Pn111 Exam 2 study guide

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Transduction from site of stimulation of peripheral receptors to spinal cord.

Transmission up spinal cord.

Perception at cerebral cortex.

Modulation back down spinal cord.

Physiology of pain involves journey


Nociceptors are primary sensory nerves located in

  • Tendons
  • Muscles
  • Subcutaneous tissue
  • Epidermis
  • Skeletal muscles

refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg.



is the study of functional changes in the body that occur in response to disease or injury. For example, if someone ingests a toxin, that toxin might be associated with a variety of physical changes, such as inflammation in the stomach lining or necrosis of the extremities. The field is designed to help people study the progress of disease so that they can quickly identify diseases and consider various treatment options.

progress of a disease changes the body, and how the changes can be treated or reversed.



the study of disease and its impact on the body



study of the body and its functions



To spread out from a central area. For example, sciatic pain may radiate outward from the lower back.



Chest pain that worsens when you breathe, cough or sneeze. Shortness of breath — because you are trying to minimize breathing in and out. A cough — only in some cases. A fever — only in some cases

Pleuritic chest pain


Perforated organ, appendix

Chemical tissue damage


burn, lose skin layers

Thermal tissue damage


edema, stone, tumor

Mechanical tissue damage


unwanted intrusive thoughts that cause anxiety or distress



unwanted repetitive behavior patterns or mental acts intended to reduce anxiety



Located in the dorsal horn, aka substantia gelatinosa, controls the stimulation of sensory tracts within the spinal cord



Pain assessment and management often referred to as.

fifth vital sign


an unpleasant sensory and emotional experience associated with actual and potential tissue damage



arises in bone, joint, muscle, skin, and connective tissue. aching or throbbing in quality & is well localized.

somatic pain (nociceptive pain)


arises from organ, GI Tract & pancreas.

1.Tumor involment organ capsule causes aching & fairly well-localized pain.

2. Obstruction of hollow viscus, causes intermittent cramping & poorly localized pain.

visceral pain (nociceptive pain)


normal processing of stimuli that damage normal tissues or has the potential to do so if prolonged; usually responsive to nonopiods and or opioids.

Arises from somatic structures such as bone, joint, or muscle. Results from activation of normal neural systems.

Nociceptive pain


Occurs because of abnormal processing of sensory input

"neuropathic" pain can radiate when the nerve is compressed or damaged (example is spinal nerve root compression that is felt in the foot).

Neuropathic pain


Pain felt in a location away from the injury.
Often visceral pain, as many abdominal organs have no pain receptors.

(nociceptive and visceral) and I want to clarify that pain from a heart attack that is felt in other places is in fact referred pain. I used the term "radiate" and referred pain does radiate to areas other than the true source of the pain.

Referred pain


Pain felt in an amputated extremity

Phantom pain


Point at which a stimulus is "perceived" as pain

Pain threshold


may be intermittent or continuous pain lasting more than 6 months.

Clinical manifestations of chronic pain are not those of physiologic stress because patient adapts to pain,

but often reports symptoms of irritability, depression, withdrawal, or insomnia.

Persistent (chronic) pain


recent onset and results from tissue damage, is usually self-limiting, and ends when tissue heals (less than 6 months), .

physiologic signs associated with pain such as an increase in blood pressure, pulse rate, and respiration
May cause physiologic signs associated with pain.

Acute pain


What makes the symptoms worse?

Are the symptoms aggravated by an activity

What Affects the Symptoms?

  • (walking, climbing stairs, eating, a particular body position)? Are there psychological or physical factors in the environment that may be causing them
  • (stress, smoke, chemicals)?
  • What makes the symptoms better? Do certain body positions relieve them?

Aggravating and Alleviating Factors


duration or intensity of pain a person will endure before outwardly responding.
decreases with repeated exposure to pain, fatigue, anger, boredom, and sleep deprivation.
increases after alcohol consumption, medications, hypnosis, warmth, distracting activities, and strong faith-related beliefs.

Pain tolerance


When does the pain occur?
During activity?
Before or after eating?
Does the pain occur suddenly or gradually?
What do you think is causing your pain?
Why do you think the pain started when it did?

When did the symptom(s) begin?
• Did they develop suddenly or over a period of time? (Ask for the specific date, time, day of week if appropriate.)
• Where were you or what were you doing when the symptoms began?
• Does anyone else with whom you have been in contact have a similar symptom?



