NURS 2910 Exam 3
Describe the pathophysiology of pain and physiologic response.
Associated with the central and peripheral nervous system
Pain stimulates the nociceptors and transmits message to the CNS
Mechanosensitive nociceptors
sensitive to intense mechanical stimulation (i.e. pliers, pinched skin, stretching of tissue,
compression, surgical incisions, friction, skin shearing)
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Brainpower
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Temperature-sensitive nociceptors
sensitive to heat and cold (touching a hot surface, earache on a cold day)
Chemical nociceptors
can be internal or external (lemon juice or acidic substance on a cut or chest pain).
Transduction
nociceptors become activated by the perception of mechanical, thermal, and chemical stimuli.
Transmission
pain impulse from the nociceptors relays the pain from the spinal cord to the brain
A-delta fibers (fast)
sharp initial pain or (seen in modulation: pleasurable stimuli can decrease pain)
C fibers (slow)
,lingering ache
Perception
pain recognition and prefrontal cortex perceives pain
Modulation
pain message is inhibited by the brain stem neuron and there is a neuron release of
endogenous neurotransmitters
Physiological responses to pain (Infants and children)
Neonates (skin mottling, grimacing, twitching, crying, poor feeding, temperature fluctuation,
elevated blood pressure, decreased oxygen saturations
Crying
Physiological responses to pain (Older Adults)
May be unable to report pain d/t cognitive impairment
Nonverbal cues (grimacing, rapid blinking, labored breathing, decreased activity withdrawal,
confusion.
All patients experiencing pain may have
Sympathetic responses (acute pain): (dilated pupils, impaired GI motility, increased HR/RR/BP,
reduced urinary output, pallor)
Parasympathetic (deep or prolonged pain): (breathing pattern changes, constricted pupils,
decreased pulse, decreased SBP, withdrawal)
Behavior & Psychological responses (voluntary): (agitation, fidgeting, grimacing, grinding teeth,
guarding, crying, rapid speech or slow, eating and sleeping poorly, reduced energy and interest,
change in gate) & (anger, anxiety, depression, fear, hopelessness, irritability, exhaustion).
Other physiological responses to pain
Decreased urinary output, resulting in urinary retention, fluid overload, depression of all immune
responses
Increased antidiuretic hormone, epinephrine, norepinephrine, aldosterone, glucagon, decreased
insulin, testosterone
,Hyperglycemia, glucose intolerance, insulin resistance, protein catabolism
Muscle spasm, resulting in impaired muscle function and immobility, perspiration
Increased respiratory rate and sputum retention, resulting in infection and atelectasis
Identify the ways pain can be classified.
Origin, cause, duration, onset, quality
Origin
Cutaneous pain/superficial pain – Skin or subcutaneous tissue
Visceral pain – Abdominal cavity, thorax, cranium
Deep somatic pain – Ligaments, tendons, bones, blood vessels, nerves
Radiating – perceived both at the source and extending to other tissues
Referred – perceived in body areas away from the pain source
Phantom pain– perceived in nerves left by a missing, amputated, or paralyzed body part.
Cause or type
Nociceptive – response to noxious insult or injury of tissues such as skin, muscles, visceral
organs, joints, tendons, or bones
Visceral pain (internal organs)
Somatic pain (skin, muscles, bones, or connective tissue)
Neuropathic – Injury to nerve resulting in repeated transmission of pain signals even in the
absence of painful stimuli. This can originate from poorly controlled diabetes, stroke, tumor,
alcoholism, amputation, a viral infection, or medications
Duration
Acute pain – usually associated with a recent injury
, Chronic pain – Usually associated with a specific cause or injury and described as a constant
pain that persists for more than 3-6 months
Intractable pain– Chronic & Defined by its high resistance to pain relief
Quality (intensity and pattern)
Pain quality - sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling
Pain periodicity - episodic, intermittent, constant
Pain intensity - mild, distracting, moderate, severe or intolerable
Factors that influence pain
Emotions, Previous pain experiences, life cycle experiences, sociocultural factors,
communication and cognitive impairments
Do not assume that patients will react in the same way as others of the same ethnic or cultural
group. Each patient is unique
Nurses have a duty to provide culturally competent care and adequate pain control to every
patient
Indicators of pain: facial expressions, vocalizations, change in physical activity, changes in
routine, mental status changes, physiologic cues
Psychological factors affecting pain perception and assessment (Developmental level)
Pediatric
Chronic pain affects 15-20% of children
Fetuses may feel pain as early as 20 weeks
Geriatric
71-83% aged 60 and older in assisted living and 64-78% aged 60-89 experience significant pain
Cultural considerations
Pain is a universal experience
Describe the pathophysiology of pain and physiologic response.
