Medical Terminology Quiz on Pain and Anemia

Pain and Alterations in Hematological Function

• The presentation is on pain and alterations in hematological function
• The presenter is Kara Sea lock, EdD MEd BN RN CNCC(C) CCNE
• A guest speaker, Sandip Dhaliwal (RN, PhD student), contributed to the slides
• The presentation date is November 2024

Topics for this Lecture

• The presentation covers pain, blood structure and function, lymphoid organs, platelet function, coagulation disorders, hematological conditions (anemia, polycythemia), leukocyte function, neonatal hematology, and skin alterations.
• Specific topics within alterations in platelet function include heparin-induced thrombocytopenia (HIT)
• Specific topics within alterations in coagulation disorders include disseminated intravascular coagulation (DIC)

By the End of this Lecture You Will...

• Critically reflect on blood and lymphoid function's systemic effects
• Explain the pathophysiology and effects of alterations in platelet function, HIT, coagulation, DIC, hematological conditions (anemia, polycythemia), leukocyte function, neonatal hematology, and skin alterations on the body.
• Begin to prioritize patient conditions related to nursing assessment and clinical manifestations

Objectives for this lecture

• Identify elements of pain and phases of nociceptive pain.
• List and apply concepts of pain in pediatric populations.
• Identify blood and lymphoid organ structures and functions.
• Verbalize HIT pathophysiology, at least three causes of DIC and alterations in erythrocyte function.
• Verbalize neonatal hematology and identify skin alterations specific to pediatric populations.

Nociceptors

• Nociception is the processing of harmful stimuli in an abnormal functioning nervous system
• Nociceptors (pain receptors) are free nerve endings in the afferent peripheral nervous system
• The nervous system, responsible for pain sensation, perception, and response, comprises three parts: afferent pathways, interpretive centers, and efferent pathways.

4 Phases of Nociception

• Pain transduction, pain transmission, pain perception, and modulation.

Differences Between Acute and Persistent Pain

• Characteristic | Acute Pain | Persistent Pain
• --|---|---
• Onset | Sudden | Gradual or sudden
• Duration | Usually within the normal time for healing | May start as acute, but persists past normal healing time
• Severity | Mild to severe | Mild to severe
• Cause of Pain | A precipitating illness or event | May not be known
• Course of Pain | Decreases over time and goes away | Pain persists and may be ongoing, episodic or both
• Types of Physical and Behavioral Manifestations | Increased HR, RR, BP, diaphoresis, pallor, anxiety, agitation, confusion | Changes in affect, decreased physical movement and activity, fatigue, withdrawal

Stimuli that Activate Nociceptors (Pain Receptors)

• Location | Stimuli
• --|---|---
• Skin | Pricking, cutting, crushing, burning, freezing
• GI Tract | Engorged or inflamed mucosa, distention or spasm of smooth muscle, traction on mesenteric attachment
• Skeletal Muscle | Ischemia, injuries of connective tissue sheaths, necrosis
• Joints | Synovial membrane inflammation
• Arteries | Piercing, inflammation
• Head | Traction, inflammation, displacement of arteries, meningeal structures, and sinuses; prolonged muscle contraction
• Heart |Ischemia and inflammation
• Bone | Periosteal injury: fractures, tumor, inflammation

Pain Assessment

• Goals: describe the patient's sensory, affective, behavioral, cognitive, and sociocultural pain experience for implementing pain management, identify patient's goal for therapy, and resources/strategies for effective self-management.
• Sensory-descriptive component: pain pattern, area, intensity, and nature of pain.
• Motivational-affective, behavioral, cognitive-evaluative, and sociocultural components of pain.
• Assessment tools include: visual analog scale, numerical rating scale, faces pain scale.

Categories of Pain

• Neurophysiologic pain (nociceptive and neuropathic pain), Neurogenic pain (neuralgia), Regional pain (abdominal, chest, orofacial, pelvic pain), Etiologic pain (cancer, dental, inflammatory, ischemic, or vascular pain). Temporal pain (time-related pain with acute and chronic durations)

Assessment of Acute Pain in Pediatrics.

• Causes include medical procedures, treatments, injuries, infections, exacerbation of conditions like arthritis or sickle cell disease, and cancer.
• The intensity evaluation should utilize behavioral measures, physiological measures, and self-report measures. This method is age-dependent.

