Transmission Fiber – Pharmacology Test
The key terms of Pharmacology Test include, Transmission, Fiber, Perception.
Transmission
Slow or Express Train?
A Delta fiber small, myelinated fibers; send impulses quickly producing sharp, pricking, well localized pain of a short duration.
C Fiber smallest, unmyelinated fibers, send impulses slower producing dull, aching, burning sensations with a diffuse, slow onset of a long duration
Perception
-Conscious experience of Pain
Involves several brain structures
Reticular activating system: autonomic response (sympathetic nervous system)
Somatosensory system: localization and characterization of the pain
Limbic: emotional and behavior responses
Cortical: meaning of pain
Pain Tolerance
Pain tolerance: The maximum degree of pain intensity that a person is willing to experience.
Ex: Bad day….stub toe….worst pain ever experienced
Factors Affecting Pain
-Age
-Gender
-Women have more:
–pain in women
–Headaches
–Arthritis, fibromyalgia
-Men have more:
–Gout
–PVD
–Back pain
-Sociocultural background
-Genetics
Physiologic Sources of Pain
Nociceptive —>normal
Neuropathic—>abnormal
Nocioceptic
Normal processing of pain
2 Types: Somatic and Viceral
>Somatic
-Superficial: Skin and tissues (incisions, drains)
Sharp and burning
-Deep somatic: Bone, muscle, blood vessels (muscle spasms, orthopedic procedures
-Dull, aching, cramping
Assessment Guidelines In The Elderly Patient
-Assume pain is present
-Ask about present pain only
-Use a standard scale
-Use a variety of descriptors
ache, sore, hurt
-If cognitively impaired assess for non-verbal symptoms of pain
Management of Pain in the Elderly
Use round the clock dosing
Start low and go slow
Monitor for adverse effects
Drug interactions
Avoid use of meperidine (Demerol)
Use nondrug therapies
Definition of Pain
“Unpleasant sensory and emotional experiences associated with actual and potential tissue damage”
study of pain 1979
Definition of Pain
“Whatever the experiencing person says it is, existing whenever s/he says it does.”
Margo McCaffery (1968)
Nurse As An Advocate
Primary role of the nurse in pain management is believing their patients.
The Joint Commission Pain Standards
-American Pain Society
-“Pain Care Bill of Rights”
.Patients have the right to be taken seriously and treated
.Have pain assessed and promptly treated
.Have ongoing reassessment & evaluation
.Treatment modified if not working
.Referral to pain specialist for persistent pain
Myth/Misinformation
Contribute to Ineffective Pain Management
-Too much pain medication too frequently constitutes substance abuse, causes addiction, will result in respiratory depression or will hasten death
-language barrier
-comatos pt
-baby
-dementia
-culture
High Risk Population for Under treatment
-Infants and children
-Older Adults
-minorities
-cognitive dysfunction
-emotional /mental illness
-addicts
-pt with terminal ill
-cultural difference
-pt who speaks a difference langugue
Untreated Pain
-Physiologic Impact
-Quality-of-Life Impact
-Financial Impact
ABCs of Pain Management
A-Ask, Assess
B-Believe
C-Choose appropriate medication
D-Deliver the medication in a timely, logical, coordinated fashion
E-Empower the patient
Nurses’ Attitudes/Barriers
-Attitudes of health care providers and nurses affect interaction with patients experiencing pain.
-Individual experiences with pain
-Personal use of meds or Nonpharmacological methods to manage pain
-Family’s or SO’s hx or experience with substances for pain control or mood altering effect
Physiology of Pain
Periphery ——>Noxious stimuli
Physiology of Pain
Nociception
Transduction
Transmission
Perception
Modulation
Transduction
Pain Stimulation
Tissue damage—> release of chemicals——> increase excitability and frequency of nerve impulses
Neurotransmitters
-Release of multiple substances
Examples
Potassium
Serotonin
Bradykinin
Histamine
substance P
prostaglandins
Transmission
Pain Transmission
-To be perceived the pain stimuli must be transmitted first to the spinal cord
-Then signals sent to the central areas of the brain
Transmission
Slow or Express Train?
A Delta fiber small, myelinated fibers; send impulses quickly producing sharp, pricking, well localized pain of a short duration.
C Fiber smallest, unmyelinated fibers, send impulses slower producing dull, aching, burning sensations with a diffuse, slow onset of a long duration
Perception
-Conscious experience of Pain
Involves several brain structures
Reticular activating system: autonomic response (sympathetic nervous system)
Somatosensory system: localization and characterization of the pain
Limbic: emotional and behavior responses
Cortical: meaning of pain
Pain Tolerance
Pain tolerance: The maximum degree of pain intensity that a person is willing to experience.
Ex: Bad day….stub toe….worst pain ever experienced
Factors Affecting Pain
-Age
-Gender
-Women have more:
–pain in women
–Headaches
–Arthritis, fibromyalgia
-Men have more:
–Gout
–PVD
–Back pain
-Sociocultural background
-Genetics
Physiologic Sources of Pain
Nociceptive —>normal
Neuropathic—>abnormal
Nocioceptic
Normal processing of pain
2 Types: Somatic and Viceral
>Somatic
-Superficial: Skin and tissues (incisions, drains)
Sharp and burning
-Deep somatic: Bone, muscle, blood vessels (muscle spasms, orthopedic procedures
-Dull, aching, cramping