Associated with the central and peripheral nervous system
Pain stimulates the nociceptors and transmits message to the CNS
Mechanosensitive nociceptors
sensitive to intense mechanical stimulation (i.e. pliers, pinched skin, stretching of tissue,
compression, surgical incisions, friction, skin shearing)
0:05
/
0:15
Brainpower
Read More
Temperature-sensitive nociceptors
sensitive to heat and cold (touching a hot surface, earache on a cold day)
Chemical nociceptors
can be internal or external (lemon juice or acidic substance on a cut or chest pain).
Transduction
nociceptors become activated by the perception of mechanical, thermal, and chemical stimuli.
Transmission
pain impulse from the nociceptors relays the pain from the spinal cord to the brain
A-delta fibers (fast)
sharp initial pain or (seen in modulation: pleasurable stimuli can decrease pain)
C fibers (slow)
,lingering ache
Perception
pain recognition and prefrontal cortex perceives pain
Modulation
pain message is inhibited by the brain stem neuron and there is a neuron release of
endogenous neurotransmitters
Physiological responses to pain (Infants and children)
Neonates (skin mottling, grimacing, twitching, crying, poor feeding, temperature fluctuation,
elevated blood pressure, decreased oxygen saturations
Crying
Physiological responses to pain (Older Adults)
May be unable to report pain d/t cognitive impairment
Nonverbal cues (grimacing, rapid blinking, labored breathing, decreased activity withdrawal,
confusion.
All patients experiencing pain may have
Sympathetic responses (acute pain): (dilated pupils, impaired GI motility, increased HR/RR/BP,
reduced urinary output, pallor)
Parasympathetic (deep or prolonged pain): (breathing pattern changes, constricted pupils,
decreased pulse, decreased SBP, withdrawal)
Behavior & Psychological responses (voluntary): (agitation, fidgeting, grimacing, grinding teeth,
guarding, crying, rapid speech or slow, eating and sleeping poorly, reduced energy and interest,
change in gate) & (anger, anxiety, depression, fear, hopelessness, irritability, exhaustion).
Other physiological responses to pain
Decreased urinary output, resulting in urinary retention, fluid overload, depression of all immune
responses
Increased antidiuretic hormone, epinephrine, norepinephrine, aldosterone, glucagon, decreased
insulin, testosterone
,Hyperglycemia, glucose intolerance, insulin resistance, protein catabolism
Muscle spasm, resulting in impaired muscle function and immobility, perspiration
Increased respiratory rate and sputum retention, resulting in infection and atelectasis
Identify the ways pain can be classified.
Origin, cause, duration, onset, quality
Origin
Cutaneous pain/superficial pain – Skin or subcutaneous tissue
Visceral pain – Abdominal cavity, thorax, cranium
Deep somatic pain – Ligaments, tendons, bones, blood vessels, nerves
Radiating – perceived both at the source and extending to other tissues
Referred – perceived in body areas away from the pain source
Phantom pain– perceived in nerves left by a missing, amputated, or paralyzed body part.
Cause or type
Nociceptive – response to noxious insult or injury of tissues such as skin, muscles, visceral
organs, joints, tendons, or bones
Visceral pain (internal organs)
Somatic pain (skin, muscles, bones, or connective tissue)
Neuropathic – Injury to nerve resulting in repeated transmission of pain signals even in the
absence of painful stimuli. This can originate from poorly controlled diabetes, stroke, tumor,
alcoholism, amputation, a viral infection, or medications
Duration
Acute pain – usually associated with a recent injury
, Chronic pain – Usually associated with a specific cause or injury and described as a constant
pain that persists for more than 3-6 months
Intractable pain– Chronic & Defined by its high resistance to pain relief
Quality (intensity and pattern)
Pain quality - sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling
Pain periodicity - episodic, intermittent, constant
Pain intensity - mild, distracting, moderate, severe or intolerable
Factors that influence pain
Emotions, Previous pain experiences, life cycle experiences, sociocultural factors,
communication and cognitive impairments
Do not assume that patients will react in the same way as others of the same ethnic or cultural
group. Each patient is unique
Nurses have a duty to provide culturally competent care and adequate pain control to every
patient
Indicators of pain: facial expressions, vocalizations, change in physical activity, changes in
routine, mental status changes, physiologic cues
Psychological factors affecting pain perception and assessment (Developmental level)
Pediatric
Chronic pain affects 15-20% of children
Fetuses may feel pain as early as 20 weeks
Geriatric
71-83% aged 60 and older in assisted living and 64-78% aged 60-89 experience significant pain
Cultural considerations
Pain is a universal experience
