nursing assessment: pain

Four processes of pain

transduction
transmission
perception
modulation

what are pain receptors

nociceptors

transduction

activation of the nociceptors

transmission

nerve signals carried via A-delta and C-fibers

nociceptors are found basically everywhere besides…..

the brain

a delta

myelinated fibers producing sharp pain

c fibers

unmyelinated fibers producing dull pain

perception

brain becomes aware of pain

modulation

body alters pain signals

NSAIDS effect which pain process

transduction

opioids effect which pain process (s)

percpetion/modulation

gate control theory

pain signas can be modulated by non-painful input

emphasizes emotions and distractions

Spinothalamic tract

2nd order neurons travel up to ST tract → thalamus —> somatosensory cortex

in charge of the localization of pain

spinoreticular tract

2nd order neurons —> reticular formation → thalamus, hypothalamus, and the cortex

response for the emotional aspect of pain

face pain signals

trigeminal nerve

types of pain

acute
chronic
cancer
phantom
referred
radicular

acute pain

rapid in onset, last less than 6 months
varies in intensity and duration
protective in nature

chronic pain

limited, intermittent, or persistent longer than 6 months

last beyond the normal healing periods

periods of remission

cancer pain

acute, chronic, or both

phantom pain

pain coming from a body part that is no longer there

refferred

pain that is felt from a part of the body that is not the actual source of problem

radicular pain

irritation or compression of the nerve root

ex: sciatica

Eitologies of pain

nociceptive - tissue injury
neuropathic
inflammatory
psychogenic
mixed/cancer

somatic pain

skin, muscles, joints

visceral pain

internal organs

neuropathic pain

due to nerve damage

ex: diabetic neuropathy

inflammatory pain

response to immune response

psychogenic pain

originating from psychological distress

patient responses to pain

physiologic
behavioral
emotional

physiologic responses

increased HR, BP, RR, pupil dilation

behavioral responses

crying, guarding, grimacing

emotional responses

anxiety, fear, hopeless

describing pain

quality
severity
periodicity

factors influencing pain

cultural
gender and age
anxiety and stress
past experiences

subjective data pain assessment

onset, duration, location, quality, and intensity

objective pain assessment

non-verbal cues, vital signs, physical assessment

Numeric Rating Scale (NRS)

For people who understand 0-10

FLACC

Behavioral pain assessment for infants to children age 7 years old

PAINAID

Dementia patients, patients who can’t express or tell pain

NIPS

neonatal pain scale

Wong-banker Pain rating

Children who can’t tell us a number 0-10

Children should avoid being prescribed ____ in regards to pain

aspirin

Older adults may…..

underreport pain, atered drug metabolism

ATC

around the clock
give meds until not needed

PRN

take as needed

four types of administration methods

oral
IV
topical
epidural

PCA

patient controlled analgesia

Numeric Sedation Scale (NSS)

Used to monitor opioid side effects

What are the phases of the NSS

S
1

2

3

4

S on NSS scale

sleep, easy to arouse

no action necessary

1 on NSS scale

awake and alert

no action necessary

2 on NSS scale

occasionally drowsy, but easy to arouse,

no action necessary

3 on NSS scale

frequently drowsy, drifts off to sleep during conversation,


reduce dosage

4 on NSS scale

Somnolent with minimal or no response to stimuli, discontinue opioid,


action:consider of naloxone