NURS 2910 Exam 3
Describe the pathophysiology of pain and physiologic response. - ANS Associated with the central
and peripheral nervous system
Pain stimulates the nociceptors and transmits message to the CNS
Mechanosensitive nociceptors - ANS sensitive to intense mechanical stimulation (i.e. pliers, pinched
skin, stretching of tissue, compression, surgical incisions, friction, skin shearing)
Temperature-sensitive nociceptors - ANS sensitive to heat and cold (touching a hot surface, earache
on a cold day)
Chemical nociceptors - ANS can be internal or external (lemon juice or acidic substance on a cut or
chest pain).
Transduction - ANS nociceptors become activated by the perception of mechanical, thermal, and
chemical stimuli.
Transmission - ANS pain impulse from the nociceptors relays the pain from the spinal cord to the
brain
A-delta fibers (fast) - ANS sharp initial pain or (seen in modulation: pleasurable stimuli can decrease
pain)
C fibers (slow) - ANS lingering ache
Perception - ANS pain recognition and prefrontal cortex perceives pain
Modulation - ANS 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) - ANS Neonates (skin mottling, grimacing,
twitching, crying, poor feeding, temperature fluctuation, elevated blood pressure, decreased oxygen
saturations
,Crying
Physiological responses to pain (Older Adults) - ANS 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 - ANS 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 - ANS 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. - ANS Origin, cause, duration, onset, quality
Origin - ANS 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 - ANS 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 - ANS 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) - ANS 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 - ANS 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) - ANS 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 - ANS Pain is a universal experience
Pain response is a learned response
Meaning of pain differs between cultures
DO NOT STEREOTYPE - everyone is unique
Culturally competent nursing - ANS Be aware of your own culture and family values.
Be aware of your personal biases and assumptions about people with different values than yourself.
Be aware and accept cultural differences between yourself and individual clients.
Be capable of understanding the dynamics of the difference.
Be able to adapt to diversity.
Affinity bias - ANS do you have a tendency to warm up to people you perceive to be "like you"?
Halo effect - ANS tendency to think everything about a person is good because you like that person.
Perception Bias - ANS The tendency to form stereotypes and assumptions about particular groups
that make it impossible to make independent judgments about members of these groups.
Describe the pathophysiology of pain and physiologic response. - ANS Associated with the central
and peripheral nervous system
Pain stimulates the nociceptors and transmits message to the CNS
Mechanosensitive nociceptors - ANS sensitive to intense mechanical stimulation (i.e. pliers, pinched
skin, stretching of tissue, compression, surgical incisions, friction, skin shearing)
Temperature-sensitive nociceptors - ANS sensitive to heat and cold (touching a hot surface, earache
on a cold day)
Chemical nociceptors - ANS can be internal or external (lemon juice or acidic substance on a cut or
chest pain).
Transduction - ANS nociceptors become activated by the perception of mechanical, thermal, and
chemical stimuli.
Transmission - ANS pain impulse from the nociceptors relays the pain from the spinal cord to the
brain
A-delta fibers (fast) - ANS sharp initial pain or (seen in modulation: pleasurable stimuli can decrease
pain)
C fibers (slow) - ANS lingering ache
Perception - ANS pain recognition and prefrontal cortex perceives pain
Modulation - ANS 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) - ANS Neonates (skin mottling, grimacing,
twitching, crying, poor feeding, temperature fluctuation, elevated blood pressure, decreased oxygen
saturations
,Crying
Physiological responses to pain (Older Adults) - ANS 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 - ANS 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 - ANS 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. - ANS Origin, cause, duration, onset, quality
Origin - ANS 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 - ANS 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 - ANS 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) - ANS 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 - ANS 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) - ANS 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 - ANS Pain is a universal experience
Pain response is a learned response
Meaning of pain differs between cultures
DO NOT STEREOTYPE - everyone is unique
Culturally competent nursing - ANS Be aware of your own culture and family values.
Be aware of your personal biases and assumptions about people with different values than yourself.
Be aware and accept cultural differences between yourself and individual clients.
Be capable of understanding the dynamics of the difference.
Be able to adapt to diversity.
Affinity bias - ANS do you have a tendency to warm up to people you perceive to be "like you"?
Halo effect - ANS tendency to think everything about a person is good because you like that person.
Perception Bias - ANS The tendency to form stereotypes and assumptions about particular groups
that make it impossible to make independent judgments about members of these groups.
