Understanding Pathophysiology: Chapter 14 Pain, Temperature, Sleep, and Sensory Function

A patient asks the nurse where nociceptors can be found. How should the nurse respond? One location in which nociceptors can be found is the:

skin. Nociceptors are pain receptors and can be found in the skin. Nociceptors are not located in the spinal cord. Nociceptors are not located in efferent, but afferent, pathways. Nociceptors are not located in the hypothalamus but can be found in the meninges.

A nurse is discussing an individual's conditioned or learned approach or avoidance behavior in response to pain. Which system is the nurse describing?

Affective-motivational system. The affective-motivational system determines an individual's conditioned avoidance behaviors and emotional responses to pain. The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain. The sensory-motivational system is not a system in the response to pain. The cognitive-evaluative system overlies the individual's learned behavior concerning the experience of pain and can modulate perception of pain.

A patient scrapes both knees while playing soccer and reports sharp and well-localized pain. Which of the following should the nurse document to most accurately characterize the pain?

Somatic pain. Somatic pain is superficial, arising from the skin. It is typically well localized and described as sharp, dull, aching, or throbbing. Chronic pain has been defined as lasting for more than 3-6 months. Referred pain is felt in an area removed or distant from its point of origin; the area of referred pain is supplied by the same spinal segment as the actual site of pain. Visceral pain is pain in internal organs and lining of body cavities and tends to be poorly localized, with an aching, gnawing, throbbing, or intermittent cramping quality.

A nurse should document on the chart that chronic pain is occurring when the patient reports the pain has lasted longer than:

3-6 months.

Several years after an amputation the patient continues to sporadically feel pain in the absent hand. What type of pain should the nurse document in the chart?

Phantom limb pain. The qualities we normally feel from the body, including pain, also can be felt in the absence of inputs from the body, such as is noted with phantom limb pain. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Visceral pain refers to pain in internal organs and the lining of body cavities. Chronic pain lasts more than 3-6 months and is not associated with loss of a limb.

When planning care for a child in pain, which principle should the nurse remember? The pain threshold in children is _____ that of adults.

more variable. The pain threshold in children is lower than or the same as that of adults.

When the nurse is taking a patient's temperature, which principle should the nurse remember? Regulation of body temperature primarily occurs in the:

hypothalamus. Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the cerebrum, the brainstem, or the pituitary gland.

When the nurse is discussing the patient's cyclical temperature fluctuation occurring on a daily basis, what term should the nurse use?

Circadian rhythm. Temperature fluctuation is related to circadian rhythm, not the thermogenesis cycle, thermoconductive phases, or adaptive patterns.

A nurse wants to teach about one of the primary organs responsible for heat production. Which organ should the nurse include?

Adrenal medulla. Thyroxine acts on the adrenal medulla, causing the release of epinephrine into the bloodstream. Epinephrine causes vasoconstriction that increases metabolic rates, thus increasing heat production. Heat production does not involve the pancreas, the liver, or the heart.

Heat loss from the body via convection occurs by:

transfer of heat through currents of liquids or gas. Convection occurs by transfer of heat through currents of gases or liquids, exchanging warmer air at the body's surface with cooler air in surrounding spaces. Convection does not involve electromagnetic waves, bringing blood to skin surfaces, or molecule-to-molecule transfer.

For evaporation to function effectively as a means of dissipating excess body heat, which one of the following conditions must be present?

Moisture. Moisture must be present because heat is lost through evaporation from the surface of skin and lining of mucous membranes, a major source of heat reduction connected with increased sweating in warmer surroundings. Fever is not required for evaporation to occur, but moisture is. Pyrogens are heat producers and do not assist with evaporation, but moisture is required. Trauma is not a portion of the evaporative process of heat loss.

A patient received a prescription for a weight loss pill. One effect of the pills is to increase the release of epinephrine. Which of the following would be expected to also occur?

Increased heat production. Epinephrine causes vasoconstriction, stimulates glycolysis, and increases metabolic rate, thus increasing secondary heat production. Epinephrine does not lead to decreased vascular tone or increased skeletal muscle tone but does increase metabolic rate.

When a patient has a fever, which of the following thermoregulatory mechanisms is activated?

