NU136
NU 136 EXAM 4 - Sleep, Pain, Comfort, Diagnostics, Fluid &
Electrolytes, Transfer Admission & Discharge (Complete +
Includes NCLEX Practice Questions) 2026
Pain
- discomfort that interferes with normal activity
- considered a vital sign
- occurs in surgery, illness, infection, trauma, fever, cancer, etc
- now understood as a condition in itself
- feeling of distress or suffering
- can be a warning of tissue damage
- considered subjective data (a symptom not a sign)
- transmitted through the nervous system
The Joint Commission requires....
- Patient rights to pain assessment and treatment
- Pain assessed in all patients
- Patient education on pain and its management
- Discharge planning must address pain care needs
Pain is discomfort caused by stimulation of....
nerve endings
Afferent neurons
These neurons carry signals to the brain & then the pain response follows
Gate Control Theory (Melzack & Wall, 1965)
- Pain transmission controlled by a CNS “gate”
- Small fibers (tissue damage) open the gate
- Large fibers (massage, vibration) close the gate
- High sensory input (e.g., distraction) closes gate
- Anxiety opens the gate; calmness helps close it
NU136
,NU136
Endorphins
- Natural opiate-like peptides
- Reduce or block pain perception
- Bind to opioid receptors like morphine
- Released by physiologic or psychological stress
- Promote pain relief and well-being
How is pain classified?
- Duration
- Cause
- Type
Acute pain
- Short duration, usually related to recent injury or illness
- Often only lasts hours to days
- Common causes: burns, fractures, strains, pneumonia, angina, infections, injury,
medical condition, surger7
- Symptoms: aching, throbbing, searing
- Physical signs: ↑ HR, BP, RR; guarding behavior (not letting you touch)
- Anxiety/fear can intensify pain
- Treatable with analgesics, surgery, or other interventions
Chronic pain
- Persists beyond normal healing time and may become its own disease process
- Lasts more than 3 months, may be lifelong
- Linked to conditions like arthritis, back pain
- May be dull, constant, shooting, tingling, or burning
- Vital signs often normal, unlike acute pain
- Can lead to psychosocial impact and lifestyle changes
- Best managed with combined pharmacologic & nonpharmacologic approaches
NU136
,NU136
Cancer pain
- Pain caused by the cancer itself or its treatments
- Considered a causative category of pain
Nociceptive pain
- Pain from actual or threatened tissue damage activating nociceptors
- Often described as aching, throbbing, or sharp
- Results from injury to body tissue such as muscles, joints, or skin
- Often caused by tissue injury to the skin, muscles, joints, and viscera
- Common causes include trauma, burns, and surgery
- Involves 4 phases: transduction, transmission, perception, modulation
4 phases of nociceptive pain....
- transduction
- transmission
- perception
- modulation
Transduction
- First phase of nociceptive pain
- Tissue damage stimulates nociceptors to convert painful stimuli into electrical signals
- Hurt happens → Pain sensors yell "OW!"
Transmission
- Second phase of nociceptive pain
- Pain signal travels from periphery through spinal cord to brain via nerve pathways
- Signal races → Up nerves to brain
Perception
- Third phase of nociceptive pain
- Brain recognizes and interprets the pain signal as a conscious experience
- Brain gets it → You feel "ouch"
NU136
, NU136
Modulation
- Fourth phase of nociceptive pain
- Brain alters pain response via descending neurotransmitters (endorphins, serotonin)
- Brain fights back → Sends painkillers down
Treatment strategies are interrupting one of the 4 phases of pain:
- NSAIDs block transduction
- Opioids affect transmission
- Distraction/imagery help perception
- Antidepressants block reuptake in modulation
Neuropathic pain
- Pain caused by injury or dysfunction of the nervous system
- Described as burning, shooting, tingling, electric-like
Occurs from nerve damage
- Receptors become overly sensitive because nerve endings grow extra branches
- Linked to medical conditions (not tissue damage)
- Often not relieved by opioids/standard analgesics; managed with NSAIDs + adjuvant
meds
NSAIDs
non-steroidal anti-inflammatory drugs
PQRST
- Precipitating effects: what activity caused the pain? what makes it feel better?
- Quality of pain and discomfort: describe how it feels eg stabbing, shooting, throbbing
- Radiation of pain: does the pain travel or is it located in any one place?
- Severity of pain (on a scale of 1-10 with 10 being the worst)
- Timing: When did the pain start?
