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

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

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