(a p n l c o n k advanced concept of nursing-...

Advanced Concept ofNursing- II

UNIT- XIAdvance Nursing Management

of Oncology Disorders

In The Name of God

(A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI)

UNIT- XIAdvance Nursing Management

of Oncology DisordersShahzad Bashir

RN, BScN, DCHN,MScN (Std.DUHS)Instructor

New Life College of NursingUpdated on April 18, 2016

Objectives• At the completion of this unit learners will be

able to:1. Review the concept of somatosensory

pathway.2. Describe the function of Nociceptors in

response to pain information.3. Describe the function of endogenous analgesic

mechanism as they relate to transmission ofpain information.

4. Describe the proposed mechanism of painrelief associated with the use of heat, cold &TENS i.e. Transcutaneous electrical nervestimulation.

• At the completion of this unit learners will beable to:

1. Review the concept of somatosensorypathway.

2. Describe the function of Nociceptors inresponse to pain information.

3. Describe the function of endogenous analgesicmechanism as they relate to transmission ofpain information.

4. Describe the proposed mechanism of painrelief associated with the use of heat, cold &TENS i.e. Transcutaneous electrical nervestimulation. 2

THE SOMATOSENSORY SYSTEM• The somatosensory system relays information about

four major modalities: touch, temperature, pain, andbody position.

• Somatosensory information is sequentiallytransmitted over three types of neurons:

• First-order neurons: (Which transmit information fromsensory receptors to dorsal horn neurons)

• Second-order CNS association neurons: (Whichcommunicate with various reflex circuits and transmitinformation to the thalamus)

• Third-order neurons: (Which forward the information fromthe thalamus to the sensory cortex).

• The somatosensory system relays information aboutfour major modalities: touch, temperature, pain, andbody position.

• Somatosensory information is sequentiallytransmitted over three types of neurons:

• First-order neurons: (Which transmit information fromsensory receptors to dorsal horn neurons)

• Second-order CNS association neurons: (Whichcommunicate with various reflex circuits and transmitinformation to the thalamus)

• Third-order neurons: (Which forward the information fromthe thalamus to the sensory cortex).

Cont….

Cont….• The fibers of different dorsal root ganglion neurons

conduct impulses at varying rates, ranging from 0.5 to120 m/second.

• There are three types of nerve fibers that transmitsomatosensory information: types A, B, and C.

• Type A fibers: (Which are myelinated, have the fastest rate of conduction,convey cutaneous pressure and touch sensation, cold sensation, mechanical pain,and heat pain.

• Type B fibers: (Which also are myelinated, transmit information from

cutaneous and subcutaneous mechanoreceptors).• Type C fibers: (Which are unmyelinated and the slowest rate of

conduction. They convey warm-hot sensation and mechanical and chemical aswell as heat- and cold-induced pain sensation.

• The fibers of different dorsal root ganglion neuronsconduct impulses at varying rates, ranging from 0.5 to120 m/second.

• There are three types of nerve fibers that transmitsomatosensory information: types A, B, and C.

• Type A fibers: (Which are myelinated, have the fastest rate of conduction,convey cutaneous pressure and touch sensation, cold sensation, mechanical pain,and heat pain.

• Type B fibers: (Which also are myelinated, transmit information from

cutaneous and subcutaneous mechanoreceptors).• Type C fibers: (Which are unmyelinated and the slowest rate of

conduction. They convey warm-hot sensation and mechanical and chemical aswell as heat- and cold-induced pain sensation.

PAIN

• Pain is both a protective & an unpleasantsensation associated with actual or potential tissuedamage.•• Pain is an unpleasant or emotional experiencePain is an unpleasant or emotional experience

originating in real or potential damaged tissueoriginating in real or potential damaged tissue•• Pain is an unpleasant or emotional experiencePain is an unpleasant or emotional experience

originating in real or potential damaged tissueoriginating in real or potential damaged tissue

• Unpleasant sensations (Sensory andemotional) associated with either potential oractual tissue damage.

Conti

• There are two pathways for pain transmission:1. The pathway for fast, sharply discriminated pain

that moves directly from the receptor to the spinalcord using myelinated Aδ(10 to 30 m/second)fibers and from the spinal cord to the thalamususing the neospinothalamic tract

2. The pathway for slow, continuously conductedpain that is transmitted to the spinal cord usingunmyelinated C fibers(0.5 to 2.5 m/second) andfrom the spinal cord to the thalamus using themore circuitous and slower-conductingpaleospinothalamic tract

• There are two pathways for pain transmission:1. The pathway for fast, sharply discriminated pain

that moves directly from the receptor to the spinalcord using myelinated Aδ(10 to 30 m/second)fibers and from the spinal cord to the thalamususing the neospinothalamic tract

2. The pathway for slow, continuously conductedpain that is transmitted to the spinal cord usingunmyelinated C fibers(0.5 to 2.5 m/second) andfrom the spinal cord to the thalamus using themore circuitous and slower-conductingpaleospinothalamic tract

NEUROANATOMIC PATHWAY.

