super real week 9 patho

Pain and Pain Assessment

What is nociceptive or somatic pain?

Pain from tissue injury involving muscles bones skin or connective tissue; may feel dull sharp stabbing aching or throbbing.

What is visceral pain?

Pain from internal organs; often diffuse poorly localized and caused by stretching distention or ischemia.

What is radicular pain?

Burning pins-and-needles or shooting pain that follows a spinal nerve root.

What is neuropathic pain?

Pain caused by nerve injury or abnormal nerve function; often burning tingling or shooting.

What is psychosomatic pain?

Physical symptoms caused or worsened by psychological stress; the symptoms are physically felt.

A patient becomes anxious and reports nausea and a “butterfly feeling” in the stomach. What type of response is this?

Psychosomatic; emotional stress is producing physical symptoms.

How does acute pain begin?

Suddenly and unexpectedly; it is usually short-term.

What physical signs may occur with acute pain?

Guarding; increased vital signs; crying; stress; teeth clenching; and decreased respiratory rate.

How is chronic pain different from acute pain?

Chronic pain lasts longer than 6 months and usually lacks the autonomic responses of acute pain.

What behaviors may occur with chronic pain?

Depression; withdrawal; sleep problems; decreased activity; and preoccupation with pain.

What is allodynia?

Pain from a normally nonpainful stimulus such as light touch.

What is hyperalgesia?

Extreme sensitivity to a painful stimulus.

What is analgesia?

Absence of pain from a stimulus that would normally cause pain.

What is pain threshold?

The point at which a stimulus is first perceived as painful.

What is pain tolerance?

The greatest intensity or duration of pain a person is willing to endure.

What is referred pain?

Pain felt in a different area from the actual source because both areas enter the same spinal cord segment.

A patient with heart ischemia reports pain in the left arm and jaw. What explains this?

Referred pain; visceral and body-wall neurons enter the same spinal segments.

Which nerve fibers transmit fast sharp pain?

A-delta fibers.

Which nerve fibers transmit slow aching pain?

C fibers.

Which pathway carries fast well-localized sharp pain?

The neospinothalamic tract.

Which pathway carries slow diffuse aching pain?

The paleospinothalamic tract.

What does gate control theory explain?

Spinal cord pathways can increase or decrease pain transmission.

What should be assessed when a patient reports pain?

Location; quality; severity; duration; radiation; triggers; and relieving factors.

What nonpharmacologic measures can reduce pain?

Relaxation; distraction; imagery; meditation; biofeedback; heat; cold; acupuncture; and acupressure.

Headaches

What is the difference between primary and secondary headaches?

Primary headaches are disorders of the headache process; secondary headaches result from another disorder.

What are the major primary headaches in the materials?

Migraine; tension-type; and cluster headaches.

What is a typical migraine headache?

Moderate-to-severe often unilateral throbbing pain that may worsen with activity and last 4 to 72 hours.

What symptoms commonly occur with migraine?

Nausea; vomiting; photophobia; phonophobia; fatigue; dizziness; and possible vertigo.

Who is more likely to experience migraines?

Females; migraines occur more often in females than males.

What can trigger a migraine?

Stress; menstruation; illness; fatigue; missed meals; bright lights; strong smells; weather changes; and hormonal changes.

What is the migraine prodrome?

Symptoms occurring hours to days before the headache such as mood changes; fatigue; food cravings; urinary frequency; constipation; or stiff neck.

What is a migraine aura?

Temporary visual sensory language or motor symptoms before or during the headache.

What can a migraine aura look like?

Seeing colors or lights; numbness; tingling; weakness; or difficulty speaking.

What occurs during the migraine attack?

Moderate-to-severe throbbing pain often begins on one side and may spread bilaterally; nausea and light or sound sensitivity may occur.

What occurs during the migraine postdrome?

Fatigue; irritability; mood changes; or depression may continue after the headache.

What is migraine without aura?

Migraine pain without preceding aura symptoms.

What is migraine with aura?

Migraine preceded by visual sensory language or motor symptoms.

What is a tension-type headache?

Mild-to-moderate bilateral pressure or tight-band pain around the head.

What commonly contributes to tension-type headaches?

Stress; muscle tension; and tenderness of the muscles around the head.

What is associated with grinding or clenching the teeth?

Temporomandibular joint syndrome.

What is a cluster headache?

Severe unilateral stabbing or throbbing headache that occurs repeatedly in clusters.

Where is cluster headache pain usually located?

Around the eye temple or cheek on one side.

What autonomic signs may occur with cluster headache?

Tearing; nasal congestion or drainage; ptosis; and same-sided eye changes.

What is chronic daily headache?

A headache occurring daily or nearly daily; it may result from frequent analgesic use or migraine progression.

How are acute migraines treated?

Avoid triggers; rest in a dark quiet room; apply cold; and use prescribed abortive medication.

How are migraines prevented?

Avoid known triggers and use prescribed preventive therapy.

Why do NSAIDs help headache pain?

They block enzymes needed to produce prostaglandins.

Spinal Cord and Vertebral Injuries

What is a spinal cord injury?

Damage to spinal neural tissue from compression; stretching; pulling; shearing; hemorrhage; edema; or transection.

What are common vertebral column injuries?

Fractures; dislocations; and subluxations.

What is a subluxation?

Partial displacement or misalignment of a vertebra.

What occurs during a hyperextension injury?

The spine is forced backward; posterior vertebral structures or ligaments may fracture or dislocate.