• Describe how the symptoms feel or look.
• Describe the sensation: stabbing, dull, aching, throbbing, nagging, sharp, squeezing, itching.
• If applicable, describe the appearance: color, texture, composition, and odor.



Describe what the pain feels like.



How would you describe intensity, strength, or severity of the pain on a scale of 0 to 10, with 0 being no pain and 10 being most intense pain possible?
At what point on this scale of 0 to 10 do you usually take medication for your pain?


  • Have you noticed that other symptoms have occurred at the same time (fever, nausea, pain)?
  • Are Other Symptoms Present?
  • What other symptoms do you have during pain?
    Shortness of breath
    Rapid or irregular heartbeat
    Nausea or vomiting

Related symptoms


Which methods of self-treatment have you tried? Medication?

  • (If so, ask for the name of the medication, dosage, and time of last dose.)
  • Heat applications? Cold applications?
    Have any of these methods been effective?
    Have you seen another health care provider for this same problem?

Treatment: Describe Self-Treatment Before Seeking Care


Have you tried to relieve the pain?
How effective have these measures been?
What medications did you take, and in what amounts?



How long do you feel the pain?
Is it constant or intermittent?
How often does it occur?
How long does it last?

• Since they began, have the symptoms become worse? About the same?
• Are the symptoms constant or intermittent (do they come and go)?
• If they are constant, does the severity of symptoms fluctuate?
• If they are intermittent, how many times a day, week, or month do the symptoms occur? How do you feel between episodes of the symptoms?



• Are they in a specific area?
• Are they vague and generalized?
• Do the symptoms radiate to another area?



How would you describe your pain?
On a scale of 0 to 10, with 0 being no pain and 10 being the worst pain possible, describe:
At which point on this 0 to 10 scale do you usually want to take your pain medicine? Describe the size, extent, number, or amount.
On a scale of 0 to 10, with 10 being most severe, how would you rate your symptoms?
Are the symptoms so severe that they interrupt your activities (work, school, eating, sleeping)?


  • helps regulate mood and maintain arousal
  • Decreased in depression
    Increased in schizophrenia, mania, and anxiety states

Norepinephrine (NE)


Decreased in depression
Increased in anxiety states

Serotonin (5 HT)


Decreased in depression



Increased in depression

cetylcholine (Ach)

  • is an inhibitory neurotransmitter that suppresses activity
  • Decreased in anxiety states and schizophrenia

Gamma aminobutyric acid (GABA)


Vitamins, Minerals

Micro nutrients


main source of fatty acids and is essential for normal growth and development (major form of stored energy)



main source of quick energy and fiber



Carbohydrates, Proteins, Fat

Macro nutrients


are global, evidenced by increased heart rate, hypertension, pallor, sweating, and decreased oxygenation saturation.

Neonate responses to pain


Observe patient for posture and behavior that helps relieve pain.
Observe facial expressions.
Listen for sounds made by patient.
Inspect skin for color, temperature, moisture.
Measure blood pressure and pulse.
Assess respiratory rate and pattern.
Observe pupillary size and reaction to light.




nurse is assessing the degree of pain or discomfort a patient is feeling. Nurse knows that this will be dependent primarily on:

perception of the pain or discomfort


Which findings by the nurse would produce the most accurate assessment of the severity level of a patient’s pain?

cause of the pain


The nurse is compelled to address and manage a patient’s pain level by which ethical principles? (Select all that apply.)




The nurse is reviewing the pathophysiology of pain. Where does the perception of pain actually occur?

The parietal lobe of the cerebral cortex


The nurse is assessing for objective findings are associated with the patient’s pain level. Which findings are commonly associated with acute pain? (Select all that apply.)

An elevated blood pressure

An elevated heart rate


Initiation of intravenous access can be a painful experience for the patient. As the needle is inserted into skin, the patient is calm. However, when the needle pierces the vein, the patient pulls the hand away. The time that the person endured the pain before outwardly responding is known as:

A. Pain tolerance.
B. Pain intolerance.
C. Pain perception.
D. Pain threshold

Pain tolerance.

Rationale: Pain tolerance is the duration or intensity of pain that can be endured before an outward response is noted. The pain threshold is the point at which pain is perceived.


What is the most reliable way to assess a patient's pain?

1. Type and frequency of analgesic medications the patient takes
2. Patient's most recent vital signs (e.g., blood pressure and pulse rate)
3. Extent of tissue damage the patient has had
4. Report from the patient describing the pain experienced

Report from the patient describing the pain experienced


A patient had a knee replaced because of arthritis. He reports that he has not slept well in several nights. He states that he can't get comfortable. Today he is asking for pain medication more often. What might be a reason for this increase in pain?

