NCMB 312 Midterms Reviewer PDF

This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 PAIN - Unpleasantsensory,emotionalexperienceassociatedwithactualorpotentialtissu...

This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 PAIN - Unpleasantsensory,emotionalexperienceassociatedwithactualorpotentialtissue damage. Causes distress and agony; it could be subjective in nature and protective nature. Radiating pain- travels from one body part to another Referred pain- pain felt caused by pain or injury in another part of the body Persistent pain- goes on for longer than would be expected after an injury or illness Severe pain- emergency situation deserving attention and professional treatment Intractable pain- no cure is possible Hyperalgesia/Hyperpathia- increased sensation of pain Allodynia- sensation of pain from a stimuli normally not producing pain Dysesthesia- imitates the pathology of central neuropathic pain disorders Pain threshold- least amount of stimuli needed for a person to label a sensation as pain Pain tolerance- maximum amount of pain stimuli that a person is willing to withstand Pain perception- the actual feeling of pain Pain reaction ANSresponse-automaticreactionofthebodythatoftenprotecttheindividualfrom further harm somatic: skin, muscles, joints Behavioralresponse-methodtocopewithpain(subjectiveorobjective) visceral: internal organs Nociceptive pain- physiologic pain; pain directly related to tissue damage and may be somatic or visceral Neuropathic pain- pathologic pain; pain associated with damage or malfunctioned nerve due to illness Sensitization- increased sensitivity of receptor Wind-up- progressive increase in excitability and sensitivity of spinal cord neurons Bradykinin- universal stimulus of pain Breakthrough pain- a transitory increase in pain that occurs in a background of otherwise controlled persistent pain Comfort- renewal amplification of power; freedom from pain according to Kolkava, the context of comfort occurs in physical, psychospiritual, environmental, sociocultural - Relief- the experience of having a specific need to meet - Ease- state of calm or contentment - Transcendence- state in which client rise above problems or pain Theories of Pain - PatternTheory- pain is perceived whenever stimulus is intense enough. Different sensation are detected by the same nerves - SpecificityTheory- one of the earliest known theories for pain; there is a specific nerve receptor particular stimuli (Ex: Nociceptor). Developed by Max von Frey - GateControlTheory- nerve-based theory; states that a metaphorical gate that either blocks or allows pain to travel to the spinal cord and brain. Substantia gelatinosa plays an important role in this theory - Affect Theory- it states that pain is emotional I'm go fin so e so y w o mi t ac l t e me we ~St. Tay Swi Flexcil - The Smart Study Toolkit & PDF, Ann  This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 - Parallel Processing Model- physiologic or neurologic deciphering of pain sensation and cognitive emotional proper occur along different nerve fibers Triad of Pain Perception: 1. Pain receptor- free nerve endings that respond only to intense, potentially damaging stimuli 2. Painstimuli- mechanical (trauma, tumor, pressure etc.) thermal (extreme hot and cold), Chemical (ischemia, lactic acid) 3. Pain fibers- Type A-Delta fibers (myelinated) fast and sharp pain, Type C fibers (unmyelinated) dull and slow pain Types of Pain ~By Location - Referredpain- arise from different area - Visceralpain- pain in visceral organs or internal organ; vague and not localized ~By Duration - Acute- when pain last only through expected recovery period regardless of intensity - Chronic- persistent pain; prolonged and recurrent pain that last 2-6 months or more - Cancer- results of direct malignancy or caused related to the disease or the treatment of cancer; also known as malignant pain ~By Intensity - Mild- 1-3 in scale - Moderate- 4-6 in scale - Severe- 7-10 in scale ~By Etiology - Physiological- when functioning nervous system detects tissue damage - Somatic- pain from bones, joints, connective tissues - Visceral- pain from internal organs - Cutaneous- pain over the body surface or the skin - Radiating- pain that extends from nearby area where the cause of pain is - Neuropathic- nerve damage pain or malfunctioned nerve - Peripheralneuropathic- sensitization of peripheral nerves - Centralneuropathic- results from malfunctioning nerves in the central nervous system - Sympatheticallymaintained- abnormal connection of pain fibers and sympathetic nervous system perpetuates pain - Psychogenic- no known pathologic cause; typically mental, emotional and psychological cause - Idiopathic- no known cause Clinical manifestation of Pain - Post-herpeticneuralgia- burning sensation and electric shock like pain caused by shingles or chickenpox. Zostavax can modulate the pain - Phantompain- phantom sensations - Phantomlimbpain- feeling of lost body part is present after limb amputation I'm go fin so e so y w o mi t ac l t e me we ~St. Tay Swi Flexcil - The Smart Study Toolkit & PDF, Ann  This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 - Post-mastectomypain- feeling of a lost breast is present after breast surgery - Trigeminalpain- stab-like pain; AKA Tic Douloureux - Headache- can be intracranial or extracranial - Fibromyalgia- pain