Pain Assessment
NU136
NU 136 EXAM 4 - Sleep, Pain, Comfort, Diagnostics, Fluid &
Electrolytes, Transfer Admission & Discharge (Complete +
Includes NCLEX Practice Questions) 2026
Pain
- discomfort that interferes with normal activity
- considered a vital sign
- occurs in surgery, illness, infection, trauma, fever, cancer, etc
- now understood as a condition in itself
- feeling of distress or suffering
- can be a warning of tissue damage
- considered subjective data (a symptom not a sign)
- transmitted through the nervous system
The Joint Commission requires....
- Patient rights to pain assessment and treatment
- Pain assessed in all patients
- Patient education on pain and its management
- Discharge planning must address pain care needs
Pain is discomfort caused by stimulation of....
nerve endings
Afferent neurons
These neurons carry signals to the brain & then the pain response follows
Gate Control Theory (Melzack & Wall, 1965)
- Pain transmission controlled by a CNS “gate”
- Small fibers (tissue damage) open the gate
- Large fibers (massage, vibration) close the gate
- High sensory input (e.g., distraction) closes gate
- Anxiety opens the gate; calmness helps close it
NU136
,NU136
Endorphins
- Natural opiate-like peptides
- Reduce or block pain perception
- Bind to opioid receptors like morphine
- Released by physiologic or psychological stress
- Promote pain relief and well-being
How is pain classified?
- Duration
- Cause
- Type
Acute pain
- Short duration, usually related to recent injury or illness
- Often only lasts hours to days
- Common causes: burns, fractures, strains, pneumonia, angina, infections, injury,
medical condition, surger7
- Symptoms: aching, throbbing, searing
- Physical signs: ↑ HR, BP, RR; guarding behavior (not letting you touch)
- Anxiety/fear can intensify pain
- Treatable with analgesics, surgery, or other interventions
Chronic pain
- Persists beyond normal healing time and may become its own disease process
- Lasts more than 3 months, may be lifelong
- Linked to conditions like arthritis, back pain
- May be dull, constant, shooting, tingling, or burning
- Vital signs often normal, unlike acute pain
- Can lead to psychosocial impact and lifestyle changes
- Best managed with combined pharmacologic & nonpharmacologic approaches
NU136
,NU136
Cancer pain
- Pain caused by the cancer itself or its treatments
- Considered a causative category of pain
Nociceptive pain
- Pain from actual or threatened tissue damage activating nociceptors
- Often described as aching, throbbing, or sharp
- Results from injury to body tissue such as muscles, joints, or skin
- Often caused by tissue injury to the skin, muscles, joints, and viscera
- Common causes include trauma, burns, and surgery
- Involves 4 phases: transduction, transmission, perception, modulation
4 phases of nociceptive pain....
- transduction
- transmission
- perception
- modulation
Transduction
- First phase of nociceptive pain
- Tissue damage stimulates nociceptors to convert painful stimuli into electrical signals
- Hurt happens → Pain sensors yell "OW!"
Transmission
- Second phase of nociceptive pain
- Pain signal travels from periphery through spinal cord to brain via nerve pathways
- Signal races → Up nerves to brain
Perception
- Third phase of nociceptive pain
- Brain recognizes and interprets the pain signal as a conscious experience
- Brain gets it → You feel "ouch"
NU136
, NU136
Modulation
- Fourth phase of nociceptive pain
- Brain alters pain response via descending neurotransmitters (endorphins, serotonin)
- Brain fights back → Sends painkillers down
Treatment strategies are interrupting one of the 4 phases of pain:
- NSAIDs block transduction
- Opioids affect transmission
- Distraction/imagery help perception
- Antidepressants block reuptake in modulation
Neuropathic pain
- Pain caused by injury or dysfunction of the nervous system
- Described as burning, shooting, tingling, electric-like
Occurs from nerve damage
- Receptors become overly sensitive because nerve endings grow extra branches
- Linked to medical conditions (not tissue damage)
- Often not relieved by opioids/standard analgesics; managed with NSAIDs + adjuvant
meds
NSAIDs
non-steroidal anti-inflammatory drugs
PQRST
- Precipitating effects: what activity caused the pain? what makes it feel better?
- Quality of pain and discomfort: describe how it feels eg stabbing, shooting, throbbing
- Radiation of pain: does the pain travel or is it located in any one place?
- Severity of pain (on a scale of 1-10 with 10 being the worst)
- Timing: When did the pain start?
Pain Assessment
NU136
