Card Set Information
Pain Chapter 31
What is pain
Whateer the person experiencing
the pain say it is-existing whenever he says it is and feeling however they say it does
What vital signs is pain categorized in?
Fifth Vital Sign
Not a vital sign but just as important like you would assess for.
Is pain objective or subjective?
Its what the person states they are feeling.
(Unless patients have objective signs of pain.)
Pain is a protective mechanism
Acute pain warns of tissue damage and alerts the body to protect itself.
Usually has an identifiable cause following acute injury, disease or surgery.
Localized in one place
It begins rapidly, varies in intenity (mild to severe) and lasts briefly.
Less than 6 months
If not taking care of quickly may become chronic
Prolonged pain develops more slowly over 6 months
Endorphins either cease to function or are reduced.
Few outward signs because you might not see the cause
The pain is outgoing and does not respond to treatment
Patients will have time of remission and or exacerbation (increases in severity)
Resistant to ain cure or relief
No matter what we do never goes away
Pain felt in a body part that is no longer there
: amputation, they still feel the pain of the limb that is no longer there.
Perceived at the source and spreads to surrounding tissues.
: MI spreads one point moves or spreads to other.
3 physiology of pain
Requires an intact peropheral nervous system and spinal cord.
Common factors that distrubt pain reception include trauma, drugs, tumor growth and metaboblic disorders.
Reception: process starts with a stimulus (pain), name 4 stimulus:
Trauma, edema, blockage, tumor or muscle spasm
Heat or cold
Low or High temperature
Tissue ischemia, perforation of an organ
Leakage of hydrochloric acid out of stomach
The cellular damage releases pain producing susbstances:
Enlarges blood vessels and lowers BP
Smooth muscle contriction
Seprates the cells in the capillary walls and allows fluids and leukocytes to move into the area.
conduction of nerve impluses so impluse can travel
The stimulation causes (BHP) causes
an action potential on
( receptors that respond to harmful stimuli)
Starting the nueral transmission of painful stimulus
The conversion is known as transduction.
Some tissues have numerous receptors
Brain and alveoli ahve not pain receptors
some receptors respond to many types of stimuli and other receptors to one type
Why do some people tolerate pain better than others?
Pain is indiviualized and it depends on there chemical makeup
Nerve impulses that travel along the different peripheral nerve fibers:
A delta fibers
A delta fibers
Carry sharp, localized distinct sensations
Carry dull, achy, chronic type of pain
Example of A delta and C fibers
Injection-hurts first at the site later the area hurts
Like a flu shot
Speeds the transmission
Increases receptiveness to pain and transmission
(makes it hurt more)
When the impulse reaches the dorsl horn and the spinal cord
Neurotransmitters (substance P) released allow transmission into the CNS and higer brain centers.
Bodys protective reflux
Stimulates motor pathways to withdraw from a pain source.
: you move away from a flame (superficial) you guard and tighten an area that hurts (internal)
Body is able to adjust to or modify the pain response-
nerve fibers send stimuli back down the dorsal horn causing release of neuroregulators that inhibt the painful stimuli.
Substances that affect the transmission of impluses across the synapse between nere fibers found at neve termainal within the dorsal spine and along receptor tracts.
Two types f of neuroregulators
Affect the transmission of impluses
Maybe be either exitatory or inhibatory
Neurotransmitters: Substance P
Needed to transit pain impulses from the periphery to higher brain centers.
Carries impluse faster across synapse.
an important regulator for pain sensation, the more the better to tolerate pain.
Increases pain sensitivy by also effecting bradykinin
Natural morphine like substances
They are activated by pain and stress
Increased with exercise (ex. football playes get hurt but don't realize it right away)
Released from plasma that leaks from surrounding blood vessels at the site of tissue injury.
Causes releases of prostaglanin-which release sensitivy of pain.
The pain becomes real
The point at which the person is aware of the pain
Gives meaning of the pain
It travels to the limbic system (same part that controls emotions anxiety)
Once it has meaning the patient reacts to pain
Patients with an impaired limbic system respond
Differently to pain.
They will have a dramatic response to pain.
Opoids mess with the limbic system
Autonomic nervous system activated
Low to moderate pain - sympathetic nervous system
Scale 2,3, or 4
: R, HR, B/P, Glucose, diaphoresis, muscle tension, pupil dilation
Decrease GI motility
Severe pain - parasympathetic system
Blood shift from periphery -pallor
decrease HR and B/P
Tachypnea (rapid breathing) and irregular R
Three behavioral responses:
Person knows pain will occur
Explain to patient what to expect
Pain threshold-level at which the pain is felt
Pain tolerance-pain a person is willing to tolerate
Aftermath-occurs afther the pain is reduced or stopped. might get rid of pain but still have physical signs of it.
Factors affecting the pain experience:
: the very young and old may not express pain well
: men and women respond differently
: concepts of acceptable behavior affect a persons reaction
The meaning of pain
: some are good ex labor
: the more you pay attenton the more you feel
: the more you have the worse you feel
: the more you are the worse you feel
: may effect either way. no experience with pain might cause you to panic
: people in control tolerate pain better ex. PCA(patient control anaglesia)
: may effect either way
- ask about pain regulary
- believe patient
-choose appr. control
-deliver pain relief in a timely manner
-Empower the patient towards pain control an Educate about the pain and controlling it.
For Nursing Interventions:
- effect of pain o patient
Effects of ADL's
Assessment Behavorial Responses:
clenching of teeth
Speech and Vocal Pitch
Immobilization of body parts
Purposeless, rythmic movements
Assessment Physiological Responses:
Increase B/P P R
ineffective indiviual coping
sleep pattern distrubance
Implementation: general stratgies
Acknowledge pts pain
assist significant other to manage pain
provide accurate information
try heat or cold but some might need an order
treat anxiety as well
Specific strategies: anaglesics
these alter the perception and inerpretation of the pan generally by depressing the CNS at the thanlmus and cerebral cortex
Basically they raise the pain thresold therefore MUST be given before the pain is sever
Two major classifications
ASA-Salicylates- (aspirin) use for mild to moderate interferes with release of prostagladin.
Antipyretic- reduces fever
May cause iron insufficiency
similar to ASA
Not anti flammatory
Doesn't inhibit platelet
No for to reduce fever
Opiod agonist- Morphine and Demerol
Bind t opiate receptors and interfere with impluse transmission
addiction can lead 3-6-8 continuous
IM Z tack method
Less respiratory supression
(Narcan- for overdose revert of opiod)
anything that produces an effect on a patient because of its intent rahte than its properties.
There is 3 types of analgeics
nonopioid-acteamiophen, aspirin, nonsteriodal inflammatory
Opoid (severe pain) narcotic codeine, morphine, demerol
Adjuvant or coanalgesic-sedatives, anticonvulants, steriods, or antidepressants