The body's thermostat is reset to a higher level. Fever (febrile response) is a temporary "resetting of the hypothalamic thermostat" to a higher level in response to endogenous or exogenous pyrogens. Fever is the result of the body's attempt to raise temperature, not adjust it to a lower level. When fever occurs, the temperature is raised, but the rise is due to a reset of the thermostat. Bacteria do not stimulate peripheral thermogenesis, but their endotoxins do.

Exogenous pyrogens are:

endotoxins. Exogenous pyrogens are endotoxins produced by pathogens. They are not interleukins, prostaglandins, or corticotropin-releasing factors.

Hikers are attempting to cross the Arizona desert with a small supply of water. The temperatures cause them to sweat profusely and become dehydrated. The hikers are experiencing:

heat exhaustion. Heat exhaustion results from prolonged high core or environmental temperatures, which cause profound vasodilation and profuse sweating, leading to dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia. Symptoms include weakness, dizziness, confusion, nausea, and fainting. Heat cramping is severe, spasmodic cramps in the abdomen and extremities that follow prolonged sweating and associated sodium loss. Heat cramping usually occurs in those not accustomed to heat or those performing strenuous work in very warm climates. Heat stroke is a potentially lethal result of an overstressed thermoregulatory center. With very high core temperatures (>40° C; 104° F), the regulatory center ceases to function, and the body's heat loss mechanisms fail. Malignant hyperthermia is a potentially lethal complication of a rare inherited muscle disorder that may be triggered by inhaled anesthetics and depolarizing muscle relaxants.

What is the physiological response when the body's core temperature is altered due to prolonged exposure to a cold environment?

Ischemic tissue damage. Hypothermia (marked cooling of core temperature) produces depression of the central nervous and respiratory systems, vasoconstriction, alterations in microcirculation, coagulation, and ischemic tissue damage. Hypothermia does not lead to increased respirations, CNS excitation, or increased cellular metabolism.

Which finding indicates the patient is having complications from heat stroke?

Cerebral edema and degeneration of the CNS. Symptoms of heat stroke include high core temperature, absence of sweating, rapid pulse, confusion, agitation, and coma, and complications include cerebral edema and degeneration of the CNS. Neither cramping nor alterations in calcium uptake are considered complications of a heat stroke.

Which condition would be treated with therapeutic hypothermia?

Reimplantation surgery. Therapeutic hypothermia is seen with reimplantation surgery, not malnutrition, hypothyroidism, or Parkinson disease.

A patient is undergoing a sleep lab test. When the sleep lab worker notices EEG patterns with brain activity similar to the normal awake pattern, which phase of sleep is occurring?

REM. REM sleep is called paradoxical sleep because the EEG pattern is similar to the normal awake pattern and the brain is very active with dreaming. Neither non-REM, fast wave sleep, nor delta wave sleep produces EEG patterns similar to the normal awake pattern.

Most memorable dreams occur during which sleep phase?

REM

Dreams occur during REM sleep. Dreams are not associated with non-REM, alpha wave, or delta wave sleep.

During the sleep cycle, when does loss of temperature control occur?

REM sleep. Loss of temperature control occurs during REM sleep. Loss of temperature control is not associated with non-REM sleep, light sleep, or delta wave sleep.

A 52-year-old male enters a sleep study to gather information about his sleep disturbances. He reports that his wife will not let him sleep in the bed with her until he stops snoring so loudly. He also reports feeling tired a lot through the day. When the nurse checks the chart, what is the most likely diagnosis?

Obstructive sleep apnea syndrome (OSAS

OSAS generally results from upper airway obstruction recurring during sleep with excessive snoring and multiple apneic episodes that last 10 seconds or longer. Insomnia is the inability to fall or stay asleep and may be mild, moderate, or severe. It does not involve snoring. Somnambulism is sleep-walking. Jet-lag syndrome is a disorder of waking and sleeping and does not involve snoring.

A child suffers from sudden apparent arousals in which she expresses intense fear or other emotion. Her mother reports that she seems to wake screaming, but that she is difficult to waken completely. The child most likely suffers from:

night terrors. Night terrors are characterized by sudden apparent arousals in which the child expresses intense fear or emotion. Parasomnia is unusual behaviors during sleep. Somnambulism is sleep-walking. Enuresis episodes are bed-wetting.

