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CHAPTER 35 PAIN (the 5th Vital sign)

Adjuvant medicationused to enhance the analgesic efficancy of opoids but developedfor uses other than pain. ex. Antidepressants, anti-epileptic, antihistimine, steroids

Afferent/ efferent pain pathwayascending/ descending

Counterstimulation (cutaneous stimulation) activate endogenous opioid analgesiasystems

Ceiling effectas the dose of the medication is increased; the analgesic effect remains

the same; only the adverse effects continue to increaseColicacute abdominal pain

Cutaneous painstimulatiuon of cutaneous nerve endings ex. Knot in hairSomatic painnon localized in support structures tendons, ligaments, nerves, deep

pain, ex. Jamming kneeVisceral paindiscomfort in internal organs, more slowly transmitted than cutaneous

Referred painnot felt in organ itselfAcute painsudden onset short duration, guarding, appetite, severe discomfort

Recurrent acute painmigraine headaches, acute yet recurrent over lifetimeChronic/ persistent painlong term lasting 6+ mo, fatigue, weight changesChronic acute painlast for long periods but has high probability of ending. Ex. BurnsChronic nonmalignant painassociated with depression, anxiety, 6+mo, mild to severe

Myofascial pain syndromesmuscle disorder w/ pain, muscle spasmNociceptionprocess which individual becomes aware of pain

Transduction- stimili in nerve endings-impulseTransmission- movement of impulse to brain, 300ft/ secPerception- conscious awareness of pain how client feels it; brain interperts painModulation- changing of pain impulses; endorphins inhibit pain

Allodynianonpainful stimulus felt as painful, tissue appears normal

Paresthesiaabnormal sensation such as bruning prickling or tinglingNociceptinve Pain intensity decrease, relief-opoids/ NSAIDSNeuropathic pain weeks/months persists allodynia, resistant to opoids, NSAIDS

ineffective, relief- tricyclic antedepressants, antidepressants, anticonvulsants, local

anestheticsGate control pain theorymelzack and wall, cognitive sensory and emotional can

block persons perception of pain/ message to brain. Massage, acupuncture can close gate.

Gating mechanism at the dorsal horn of spinal chord.Transcutaneous electrical nerve stimulation (TENS)stimulates large nerve fibers toclose the gate.

Trigger Pointhypersensitive point causes twitch/ jumpHyperalgesiaextreme sensitivity to painIschemic painpain when blood supply is cut off in area

Factors affecting pain:

Age, previous experience with pain, cultural attitudesPain Assessment:

Client perception- intensity, location, quality, associated manifestation,

aggravated factors, alleviated factors

Lancinatingpiercing/stabbing painMixed agonist-antagonistblocks opoid effects on one receptor type while producing

opoid effects on a second.

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Chronobiologystudies rhythms that are controlled by our biological clocks

Narcolepsy urges to sleep during daytime

Hyper somniaexcessive sleep during daytimeParasomnia sleep alteration from physiological systems during sleep

Bruxismgrinding teeth while sleeping

Reframingteaches clients to monitor negative thoughts and replace them with positiveSleep apneastop breating during sleep 10+ secs

Somnambulismsleep walking

CHAPTER 27 PHYSICAL ASSESSMENT

Aneurysmlocalized aortic abnormal dilation of a blood vessel wallAngina pain in the chest neck or arem resulting from myocardial ischemiaAphasia-

Ascitesexcessive fluid accumulation in the abdominal cavityBronchial soundsloud and high pitched, heard longer on expiration than

inspirationBronchovesicular soundsmedium pitched and blowing sounds heard equally on

inspiration and expiration

Vesticular soundssoft breezy, low pitched, longer on inspiration than expiration

Bruitssound blood makes when it rushes past an obstructionCrepitusgrating or crackling sensation caused by two rough surfaces rubbing togetherCystocele-prolapsed bladderDermatome mapcutaneous area whose sensory receptors and axons feed into a single

dorsal root of the spinal chordDeep Vein Thrombosisformation of clot in deep veinGlasgow coma scaleclient level of consciousness

Goniometer- used to measure range of motionGraphesthesiaidentify things drawn on skinHeaveslifting of the cardiac area secondary to an increased workloadand force of left

ventriclar contractionAtrophythin muscles due to size and shapeHypertrophyincrease in muscle size and shape

Hyperotonicityincreased muscle toneHypotonicityflabby muscle, poor toneIschemialocal and temporary lack of blood supply to the heartMyocardial infarctionnecrosis of the heart muscle

Murmerswishing or blowing sounds of long duration heard during the systolic and

diastolic phases created by turbulent blood flowRegurgitationthe backward flow of blood through a diseased heart valve, aka

insufficiencySnellen charteye chartStenosisnarrowing or constricting of a blood vessel or valve

Stereognosisidentify objects by touchThrillsvibrations felt when placed over heart

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Chapter 26 VITAL SIGNS

Methods of heat loss:

Radiation- loss of heat in the form of infrared rays

Conduction- loss to an object in contact with body

Convection- movement of heat away from body surfaceEvaporation- insensible from the skin

Normal Vital Signs

Temperature- 98.6 F, 37C; should not vary more than 1.4FResting Pulse- 60-100

Resting Respiration- 12-20

Blood pressure- 120/80

Prehypertension- 120-139 / 80-90Stage 1 hypertension- 140-159 / 90-99

Stage 2 hypertension- >160 / >100

1 Kilocalorie = 1,000 Calorie

1in= 2.5cm1kg= 2.2 lb

C= (F-32) x 5/9F=(Cx5/9) + 32

Pyrexia- temperatureCachexia- weight loss marked by weakness and emaciation usually occurs with chronic

illnessNeurogenic fever- pt. with traumatic brain injury

Heat exhaustion- 100.4-104F- loss of excessive H20, naseua, vomiting, weakness

Heat stroke- 100.6-112F- dry hot skin, muscle cramps, deliriousPulse Deficit- apical pulse is greater than radial pulse