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Student ID No:57254313031 Student IC No:820504086244 Programme:Bachelor Of Nursing

ROYAL COLLEGE OF MEDICINE PERAK

FORMATIVE TEST JULY 2013 SEMESTER

SUBJECT CODE SUBJECT TITLE LEVEL TIME / DURATION DATE : : : : : RNB10404 WOUND AND PAIN MANAGEMENT BACHELOR OF SCIENCE NURSING (HONOURS) (POST REGISTRATION) ONE (1) WEEK 10 17 SEPTEMBER 2013

ANSWER SCRIPT
INSTRUCTIONS TO CANDIDATES
1. Type your student ID No., IC No., and Programme name on the top left of this answer script. 2. Please type your answers in the box provided and email to hychen@rcmp.unikl.edu.my latest by 17 September 2013, 12.00 MN.

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PART 1: SHORT ANSWER QUESTION (SAQ) 1. Define dermatomes. [2 marks] Dermatomes is an area of skin that is mainly supplied by a single spinal nerve.

2. Explain the significant of dermatomes in pain management. [4 marks] Dermatomes can be associated with the bodys sensory nerves (the sense of touch) or the motor nerves (the ability to move). Dermatome routes are significant because the nerves traveling along those routes serve specific areas of the body,which can help doctors isolate and identify which specific nerve are malfunctioning if spinal nerve having damaged. Dermatomes are useful to help localize neurologic levels,particular in radiculopathy. Effacement of a spinal nerve may or may not exhibit symptoms in the dermatomic area covered by the compressed nerve roots in addition to weakness,or deep tendon reflex loss. 3. List TEN (10) possible clinical manifestations of chronic pain.[5 marks] 1) Anxiety 2) Despress 3) Fatigue 4) Irritability 5) Headache 6) Inactivity 7) Insomnia 8) Anorexia 9) Constipation 10) Weight loss

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4. Explain the following types of pain scales. [4 marks] a. Numerical rating scale (NRS) A scale used for the subjective measurement of a clinical sign/syndrome, in which numerical scores are given. A description is given for each score.Patients are instructed to rate the intensity of their pain on this scale. Example:- 0 =no pain 1-3 =mild pain 4-6 =moderate pain 7-10=severe pain b. Faces rating scales This rating scale is recommended for children ages 3 and older.Point to each face using the words to describe the pain intensity. Ask the patient to choose the face that best describes his or her own pain. Example:- 0 = no pain,2 = little bit pain,4 =little bit more,6=hurt more,8=hurt whole more 10=worst hurt (sometime can crying) 5. State the mechanism of action for the following pain relief drugs. [2 marks] a. Aspirin First stat with suppression of the production of prostaglandins & thromboxane.This happen because cyclooxygenase,all enzyme which participates in the production of prostaglandins &thromboxane,is irreversible inhibated when aspirin aceytylates it prostaglandins are local hormones(paracuine)produced in the body & have diverse effect in the body,including transmission of pain information to the brain.

b. Morphine 2/2
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Morphine was binds of opinoids receptor in the brain and central nervous systemreducing the perception of pain.

6. List ONE (1) example of the complementary and alternative therapies as follow. [4 marks] a. b. c. d. Mind-body approaches Alternative medical systems Biological-based therapies Biofield therapies Creative Art therapy Reflexology Aromatherapy Vibration therapy

7. State ONE (1) nursing goal for the following nursing diagnosis. [4 marks] a. Impaired comfort related to acute pain. b. Self-care deficit related to fatigue. c. Fear related to unknown cause of pain. d. Impaired sleep pattern related to chronic pain. Patient more comfortable after 1hour given analgesic. Patient verbalizes increased energy & improved well. Patient will report of reducing the fear and anxiety after orientation and information of pain given. Patient feel refreshed and not fatiqued during day.

PART 2: ESSAY QUESTION 1. Explain the physiologic response of Fight-or-Flight. 3/2

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(200-300 words) [15 marks]

To produce the fight or flight response,the hypothalamus activates two system.The sympathetic nervous system and the adrenal cortical system.the sympathetic nervous system uses nerve pathways to initiate reactions in the body,and the adrenal cortical system uses the bloodstream.The combined effects of these two systems are the fight or flight response. When the hypothalamus tells the sympathetic nervous systems to kick into gear,the overall effect is that the body speeds up,tenses up and becomes generally very alert.The sympathetic nervous system sends out impulses to glands ans smooth muscles and tells the adrenal medulla to release epinephrine(adrenaline) and norepinephrine(noradrenaline) into the bloodstream.These stress hormones cause several changes in the body,including an increase in heart rate and blood pressure. At the same time,the hypothalamus releases corticotrophin- releasing factor(CRF)into the pituitary gland,activating the adrenal- cortical system.The pituitary gland secretes the hormone ACTH(adrenocorticotropic hormone).ACTH moves through the bloodstream and ultimately arrives at he adrenal cortex,where it activates the release of approximately 30 different hormones that get the body prepared to deal with a threat. The sudden flood of epinephrine,norepinephrine and dozens of other hormones causes changes in the body that include: Hearth rate and blood pressure increase Pupils dilate to take in as much light as possible Veins skin constrict to send more blood to major muscle groups Blood glucose level increase Smooth muscle relaxes in oder to allow more oxygen into the lungs

Explain the EIGHT (8) assessment of acute pain. (100-150 words) [10 marks] 4/2
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Assessment of acute pain is important to describe stage of pain by the patient. All specific questions must be gather to get information and provide all healthcare for them.There includes:1)Location - Ask client to locate area of the pain.Example-where is your pain. -Chart part of the body.Example- which part of the body pain. 2) Onset and duration How often does the pain occurs? 3) Intensity Can be use the tool of assessment.Example On a scale of 0 to 10 with 0 representing no pain,how much pain would you say youre experiencing now? 4)Quality or character Describe type of pain.Example-In your own word,please tell me about your pain feels like stabling,tingling,shooting and others? 5)Aggravating factors Ask them any factor predisposing the pain.Example What triggers the pain?what makes your pain getting worse? 6)Alleviating factors Ask them something can be make them better.example-what measures have you found to relieve the pain? 7)Effect of pain Example- what do you believe is causing the sysptom?How the symptoms effect yourself and your family? 8)Any previous treatment Currently to find out any side effect of past medication that theyre getting, Example What medications and treatments have you used in the past?

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