NURS 2910 Exam 3
Describe the pathophysiology of pain and physiologic response. - CORRECT ANSWER Associated
with the central and peripheral nervous system
Pain stimulates the nociceptors and transmits message to the CNS
Mechanosensitive nociceptors - CORRECT ANSWER sensitive to intense mechanical stimulation (i.e.
pliers, pinched skin, stretching of tissue, compression, surgical incisions, friction, skin shearing)
Temperature-sensitive nociceptors - CORRECT ANSWER sensitive to heat and cold (touching a hot
surface, earache on a cold day)
Chemical nociceptors - CORRECT ANSWER can be internal or external (lemon juice or acidic
substance on a cut or chest pain).
Transduction - CORRECT ANSWER nociceptors become activated by the perception of mechanical,
thermal, and chemical stimuli.
Transmission - CORRECT ANSWER pain impulse from the nociceptors relays the pain from the
spinal cord to the brain
A-delta fibers (fast) - CORRECT ANSWER sharp initial pain or (seen in modulation: pleasurable
stimuli can decrease pain)
C fibers (slow) - CORRECT ANSWER lingering ache
Perception - CORRECT ANSWER pain recognition and prefrontal cortex perceives pain
Modulation - CORRECT ANSWER 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) - CORRECT ANSWER Neonates (skin mottling,
grimacing, twitching, crying, poor feeding, temperature fluctuation, elevated blood pressure,
decreased oxygen saturations
Crying
Physiological responses to pain (Older Adults) - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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. - CORRECT ANSWER Origin, cause, duration, onset, quality
Origin - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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) - CORRECT ANSWER 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 - CORRECT ANSWER 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) - CORRECT
ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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.
Describe the pathophysiology of pain and physiologic response. - CORRECT ANSWER Associated
with the central and peripheral nervous system
Pain stimulates the nociceptors and transmits message to the CNS
Mechanosensitive nociceptors - CORRECT ANSWER sensitive to intense mechanical stimulation (i.e.
pliers, pinched skin, stretching of tissue, compression, surgical incisions, friction, skin shearing)
Temperature-sensitive nociceptors - CORRECT ANSWER sensitive to heat and cold (touching a hot
surface, earache on a cold day)
Chemical nociceptors - CORRECT ANSWER can be internal or external (lemon juice or acidic
substance on a cut or chest pain).
Transduction - CORRECT ANSWER nociceptors become activated by the perception of mechanical,
thermal, and chemical stimuli.
Transmission - CORRECT ANSWER pain impulse from the nociceptors relays the pain from the
spinal cord to the brain
A-delta fibers (fast) - CORRECT ANSWER sharp initial pain or (seen in modulation: pleasurable
stimuli can decrease pain)
C fibers (slow) - CORRECT ANSWER lingering ache
Perception - CORRECT ANSWER pain recognition and prefrontal cortex perceives pain
Modulation - CORRECT ANSWER 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) - CORRECT ANSWER Neonates (skin mottling,
grimacing, twitching, crying, poor feeding, temperature fluctuation, elevated blood pressure,
decreased oxygen saturations
Crying
Physiological responses to pain (Older Adults) - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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. - CORRECT ANSWER Origin, cause, duration, onset, quality
Origin - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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) - CORRECT ANSWER 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 - CORRECT ANSWER 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) - CORRECT
ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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.