1. Arthritis pain is variable; it can be mild one day and severe the next.
2. Pain tolerance decreases with sleep deprivation.
3. The anesthesia from surgery is wearing off.
4. The patient is using the pain medication to help him sleep during the day.

Pain tolerance decreases with sleep deprivation.


A patient complains of leg pain. Which question is pertinent to ask to gain additional information?

1. "What were you doing when the pain first occurred?"
2. "How do you feel about having this pain?"
3. "Do you think the pain is caused by a cramp?"
4. "Has anyone in your family ever had similar pain?"

"What were you doing when the pain first occurred?"


A female has been admitted to the emergency department with severe abdominal pain. She is lying on a stretcher quietly, with very little movement. The nurse preparing to assess her abdomen should expect to see which behavior when it is time to palpate this patient's abdomen?

1. Flushing of the face and neck
2. Guarding over the abdomen
3. Relaxation of abdominal muscles
4. Decreased peristalsis

Guarding over the abdomen


The nurse is compelled to address and manage a patients pain level by which ethical principles? Select all that apply:

A. Beneficence
B. Liberty
C. Autonomy
D. Nonmaleficence
E. Justice

Beneficence, Nonmaleficence

Rationale: The ethical principles of beneficence (the duty to benefit another) and nonmaleficence (the duty to do no harm) compel health care professionals to provide pain management and comfort.Liberty and justice are ethical principles that deal with fairness. Autonomy deals with the patients right to make decisions independently.


The nurse is assessing the degree of pain or discomfort a patient is feeling. The nurse knows that this will be dependent primarily on the:

A. Ability to explain the pain or discomfort
B. Perception of the pain or discomfort
C. Age of the individual
D. Type of painful stimulus

Perception of the pain or discomfort

Rationale: Individuals may perceive a stimulus differently, making the pain experience very individualized.


The nurse is attending an in-service on pain management for postoperative patients. Which statement regarding pain is true? Select all that apply:

A. An individuals pain response is predictable based on his or her culture or ethnicity.
B. Individuals from all cultures respond to pain similarly.
C. The pain response may be influenced by ones culture.
D. Individuals may express pain differently.
E. Pain management may vary depending on the source of pain.

Answers: C. The pain response may be influenced by ones culture., D. Individuals may express pain differently., E. Pain management may vary depending on the source of pain.

Rationale: Culture influences how an individual responds to pain. Pain tolerance is highly variable. Patients may need narcotics for postoperative pain, whereas muscle strains may respond well to anti-inflammatory medications. Pain is not predictable regardless of culture or ethnicity and cannot be stereotyped by culture.


Which findings by the nurse would produce the most accurate assessment of the severity level of a patient's pain?

A. The nurse's experience
B. The cause of the pain
C. The patient's subjective data
D. The patient's objective findings

the patient's subjective data

Rationale: The most accurate and reliable evidence of pain is the patient's report.


The nurse is assessing a patient who has pain with a sudden onset and a limited duration and that subsides as healing occurs. Which type of pain would this be considered?

A. Acute pain
B. Chronic pain
C. Cancer pain
D. Nonmalignant pain

Acute pain

Rationale: By definition, acute pain is pain that lasts less than 6 months.


When assessing the quality of a patient's pain, the nurse should ask which question?

A. "When did the pain start?"
B. "Is the pain a stabbing pain?"
C. "Is it a sharp pain or dull pain?"
D. "What does your pain feel like?"

"What does your pain feel like?"

Rationale: To assess the quality of a person's pain, have the patient describe the pain in his or her own words.


The nurse is reviewing the pathophysiology of pain. Where does the perception of pain actually occur?

A. The dorsal horn of the spinal cord
B. The parietal lobe of the cerebral cortex
C. The afferent (sensory) nerves
D. The visceral and somatic free nerve endings (nociceptors)

The parietal lobe of the cerebral cortex

Rationale: Pain is not actually perceived until the parietal lobe is stimulated.


The nurse is assessing for objective findings are associated with the patients pain level. Which findings are commonly associated with acute pain? Select all that apply:

A. The patient is crying
B. An elevated blood pressure
C. An elevated heart rate
D. Diaphoresis
E. The patient states a pain level of 8 out of 10 on pain scale
F.Vital signs stable

Answers: B. An elevated blood pressure, C. An elevated heart rate, D. Diaphoresis

Rationale: All of these are common objective findings associated with acute pain.Crying and pain level are subjective findings. Vital signs will most likely be elevated during acute pain.


