Pain

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Pain
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THE FIFTH VITAL SIGN

• Categories
• Location
• Effects of acute pain
• Effects of chronic pain

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STRESS RESPONSE-ACUTE

• General adaptation syndrome
• I. Alarm the sympathetic fight-or-flight
  response is activated.
• Release of catecholamines and adrenocorticotropic
  hormone (ACTH)
• II. Resistance adaptation to noxious stressors
  occurs, and cortisol is still increased
• III. Exhaustion endocrine activity increases
  and all body systems are affected negatively and
  can lead to death

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CHRONIC PAIN

• Suppression of the immune function
• Depression and disability
• Anger and fatigue
• Issues with interpersonal relationships

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INJURY
Reaction to assault at tissue level
Cell damage or death
Histamine Bradykinin Acetylcholine Serotonin
Substance P
NOCICEPTION
Vasodilation Increased vascular permeability
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Nociception
Reaction to assault up to the brain
First-order neurons travel from the periphery to
the spinal cord via the dorsal horn
Smaller A delta fibers
C fibers
Sent to the thalamus, limbic system and cerebral
cortex
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Gate-Controlled Theory

• Have a headache-squeeze your hand!

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Factors that influence pain

• Past experience
• Anxiety and depression
• Culture
• Age
• Gender
• Placebo effect
• Environment

• Lifestyles and habits
• Comorbidity
• Fear of death
• Meaning of pain

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Reticular Activating System

• Responsible for bringing all the pieces together.
• Located between the nerve centers of the medulla
  in the brain stem
• Highly selective as to input it chooses to
  receive and interpret
• Regulates awakeness and alertness

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Tools used to measure

• Visual analog scale
• Visual descriptor scale

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Nursing Interventions

• Basic principles
• Alleviating anxiety

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Noninvasive Interventions

• Behavioral technique
• Meditation
• Progressive Relaxation Training
• Rhythmic breathing
• Guided imagery
• Autogenic training
• Therapeutic touch
• Hypnosis
• Music
• Acupressure

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Invasive Interventions

• Analgesic
• Anesthetic
• Local Anesthesia
• Topicals
• PCA
• Intraspinal anesthesia
• Nerve blocks

• Neurosurgery
• Neurectomy
• Rhizotomy
• Chordotomy
• Transcutaneous Electrical Nerve Transmitters