What occurs during a hyperflexion injury?

The spine is forced forward; vertebral bodies disks or ligaments may fracture or dislocate.

What is an axial compression injury?

A force travels down the spinal axis and may cause shattering fractures.

What is a rotational injury?

Twisting creates shearing forces that may rupture ligaments and fracture vertebrae.

Which spinal areas are commonly injured?

C1-C2; C4-C7; and T10-L2.

What is the priority action for suspected spinal injury?

Immobilize the spine immediately to prevent further damage.

What determines the effects of a spinal cord injury?

The level; location; completeness; and severity of the injury.

What is paraplegia?

Paralysis of both lower extremities.

What is quadriplegia or tetraplegia?

Paralysis of all four extremities from a cervical spinal cord injury.

What is a complete spinal cord injury?

Loss of motor sensory reflex and autonomic function below the lesion.

What is an incomplete spinal cord injury?

Some motor sensory or autonomic function remains below the lesion.

What is central cord syndrome?

An incomplete cervical injury causing greater weakness in the upper extremities than the lower extremities.

What is Brown-Séquard syndrome?

Cord hemisection causing ipsilateral motor and touch-position loss plus contralateral pain-temperature loss.

What is cauda equina syndrome?

Compression of nerve roots below L1 causing leg deficits and possible bowel bladder or sexual dysfunction.

What findings suggest cauda equina syndrome?

Urinary retention or incontinence; bowel incontinence; saddle anesthesia; decreased anal tone; and leg weakness.

Why is cauda equina syndrome an emergency?

Persistent compression can cause permanent paralysis and bowel or bladder dysfunction.

What complications can occur after spinal cord injury?

Respiratory impairment; DVT; edema; pressure injuries; bowel or bladder dysfunction; and autonomic dysreflexia.

Spinal Shock and Autonomic Dysreflexia

What is spinal shock?

Temporary loss of motor sensory reflex and autonomic function below a spinal lesion.

Why does spinal shock occur?

Spinal trauma edema hemorrhage or transection interrupts descending brain signals and suppresses spinal reflexes.

What are the main findings of spinal shock?

Flaccid paralysis; absent reflexes; loss of sensation; atonic bowel and bladder; hypotension; bradycardia; and impaired temperature control.

How long does spinal shock usually last?

Usually about 2 to 3 days; reflex recovery may take longer.

What indicates that spinal shock is resolving?

Return of reflexes followed by hyperreflexia; spasticity; and reflex bladder emptying.

What is neurogenic shock?

Loss of sympathetic activity after cervical or upper thoracic injury causing vasodilation hypotension bradycardia and poor temperature regulation.

How is neurogenic shock different from hypovolemic shock?

Neurogenic shock causes hypotension with bradycardia; hypovolemic shock usually causes hypotension with tachycardia.

What is autonomic dysreflexia?

A sudden uncontrolled sympathetic discharge after spinal cord injury usually at T6 or above.

When does autonomic dysreflexia usually occur?

After spinal shock resolves.

What commonly triggers autonomic dysreflexia?

Distended bladder; fecal impaction; tight clothing; skin irritation; or pain below the lesion.

What are the main signs of autonomic dysreflexia?

Severe hypertension; pounding headache; sweating and flushing above the lesion; blurred vision; nausea; nasal congestion; piloerection; and bradycardia.

Why does bradycardia occur during autonomic dysreflexia?

Baroreceptors respond to severe hypertension by increasing parasympathetic activity; the injured cord prevents vasodilation below the lesion.

What is the priority action for autonomic dysreflexia?

Sit the patient upright; loosen tight clothing; check the bladder first; monitor blood pressure; and notify the provider.

Why is autonomic dysreflexia dangerous?

Severe hypertension can cause stroke; seizures; myocardial ischemia; or death.

Back Pain and Degenerative Spinal Disorders

How common is low back pain?

About 80% of people experience it during their lifetime.

What are risk factors for low back pain?

Repetitive lifting while bending and twisting; vibration exposure; obesity; osteoporosis; and smoking.

What commonly causes acute low back pain?

Muscle strain; ligament sprain; disk inflammation; or minor trauma.

What commonly causes chronic low back pain?

Degenerative disk disease; spondylolysis; spondylolisthesis; spinal stenosis; disk herniation; tumors; infection; osteoporosis; or referred visceral pain.

What is sciatica?

Radicular pain traveling along the sciatic nerve into the buttock leg or foot.

What symptoms may accompany sciatica?

Tingling; numbness; weakness; and pain radiating down the leg.

What is degenerative disk disease?

Progressive disk degeneration from aging genetic factors compression inflammation and cartilage breakdown.

What is spondylolysis?

A stress fracture or defect in the pars interarticularis of the vertebral arch.

What is spondylolisthesis?

Forward slipping of one vertebra in relation to the vertebra below it.

What symptoms may occur with spondylolisthesis?

Low back or buttock pain; leg pain; muscle spasms; and tight hamstrings.

What is spinal stenosis?

Narrowing of the spinal canal that compresses spinal nerves or the spinal cord.

What may cause spinal stenosis?

Bulging disks; arthritis; enlarged facet joints; or thickened ligaments.

What symptoms may occur with spinal stenosis?

Pain; numbness; tingling; weakness; and difficulty walking.

What is a herniated intervertebral disk?

Displacement of the nucleus pulposus or annulus fibrosus beyond the normal disk space.