Term
Name six adverse physiologic effects of postoperative pain r/t the pulmonary system. |
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Definition
-decreased lung volumes
-atelectasis
-ventilation to perfusion mismatching
-arterial hypoxemia
-hypercapnia
-pneumonia |
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Term
Name four physiologic effects of postoperative pain r/t the coagulation system.
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Definition
-increased platelet adhesiveness
-decreased fibrinolysis
-hypercoagulation
-DVT |
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Term
Name three adverse physiologic effects associated with postoperative pain and the endocrine system. |
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Definition
-hyperglycemia
-sodium and water retention
-protein catebolism |
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Term
T/F
Young children do not feel pain as severely as adults. In addition the magnitude and duration of pain is less. |
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Definition
Hells no!! This is a popular misconception-Docs who believe this are little bitches. |
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Term
Name the estimated % of persistent post-op pain in the following:
-Amputation
-Breast
-Thoracotomy
-Inguinal hernia repair
-CABG |
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Definition
Amputation 30-50%
Breast 20-30%
Thoracotomy 30-40%
Inguinal hernia repair 10%
CABG 30-50% |
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Term
Nociception involves the recognition and transmission of what? Via what nerve endings? |
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Definition
Painful stimuli
Afferent nerve endings of myelinated A-delta and unmyelinated C fibers |
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Term
| Name the three stimuli that can generate nociceptive pain pathways. |
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Definition
Thermal
Mechanical
Chemical tissue damage |
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Term
Where do the peripheral afferent nerve endings send axonal projections? |
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Definition
The dorsal horn of the spinal cord |
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Term
Why do some patients who have had rhizotomies sill experience pain? |
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Definition
Because some of the C fibers may enter the spinal cord via the ventral (motor) nerve. |
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Term
First order neurons can ascend or descend how many segments and where before synapsing with second order neurons? |
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Definition
1-3 segments in LISSAUER's tract |
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Term
Where do second order neurons synapse with third order neurons? |
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Definition
In the thalamus which then sends axonal projections into the sensory cortex. |
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Term
Where does the spinalthalmic tract lie? |
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Definition
Anteriorolaterally in the white matter of the spinal cord |
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Term
How is the spinalthalmic tract divided? |
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Definition
| Into the lateral spinothalamic (neospinothalamic tract) and the medial spinothalamic (paleospinothalamic tract) |
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Term
What is the lateral spinothalamic tract responsible for? |
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Definition
Carrying discriminative aspects of pain, such as location, intensity and duration. |
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Term
What is the medial spinothalamic tract responsible for? |
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Definition
Mediating the autonomic and unpleasant emotional perceptions of pain. |
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Term
What does the periaquaductal gray play a role in? |
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Definition
Modulation of the descending pathways and the reticular activating system and hypothalamus responsible for the arousal to pain. |
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Term
What releases and synthesizes Substance P? |
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Definition
1st order neuron both peripherally and in the dorsal horn. |
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Term
What receptor does Substance P attach to? |
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Definition
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Term
What does Substance P do in the periphery? |
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Definition
1) impacts blood vessels
2) degranulates MAST cells
3) sensitizes the nociceptors
4) causes platelets to release serotonin
5) its a vasodilator |
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Term
T/F
Visceral organs are normally sensitive tissue. |
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Definition
FALSE-Visceral organs are normally INsensitive tissue that contain silent nociceptors. |
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Term
Visceral organs are normally insensitive, however, they are sensitive to certain stimuli, what are they? |
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Definition
1) inflammatory mediators
2) distention
3) pressure |
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Term
If a patient is having brain surgery, will they feel anything during any part of the procedure? |
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Definition
The brain lacks nociceptors completely (so no pain if it just brain tissue), but the meninges DO have them. |
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Term
What do nociceptive C fibers of the esophagus, larynx and trachea travel with? |
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Definition
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