all over the body - Intermittentpain- episodic pain regardless of intensity - Intractablepain- pain that resistant to cure or relief Pain Physiology - Transduction- noxious stimuli activates the afferent neurons, thus nociceptors gets excited Transmission- pain impulses travels to spinal cord (1st segment) Pain travels to ascending - pathway (2nd segment) Transmission of signal to thalamus down to somatosensory area of the cerebral cortex Perception- client becomes conscious to the pain Modulation- descending system, where neurons sends signal back to the doral wall of spinal cord; - releases substances that inhibits the painful stimuli (endogenous opioids) like endorphins, - epinephrine and norepinephrine Capsaicin-depletesthesubstanceP I'm go fin so e so y w o mi t ac l t e me we ~St. Tay Swi Flexcil - The Smart Study Toolkit & PDF, Ann  This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 Excitatory glial cells produces amino acids that can prolong pain (glutamyl n-aspartate) Pain Pathway Stimuli → Nociceptor → A Delta Fibers/C-Fibers → Ganglion → Dorsal Horn of the Spinal Cord → Spinothalamic tract → Thalamus → Cerebral cortex = Response Factors Affecting Pain Perception - Ethnic and Cultural Values - Age and Developmental Stage - Environment and support people - Previous pain experiences - Meaning of Pain Pain Response - Involuntary- Physiological response = mediated by sympathetic and parasympathetic nervous system - Voluntary- behavioral or emotional response Pain Assessment Tool C - Character - Description of pain Ex: Sharp, Burning O - Onset - When was the pain started (Acute or Chronic) L - Location - Specific region/parts of body D - Duration - When is usually pain occur or subsides S - Severity - Describe the intensity of the pain (Ex: bearable or unbearable) P - Patterns - how often does the pain attack or when it is usually occurs (Ex: Night time) A - Associating Factors - Factors that might contribute to the pain (Ex: Post-op) Wong-Baker Face Rating Scale- pain scale of 1-10 associated with facial grimace. Useful for pediatric assessment Pharmacologic Pain Management - RationalPolypharmacy- combination pharmacotherapy; one or more pharmacologic therapy with more synergistic effect - MultimodalTherapy- uses pharmacologic and non pharmacologic approach to control pain I'm go fin so e so y w o mi t ac l t e me we ~St. Tay Swi Flexcil - The Smart Study Toolkit & PDF, Ann  This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 WHO 3 Steps Analgesic Ladder Pain Management Concept - Ceilingeffect- maximum analgesic benefit of the drug is achieved and additional amount will not produce more analgesic effect I'm go fin so e so y w o mi t ac l t e me we ~St. Tay Swi Flexcil - The Smart Study Toolkit & PDF, Ann  This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 - Equianalgesia- approximately the same pain relief when the drug is given different routes. Use equianalgesic table - Placebo- produces an effect in the client because of its implicit/explicit effect and not because of its specific physical or chemical properties Types of Opiods 1. Fullagonist- has an agonist effect; no ceiling effect (Ex: Morphine) 2. Mixed agonist-antagonist- block and inactivate other opioid analgesics; it has ceiling effect (Ex: Nalbuphine HCl or Nubain) 3. Partial agonist- has ceiling effect; considered safe and has favorable side effects (Ex: Tramadol or Ultram) Types of Coanalgesics Coanalgesics- medication that is not classified as pain medication but may produce pain relieving properties and appear to be particularly beneficial for the management of neuropathic pain. Also known as Adjuvants - Tricyclicantidepressants- useful for central neuropathic pain - Anticonvulsants- useful for peripheral neuropathic conditions - Topicallocalanesthetic- alleviate neuropathic as well as other types of pain Routes of Opiates Delivery - Epiduralspace- commonly used intraspinal route of administration of pain medications - Continuouslocalanesthetics- continuous subcutaneous administration of long acting local anesthetics - Patient-controlledanalgesia- permits clients to treat their pain by self-administration of analgesia. Ex: IV route of fentanyl, Morphine, Hydromorphone (Dilaudid) Surgical Management of Pain - Neurectomy- removal of nerve supplies - Rhizotomy- removal of dorsal anterior, posterior nerve root area near spinal cord treat chronic back pain - Cordoctomy/Spinothalamictractotomy- surgical removal of the anterolateral pathway where pain is present. Useful for treatment of cancer pain - Tractotomy- resection of anterolateral pathway in the brainstem. Treats severe headache and trigeminal neuralgia - Gyrectomy- removal of post central gyrus, a part of cerebral cortex - Hypophysectomy- removal of pituitary gland. Treats cancer pain - Nerveblock- chemical interruption of nerve pathway by injecting local anesthetic nerve. Used in different surgical procedures - Sympathectomy- pathway of sympathetic division of autonomic nervous system is cut and cauterized I'm go fin so e so y w o mi t ac l t e me we ~St. Tay Swi Flexcil - The Smart Study Toolkit & PDF, Ann  This Document has been modified with Flexcil app Property of: Alfie Velasco BSN 3-Y1-11 Non-Pharmacological Interventions for Pain I'm go fin so e so y w o mi t ac l t e me we ~St. Tay Swi Flexcil - The Smart Study Toolkit & PDF, Ann