The nurse is performing a pain assessment of a 4-year-old toddler. Which pain assessment scale would be best for this patient?

A. Visual Analog Scale
B. Numeric Pain Intensity Scale
C. Wong/Baker Faces Rating Scale
D. Pain Intensity Scale

Wong/Baker Faces Rating Scale

Rationale: This scale is works well for children over 3 years of age because it has pictures.


Assessment of circulation, motion, and sensation is done every 8 hours in a patient recovering from a laminectomy 3 days after surgery. The patient had the surgery for consistent low back pain. Now on day 3, the patient has a burning sensation on the lateral edge of the right foot. This is best described as:

Neuropathic pain.
Cellulitis is an interstitial infection. Nociceptive pain is usually associated with tissue destruction or damage. Neuropathy is connected to nerve-related pain. It would appear that a nerve is being disturbed as a result of the surgery or the initial disease process. Burning sensation is a classic presentation or complaint related to nerve pain.


Initiation of intravenous access can be a painful experience for the patient. As the needle is inserted into skin, the patient is calm. However, when the needle pierces the vein, the patient pulls the hand away. The time that the person endured the pain before outwardly responding is known

Pain tolerance.
Pain tolerance is the duration or intensity of pain that can be endured before an outward response is noted. The pain threshold is the point at which pain is perceived.


recurrent binge and purge eating cycles. This disorder produces electrolyte imbalance, chronic irritation or erosion of the pharynx, esophagus, and teeth

Bulimia nervosa


refusing to eat, extreme thinness, and other symptoms of protein calorie malnutrition

Anorexia nervosa


document gender and age
(women greater risk, most common age 25-44)
note facial expression, eye contact, body language, tone of voice
(depressed pt's have sad face, tearfulness. avoid eye contact, monotone, little facial expression)
in past month have you felt down, depressed?
able to fall and stay asleep? eating habits? gained or lost weight w/o trying?
describe your mood
have you had depressive feelings like this before?
screen for suicidal thoughts?
whats kept you from hurting yourself?



Abnormal mood state in which a person characteristically has a sense of sadness, hopelessness, helplessness, worthlessness, and despair resulting from loss or tragedy

Clinical findings: Persistent sad, anxious, or "empty" mood; pessimism, reduced or increased appetite, insomnia, suicidal thoughts

Major depression


sleep deprivation? concentration? decision making?
fatigue? irritable? muscles seem tense?
felt nauseated? feel heart racing?
change in feelings? describe these feelings



changes in tone of voice and rate or speech, body tremors, increased muscle tension, perspiration, and sweaty palms
elevated BP
elevated pulse rate
increased respiratory rate

physical signs of anxiety


Type of depression characterized by episodes of mania, depression, or mixed moods.

Clinical findings: Emotional displays, euphoria, decreased need for sleep,profound sadness, and hyperactivity

Bipolar disorder


disorders characterized by severe disturbance of thought and associative looseness (HALLUCINATIONS, DELUSION) limited Socialization

Clinica finding: Hallucinations, delusions, autism, ambivalence, and associative looseness



observe pt's posture and movement, for appropriate dress
notice changes in voice tone, rate of speech, perspiration, and muscle tension or tremors
measure blood pressure
palpate a pulse for rate
observe and count respirations for rate and pattern
observe eye movement & measure pupil size

Mental status exam


is pt answers yes to any of the screening questions, the nurse asks additional quetiosn in private.

Interpersonal violance


Cirrhosis and injuries from falls and complicates management of other medical problems

Alcohol causes or increases the risk of


What often keeps patients from ending their lives



Outlandish dress may be worn by a patient in manic phase of

A bipolar disorder


feeling of uneasiness or discomfort experienced in varying degrees, from mild to panic
fearful response when no actual danger is present
emotional distress that interferes w/ everyday life and avoidance of situations that cause anxiety

clinical findings 4 levels: mild, moderate, severe, and panic



broad perceptual field because anxiety heightens awearens to sensory stimuli
person sees more, hears more, and thinks more logically
learning occurs during

mild anxiety


narrower field of perception and uses selective inattention to ignore stimuli in the environment to focus on a specific concern

moderately anxious


reduced perception of stimuli and develops compulisve mechanisms to avoid the anxiety-producing object or situation
impaired memory, attention, concentration
difficulty solving problems, unable to focus on events in environment

severely anxious


complete disruption of the perceptual field
experiences intense terror and is unable to think logically or make decisions
physical manifestations; represent sympathetic NS
muscle tension, tachycardia, dyspnea, HTN, increased respiration, profuse perspiration



fine tremors
nausea & vomiting
increased in heart rate and blood pressure

mild to moderate AWS


Changes in tone, rate of speech, body tremors, increased muscle tension, perspiration, and sweat palms

