NURS2037 Health Variations 1: Module 1 Overview

• Overview of NURS2037 "Health Variations 1" and Module 1: The Periop Nurse, Pain, and Pain Management.

Subject Coordinators

• The Subject Coordinator is Philippa Mann.
• The Deputy Coordinator is Soumya Joseph.
• The contact email is [email protected].

Expectations of Staff

• Staff will be prepared and on-time.
• Professional, clear, and respectful communication will be provided.
• Questions will be answered and assistance will be provided to find the right answers.
• Consults will be available in person or via Zoom.
• Staff aim to be approachable and help students achieve their best.

Expectations of Students

• Students should arrive on time.
• Students must be prepared to engage in class and study; this is the student's learning.
• Pre-readings and the StintBook (HV1 interactive workbook on vUWS) should be utilized.
• Communication with tutors about any issues and seeking help early is expected.
• Students should be respectful of their tutor and peers.
• The learning space should be safe and professional.
• Tutorials are 1/5 of expected subject engagement, which means read, study and prepare with a study load of 10 hours per week for a 10cp subject.

Subject Outline

• The subject outline can be found on vUWS.
• The outline includes: Contact details and policies, semester structure, assessments, and attendance information.

Interactive Workbook

• Open the Interactive Workbook on vUWS.

How to Open the Interactive Workbook on vUWS:

• Open vUWS.
• Open NURS2037.
• Go to Learning Modules.
• Click on the Stintbook link.
• Go to the current week’s module to get ready to learn.
• The online workbook is specifically designed for NURS2037 Health Variations 1.

Resources for the Week:

• Craft & Gordon Textbook
• HV1 interactive workbook
• Readings and resources on vUWS
• NSW Health website
• Australian perioperative website

Perioperative Nurse

• Class brainstorm- what does the term perioperative mean and the roles of a perioperative nurse?

Pain Definition

• An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (The International Association for the Study of Pain).
• Pain results from complex brain processes influenced by physical (nociceptive and neuropathic), psychological, and environmental factors.
• Pain is a subjective individual human experience.
• Attitudes, beliefs, and personality can strongly affect a person's pain experience.

Pathophysiological Processes of Pain

• Tissue injury leads to mediator release and inflammation.
• Peripheral stimulus activates nociceptors.
• Signal Transduction occurs.
• Peripheral nerves conduct the signal.

Central Pain Pathway

• The signal travels to the dorsal root ganglion and then to the spinal cord.
• It ascends to the brain stem, thalamus, then the cortex for central perception.
• Descending inhibitory pathways modulate the pain.

Pain Perception Steps

• Contact with Stimulus: Stimuli can be mechanical (pressure, punctures, cuts) or chemical (burns).
• Reception: A nerve ending senses the stimulus.
• Transmission: A nerve sends the signal to the central nervous system involving several neurons.
• Pain Center Reception: The brain receives the information for further processing and action.

Anatomy of the Pain Pathway

• Transduction: Noxious stimuli (chemical, mechanical, or thermal) convert into electrical energy.
• Transmission: Electrical stimulus is sent to the dorsal horn of the spinal cord and synapses at the 2nd order neuron.
• Modulation: Inhibition vs amplification of signal (facilitated by EAA).
• Perception: Conscious awareness of pain, a culmination of previous processes within individual experiences.

Ascending/Descending Pain Pathway

• Ascending Pathway: Stimulus travels "up" to the brain. This involves substance P, prostaglandins, serotonin, and acetylcholine being related following tissue damage and inflammation. This results in a peripheral stimulus activating a nociceptor. The signal is transduced and sent via the peripheral nerve via conduction to the dorsal root ganglion in the spinal cord, moving up to the brain.
• Descending Pathway: Brain processes and then sends a response "down" to modulate the pain.

Pain Signal Receptors

• Three classes of nociceptors exist.
• Aδ mechanosensitive receptors: lightly myelinated, faster conducting neurons that respond to mechanical stimuli (pressure, touch).
• Aδ mechanothermal receptors: lightly myelinated, faster conducting neurons that respond to mechanical stimuli (pressure, touch) and to heat.
• Polymodal nociceptors (C fibers): unmyelinated, slowly conducting neurons responding to a variety of stimuli.

Nociceptors

• Nociceptive pain arises from an identifiable lesion causing tissue damage, stimulating nociceptors in somatic or visceral structures.
• Nociceptors are receptors in tissues activated specifically by painful stimuli.
• This "noxious" information transduces into an electrical signal, transmitted from the periphery to the central nervous system along axons.
• High-threshold mechanoreceptors (HTM) respond to mechanical deformation
• Polymodal nociceptors (PMN) respond to a range of tissue-damaging inputs.

Nociceptor Nerve Endings

• Nociceptors are free nerve endings of nerve fibres.
• There are two main fibre types: Aδ and C fibres.
• Aδ fibres: Myelinated with a low threshold for firing and fast conduction speed, responsible for transmitting the first pain felt.
• C fibres: Unmyelinated with slow conduction speed; responsible for the secondary (dull, deep, throbbing) pain and have large receptive fields, resulting in poor localization of pain.

