CH 11: Pain Assessment

Question 1

pain is always?

Answer 1

subjective

Question 2

what is pain assessment?

Answer 2

interpretation of scale number and critical thinking about influencing factors

Question 3

signs of pain?

Answer 3

facial expression
guarding
moaning
vital changes

Question 4

what can hypoventilation lead to?

Answer 4

hypoxia
collapsed alveoli

Question 5

pain requires attention to what?

Answer 5

response to relief methods
medication side effects
what else can be done?

Question 5

why is pain assessment important?

Answer 5

to develop non-pharmacological and pharmacological strategies to improve clinical results
-important for treatments, diagnoses, etc

Question 6

pain assessment details?

Answer 6

intensity
location
onset (acute more emergent, chronic harder to treat)
referred or radiating
limitations of ADL
duration
alleviating and aggravating

Question 7

what is holistic?

Answer 7

non pharma

Question 8

holistic method examples?

Answer 8

distraction: music, relaxation, massage, acupuncture
tubes: decompress and relieve pressure
anxiolytics
improve breathing and oxygenation
positioning
heat/cold (good for musculoskeletal)
psychological support, palliative care, conflict resolution

Question 9

what is nocioreception?

Answer 9

describes noxious stimuli perceived as pain
originates from CNS or PNS

Question 10

nocireceptors?

Answer 10

specialized nerve endings that detect pain
transmit signals to sensory fibers: A (rapid signal, shorter term) and C (slower signal, persist after injury)

Question 11

nociception concepts: transduction?

Answer 11

stimulus in periphery (cut or burn felt at peripheral level)
- mediators released: substance P, histamine, prostaglandins, serotonin, bradykinin

Question 12

nociception concepts: transmission?

Answer 12

pain moves from spinal cord to brain (enacts reflexes to feel pain faster)

Question 13

nociception concepts: perception?

Answer 13

conscious awareness of pain sensation (brain is aware)
-cortical structures (limbic system=emotional response)
only perceived as pain when reaches cortical structures

Question 14

nociception concepts: modulation?

Answer 14

inhibition of pain sensation (how body reacts to pain - endogenous relievers)
-body’s built in mechanism to slow/stop pain stimulus
-analgesic effects (serotonin, norepi, neurotensin, GABA)

Question 15

pain treatment approaches?

Answer 15

modify source
alter central perception
modulate transmission of pain in CNS (alter pain signal)
block transmission of pain in CNS (nerve blocks, anesthesia)

Question 16

what is neuropathic pain?

Answer 16

abnormal processing of pain messaging
*signal mixup/nerve dysfunction
does not follow predictable phase
MOST DIFFICULT to assess/treat
perceived long after healing
ex. diabetes, herpes zoster, HIV, sciatica, chemo, phantom limb pain

Question 16

what is visceral pain?

Answer 16

originates from large organs
-stems from direct injury to organ
-autonomic responses (N/V, pallor, diaphoresis) bc transmitted by ascending nerve fibers
ex. appendicitis, ulcer pain, cholecystitis

Question 17

what is deep somatic pain?

Answer 17

from blood, vessels, joints, tendons, muscles, bone
-from pressure, trauma, ischemia
-described as aching/throbbing, usually localized
-nausea, sweating, tachycardia, HTN

Question 18

what is cutaneous pain?

Answer 18

from skin or SUBQ
-superficial with sharp, burning sensation

Question 19

what is referred pain?

Answer 19

felt at specific site but originates in diff location
both sites innervated by same spinal nerve

Question 20

what is acute pain?

Answer 20

short term
self limiting
predictable
dissipates after healing
protective quality
vital signs indications bc ANS

Question 21

what is chronic pain?

Answer 21

continues beyond expected time
malignant and non
in cancer: increase pain=increase disease
does not stop when healed
no protective qualities
pain level may not correspond with physical findings

Question 22

acute pain symptoms?

Answer 22

protective responses
diaphoresis
anxiety
restlessness or stillness
moaning

Question 23

chronic pain symptoms?

Answer 23

normal VS
skin warm and dry
depressed/withdrawn
anxiety
anger/irritability
substance abuse
no protective
bracing/rubbing
sighing
appetite change
reduced activity

Question 24

aging adult?

Answer 24

pain not normal process, indicates pathology or injury

Question 25

what is PAINAD?

Answer 25

scale for dementia patients
0-2 (0 being normal)
measures:
breathing
vocalization
facial expression
body language
consolability

Question 26

what makes up PAINAD?

Answer 26

breathing
negative vocals
face expression
body language
consolability
0 (normal) to 2 (not)

Question 27

what is PQRST?

Answer 27

provocation
quality
region/radiation
severity
time

Question 28

what should you ask?

Answer 28

where?
started?
feels like?
how much now?
what makes it better or worse?
limit ADLs?
how do you know?
how do others know?

Question 29

types of pain assessment?

Answer 29

numeric: 0-10
verbal descriptor: use words
visual analog: mark on line none - worst
descriptor: select pain term words

Question 30

don’t assume patients know what?

Answer 30

0 - 10 scale

Question 31

AA pain beliefs?

Answer 31

illness sign
no pain= may affect treatment compliance
inevitable/endured
high tolerance
spiritual/religious beliefs
praying

Question 32

mexican beliefs?

Answer 32

accepted as necessary
consequence of behavior
restores balance
delay treatment seeking
divinely predetermined

Question 33

objective assessment?

Answer 33

joints- ROM
muscle/skin- color, swelling, deformity
abdomen- contour and symmetry