NURS 1660 Study Guide - Quiz Guide: Tachycardia, Dementia, Phantom Limb
26 Jun 2018
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October 5, 2017
Health Assessment I Study Guide Questions (Chapters 7 and 12)
Questions/Answers:
Chapter Seven: Pain Assessment
1. Name the three components of pain and describe each.
a. Sensory Discriminative: Severity and location.
b. Affective Motivational: Emotional Aspects; how it makes us feel and what it
makes us do.
c. Cognitive Evaluative: Meaning attributed to the pain.
2. There are two types of nerve fibers that transmit pain. Name them, along with their
description, how they conduct pain impulses, what type of pain they produce and what
reaction/stimulus they produce.
a. A delta fibers:
a.i. Large nerve fibers covered with myelin;
a.ii. Conduct pain impulses rapidly.
a.iii. Produces sharp, stabbing, centralized pain.
a.iv. Simulates withdrawal or flinching.
b. C fibers:
b.i. Smaller unmyelinated nerve fibers.
b.ii. Conduct pain impulses more diffusely and slowly.
b.iii. Produces non-well localized achy, and ongoing pain; even after stimulus
is removed.
b.iv. Stimulate protective response (ie. guarding).
3. What do C fibers release? What does the substance do?
a. C fibers release a pain-facilitating substance from nerve endings called
substance P: which speeds the transmission of the pain stimulus up the pain
pathway.
4. What is bradykinin? Where is it released, what releases it and what is it’s function/role?
a. Bradykinin is another pain-facilitating substance, it is released at the site of
injury; released from damaged tissue and its function is to cause continued
irritation at the injury site.
5. A- and C-nerve fibers are referred to as pain receptors; they carry pain to the CNS. They
are located in the PNS.
6. Describe in six steps how pain travels through the peripheral nervous system
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October 5, 2017
a. Pain begins as a message received by nerve endings (nociceptors).
b. Release of substance P, bradykinin, and prostaglandins sensitizes the nerve
endings; helping transmit pain from site of injury toward the brain.
c. The pain signal travels as an electrochemical impulse along nerve to dorsal horn
on spinal cord.
d. Spinal cord then sends the message to thalamus and the to the cortex.
e. Pain relief starts with signals from the brain that descend by way of spinal cord.
f. Chemicals (endorphins) are then released in dorsal horn to diminish pain
message.
7. What is the Gate Control Theory?
a. This theory states that the body responds to a painful stimulus by either opening
a neutral gate to allow pain to be produced or creating a blocking effect at the
synaptic junction to stop/block the pain. The steps for pain transmission in the
gate control theory are as follows:
1. Continued painful stimuli on peripheral neuron causes “gate” to
open through depolarization of nerve fibre.
2. The pain stimulus then passes from PNS at a synaptic junction to
the CNS up the afferent nerve pathways.
3. Pain stimulus passes up through and across the dorsal horn of the
spine to the structures of the limbic system and the cerebral
cortex.
4. In the cerebral cortex, the stimulus is identified as pain and a
response is created. The response, once generated, passes down
the efferent pathways where reaction to the pain is created.
8. What is nociception?
a. the perception of pain by sensory receptor located throughout the body called
nociceptors.
9. What do nociceptors do/produce?
a. Produce pain resulting from heat, pressure or noxious chemicals
10. State and describe each of the four steps of nociception.
a. Transduction: Noxious stimuli create enough of an energy potential to cause a
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October 5, 2017
nerve impulse perceived by
nociceptors (free nerve endings).
b. Transmission: The neuronal signal
moves from the periphery to the spinal
cord and up to the brain.
c. Perception: The impulse being
transmitted to the higher areas of the
brain are identified as pain.
d. Modulation: Inhibitory and facilitating
input from the brain
modulates/influences the sensory
transmission at the level of the spinal
cord.
11. What is neuroplasticity?
a. Neuroplasticity is persistent/chronic
pain which exists without any identifiable causes and results in the body to
change/adapt how it transmits or perceives pain signals.
12. Name three pain-facilitating substances and three pain-blocking substances.
Pain-Facilitating Substances: Pain-Blocking Substances:
- Substance P
- Bradykinin
- Glutamate
- Serotonin
- Opioids (both natural and synthetic)
- GABA: gabapentin (Neurontin) and
pregabalin (Lyrica)
13. Name the six ways that pain can be classified; as well as their ‘sub-categories’ (where
necessary)
a. Duration (acute, chronic)
b. Frequency (intermittent, continuous)
c. Form (nociceptive, neuropathic)
d. Cause (etiology)
e. Location
f. Association with Cancer and it’s treatments
14. Arthritis and migraines are examples of Continuous or Intermittent/Episodic pain.
15. Name and briefly describe the various locations of nociceptive pain.
a. Visceral pain - from abdominal organs → crampy or gnawing.
b. Somatic pain - from skin, muscles, bones, and joints → sharp.
c. Cutaneous pain - from the dermis, epidermis, and subcutaneous tissues- burning
or sharp, such as with a partial thickness burn.
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