Pain
What is pain?
- qualitative or quantitative?
- objective or subjective?
Qualitative, subjective, and patient-focused.
What ...
Creates a barrier to foreign materials, dilutes and 'flushes out' contaminants, promotes cell-mediated immune response, facilitates removal of necrosis, and assists healing via immobilization?
What is the acronym for the ideal treatment plan? Medication options?
Inflammation!
R.I.C.E.
Aspirin, Acetaminophen, NSAIDs, Antihistamines, Corticosteroids, Biologics
1.Chain of Infection - (order)
Susceptible Host Mode of Transmission
Portal of Entry Portal of Exit
Reservoir Pathogen
2. Best method of infection control?
1. Pathogen, Reservoir, Susceptible Host, Portal of Entry, Mode of Transmission, Portal of Exit
2. Handwashing
What is a protein based substance that elicits an immune system response by the host plasma cells? It is recognized by receptors on WBC.
Antigens
What is a treatment that can help reduce the uptake of chemotherapy into to nerves?
Cryotherapy
Pain Fibers
1. myelinated; rapid, sharp, pricking, piercing; well defined, localized; mechanical nociceptors
2. unmyelinated; diffuse, dull; consistent; thermal, chemical, strong mechanical sensations
1. A. Fibers
2. C Fibers
What's the Inflammatory Response
Occurs immediately after injury, beginning with vasoconstriction then releases histamines and prostaglandins to promote vascular dilation. This results in vascular fenestrations causing fluid to shift and leak into the ECS creating the formation of edema. Leaked fluid is albumin, increased edema. Fibrin activation triggers an inflammatory cascade to contain the injury.
Ex. Sprained ankle, trauma
Vascular Inflammatory Response
Distinguishing differences between a vector and fomite?
Vector: Living ->people, animals, insects
Fomite: Non-living -> soil, inanimate objects, water, improperly handled food, IV tubing, wounds, dressing, urine collection devices
Which Level Immune Dense Am I?
1. Antibodies
2. WBC phagocytosis
3. Inflammation / fever
4. Intact skin and barriers
5. Mucus membrane and secretions
6. Killer cells
7. Leukotrienes & Interferons
1. Third
2. Second
3. Second
4. First
5. First
6. Second
7. Third
The Top 3 ... Cancers
Men =
Women =
women - breast, lung, colorectal
Types of Pain (and provide example)
1. organ and lining of body cavities / squeezing, aching
2. nerve fibers, spinal cord, CNS / tingling, numbness, burning, stabbing
2. cutaneous or deep somatic /anching, cramping, gnawing, sharp
1. Visceral - pancreatitis, bladder pain, IBS, crohn's, endometriosis
2. Neuropathic - peripheral neuropathy, phantom limb pain
3. Somatic - cutaneous - skin cuts, SQ tissues - cellulitis, wounds
deep somatic - bone, muscle, blood vessels, connective tissue, tendon
What cellular response am I?
1. On site response in 6-12rs. Phagocytize bacteria, debris. Life span 1-2d. 2. Responds within 3-7 days in response to chemotactic substances.
3. Mediate immune response
4. Are converted from monocytes. Long life span. Encapsulate debris.
1. Neutrophil
2. Monocytes
3. Lymphocytes
4. Macrophages
Name 4 factors that influence the development of infection.
Immune system status - neutropenia, autoimmune disorders
Age - very old/young
Hormonal factors - prednisone (steroids), cortisol, thyroid
Nutrition status - malnutrition, diabetes
Environmental - social habits, air quality
Medical interventions - chemotherapy, radiation
Lymph Organ
1. Red pulp filters antigens from blood and disposes of injured RBC.
White pulp produces antibodies.
1. Spleen
Abnormal Cell Growth
What is a cell that changes cell function?
What is a cell that changes cell growth?
What is a cell that is non inherently harmful?
What is a cell that is invasive and leads to cancer?
Dysplastic
Benign
Malignant
What are the elements of a pain assessment?
SOCRATES - site, onset, character, radiates, associated sx, time/duration, exacerbation/relieving factors, severity
OLD CART - onset, location, duration, characteristics, associated sx, radiation, treatment
PQRST - provoking factors, quality, region/radiation, severity, time
Tell Me!
What is the fluid and WBC accumulation at site of injury.