Physical signs of anxiety


ethanol: central nervous system depressant found in alcohol
2 phases: alcohol withdrawal (AWS) and alcohol withdrawal delirium (DT)

clinical findings: when pt are dependent on alcohol,
manifestations subside w/in a few days
severe withdrawl-mainfestations continue for 2 or more weeks

Alcohol withdrawal syndrome


experience delirium that may be accompanied by seizures
tremors become uncontrolled shacking, diaphoresis becomes diffuse
HTN and tachycardia become worse
tachypnea develops
hyperthermia may occur
mental state: extreme agitation, fluctuating, disorientation, confusion, hallucinations

severe AWS


elevated BP
hyperactive tendon reflex
pupils dilated and reactive to light
distortion of body image and perception, delusions, and hallucinations

hallucinogenic angents


Men should have no more than _____ drinks a day.



altered level of consciousness
impaired memory, judgement, and calculation, fluctuating attention span
emotional state can change abruptly and range from fearful to aggressive w/ hallucinations and delusions
activity may increase or decrease and worsen at night
sleep circle may be reversed
speech may be rapid, inappropriate and rambling

clinical findings for delirium


cognitive disorder characterized by a disturbance of consciousness and a change in cognition that develops rapidly over a short period of time
manifestations arise suddenly, last a short duration and are reversible w/ treatment



cognitive disorder characterized by memory impairment and one of the following disorders: aphasia (language disturbance)
apraxia (inability to perform motor actives)
agnosia (cant recognize familiar objects)
disturbance of executive functions
usually not reversible



onset occurs slowly over months
level of consciousness is intact, memory, judgment, and calculation are impaired
flat affect and may have delusions
speech is slow and incoherent

dementia clinical findings


Women should have no more than _____ drinks a day.



Soiled clothing or lack of hygiene may indicate

Organic brain syndrome


assess mental status by determining orientation, memory, calculation ability, communication skills, judgement, and abstraction

Altered mental status


< 120 mm Hg systolic and < 80 mm Hg diastolic

Average blood pressure range


60 to 100 beats/min

Average pulse rate range


12 to 20 breaths/min

Average respiration rate range


a state of well-being in which people realize their own abilities, can cope with normal stresses of life, can work productively, and are able to make contributions to their communites

mental health


the degree of competence that a person shows in intellectual, emotional, psychologic, and personality functioning
(abusive experiences may influence mental health)

mental status


regulates memory and basic emotions (fear, anger, sex drive)

limbic system/emotional brain


communicate between limbic system and cerebral cortex

structures of limbic system


essential function in the role of human emotion and behavior




neurotransmitters affecting mental health


recent changes in life? how have they affected your stress level?
major stressors in life now?
*holmes social readjustment rating scale



how satisfied w/ your relationships? screen for interpersonal violence

interpersonal relationships


feelings about self
how would you describe yourself to others? best characteristics? what do you like about yourself?

self concept


assessment of client's amount of stress
-point system for events in life that are stressful (death of spouse=100, pregnancy=40, change in schools=20)
add up points,
below 150:
stress is a result of changes in life and is normal and manageable
stress is a result of changes in life is moderate
based on stress alone 50/50 chance of developing serious illness w/in next 2 years
over 300:
stress resulting of changes in life is high
90% chance of developing serious illness

Holmes social readjustment rating scale


have you been feeling angry?
how do you react when you are angry?
what happens when you and your partner disagree?



how often?
males-more than 5 drinks daily or 15 weekly (issue)
women-5 drinks/day or 8/week

alcohol use


determine if its a health problem

recreational drug use


when data from present health status suggests a further assessment is indicated, nurse asks additional questions to identify common problems
(symptom analysis not useful when asking about pt's behavior and feelings)

problem based history


depression, anxiety, altered mental status

common reported problems related to mental health


alcohol abuse, drug abuse, and interpersonal violence

common problems of abusive behaviors