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NS 233 Theory Exam #1 Review.
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NS 233 Theory Exam #1 ReviewBlueprint: 2 EKG, 6 Pain, 6 Mobility, 2 Glaucoma, 4 Cataracts, 3 Hearing, 7 Multiple
Sclerosis, 7 Parkinson’s, 7 CVA/stroke, 6 Rheumatoid Arthritis, 1-2 Math questions
Sensation Concept
Pain
o Whatever the person experiencing the pain says it is, existing whenever
the person says it does
o Complex, multidimensional experience that can cause suffering and
decreased quality of life
o Pathophysiology
Alteration of somatosensory system
Complex multidimensional experience that cause suffering and
decreased quality of life
Nociception: physiologic process by which information about
tissue damage is communicated to CNS
Transduction
o Conversion of noxious mechanical (surgical
incision), thermal (sunburn), or chemical (toxic
substances) stimulus into an electrical signal (action
potential)
o Noxious (tissue damaging) stimuli cause release of
numerous chemicals such as hydrogen ions,
substance P, and ATP into damaged tissues
o Other chemicals released from mast cells
(serotonin, histamine, bradykinin, prostaglandins)
and macrophages
o Chemicals activate Nociceptors (specialized
receptors or free nerve endings) that respond to
painful stimuli
o Activation of nociceptors results in action potential
that is carried from nociceptors to spinal cord
Transmission
Site of injury to spinal cord
Spinal cord to brainstem and thalamus
Thalamus to cortex for processing
Process by which pain signals relayed from
periphery to spinal cord then to brain
Perception
o Occurs when pain is recognized, defined, and
assigned meaning by individual experiencing pain
o Conscious experience of pain
o Nociceptive input perceived as pain
Modulation
, o Neurons originating in brainstem descend to spinal
cord and release substances that inhibit nociceptive
impulses
o Activation of descending pathways that exert
inhibitory or facilitatory effects on transmission of
pain
o Depending on type and degree, nociceptive stimuli
may or may not be perceived as pain
o Occur at level of periphery, spinal cord, brainstem
and cerebral cortex
o Descending fibers release chemicals (GABA,
serotonin, norepinephrine, endogenous opioids) that
inhibit pain transmission
o Classification
Subjective: what patient says it is
Severe, radiating, intermittent, constant
Nociceptive Pain
Caused by damage to somatic or visceral tissue
Somatic pain: further categorized as superficial or deep
o Superficial pain: arises from skin, mucous
membranes, and subcutaneous tissues. Sharp,
burning or prickly
o Deep pain: deep, aching or throbbing. Originates in
bone, joint, muscle, skin, or connective tissue
Visceral Pain: comes from activation of nociceptors in
internal organs and lining of body cavities
o Visceral nociceptors respond to inflammation,
stretching, and ischemia
o Examples: appendicitis, pancreatitis, cancer affecting internal organs,
irritable bowel and bladder syndrome
Neuropathic Pain
Caused by damage to peripheral nerves or structure in CNS
Trauma, inflammation, herniated disc, metabolic diseases,
alcoholism, infections of nervous system, tumors, toxins,
and neurologic diseases
Deafferentation pain: loss of afferent input secondary to
peripheral nerve injury or CNS damage
Sympathetically maintained pain: associated with
dysregulation of ANS
Central Pain: caused by CNS lesions or dysfunction
Complex regional Pain syndrome (CRPS): dramatic
changes in color and temperature of skin over affected limb
or body part accompanied by intense burning, skin
sensitivity, sweating and swelling
Treatment: not well controlled by opioids alone
o Phantom limb pain, complex regional pain syndrome
, Acute Pain
Postoperative, labor, trauma pain
Treatment includes analgesics for symptom control and
underlying cause
Diminishes over time as healing occurs
Pain that persists and develops into chronic pain:
postherpetic neuralgia
Chronic Pain
Lasts for longer periods, longer than 3 months
Disabling and often accompanied by anxiety and
depression
o Assessment
Onset
When did it begin? How long does it last (duration)? How
often does it occur (time)? What were you doing when pain
started?
Provoking or Palliating Factors
What brings it on? What makes it better? What makes it
worse?
Quality
What does it feel like? Can you describe it (throbbing,
stabbing, dull)?
Region and Radiation
Does your pain radiate? Where does it spread? Point to
where it hurts the most. Where does your pain go from
there?
Severity
What is the intensity (pain scale of 1-10) of symptom?
Right now? At worst? Are there any other symptoms that
accompany pain?
Time and Treatment
When did symptoms first begin? What medications are you
currently taking for this? How effective are these? Side
effects?
Understanding and Impact
What do you believe is causing this? How is this affecting
your ADLs, you, and/or family? Do you have any other
concerns?
Crucial part in role of nurses
Goal
Medication
Non-Pham option
Do pharm and non-pharm at same time
Reassess
30-60 mins then reassess then try non-pharm or
collaborative care if doesn’t work
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