _______ are released when certain measures are used to relieve pain
endorphins & dynorphins
_______ are the peripheral nerve fibers that transmit pain
nociceptors
what are the sympathetic response to pain (fight or flight)?
What is the parasympathetic response to pain? (rest and digest)
pallor, rapid, irregular breathing, nausea, vomiting, weakness, fainting, heart rate decreased, hypotension, prostration (extreme mental or emotional depression or dejection)
What is the behavioral responses to pain?
Moving away from the painful stimuli, clenching teeth, clenching, fist, guarding, refusing to move, crying, grimacing, tensing the muscles, demanding, bending over
culture, ethnic variables, family, gender, and age variables, religious beliefs, environment, and support people, anxiety and other stressors, past pain experience
When assess for pain you look for these factors?
does the pt's verbalize and description of pain?
duration of pain
location of pain
quantity and intensity of pain
quality of pain
chronology of pain
aggravating and alleviating factors
physiologic indicators of pain
behavioral responses
effect of pain on activities and lifestyle
True or false.
the best judge of the existence and severity of a patient's pain is the physician or nurse caring for the patinet.
false
the best judge of the existence and severity of the pt's pain is the PATIENT
What does WILDA stand for
Words that describe the pain
Intensity of pain
Location of pain
Duration of pain
Aggravating or alleviating factors
Which of the following pain assessment tools is recommended for use with children?
A. Wong-Baker faces
what are some nonpharmacologic pain relief measures?
baseline leve of consciousness, resp rate, O2 saturation, BP
_____ ____various medication are given to the patient for surgical procedures to produce pain relief and amnesia
general anesthesia
by trained RN medication for pain and amnesia but should not render unconscious, should be able to maintain airway. Precautions for airway, suction
conscious sedation
A patient complains of abdominal pain that is difficult to localize. The nurse categorically interprets this as.
A. visceral
complex regional pain syndrome
causalgia
a patient complains of pain in a site that is different from where it originates. The nurse documents this as
C. referred pain
A patient who has fallen and injured his wrist carefully cradles it with the other hand. the pt is demonstrating which of the following responses to pain?
C. behavioral (protecting or guarding a painful area is a behavioral response)
To help relieve her pain, Ann concentrates on a favorite vaction setting. The nurse interprets this technique as
a. distraction
b. relaxation
c. recall
d. imagery
imagery is a mind--body interaction that decreases pain sensation by focuing on a pleasurable image
The nurse best describes intractable pain as being
D. resistant to treatment.
Intractable pain is severe pain that is resistant to relief measures
Applying the gate control theory of pain, an effective nursing intervention for paitient with lower back pain would be.
D. applying a moist heating pad to the area at prescribed intervals.
(nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain)
Which of the following would the nurse expect to assess as a physiolgic response to moderate pain?
B. ^BP
increaed BP is a physioligc or involuntary response to moderate pain, whereas decreased pulse rate occurs when pain is severe and depp. Restlessness and protection of the painful area are behavioral responses
Mrs. young is receiving ATC medication for treatment of terminal cancer. She has recently reported several episodes of breakthrough pain. What treatment is most effective to manage these sudden flare--ups of pain?
d. supplementing w/doses of a short-acting opioid
When assessing pain in a child, the nurse needs to be aware that?
D. inadequate or inconsistent relief of pain is widespread
Mr. Wright is recovering from abdominal surgery. When the nurse assists him to walk, she observes that he grimaces, moves stiffy, and become pale. She is aware that he has consistently refused his pain medication. A priority nursing diagnosis would be?
B. acute pain related to fear of taking prescribed medications in the postoperative period
When planning strategies for pain control in older patients, the nurse should be aware that
C. denial of pain may occur
chronic pain is most effectively relieved when analgesics are administered
B. ATC
Using a placebo for pain control w/out the pt's consent is
C. deceptive and unethical
The patient receiving epidural analgesia requires vigilant monitoring to prevent the occurrence of
D. respiratory depression
When assessing a pt receiving a continuous opiod infusion, the nurse immediately notifies the physician when the patient has.
A. sedation level of 4
1=awake and alert
2=occasionally drowsy but easy to arouse; requires no action
3=frequently drowsy and drifts off to sleep during conversation; descrease the opiod dose
4= somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone
