PrepU Patho Ch 35

The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate?

"Many people find that maintaining regular eating and sleeping habits is beneficial." Nonpharmacologic treatment includes the avoidance of migraine triggers, such as foods, that precipitate an attack. Many persons with migraines benefit from maintaining regular eating and sleeping habits. The client may need to change her lifestyle, but not to the extent of moving and changing jobs. Migraines are avoidable, most of the time, if individuals adhere to their diets and watch the triggers. Medication is very useful for most clients.

A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be:

"Pain threshold is the point at which a stimulus is perceived as painful." Pain threshold is closely associated with the point at which a nociceptive stimulus is perceived as painful. Pain tolerance relates more to the total pain experience; it is defined as the maximum intensity or duration of pain that a person is willing to endure before the he or she wants something done about the pain. Psychological, familial, cultural, and environmental factors significantly influence the amount of pain a person is willing to tolerate. The threshold for pain is fairly uniform from one person to another, whereas pain tolerance is extremely variable.

A nurse who is testing a client's response to passive movement of the fingers with the client's eyes closed notes that the client cannot accurately identify on which side the movement occurred or in what position the finger was placed. What is an appropriate interpretation of this result?

Abnormal discrimination pathway function The discriminative dorsal column-medial lemniscus pathway is able to sense fine touch and discriminate between two points as close as 5 mm. This pathway also mediates sense of position. Loss of this pathway means only that the anterolateral pathway is functioning and is unable to make fine distinctions in touch proprioception and points. The test does not test reflexes or temperature.

Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many comorbidities that require several prescription medications. The nurse knows that which factor is likely to complicate the clinician's assessment and treatment of the client's pain?

Assessment and treatment are possibly complicated by the large number of drugs that the client receives. Polypharmacy complicates both assessment and treatment of pain in the older adult. While minor changes in pain pathways do occur as an age-related change, these do not mean that treatment is unsuccessful. Pain assessment is more difficult in clients with cognitive deficits, but it is not impossible. Reports of pain in older adults, as with any client, may signal an underlying health problem.

When conducting a health assessment that focuses on the pain experienced by an older client diagnosed with early dementia, the nurse will pay particular attention to which of the following?

Behavioral signs of pain demonstrated by the client The assessment of pain in older adults can range from relatively simple in a well-informed, alert, cognitively intact person with pain from a single source and no comorbidities to extraordinarily difficult in a confused person. When possible, a person's report of pain is the gold standard, but behavioral signs of pain should also be considered. This is especially true when the client's cognitive function is impaired. While the other options should be considered, the client's nonverbal behaviors should be of particular interest to the nurse.

What will the nurse teach a client with trigeminal neuralgia about the condition?

Carbamazepine is a first-line treatment. Trigeminal neuralgia is a condition in which clients experience brief, severe, repetitive lightninglike or throbbing pain along the distribution of one or more of the branches of the fifth cranial nerve. Clients should be taught to avoid triggers when possible, but although eating may be a trigger, it is necessary for the client to maintain nutrition. Social isolation is a possible problem arising from the condition. Time alone does not contribute significantly to improvement of the condition. Although treatment rarely provides total relief, trigeminal neuralgia can be controlled with carbamazepine and surgical release of vessels, nerve roots, or scar tissue. If other treatments are ineffective, partial destruction of the nerve branches with heat, balloon compression, or glycerol injection may be performed. Newer therapies to be considered are botulinum toxin injection and gamma radiation with stereotactic surgery.

The nurse knows that chronic pain lacks which of the characteristic pain-related reactions?

Increased heart rate Characteristics of chronic pain do not include autonomic responses like increased heart and respiratory rate. Loss of appetite, disturbed sleep patterns, and depression are common among people dealing with chronic pain.

A nurse on a postsurgical unit is providing care for a 76-year-old female client who is two days post-hemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which guideline should the nurse use for short-term and long-term treatment of the client's pain?

Knowing that the client's self-report of pain is the most reliable indicator of pain Clinically, the client's self-report of pain is the most reliable indicator of pain. The risk of addiction to opioids is extremely low and since the client's pain is acute rather than chronic, it is likely self-limiting.

Which tactile receptors will signal continuous touch on the skin?

Merkel discs Merkel discs transmit an initial strong signal but decrease in strength, indicating continuous pressure on the skin. Meissner corpuscles respond to light touch and low-frequency vibration. Ruffini end-organs are found in skin and deeper structures like joint capsules. Hair-follicle receptors are near the skin surface and respond to light touch.

When a peripheral nerve is irritated enough, it becomes hypersensitive to the noxious stimuli, which results in increased painfulness or hyperalgesia. Health care professionals recognize both primary and secondary forms of hyperalgesia. What is primary hyperalgesia?

Pain sensitivity that occurs directly in damaged tissues Primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues.

When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used?

Pressure from a sharp object Stimuli used to elicit a withdrawal reflex include pressure from a sharp object, strong electric current to the skin, or application of heat or cold of approximately 10°C above or below normal skin temperature.

A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:

Referred Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. Visceral pain originates in the visceral organs and is one of the most common pains produced by disease. Cutaneous pain arises from superficial structures. Somatic pain originates in deep body structures.

The renal excretion of drugs in children is dependent on which factors? Select all that apply.

Renal blood flow Glomerular filtration rate Tubular secretion Renal function in children reaches adult level by age 1. The renal excretion of drugs in children is dependent on renal blood flow, glomerular filtration rate, and tubular excretion.

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy?

Tension Tension-type headaches often are more responsive to nonpharmacologic techniques, such as biofeedback, massage, acupuncture, relaxation, imagery, and physical therapy, than other types of headache. For people with poor posture, a combination of range-of-motion exercises, relaxation, and posture improvement may be helpful. The other options are usually best treated with medications that focus on the cause of the pain.

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items?

The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron The discriminative pathway, which is associated with the fine touch of item discrimination, involves just three neurons: the primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron. Slow-conduction and anterolateral pathways that involve the reticular activating system are associated with pain, thermal sensation, and indiscriminate touch.

A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating her feet are "burning." The nurse in the emergency department knows that the child's response is based on which pathophysiologic principle listed below?

The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. If a person places a foot in a tub of hot water, the tactile sensation occurs well in advance of the burning sensation. The foot has been removed from the hot water by the local withdrawal reflex well before the excessive heat is perceived by the forebrain.

A client comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as "like an electric shock." The pain occurs on only one side of her face. It seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. Often it is accompanied by involuntary grimacing. What diagnosis is most likely?

Trigeminal neuralgia Her symptoms are characteristic of trigeminal neuralgia, caused by damage to cranial nerve V, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw. Postherpetic neuralgia is a complication of shingles. Migraine headache symptoms feel as if they occur in one or more regions of the head, not the face. Complex regional pain syndrome affects either one arm or leg.

A client is admitted to the acute care facility with severe pain in the abdomen related to inflammatory bowel disease. What type of pain will the nurse be administering medication to relieve?

Visceral pain Visceral pain has its origin in the visceral organs and is one of the most common pains produced by disease. While similar to somatic pain in many ways, both the neurologic mechanisms and the perception of visceral pain differ from somatic pain. One of the most important differences between surface pain and visceral pain is the type of damage that causes pain. Strong contractions, distention, or ischemia affecting the walls of the viscera can induce severe pain.

A client with a history of migraine headaches tells the physician that he or she usually experiences an aura before the onset of the headache. The client is most likely experiencing:

Visual disturbances Migraine aura is associated with visual symptoms, including flickering lights, spots, or loss of vision; sensory symptoms, including feeling of pins or needles, or numbness; and speech disturbances or other neurologic symptoms.

Which scenario would be an example of a child born with congenital insensitivity to pain? A child who:

fell off a skate board and fractured ankle but did not feel any pain, just noted swelling in foot. Analgesia is the absences of pain on noxious stimulation or the relief of pain without loss of consciousness. Congenital insensitivity is when a peripheral nerve defect apparently exists such that the transmission of painful nerve impulses does not result in perception of pain. Pins-and-needles sensation is called paresthesia. Burning sensations are usually associated with temperature (hyperthermia). Pain associated with wind (or any non-noxious stimuli) is called allodynia.