The ophthalmologist is teaching about the structure of the eye that prevents light from scattering in the eye. What structure is the ophthalmologist describing?

Choroid. The choroid is the deeply pigmented middle layer that prevents light from scattering inside the eye. The iris is a part of the choroid and contains the pupil, which lets light into the eye. The retina is the innermost layer of the eye.

A 50-year-old diabetic patient experiences visual disturbances and decides to visit his primary care provider. After examination, the primary care provider tells the patient that the cells that allow him to see are degenerated. Which of the following structures is most likely damaged?

Retina. The retina is the innermost layer of the eye, converting light energy into nerve impulses.

Light entering the eye is focused on the retina by the lens. The pupil allows light to enter the eye. The cornea is the portion of the sclera in the central anterior region that allows light to enter the eye.

A young child presents to the ophthalmologist for visual difficulties secondary to eye deviation. One of the child's eyes deviates inward, thereby decreasing the visual field. Which of the following diagnoses is most likely?

Entropia. The deviation of the eye inward is entropia, while deviation of the eye outward is extropia. Diplopia is double vision. Nystagmus is an involuntary unilateral or bilateral rhythmic movement of the eyes.

A patient has increased intraocular pressure. Which diagnosis will the nurse observe on the chart?

Glaucoma. Glaucoma is the result of increased intraocular pressure. Ocular degeneration results in changes in vision, but not intraocular pressure. Diplopia is double vision. Nystagmus is an involuntary unilateral or bilateral rhythmic movement of the eyes.

A 70-year-old patient presents to the primary care provider reporting loss of vision. A history that includes hypertension and cigarette smoking supports which visual diagnosis?

Macular degeneration. Age-related macular degeneration (AMD) is a severe and irreversible loss of vision and a major cause of blindness in older individuals. Hypertension and cigarette smoking are risk factors. Presbyopia is a condition associated with aging in which the patient experiences reduced near vision. In strabismus, one eye deviates from the other when the person is looking at an object. In amblyopia, vision is reduced in the affected eye caused by cerebral blockage of the visual stimuli.

Which group of people is most prone to color blindness?

Males. Color blindness, present most often in males, affects 8% of the male population and 0.5% of the female population. Neither the elderly nor children are most prone to color blindness.

A nurse is teaching about the structure that connects the middle ear with the pharynx. Which structure is the nurse describing?

Eustachian tube. The Eustachian tube connects the middle ear to the pharynx. The organ of Corti contains the hair cells. The semicircular canal is one of the three bones of the labyrinth. The auditory canal leads to the middle ear.

The most common form of sensorineural hearing loss in the elderly is:

presbycusis. Presbycusis is the most common form of sensorineural hearing loss in elderly people. Conductive hearing loss does not occur as frequently as presbycusis. Otitis media is an infection in the middle ear and is not defined as a hearing loss. Ménière disease leads to vertigo, not hearing loss.

A 15-year-old is diagnosed with an outer ear infection. Which of the following is most likely to cause this infection?

Escherichia coli. The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus.

The nurse would expect the patient with an alteration in proprioception to experience vertigo, which is manifested by:

sensation that the room is spinning. Alterations in proprioception are manifested by a sensation that the room is spinning, not headache, light sensitivity, or loss of feeling in the lips.

Which system modulates a patient's perception of pain?

Cognitive-evaluative system. The cognitive-evaluative system overlies the individual's learned behavior concerning the experience of pain and can modulate perception of pain. The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain. The affective-motivational system determines an individual's conditioned avoidance behaviors and emotional responses to pain. The reticular-activating system does not play a role in the perception of pain.

While planning care for infants, which principles should the nurse remember? (select all that apply) Infants have problems with thermoregulation because they:

cannot conserve heat.

do not shiver. Infants cannot conserve heat; thus, they have a problem with thermoregulation because of their small size. Infants are unable to shiver, do have the ability to sweat, have an increased metabolic rate, and have little subcutaneous fat

A patient asks the nurse how often REM sleep occurs. The nurse responds, "About every _____ minutes."

REM sleep occurs every 90 minutes.

Fever of unknown origin (FUO) is characterized by a fever of ____° F or greater.

FUO is a fever of greater than 38.3° C (101° F) that remains undiagnosed after 3 days of hospital investigation or three or more outpatient visits