Pain Health Assessment 308
The patient with a broken leg reports swelling, stiffness, and a burning pain in the leg.
The nurse also finds that the patient has brittle nails along with the pale, dry, and shiny
skin. What does the nurse infer from these findings?
The patient has reflexive sympathetic dystrophy (RSD).
The patient with a broken leg may suffer from a nerve injury resulting in reflexive
sympathetic dystrophy (RSD). The presence of swelling, stiffness, and a burning pain at
the site of injury, along with brittle nails, pale, dry, and shiny skin all indicate that the
patient has RSD. This is caused by impaired functioning of the sensory, motor, and
autonomic nervous system. Osteoarthritis is a degenerative joint disease which is
caused by inflammation of the synovial membrane, not impaired nervous system
functioning. The patient with Alzheimer disease has loss of memory and muscle
weakness, but does not have pale, dry, and shiny skin. Acute coronary syndrome
occurs due to reduced flow of blood to the heart. It manifests as chest pain, dyspnea,
and diaphoresis.
Which pain assessment tool is most useful to evaluate the intensity of pain in children?
Faces pain scale
The Faces pain rating scale is a pain assessment tool that can be used to evaluate the
intensity of pain in children. It consists of drawings of six faces with different facial
expressions. Each face depicts a different level of pain intensity, from no pain to a lot of
pain. The children are asked to select one picture that matches their facial expression
while experiencing pain. In the numeric rating scale, the patients are asked to rate the
intensity of the pain they are experiencing. The visual analogue scale consists of a 10
cm horizontal line with markings for "no pain" to "worst imaginable pain." While using
the verbal descriptor scale, the nurse asks the patient to describe the pain. As cognition
and communication skills are not well developed in children, the numeric rating scale,
visual analogue scale, and verbal descriptor scale are not useful for assessing pain in
these patients.
Which patients will require antidepressant therapy for pain management?
A patient with trigeminal neuralgia
A patient with diabetic nephropathy
A patient with fibromyalgia
Antidepressants are required for the management of chronic pain conditions.
Fibromyalgia involves chronic widespread pain and allodynia, a heightened and painful
response to pressure. Antidepressants will help to alleviate the pain, depression,
fatigue, and anxiety associated with the disease. A patient with trigeminal neuralgia has
chronic pain manifested in the form of severe stabbing pain in the facial muscles. A
patient with diabetic neuropathy, who has chronic pain symptoms such as burning pain
,in the feet bilaterally, also benefits from this therapy. A patient with osteoarthritis and a
sports injury may not require antidepressant medications because the damage is due to
tissue degeneration, not nerve degeneration.
The nurse is reviewing the prescriptions of patients in a health care setting. Which
patient has an effective treatment?
Patient A
Patient A would experience nociceptive pain. Corticosteroids reduce the inflammation
and provide pain relief from nociceptive pain. In Patient B, liver metastasis may cause
visceral nociceptive pain. Antineuroleptic drugs act on damaged nerve fibers and would
be effective for neuropathic pain, but are not an effective treatment for liver metastasis.
In Patient C, distal polyneuropathy may cause neuropathic pain. NSAIDs treat pain by
decreasing the prostaglandin levels, but they do not show effect on damaged nerve
fibers. Patient D with Herpes zoster infection would experience neuropathic pain.
Muscle relaxants are effective in the treatment of muscle sprain that results in
nociceptive pain. Neuropathic pain cannot be alleviated with muscle relaxants.
A patient with a severe muscle cramp tells the nurse, "The pain is a little better when I
massage the muscle or apply a cold pack." Which criterion of the PQRST method of
pain assessment is addressed in the patient's statement?
Provocation/Palliation
PQRST is a pain assessment scale; it stands for Provocation/Palliation,
Quality/Quantity, Region/Radiation, Severity Scale, and Timing. Because the patient is
describing methods that provide comfort and relieve the pain, it indicates that the patient
is addressing Provocation/Palliation. If the patient reports about severity of pain on a
scale of 0 to 10, then it indicates that the patient is addressing Severity. When
addressing the Quality/Quantity of the pain, the patient describes the pain felt. If the
patient reports about the site of pain, then the patient is addressing Region/Radiation.
What are the signs of somatic pain?
Nausea
Sweating
Tachycardia
Somatic pain is caused by the transmission of pain impulses from ascending nerve
fibers to the autonomic nervous system (ANS). This results in increased autonomic
functioning. An increase in autonomic functioning triggers the chemoreceptor zone in
the brain that causes nausea and vomiting. It also causes sweating, and increases
heart rate, resulting in tachycardia. Increased autonomic functioning increases blood
pressure and causes hypertension, not hypotension. Due to vasoconstriction, the
patient may exhibit pallor, but not hyperpigmentation.
, The nurse is caring for a patient who has undergone liver transplantation. The patient
reports severe lower back pain while standing for the past 2 days. Which type of pain is
the patient experiencing?
Incident pain
Incident pain is a type of acute pain caused due to certain body movements. Lower
back pain while standing indicates that the patient is having incident pain. If a patient
experiences lower back pain for more than 6 months, which is not the case here, then it
indicates chronic pain. Breakthrough pain occurs in patients who undergo opioid
therapy; the patient experiences sudden pain due to the reduced half-life of the
medication. Malignant pain is a type of chronic pain; it is induced by tissue necrosis or
stretching of an organ by the growing tumor.
The nursing instructor is teaching about the transduction phase of nociception to a
group of nursing students. Which statement, if made by a nursing student, indicates
effective teaching?
"The peripheral tissue secretes histamine and prostaglandins during this phase."
The perception of pain depends on the functioning of nerve fibers. Nociception is
categorized into four phases: transduction, transmission, perception, and modulation. In
the transduction phase, the peripheral tissues secrete neurotransmitters such as
prostaglandins and histamines at the site of the injury. These neurotransmitters transmit
the pain impulses from the sensory nerve fibers to the spinal cord. During the
perception phase, the pain stimuli are received and interpreted by the higher cortical
structures of the brain and cause the sensory perception of pain. During the
transmission phase, the endogenous opioids are secreted in the brain, and block the
pain signals by activating opioid receptors. If the opioid receptor does not block the pain
impulse during transmission, then the impulse moves from the spinal cord to the
thalamus.
The nurse is assessing a pregnant patient at 20 weeks of gestation. On reviewing the
3D magnetic resonance reports of the fetus, the nurse finds that the cerebral cortex of
the fetus is not well developed. What does the nurse interpret from these findings?
The fetus will not experience emotional pain until 30 weeks of gestation.
The cerebral cortex plays an important role in the perception of pain. The fetal brain
usually develops by the 20th week of gestation, and the fetus experiences the same
intensity of pain as an adult. If the cerebral cortex is not well developed, the fetus will
not experience any emotional pain until the 30th week of gestation. Due to impaired
development of the cerebral cortex, the fetus will not have increased sensory
perceptions and will not experience any somatic pain. At the time of birth, the fetal brain
is developed enough to experience pain. Therefore, the nurse should not interpret that
the fetus will not experience cutaneous pain after its birth. Because the cerebral cortex
of the fetus is not well developed, the fetus will have reduced conscious awareness and
may not experience any pain until 25 weeks of gestation.
