Nupd 400 chapter 10 pain
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  • Note to faculty: Because of the amount of text used on this screen, each bullet point is set to appear on a mouse click. This will prevent your students from reading ahead and being distracted.
  • Note to faculty: Because of the amount of text used on this screen, each bullet point is set to appear on a mouse click. This will prevent your students from reading ahead and being distracted.
  • Note to faculty: Because of the amount of text used on this screen, each bullet point is set to appear on a mouse click. This will prevent your students from reading ahead and being distracted.
  • Correct Answer: B. Visceral.
  • Correct Answer: D. Patients with persistent pain may show few or no outward signs of pain.

Nupd 400 chapter 10 pain Presentation Transcript

  • 1. Chapter 10
  • 2. What is Pain?
    • Highly complex & subjective experience originating in CNS or PNS or both
    • Nociceptors detect painful stimuli in skin, connective, tissue, muscle and throacic, abdominal & pelvic viscera  CNS
    • Stimuli sent to CNS via:
      • A δ fibres
          • Myelinated & larger in diameter
          • Transmit pain quickly
          • Described as localized, short-term and sharp, shooting
      • C fibres
          • Nonmyelinated & smaller in diameter
          • Transmit pain more slowly
          • Described as diffuse, dull, aching, throbbing, persitent after initial injury
  • 3. Neuroanatomical Pathway
  • 4. Nociception
    • Describes how noxious stimuli are percived as pain
    • 4 phases:
      • Transduction
      • Transmission
      • Perception
      • modulation
  • 5. Nociception
  • 6. Sources of Pain
    • Pain is based on its origin
      • Nociceptive
        • d/t tissue injury
        • Resolves as tissue healing occurs
        • Localized
        • Described as aching or throbbing
          • Somatic: superficial or cutaneous (ie. Skin surface & subcutaneous layer) or deep (ie from tendons, joints, muscles or bone)
          • Visceral: originates from internal organs
      • Neuropathic
        • Initiated or caused by a primary lesion or dysfunction of the nervous system
        • d/t injury to PNS, CNS or both
        • Described as burning, shooting
      • Referred
        • Pain felt at a particular site but originates from another location
        • May originate from visceral or somatic structures
  • 7. Common Sites of Referred Pain © Pat Thomas, 2006.
  • 8. Types of Pain by Duration
    • Acute pain
      • Short term
      • Self-limiting
      • Follows a predictable trajectory
      • Dissipates after injury heals
    • Persistent pain
      • Continues for 6 months or longer
      • Types are malignant (cancer-related) and nonmalignant
      • Does not stop when injury heals
  • 9.
    • Pain assessment questions
    • Pain assessment tools
  • 10.
    • Questions to ask:
      • Where is your pain?
      • When did your pain start?
      • What does your pain feel like?
      • How much pain do you have now?
      • What makes the pain better or worse?
      • How does pain limit your function/activities?
      • How do you behave when you are in pain? How would others know you are in pain?
      • What does pain mean to you?
      • Why do you think you are having pain?
    Subjective Data
  • 11.
    • Initial pain assessment
    • Brief pain inventory
    • Short-Form McGill Pain Questionnaire
    • Pain rating scales
      • Numeric rating scales
      • Descriptor scale
      • Wong Baker scale
  • 12. Brief Pain Inventory From McCaffery, M. & Pasero, C. (1999). Pain: Clinical manual, 2 nd ed. St. Louis: Mosby.
  • 13.
    • Joints— note
      • Size/contour/circumference
      • AROM/PROM
    • Muscles/skin— inspect
      • Color/swelling
      • Masses/deformity
      • Sensation changes
    Objective Data Collection
  • 14. Objective Data Collection Cont’d
    • Abdomen— inspect and palpate
      • Contour/symmetry
      • Guarding/organ size
    • Pain behaviour— inspect
      • Nonverbal cues
      • Acute pain behaviour
      • Persistent pain behaviour
  • 15.
    • Acute Pain Behaviours
    • Guarding
    • Grimacing
    • Vocalizations such as moaning
    • Agitation, restlessness
    • Stillness
    • Diaphoresis
    • Change in vital signs
    Objective Data Collection Cont’d
  • 16.
    • Persistent (Chronic) Pain Behaviours
    • Bracing
    • Rubbing
    • Diminished activity
    • Sighing
    • Change in appetite
    • Being with other people
    • Movement
    • Exercise
    • Prayer
    • Sleeping
    Objective Data Collection Cont’d
  • 17.
    • Assessing pain is very challenging in the unconscious.
      • Critical Care Observation Tool (CPOT)
    • Neonates:
      • NPASS
      • PIPP
  • 18.  
  • 19.
    • Somatic
    • Visceral
    • Cutaneous
    • Persistent
  • 20.
    • Patients with persistent pain have trouble sleeping.
    • Patients with persistent pain show elevated blood pressures.
    • Patients with persistent pain need less medication.
    • Patients with persistent pain may show few or no outward signs of pain.