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the system that processes info about intensity & location of pain |
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the system that determines approach/avoidance behavior to pain (Kathleen vs Nathaniel example) |
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learned behavior, individual's concept of appropriate pain behavior; can block, modulate, or enhance (i.e. Victorian lady and fainting) |
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pain that has physical cause, i.e. heart attack |
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pain that has no known physical cause, just as intense and painful, NOT imagined; i.e. migraines (stress seems to precipitate migraines but the resulting headache is very real) |
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pain that mobilizes a person to respond, produces much anxiety |
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persistent, lasting at least 6 months; pain develops insidiously, person adapts; hopeless and helpless because pain is meaningless; causes depression |
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lower back pain is most common followed by myofascial (muscles & connective tissue) pain |
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most common type of chronic pain |
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point at which stimulus is perceived as painful...with intense pain in one location, other thresholds go up, i.e., break wrist & back pain is no longer felt |
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amount of time person will endure pain before responding...goes down with repeated exposure to pain, fatigue, anger, boredom, apprehension & sleep deprivation (i.e. surgery) |
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nociceptors, A delta and C fibers |
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what are pain receptors called and what are the 2 types |
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larger myelinated pain receptors (fast,-saltatory conduction-Nodes of Ranvier), localized sharp pain |
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smaller unmyelinated pain receptor, transmits slowly, burning or aching sensation... (chronic pain) - terminate in the reticular formation of the brain stem, & excite the reticular activating system. Wakes person up at night....i.e. after surgery, patient has startle reflex when sleeping, jumps awake. |
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bradykinin, histamine, prostaglandin, leukokinin released from lymphycytes (mimics the 1st 3 substances) ***all are part of the inflammation response*** |
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name 4 substances that nociceptors respond to |
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Substance P (P is for pain) |
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after injury, this is released from the synaptic vessicles of unmyelinated fibers & activates the pain response |
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An impulse at the dorsal horn of the spine, substantia gelatinosa, can be stopped by flooding this point with sensory information, or stimulating the large A delta fibers. Skin cell receptors (Meissner's-light touch and Pacinian-pressure) terminate in the dorsal horn of the cord and can close it off to pain, diminishing perception of pain, i.e. massage, rubbing, acupuncture, terrycloth or rice, hot/cold bath, popcorn kernels (increase sensory output) |
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intermittent stress, excessive physical exertion (running), acupuncture, sex, chocolate (1 ounce) |
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list 5 activities that raise endorphin levels :) |
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acute pain that is superficial, skin or close to surface |
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acute pain that is poorly localized, often radiates, internal organs |
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acute pain in area removed from point of origin, but predictable because the area is supplied by the same spinal nerve segment |
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Fight of Flight response (physiological response to acute pain) |
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in response to acute pain: endorphin levels increase, HR and RR increase, Face/skin turns pale or flushed, pupils dilate (an effort to see everything) sweating increases, BG increases (stress response causes sugars to be released into blood), gastric secretions decrease --> indigestion, blood supply to the viscera (gut) decreases - more important to deal with pain than digest food |
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fear, anxiety, unease, doom |
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what is the psychological response to acute pain (4 things) |
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excessively excitable pain pathway |
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increased sensitivity to any stimuli: touch causes pain, usually diffuse, worse when tired, result of chronic irritation, of the thalamus and central areas. "Don't touch me." |
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unable to identify source of pain on one side, and when exposed to pain, can't move away from it, i.e. stroke with paralysis on one side |
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ind. feels amputated limb...happens more often in ind. who had a lot of pain before amputation. |
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small hypersensitive region in muscle or connective tissue. Can be close or removed, but stimulus produces pain in a specific area. |
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1) dilated blood vessels 2) increased vascular permeability, leaking plasma = serous exudate 3) WBC adhering to inner walls of vessels, then crossing wall to site of injury |
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Definition
3 observations of inflammation by Cohnheim are... |
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redness, swelling, heat, pain, loss of function of inflamed tissue |
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cardinal signs of inflammation |
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1) destroys injurious agent and removes it, 2) walls off the site, prevents spread, 3) stimulates immune response, 4) promotes healing |
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what 4 things does inflammation accomplish? |
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granulocytes (mostly neutrophils) marginate or move to the wall of the vessel, then emigrate through the spaces by this process, across the vessel into the interstitial space. |
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Leukotrienes and prostaglandins |
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mast cells synthesize these 2 chemical mediators |
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1 of the 3 chemical mediators of inflammation;a plasma protein that activates and assists immune process |
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1 of the 3 chemical mediators of inflammation; a plasma protein system that traps bacteria and prevents hemorrhaging |
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1 of the 3 chemical mediators of inflammation; plasma protein system that controls vascular permeability |
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most important cell in inflammation response; releases: histamine, chemotactic factors, prostaglandins, and leukotrienes; lungs are filled with these cells; activate inflammation rx in 2 ways: 1) degranulation, release histamine neutrophil & eosinophil chemotactic factor. Platelets release serotonin. 2) synthesize leukotrienes & protaglandins |
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induce pain and are classified in groups according to structure: A, B, E, F. Most NSAIDs, such as Nuprin and Motrin are aimed at preventing the synthesis of prostaglandin E |
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leukotrienes aka Slow Reacting Substance of Anaphylaxis (SRS-A) |
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formed by prostaglandins, produce effects like histamine; important in inflammatory response because they stimulate slower more prolonged responses than histamine; bring about anaphylaxis and often trigger asthma attacks |
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1) complement (activates and assists immune process) 2) clotting traps bacteria & prevents hemorrhaging 3) kinin controls vascular permeability |
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Name the 3 chemical mediators of inflammation |
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a serum protein made by the liver that helps fight infection by lysing bacteria that are Ab coated; many reactions in the body are dependent on this system (C1-C2-C3-C4-C5-C6-C7-C8--C9) |
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clots are needed to trap bacteria and stop bleeding. Hageman Factor (XII) is needed to form thrombin. platelet ruptures--------------------->thromboplastin prothrombin-------------------->thrombin fibrinogin-------------------->fibrin clot |
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describe the clotting system |
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bradykinin is the primary and most common kinin. Bradykinin is a strong vasodilator and contracts smooth muscle. |
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describe the kinin system; what is the primary/most common kinin |
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1) fever 2) high erythrocyte sedimentation rate or Rouleaux formation (stacking of RBC) because of altered plasma proteins 3) Leukocytosis (increased WBC count) |
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evidence of acute inflammation (3 things) |
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clean surgical wound heals much faster than a bedsore because this wound is healing by.... |
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heals from inside to outside, i.e., bedsore needs more tissue replaement; sometimes surgical debridement, pack with wet dressings to heal in this way... |
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body must replace damage (missing) tissue with scar tissue = collagen, restores strength but not physiologic function; can cause problems: strangulation of bowels by fibrous bands. *need protein, glucose, O2...calcium for bones, good nutrition. Hypoxia, diabetes, & bleeding disorder will all impair healing. |
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