Stages of Pain Perception

• Pain Sensitivity
• Signals are transmitted from the periphery to the dorsal horn (DH) of the spinal cord via the peripheral nervous system (PNS).
• Signals are then transmitted to the higher brain via the central nervous system (CNS).

Brain Areas Involved in Pain Perception

• Cortical awareness: Somatosensory cortex, insula, and anterior cingulate cortex.
• Subcortical structures: Hypothalamus, Thalamus, Amygdala, Hippocampus.

Pain Perception Revision

• Transduction: Noxious stimuli causes cell damage, releasing sensitizing chemicals (prostaglandins, bradykinin, serotonin, substance P, histamine), which activate nociceptors to generate action potentials.
• Transmission: Action potentials continue from the site of injury to the spinal cord, then to the brainstem and thalamus, and finally to the cortex for processing.
• Perception: Conscious experience of pain.
• Modulation: Neurons originating in the brainstem descend to the spinal cord and release substances (e.g., endogenous opioids) that inhibit nociceptive impulses.

Types of Pain:

• Acute Pain: Short-term pain following surgery, trauma or other conditions, acting as a warning signal.
• Sub-Acute Pain: Pain progressing towards chronic pain but potentially preventable; known as the transition phase.
• Recurrent Pain: Pain that occurs on a cyclical basis, such as migraines or pelvic pain.
• Chronic Pain: Pain lasting beyond the expected healing time, associated with increased pain experience beyond the injury area, or existing without a clear reason.
• Visceral Pain: Pain from internal organs, described as "colicky," often accompanied by nausea and autonomic disturbance.
• Somatic Pain: Caused by stimuli like cutting or crushing, unlike visceral pain which responds to distension, inflammation, and ischemia.

Neuropathic Pain

• Neuropathic Pain: Abnormal pain and the nervous system response to injury.
• Pain or abnormal sensation initiated or caused by a primary lesion or dysfunction of the nervous system.
• It can manifest as motor, sensory, or autonomic dysfunction.
• Patients may report spontaneous pain without an obvious peripheral stimulus.
• The pain may be paroxysmal or continuous, often described as burning, tingling, shooting, stabbing, or numb.
• An example of neuropathic pain is shingles.

Neuropathic Pain Characterisation

• It is characterized by evoked pains.
• Allodynia: Painful response to a normally innocuous stimulus.
• Hyperalgesia: Pain of abnormal severity following a noxious stimulus.
• Hyperpathia: Exaggerated and prolonged response to stimulation, potentially delayed and explosive.
• Hyperaesthesia: Increased sensitivity to stimulation.
• Dysaesthesia: Evoked or spontaneous altered sensation with discomfort rather than pain.

Sympathetic Nervous System Role in Neuropathic Pain

• Abnormal sympathetic outflow to an injured extremity in response to neuropathic pain includes:
  • Abnormal regulation of vasculature
  • Oedema
  • Discolouration
  • Changes in sweating
  • Temperature changes
  • Trophic changes in skin
  • Reduced motor activity in the affected part

Pain Information From the Face

• Pain information is received via the trigeminal nerve.

Pain Relief

• Types of pain relief.

Pharmacological Pain Relief

• Non-opioid analgesics (aspirin, acetaminophen, ibuprofen): Act at the site of pain.
• Opioid analgesics: Act on synaptic transmission in the central nervous system by binding to natural opioid receptors.
• Adjuvant analgesics (co-analgesics): Primarily used for treating another condition but also relieve pain.
• Anti-epileptic drugs: Reduce membrane excitability and action potential conduction in neurons of the central nervous system.

Pain Relief Action Sites

• Opioids and Alpha 2 agonists act on the brain and spinal cord.
• Local anesthetics block nerve conduction.
• Anti-inflammatory drugs relieve pain at the site of injury.

Nursing Considerations for Opioids

• Monitor patients on opioids for constipation, pain relief, side effects, and appropriate usage.
• Monitor blood pressure, heart rate, and respiratory rate, especially in the first 24-72 hours after starting or increasing the dosage.

Non-Pharmacological Pain Relief:

Nonpharmacologic Interventions (pediatric and adult)*

• Physical (Sensory) Interventions:

  • Comfort positioning
  • Cutaneous stimulation
  • Nonnutritive sucking
  • Pacifier +/- sucrose solution
  • Pressure, massage
  • Hot or Cold treatments

• Cognitive-Behavioral Interventions:

  • Psychological preparation, education, or coaching
  • Distraction tools: movies, games, videos, apps, toys with light/sound, bubbles
  • Relaxation techniques (breathing, meditation, etc.)
  • Music and singing
  • Guided imagery
  • Conversation and therapeutic language

Exporting StintBook Notes

• Export your StintBook document from today as a Word document to your computer to continue making study notes without internet.
• To export the document, click "Create Document" then follow the prompts to Save to a designated folder on your computer.
• If it appears in red and says there is a field missing, go back to the tutorial work and mark it with an asterisk or similar to come back to later, then it will allow you to export.