Pathophysiology Exam 2

CH. 3, 4, 5, 6

pain

experience by the nervous system, 5th vital sign, most common reason people seek medical attention, transmitted through nervous system, no objective comparative

pain management barriers

1. healthcare systems: slow to hold itself accountable for assessing and relieving pain

2. healthcare professionals: lack of education and concern regarding addiction/pts

   1. Clients/patients: addiction, stigma, cost, access

pain assessment and opiods

1. need a directive/plan to get off of: patient centered

2. what treatment is appropriate for the patient?

3. what is the severity?

4. what stage of recovery are they in?

types of pain

acute: warning that something is wrong

chronic: persistent pain that alters daily patterns, and has a direct implication on quality of life

• nociceptive: tissue pain, mechanical/thermal/musculoskeletal stimulus, damage to nerves and sends message to spinal cord

• neuropathic: lesion/disease, follows the dermatomes, sharp/stabbing/burning/cold/numbing

angina: myocardial infarction, blood supply to heart disrupted

breakthrough: recurrence of chronic pain that used to respond to pain management

malignant: pain from cancer or cancer treatment

phantom limb: pain from an amputated body part

psychogenic: real pain without a physical cause, emotional

Experience of Pain

Early experiences: shape how you view/fear pain and learn what helps/does not help pain and how to avoid pain

Cultural background: could influence when and if they seek treatment, etc

Anxiety and depression: longer duration of pain may mean an increased depression/anxiety or chance of

Age: slower metabolism and greater ratio of body fat to muscle mass could dictate dosage

Gender: females exhibit greater sensitivity and attach an emotional aspect to the pain they experience and men concentrate of physical sensations

Pain Perception Stages

1. Transduction: trigger (inflammatory cells) nociceptors and converts the electrical signal. detect noxious/potential damage and inflammation lowers the stimulus/threshold

2. Transmission: signal to CNS, afferent myelinated A Delta fibers are initial, and C fibers are the dull/ache after

3. Ascending Process: spinal cord talking to brain. thalamus, limbic (unpleasant), cortical (attention/decision)

4. Perception:

5. Modulation: CNS control output, efferent to PNS; nociceptive transmission. intermake andagones opiods (endorphins/enkephalins) touch (direct attention)

Gate Control Theory

P.D. Wall and Ronald Melzack

pain is a balance between information traveling to the spinal cord through large nerve fibers and small nerve fibers.

substantia gelatinosa (gate): blocks signal to the transmission cell (t cell) connected to the brain. with pain stimulation small nerve fibers (a delta/c fibers) and activate t cell neurons which transmits to the brain. beta fibers = touch and are not pain and release endorphins and enkephalins

Assessment of Pain

P=place (point to the location)

A=amount (0-10 scale)

I=interactions (what makes it worse)

N=neutralize (what makes it better)

Medications

Analgesics:

• opiods: calm nociceptor transmission, close monitoring, morphine like drugs

• nonopiods: tylenol (pain), NSAID (non-steroidal anti inflammatory ibuprofen), acetaminophen

Adjuvant Analgesics:

• depression/seizure control/corticosteroid meds for pain

Patient Controlled Analgesia Pump: clients administer own pain meds and gives some control, designed not to release more than the prescribed amount in a set time, IV

Intrathecal: medicine pump to intrathecal space around spinal cord

Placebos: effect because of intent, works because the person believes it works, natural production of endorphins and enkephalins, mind/body connection

Complementary Therapies

Physical Therapy: improve movement and body function that was impaired by injury or disability, ultrasound, warm water

Biofeedback: voluntary control over normally involuntary physiological functions, increase blood flow and reduce muscle tension

Relaxation: body awareness and visual imagery, combat fatigue and muscle tension

Imagery: produce relaxation and increase production of endorphins and enkephalins (placebo)

Hypnosis: psychogenic and other pain management, readily accepted suggestions to lower pain by a hypnist or self hypnosis

Massage: manipulation/methodical pressure/friction/kneading of body to stimulate blood flow, relaxation, and increase endorphins and enkephalins

Humor/Laughter/Play

Music

Acupuncture

Aromatherapy

Therapeutic Touch and Reiki

Tai Chi and Yoga

Infectious disease

caused by micro-organisms that can transfer to new individuals

communicable diseases

READILY TRANSMITTED from one person to another

AIDS

transmitted: sexual contact, semen, blood, needles, placenta, breast milk

incubation: antibodies appear within 1-3 months of infection

Anthrax

transmission: break in skin, inhaled, consumed

incubation: 1-43 days

botulism

transmission: contaminated food, wound or break in skin

incubation: 6hrs-10 days

common cold (coryza)

transmission: airborne respiratory droplets, hand to hand, contact with items

incubation: 2-5 days

COVID-19

transmission: airborne respiratory droplets, contact with items

incubation: 2-14 days

Diptheria

transmission: intimate contact with nose/throat/eye/skin lesion discharge

incubation: 2-5 days

E-coli

transmission: eating/drinking contaminated things, swimming in sewage

incubation: 4-14 days

Erythema infectious (fifth disease)

transmission:respiratory secretion, contact

incubation: 4-14 days

H1N1 influenza

transmission: respiratory secretions, hand to hand contact

incubation: 1-7 days

infectious diarrheal diseases

transmission: oral fecal route

incubation: 48 hours

influenza

transmission: respiratory secretions contact

incubation: 1-3 days

methicillin resistant staphylococcus aureus

transmission: contact

incubation: 1-10 after entering bloodstream

Mumps

transmission: saliva/airborne

incubation: 18 days

Pertussis (whopping cough)

transmission: respiratory secretions, contact

incubation: 7-10 days

plague (pneumonic)

transmission: contact, respiratory droplets

incubation: 1-6 days

Rubeola (hard measles)

transmission: respiratory droplets

incubation: 8-13

Rubella (3 day measles)

transmission: respiratory droplets

incubation: 14-23

Smallpox

transmission: respiratory droplets, dried scales, contact

incubation: 10-14 days

Varicella (chickenpox)

transmission: respiratory secretions, contact

incubation: 13-17 days

viral hemorrhagic fevers

transmission: airborne, contact

incubation 2-21 days

Reasons for emerging and reemerging

1. Microorganisms adapt/mutate

2. vaccination pools change

3. population immunity changes

4. International travel/commerce

5. Climate change/weather

6. Public health infrastructure

7. antibiotic resistance

8. displacement

causes

bacteria: single cells, antibiotics

viral disease/infection: require host cell and hijack DNA into cells for replication

fungi: superficial infections (skin), can cause systemic whole body infection in the immunocomprimised

The host matters

age/genetics/immune systems

transmission

respiratory secretions from droplets

direct physical contact with persons or secretions

indirect contact: touching an object that has droplets

fecal-oral: gastrointestinal (e coli), contaminated food/water sources

blood/bodily fluids: aids/sex

vector borne: from insect/bug (malaria/Lyme disease/mosquitos)

incubation

time it takes for symptoms to appear (days/weeks/months) can be contagious and asymptomatic, different strands change this

reemerging

surging and going back down (flu)

emerging

incidence where new is coming

antimicrobial resistance

cause of a number of nosocomial disease/sepsis(systemic outward symptom)