CHAPTER 35 PAIN (the 5th Vital sign)

Adjuvant medication—used to enhance the analgesic efficancy of opoids but developed

for uses other than pain. ex. Antidepressants, anti-epileptic, antihistimine, steroids
Afferent/ efferent pain pathway—ascending/ descending
Counterstimulation— (cutaneous stimulation) activate endogenous opioid analgesia
systems
Ceiling effect—as the dose of the medication is increased; the analgesic effect remains
the same; only the adverse effects continue to increase
Colic—acute abdominal pain
Cutaneous pain—stimulatiuon of cutaneous nerve endings ex. Knot in hair
Somatic pain—non localized… in support structures tendons, ligaments, nerves, deep
pain, ex. Jamming knee
Visceral pain—discomfort in internal organs, more slowly transmitted than cutaneous
Referred pain—not felt in organ itself
Acute pain—sudden onset short duration, guarding, appetite, severe discomfort
Recurrent acute pain—migraine headaches, acute yet recurrent over lifetime
Chronic/ persistent pain—long term lasting 6+ mo, fatigue, weight changes
Chronic acute pain—last for long periods but has high probability of ending. Ex. Burns
Chronic nonmalignant pain—associated with depression, anxiety, 6+mo, mild to severe
Myofascial pain syndromes—muscle disorder w/ pain, muscle spasm
Nociception—process which individual becomes aware of pain
Transduction- stimili in nerve endings-impulse
Transmission- movement of impulse to brain, 300ft/ sec
Perception- conscious awareness of pain how client feels it; brain interperts pain
Modulation- changing of pain impulses; endorphins inhibit pain
Allodynia—nonpainful stimulus felt as painful, tissue appears normal
Paresthesia—abnormal sensation such as bruning prickling or tingling
Nociceptinve Pain— intensity decrease, relief-opoids/ NSAIDS
Neuropathic pain— weeks/months persists allodynia, resistant to opoids, NSAIDS
ineffective, relief- tricyclic antedepressants, antidepressants, anticonvulsants, local
anesthetics
Gate control pain theory—melzack 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 to
close the gate.
Trigger Point—hypersensitive point causes twitch/ jump
Hyperalgesia—extreme sensitivity to pain
Ischemic pain—pain when blood supply is cut off in area
Factors affecting pain:
Age, previous experience with pain, cultural attitudes
Pain Assessment:
Client perception- intensity, location, quality, associated manifestation,
aggravated factors, alleviated factors
Lancinating—piercing/stabbing pain
Mixed agonist-antagonist—blocks opoid effects on one receptor type while producing
opoid effects on a second.
Chronobiology—studies rhythms that are controlled by our biological clocks
Narcolepsy— urges to sleep during daytime
Hyper somnia—excessive sleep during daytime
Parasomnia— sleep alteration from physiological systems during sleep
Bruxism—grinding teeth while sleeping
Reframing—teaches clients to monitor negative thoughts and replace them with positive
Sleep apnea—stop breating during sleep 10+ secs
Somnambulism—sleep walking

CHAPTER 27 PHYSICAL ASSESSMENT

Aneurysm—localized aortic abnormal dilation of a blood vessel wall

Angina – pain in the chest neck or arem resulting from myocardial ischemia
Aphasia-
Ascites—excessive fluid accumulation in the abdominal cavity
Bronchial sounds—loud and high pitched, heard longer on expiration than
inspiration
Bronchovesicular sounds—medium pitched and blowing sounds heard equally on
inspiration and expiration
Vesticular sounds—soft breezy, low pitched, longer on inspiration than expiration
Bruits—sound blood makes when it rushes past an obstruction
Crepitus—grating or crackling sensation caused by two rough surfaces rubbing together
Cystocele- prolapsed bladder
Dermatome map— cutaneous area whose sensory receptors and axons feed into a single
dorsal root of the spinal chord
Deep Vein Thrombosis— formation of clot in deep vein
Glasgow coma scale—client level of consciousness
Goniometer- used to measure range of motion
Graphesthesia—identify things drawn on skin
Heaves—lifting of the cardiac area secondary to an increased workloadand force of left
ventriclar contraction
Atrophy—thin muscles due to size and shape
Hypertrophy—increase in muscle size and shape
Hyperotonicity—increased muscle tone
Hypotonicity—flabby muscle, poor tone
Ischemia—local and temporary lack of blood supply to the heart
Myocardial infarction—necrosis of the heart muscle
Murmer—swishing or blowing sounds of long duration heard during the systolic and
diastolic phases created by turbulent blood flow
Regurgitation—the backward flow of blood through a diseased heart valve, aka
insufficiency
Snellen chart—eye chart
Stenosis—narrowing or constricting of a blood vessel or valve
Stereognosis—identify objects by touch
Thrills—vibrations felt when placed over heart
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 surface
Evaporation- insensible from the skin
Normal Vital Signs
Temperature- 98.6 F, 37C; should not vary more than 1.4F
Resting Pulse- 60-100
Resting Respiration- 12-20
Blood pressure- 120/80
Prehypertension- 120-139 / 80-90
Stage 1 hypertension- 140-159 / 90-99
Stage 2 hypertension- >160 / >100
1 Kilocalorie = 1,000 Calorie
1in= 2.5cm
1kg= 2.2 lb
C= (F-32) x 5/9
F=(Cx5/9) + 32
Pyrexia- temperature
Cachexia- weight loss marked by weakness and emaciation usually occurs with chronic
illness
Neurogenic 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, delirious
Pulse Deficit- apical pulse is greater than radial pulse