Provide the 6 examples.
Exudate
Serous, Serosanguinous, Fibrinous, Hemorrhagic, Purulent, Catarrhal
What is...
1. the state of no detectable symptoms, no apparent symptoms of reaction in host, and only identified by immune response (antibodies)?
2. the state of detectable symptoms, injury and insult to tissues of host, considered infectious disease, and may range from mild to life threatening?
1. Subclinical Infection
2. Clinical Infection
What do I do again? Immune Globulin (Ig)
1. Saliva/GI Tract
2. Hypersensitivity/Allergic Reaction
3. Activate B cells and other key lymphocytes
4. Most common, targets and protects against bacteria and some viral
5. Dimerized version of IgG; similar protection as IgG
1. IgA (think "Awweeee" open mouth saliva/ GI tract)
2. IgE (think "EKKKK")
3. IgD (think "Defense" WBC / Bcells)
4. IgG (think "Gurls lets get it" most common (s), goed after bacteria/ viral)
5. IgM (think "Mostly like G"
Warning signs of cancer? Acronym?
C changes in bowel or bladder habits
A sore that does not heal
U unusual bleeding or discharge
T thickening or lumps in breast
I indigestion or difficulty swallowing
O obvious changes in wart/mole
N nagging cough or hoarseness
U unexplained weight loss
P pernicious anemia
What are the objective and subjective findings of
Acute and Chronic Pain
Acute
- objective - increased BP/HR/RR; mydriasis, diaphoresis, xerostomia
-subjective - restless, tense, rigid, irritable, apprehension, distress, crying, anger, hostile, grimace, moaning, nonverbal ques, guarding
Chronic
- objective - normal VS; moderate-high pain score
- subjective- immobility, physical inactivity, social isolation, withdrawal, anxiety, irritability, loss of interest in activity, depression, self-medicate
What the Cellular Response
Injury occurs leading to a membrane disruption of the phospholipids triggering the inflammatory cascade. Arachidonic acid is released and becomes the precursor to what cellular response? What does each cell response do?
1. Prostaglandins - potent vasodilator, neutrophil chemotaxis, stimulate pain
2. Thromboxane - potent vasoconstrictor, mediated PLT aggregation, clotting
3. Leukotriene - bronchoconstriction, allergen/anaphylaxis, chemotaxis of leukocytes
What The Precautions (Extra points for examples)
1. Standard / Universal
2. Airborne
3. Droplet
4. Contact
5. Soap and Water
6. Reverse
1. Gloves, mask, eyewear, and gown, as necessary. Hand washing. Needle and sharps safety.
2. Private negative pressure room, high efficiency filter, N-95 or PAPR, no susceptible visitors, limited out of room time with mask on (TB, rubeola, varicella, covid-19)
3. Private room, mask with 6ft, limited out of room time (Flu, PNA, rubella, pertussis, diphtheria, covid-19)
4. Private room, gown, gloves (RSV, pediculosis, scabies, ebola)
5. Private room, gown, cloves, soap and water hand hygiene (c.diff)
6. Private positive pressure room, masks work by visitors (CF, neutropenia, bone marrow suppression)
Antigen-Antibody Interactions
A. Response increases with each re-exposure. Antigen-specific IgE. Anaphylaxis is the most extreme reaction causing total vascular collapse and angioedema.
B. Immune complexes formed, deposited in walls of small vessels, damage to tissues and vascular beds.
C. Antibodies formed against foreign protein tissue. Ex.Transfusion reaction, drug induced hemolytic anemia.
D. Lymphocytes response to allergen activating macrophages.Causes a reaction hours to days later and often leads to edema, ischemia, and tissue damage
A. Type 1 - Rapid Hypersensitivity
B. Type 3 - Immune Complex Reactions
C. Type 2 - Cytotoxic Reactions
D. Type 4 - Delayed Hypersensitivity Reactions
Who can name the most side effects of chemotherapy / radiation?
Alopecia, cachexia, emetogenic, extravasation, mucositis, nadir, neutropenia, vesicants, impaired immune function, impaired hem/clotting, N/V/D, stomatitis, impaired liver, neuropathy, changes in mobility, neurological impairment, Myocardial injury, acute/chronic pain, fatigue, lethargy, insomnia, impaired thermoregulation, altered blood flow, air hunger, ect