Nursing Lecture Review: Pain, Perioperative Care, and Skin Integrity

Vocabulary practice cards covering pain physiology, assessment, perioperative nursing stages and safety, as well as wound classifications, healing phases, and exudate types.

Pain

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage; always subjective and involves cognitive, affective, behavioral, and sensory components.

Acute Pain

Pain lasting from $3\text{ to }6\text{ months}$ that triggers a sympathetic nervous system (SNS) response, increasing blood pressure, heart rate, and respiratory rate.

Chronic Pain

Pain lasting $3+\text{ months}$ without surgery or $6+\text{ months}$ with surgery that triggers a parasympathetic nervous system (PSNS) response, resulting in a decrease in systolic blood pressure and heart rate.

Nociceptive Pain

A pain response to trauma, tissue damage, or inflammation, categorized into somatic, visceral, referred, or radiating pain.

Somatic Pain

A type of nociceptive pain originating from the skin, muscles, joints, or bones.

Visceral Pain

A type of nociceptive pain originating from internal organs.

Referred Pain

Pain perceived at a location different from the original site of tissue damage (such as pain felt during a heart attack).

Radiating Pain

Pain that extends or spreads outward around the primary site of origin, as seen in GERD.

Transduction

The phase of pain perception where nociceptors detect noxious stimuli and convert them into electrical signals via neurotransmitters and inflammation.

Transmission

The movement of a pain electrical signal along afferent nerves from the body to the central nervous system (CNS) and spinal cord/brain, triggering motor reflexes that cause withdrawal.

Perception

The process by which the brain translates incoming sensory signals into the conscious experience of pain.

Modulation

The process by which the brain inhibits the sensation of pain, primarily utilizing serotonin.

Pain Threshold

The lowest intensity of stimulation at which a person recognizes or perceives pain.

Pain Tolerance

The maximum level of pain intensity or duration that an individual is willing to endure.

Multimodal Analgesia

The simultaneous use of more than one pharmacological or non-pharmacological method to manage pain.

Preemptive Analgesia

The administration of analgesics prior to a painful event or intervention to minimize subsequent pain.

Perioperative Nursing

The specialized nursing role that provides care for surgical patients before, during, and after a surgical procedure.

Preoperative Phase

The perioperative stage focused on preparing the patient, verifying consent, performing diagnostic testing, conducting risk assessments, and promoting positive surgical outcomes.

Intraoperative Phase

The period beginning when the patient enters the operating room, where anesthesia is administered, monitoring is continuous, prepping and draping occur, and the surgical procedure is performed.

Time Out

A mandatory, documented intraoperative pause required before incision to verify the correct patient, correct procedure, and correct surgical site.

Postoperative Phase

The period beginning with admission to the PACU, involving interval monitoring of respiratory, circulatory, and neurologic status, alongside vital signs, dressings, and drains.

Ablative Surgery

Surgical excision or removal of a diseased body part.

Palliative Surgery

Surgery aimed at improving comfort and reducing pain without curing the underlying disease condition.

Malignant Hyperthermia (MH)

A life-threatening complication occurring during or up to $12\text{ hr}$ after anesthesia administration, characterized by severe fever, cyanosis, muscle rigidity, hypertension, tachycardia, tachypnea, hyperkalemia, dysrhythmias, and acidosis.

Sedation

A state of calm or reduced anxiety in which the patient remains able to speak, respond to commands, maintain an airway, and experience a brief period of amnesia.

General Anesthesia

A drug-induced coma with central nervous system depression, resulting in loss of consciousness, loss of sensation, amnesia, analgesia, and skeletal muscle relaxation across $4\text{ stages}$.

Regional Anesthesia

Anesthetic technique that renders a specific area of the body numb while the patient remains awake and alert; includes nerve blocks, Bier blocks, epidural, and spinal anesthesia.

Bier Block

A form of regional intravenous anesthesia that administers local anesthetic into the venous circulation of an extremity isolated with a tourniquet.

Circulating Nurse

A non-sterile operating room nurse who oversees overall room safety, assists the team, and manages environmental controls.

Scrub Nurse

A sterile surgical team member who prepares the sterile field and directly hands surgical instruments and supplies to the surgeon.

Medical Adhesive-Related Skin Injury (MARSI)

Superficial skin damage where epidermis or superficial layers are stripped or detached by medical adhesive tape or devices.

Superficial Wound

A wound that involves damage limited exclusively to the epidermal skin layer.

Partial-Thickness Wound

A wound extending through the epidermis and into, but not through, the dermal layer of the skin.

Full-Thickness Wound

A deep wound extending completely through the dermis into the underlying subcutaneous fat tissue or deeper structures.

Infected Wound

A wound characterized by clinical signs of redness, warmth, swelling, purulent drainage, odor, and a bacterial count equal to or exceeding $10^5\text{ per gram of tissue}$.

Primary Healing (Primary Intention)

The healing process occurring in wounds with clean, approximated wound edges, typical of closed surgical incisions.

Secondary Healing (Secondary Intention)

The healing process wherein a wound is left open and allowed to fill with granulation tissue from the base upward, common in chronic wounds and diabetic ulcers.

Tertiary Healing (Tertiary Intention)

Delayed wound closure where an open wound is intentionally left open for a period of time before undergoing subsequent surgical closure.

Inflammatory Phase

The initial wound healing phase lasting approximately $3\text{ days}$, involving activation of the coagulation cascade and cytokine release by platelets.

Proliferative Phase

The reparative phase of wound healing lasting several days, characterized by tissue reconstruction and the formation of vascularized granulation tissue.

Maturation Phase

The final phase of wound healing lasting up to $1\text{ year}$, characterized by collagen remodeling and scar tissue strengthening.

Undermining

Tissue destruction underlying intact skin margins along wound perimeters, frequently caused by pressure or shear and assessed using a sterile cotton-tipped applicator.

Tunneling

A narrow channel or passage extending in any direction from a wound into deeper subcutaneous tissue or muscle, creating dead space.

Serous Drainage

Clear, thin, watery wound exudate derived from blood plasma.

Sanguineous Drainage

Fresh, bright red, bloody wound exudate indicating active vascular disruption or bleeding.

Serosanguineous Drainage

A pale, pink-to-red, thin, watery wound exudate containing a mixture of clear serum and red blood cells.

Purulent Drainage

Thick, opaque, yellowish-to-green wound exudate indicating the presence of pus and active wound infection.

Hypovolemic Shock

A state of inadequate organ perfusion occurring postoperatively secondary to critical reductions in circulating blood volume from severe hemorrhage or dehydration.