Developmental Characteristics of Children's Responses to Pain

• Responses vary by age.
• Young infants may exhibit generalized body responses like rigidity.
• Older infants may display localized body responses.
• Older children may stall, display verbal expression of discomfort or request comfort or cessation of the procedure.

Videos for Extra Resources

• The document provides links to videos for further learning regarding pain, nociceptors, and a gymnast injury.

Hematology

• The presentation discusses heparin-induced thrombocytopenia, disseminated intravascular coagulation, anemia, polycythemias, and alterations in leukocyte function.

Structure and Function of Blood

• Blood is composed of plasma (albumin, globulins) and cellular components (erythrocytes, leukocytes, granulocytes, agranulocytes, platelets)

Structure and Function of Lymphoid Organs

• Primary lymphoid organs: thymus and bone marrow
• Spleen: critical component in the blood
• Lymph nodes

Platelets

• Platelets regulate blood flow, halt bleeding, activate the coagulation cascade, and facilitate clot repair.

Alterations of Platelet Function

• Clinical manifestations include spontaneous petechiae, purpura, and bleeding from GI tract or other mucous membranes
• Causes that affect platelet function include chronic renal failure, liver disease, cardiopulmonary bypass surgery, deficiencies in iron or folate, autoimmune disorders and hematological disorders.

Disorders of Platelets: Heparin-Induced Thrombocytopenia (HIT)

• Typically occurs with IV heparin or LMWH.
• Immune-mediated.
• Starts 5-10 days after heparin administration.
• Thrombocytopenia and potential for thrombotic events (DVT, PE, limb ischemia) necessitate clinical observation, laboratory monitoring, and alternative anticoagulants.

Disorders of Coagulation

• Impaired hemostasis, inability to produce stable fibrin clots, associated with vitamin K deficiency/liver disease, consumptive thrombohemorrhagic disorders and Disseminated intravascular coagulation (DIC)

Disorders of Coagulation: Disseminated Intravascular Coagulation (DIC)

• An acquired and activated systemic coagulation syndrome.
• Results from damage to the endothelial lining of vessels, extensive fibrin clot formation, leading to organ dysfunction, and a consumption coagulopathy
• Etiologies include sepsis, malignancy, infections, intravascular hemolysis, transfusion reactions, drug-induced hemolysis, pregnancies, medical devices, hypoxia, and arterial hypotension.
• Pathophysiology involves the activation of the clotting cascade in response to vascular endothelial damage, cytokine and platelet activation factors, and tissue factor, leading to the consumption of clotting factors and platelets, promoting bleeding.

Hematological Conditions

• This category includes anomalies related to blood components: anemia, polycythemia, leukocyte abnormalities, neonatal hematology, and skin alterations.

Hematological Conditions: Anemia

• Characterized by low erythrocyte count or volume.
• Caused by altered production, blood loss, increased erythrocyte destruction, combined factors, and alterations in erythrocyte shape/size/substance.

Hematological Conditions: Polycythemia

• Excessive red blood cell production, two primary types (relative and absolute, the latter involving abnormal bone marrow stem cell proliferation)

Alterations in Leukocyte Function

• Leukopenia relates to decreased leukocyte levels due to infectious processes and marrow suppressors.
• Leukocytosis relates to increased leukocytes due to infection or myeloproliferative disorders.

Neonatal Hematology and Skin Alterations

• Discusses hemolytic disease of the newborn (HDN) due to Rh incompatibility, its pathophysiology, diagnostic evaluation, and clinical manifestations, and skin alterations which are distinct features of the pediatric population.

Skin Alterations

• The physical examination of skin involves observations of various lesion types, distribution, progression over time, and associated signs and symptoms.
• Classifications of skin lesions may be primary (macule, papule, vesicle, bulla, plaque, nodule, pustule) or secondary (ulceration, erosion, keloid, scale, fissure, scar).
• Possible etiologies for generalized/localized rashes include drug eruptions, viral infections, toxins, immunologic conditions, chemical irritation, hives, lice and other parasites.
• Evaluation of rashes often relies on details of distribution, morphology, associated symptoms and potential medical history.

Key Points to Remember

• The presentation emphasizes the knowledge and application of pathophysiology and clinical assessment related to hematopoietic, coagulation, and skin disorders and includes considerations of the pediatric population.

This quiz covers various types of pain including neuralgia and somatic pain, as well as conditions related to anemia, such as macrocytic-normochromic anemia and disseminated intravascular coagulation. Test your knowledge on the definitions, causes, and manifestations associated with these medical terms.