3. SITTING
Head and Neck
Anterior and posterior chest
for respiratory, cardiac, and
breast exams.
Vital signs and upper
extremities.
4. DORSAL
RECUMBENT
Abdomen: Basically supine
position with knees slightly
flexed to relax abdominal
muscles.
Female pelvic area if patient is
unable to assume lithotomy or
Sim’s position.
Lithotomy position for female
pelvic and rectal areas
essentially same as dorsal
recumbent but legs and feet I
stirrups.
Female pelvic and rectal areas:
Best alternative if patient is
unable to assume lithotomy
position.
5. SIM’S
Female pelvic and rectal
areas:
Best alternative if patient is
unable to assume lithotomy
position.
9. STANDING
Supine and joints (ROM);
Best for these
musculoskeletal areas; used
for both neurological exam
and to assess gait and
cerebellar function.
13. TYPE CAUSE DURATION EXAMPLES
ACUTE Injury or pathology self-limiting, resolves with healing trauma, medical or surgical, labor, acute
diseases
CHRONIC may or may not be associated with pathology persists beyond expected healing time injury, malignant conditions, chronic non-life
threatening
diseases such as arthritis.
CANCER /MALIGNANT associated with underlying malignancy, may be acute or chronic, pain level malignancy and associated diagnostic tests
and treatments
diagnostic procedure, or disease treatment strongly correlates with the degree of
pathology
CHRONIC NON- weak connection between cause and extent of prolonged or possibly lifelong osteoarthritis, low back pain, myofascial pain,
fibromyalgia
CANCER PAIN pain headaches, central pain, chronic abdominal pain,
CHRONIC PAIN SYNDROME chronic pain that consumes and incapacitates prolonged, possibly lifelong
pain
15. NOCICEPTIVE/NEURO
PATHIC PAIN
• Nociceptive Pain – results from exposure to noxious (painful) stimuli.
The painful stimuli can occur in the viscera, resulting in visceral pain,
or tissue, resulting in somatic pain. Visceral pain results from
overdistention, spasms, ischemia, inflammation, or traction, of organs
such colic, appendicitis peptic ulcer disease, and bladder distention.
• Referred Pain
• Radiating Pain
• Somatic Pain
• Deep Somatic Pain
17. PRECIPITATING/
PALLIATIVE/
PROVOCATIVE
FACTORS
What were you doing
when the pain started?
Does anything make it
better, such as
medication or a certain
position?
Does anything make it
worse, such as
movement or
breathing?
This Photo by Unknown Author is licensed under CC BY
18. QUALITY/QUALITY
What does it feel like?
Superficial somatic pain
is sharp, pricking or
burning.
Deep somatic pan is dull
or aching.
Visceral pain is dull,
aching, or cramping.
Neuropathic pain is
burning, shocklike,
lancing, jabbing,
squeezing, or aching.
This Photo by Unknown Author is licensed under CC BY
19. REGION/RADIATION/R
ELATED SYMPTOMS
Can you point to where it hurts?
Does the pain occur or spread
anywhere else?
Localized pain is confined to the
site of origin, such as cutaneous
pain.
Referred pain is referred is related
to a distant structure such as
shoulder pain, with acute
cholecystitis or jaw pain associated
with angina.
Projected (transmitted pain) is
transmitted along a nerve, such
with herpes zoster.
Dermatomal pain as with peripheral
neuropathic pain.
Nondermatomal pattern as with
central neuropathic pain,
fibromyalgia. This Photo by Unknown Author is licensed under CC BY
20. REGION/RADIATION/R
ELATED SYMPTOMS
Do you have any other
symptoms? (nausea,
dizziness, shortness of
breath)
Visceral pain-related
symptoms include sickening
feeling, nausea, vomiting,
and autonomic symptoms.
Neuropathic pain-related
symptoms include
hyperalgesia and allodynia.
Complex regional pain
syndrome-related symptoms
include hyperalgesia,
htyperesthesia, allodynia,
autonomic changes, and
shin, hair, and nail changes This Photo by Unknown Author is licensed under CC BY
22. TIMING
When did the pain begin?
How long did it last?
Brief flash: Quick pain as with
needle stick
Rhythmic pulsation – pulsating
pain as with migraine or
toothache.
Long-duration rhythmic: as
with intestinal colic
Plateau pain: pain that rises
then plateaus such as angina
Paroxysmal: such as
neuropathic pain
This Photo by Unknown Author is licensed under CC BY
23. TIMING
How often does it occur?
Continuous fluctuating
pain: as with
musculoskeletal pain
Do you have times when
you are pain free?
This Photo by Unknown Author is licensed under CC BY
