Older persons experiencing pain
Experience of pain changes with age
may have atypical presentation
pain or pain treatments canhave increased negative effects
may have misconceptions re: pain managements
: 37% at home and 41% in institutions live with chronic pain
4 ways of pain in nociception
- tranduction
- transmission
- perception
- modulation
Transduction
first phase: conversion of pain stimuli to electrical impulses
* refers to how the pain nerve fiber recognizes the signal of tissue or cell damages
* nociceptors are sensory nerve cells that react to noxious stimuli by sending signals to the spinal cord and brain
- damaged cells (burn, cut, etc..)
- chemical release (pain-sensitizing & inflammatory substances
- nociceptor activation (action potential (AP))
Transmission
second phase: pain moves from PNS to CNS, sending pain signals to the brain
- pain-sensitizing & inflammatory substances spread the message
- via nerve fibers
- transmission of PAIN in dorsal horn
- spinothalamic tract (goes to the brain)
types of fibers
peripheral nerves:
- A-delta fibers: myelinated, sharp, and short in duration
- C fibers: unmyelinated, dull, aching, diffuse nature, slow onset, adn relatively long duration
Perception
third phase: brain processing and recognizing pain
- pain interpretation: intensity, quality, character, experience, location
- somatosensory cortex: location and intensity
- asociation cortex: how we feel about the pain? - limbic system; emotion & memory (anxiety)
modulation
(fourth phase): altered signals and response; the body’s response, which may amplify or inhibit pain signals.
- pain increases or pain decreases
What is mobility
ROM (passive vs active)
* passive: needs an assistance
* active: the patient can move independently
Gait
Exervise
Activitiy tolerance
What is proprioception?
awareness of the body position and its parts. proprioceptors are in muscles, bones and joints. the ability to walk without watching our feet. controlled by our nervous system
- balance: cerebelum and inner ear
Joints?
connection between the bones
* synarthrotic: bone on bone
* cartilaginous: joints with little movements; cartilage found in between bones
* fibrous: a joint where 2 bony surfaces meet with a ligament
* synovial: freely moving joint covered by articular cartilage & connected by ligaments
Ligaments, tendons & cartilage?
ligament: flexible bands of fibrous tissue. they connect bones and cartilage; or bone to bone
tendons: fibrous bands of tissue that connect bone to muscle
cartilage: supporting connective tissue, used for shock absorption
skeletal muscles:
muscles are made from fibers that contract when stimulated by impulses that travels from one nerve to the muscle across the neuromuscular junction
(functions of muslces):
* moving, stabilizing, posture
* heat, circulation, organ protection
2 types of contractions in skeletal muscles:
- isotonic: muslces contraction and change in length (e.g. weight liftting)
- isometric: muscles being tightened/ tense without moving body parts (e.g. yoga)
the important of alignment, postures and balance?
- together these reduce risk of injury and facilitate proper function of other organs
- body alignment is relationship from one body part to another e.g. distal, mid, proximal
- body balance (equilibrium) happens when your center of gravity is balanced over a stable base
The nurse completed a focused pain assessment with a client who reports pain to their left knee. The patient reports the following: “it is a 10/10 right now because I just went for a walk”, ”it is just in my knee and it is achy and throbbing”, “I take Tylenol sometimes, I have had it for years so I am used to it” “I do not walk too much on days it really hurts and use a cane when the pain is bad. I know I should move more, it is always worse in the morning” You notice the patient rubbing their knee as they talk, they are grimacing as they put weight on the knee and grabbing onto something close by. The patient is an overweight 75-year old.
- acute or chronic?
- severity of pain?
- classification of pain?
- cause of pain?
- chronic
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