Clin Phys Exam 2: O Neil Pain

Pain

-an unpleasant sensation

-symptom of underlying disease

-many influences

-____ experience

-net effect of complex interactions of the ___ and ___ neurosystem

subjective, ascending, descending

Mechanism of Pain

1. ____ pain transmission

2. pain ____

3. ___ pain transmission

afferent, modulation, efferent

Classification of Pain

1. acute (up to __ ___)

1 month

acute pain is categorized as ___ (localized, throbbing, burning) or ____ (dull, aching, deep, squeezing-referred pain)

somatic, visceral

Classification of Pain

2. subacute (__-___ ___)

1-3 months

Classification of Pain

3. chronic (>__ ___)

3 months

chronic pain is categorized as ___ (cancer, AIDS, sickle cell) or ___ (neuropathic or musculoskeletal)

malignant, nonmalignant

Assessment of Pain

-___ is pain?

-does pain ___?

-on scale of 1-10, how bad is pain?

where, move

Assessment of Pain

-have you had pain like this ___? how does it compare to usual pain?

-is pain sharp, dull, burning, shooting, aching, or stabbing?

before

Assessment of Pain

-is any part of your body __ or swollen?

-how ___ have you had this pain?

red, long

Assessment of Pain

-does pain occur or recur at a particular time?

-what makes pain ___ or ___?

-do you have any other symptoms associated with the pain?

better, worse

Pain Assessment and Monitoring

-includes pain ___ and ___ evaluation

interview, PQRST

PQRST evaluation

P: ___ or ___

palliative, precipitating

PQRST evaluation

Q: ___ of pain

quality

PQRST evaluation

R: ___, ___

region, radiation

PQRST evaluation

S: subjective description of ____

severity

PQRST evaluation

T: ___ or ___-related nature of the pain

temporal, time

It is important to obtain pertinent ___ and ___ history

medication, health

When to refer?

-headache with ___ changes or ___

vision, dizziness

When to refer?

-___ to ASA, APAP, NSAIDs

allergy

When to refer?

-pain with ___ or severe ___

nausea, vomiting

When to refer?

-weakness in ____

-red, hot, or swollen ____

limbs, joint

When to refer?

-suspected ___ or ___

-acute ___ injury, LOC

fracture, infection, head

When to refer?

-pelvic or ___ pain

abdominal

When to refer?

-last menstrual period > ___ ___ ago

6 weeks

When to refer?

-any increase or change in ___ of pain

-___ pain

character, chest

When to refer?

-___ or tooth pain (except if patient is teething)

oral

When to refer?

-___ discharge or wound dehiscence

-duration of pain is more than ___ ___

purulent, 2 weeks

Headache Danger Signals

-sudden and severe

-worsening headache

-occurs with straining or coughing

-associated symptoms; trauma

-onset after age ___

50

Headache Danger Signals

-stiff __

-fever

-___

-altered mental status

-children under ___

-glaucoma/__ pain

neck, HTN, 7, eye

Subjective Assessment of Pain-single dimensional

1. ____ ___ (1-10 numeric scale)

2. ____ ___ ___ (10cm line)

3. ____ ____ ____ ____ (mild (1-3), moderate (4-6), severe (7-10))

verbal analog scale, visual analog scale, assessment frequency and interpretation

Subjective Assessment of Pain-multidimensional

1. pain ___

2. pain ____

3. ___ of pain

4. McGill Pain Questionnaire (___)

5. ___ Assessment Tool

diary, drawings, faces, MPQ. PEG

PEG Assessment Tool Questions

-what number best describes your __ on average in the past week?

-what number best describes how pain has interfered with your ___ of life within the past week?

-what number best describes how pain has interfered with your ___ ___ within the past week?

pain, enjoyment, general activity

Objective Information-Behavioral Observation

1. ___ complaints, taking of medicine, seeking treatment

2. impaired ___ or ___ functioning

verbal, physical, social

Objective Information-Behavioral Observation

3. ___ expressions

4. ___ movements

5. vocalizations

facial, body

Objective Information-Physiological Indicators

-Acute pain can present as ___, ___, sweating, pallor, and extreme anxiety

-Chronic pain physiologic changes are uncommon

tachycardia, tachypnea

What Pain Assessment Tools Should We Use in Children?

1. _____ ____

2. ____ of pain

3. ___ indicators

poker chip, faces, physiologic

What Pain Assessment Tools Should We Use in Geriatric Patients?

1. ___ ___ ____

2. pain ____

3. pain ____

4. pain ____

visual analog scale, thermometer, diaries, drawings

Be aware of the barriers to pain reporting in Geriatric Patients:

-getting ___

-consequences

-fear of impending ___

old, illness

What Pain Assessment Tools Should We Use in Cognitively Impaired Patients?

1. ___ indicators

2. ___/___ clues

3. ____ (Pain assessment in alzheimer's disease)

physiologic, facial/body, PAINAD