SENSORY PATHWAYS

Conti

• Type I / Nocciceptive /Immediate PainIt is activated due to actual tissues injury

• Type II / Inflammatory PainIt is caused due to inflammatory process

• Type III / Naturopathic PainIt arises due direct nerve injury

• Type I / Nocciceptive /Immediate PainIt is activated due to actual tissues injury

• Type II / Inflammatory PainIt is caused due to inflammatory process

• Type III / Naturopathic PainIt arises due direct nerve injury

PAIN

Stimuli

Phospholipidsare convertedto Arachidonic

Acid byphosholipase

A2

AA is convertedto Prostaglandins

bycycloxygenase

PGE2 and PGI2 sensitize theperipheral nerve endings to painfulstimuli by lowering the threshold ofnociceptors. Centrally, PGE2 can

increase excitability in paintransmission neuronal pathways in

the spinal cord

PGE2 and PGI2 sensitize theperipheral nerve endings to painfulstimuli by lowering the threshold ofnociceptors. Centrally, PGE2 can

increase excitability in paintransmission neuronal pathways in

the spinal cord

PHYSIOLOGY OF PAIN

ENDORPHINS

COMMON SITES FOR REFERRED PAIN

Slide 10-21

ACUTE PAIN

•• Acute pain is a protective mechanism that alerts theAcute pain is a protective mechanism that alerts theindividual to a condition or experience that isindividual to a condition or experience that isimmediately harmful to the body.immediately harmful to the body.

•• Sudden onset, short duration, severeSudden onset, short duration, severe•• It lasts less than 6 monthsIt lasts less than 6 months•• It often results from injury, surgeryIt often results from injury, surgery•• It is presenting symptoms of some infections i.e.It is presenting symptoms of some infections i.e.

pharyngitis, appendicitis, otitis media etc……….pharyngitis, appendicitis, otitis media etc……….

•• Acute pain is a protective mechanism that alerts theAcute pain is a protective mechanism that alerts theindividual to a condition or experience that isindividual to a condition or experience that isimmediately harmful to the body.immediately harmful to the body.

•• Sudden onset, short duration, severeSudden onset, short duration, severe•• It lasts less than 6 monthsIt lasts less than 6 months•• It often results from injury, surgeryIt often results from injury, surgery•• It is presenting symptoms of some infections i.e.It is presenting symptoms of some infections i.e.

pharyngitis, appendicitis, otitis media etc……….pharyngitis, appendicitis, otitis media etc……….

RESPONSES TO ACUTE PAINRESPONSES TO ACUTE PAIN

--Increased heart rateIncreased heart rate-- Increased respiratory rateIncreased respiratory rate -- blood sugarblood sugar--Elevated blood pressureElevated blood pressure -- gastric acidgastric acid-- Pallor or flushingPallor or flushing,, -- gastric motilitygastric motility

dilated pupilsdilated pupils

--Increased heart rateIncreased heart rate-- Increased respiratory rateIncreased respiratory rate -- blood sugarblood sugar--Elevated blood pressureElevated blood pressure -- gastric acidgastric acid-- Pallor or flushingPallor or flushing,, -- gastric motilitygastric motility

dilated pupilsdilated pupils

CHRONIC PAIN

•• Continuous, long term processContinuous, long term process

•• Lasts more than 6 months.Lasts more than 6 months.

•• Examples: Back pain, cancer pain, arthritisExamples: Back pain, cancer pain, arthritis

•• Continuous, long term processContinuous, long term process

•• Lasts more than 6 months.Lasts more than 6 months.

•• Examples: Back pain, cancer pain, arthritisExamples: Back pain, cancer pain, arthritis

Conti

Cutaneous painCutaneous pain•• It is superficial coming from the skin or close to theIt is superficial coming from the skin or close to the

surface of the body.surface of the body.•• It is sharp painIt is sharp pain

Deep somatic painDeep somatic pain•• Deep somatic pain originates from deep structuresDeep somatic pain originates from deep structures•• i.e. muscles, joints, blood vessels etc……..i.e. muscles, joints, blood vessels etc……..

Cutaneous painCutaneous pain•• It is superficial coming from the skin or close to theIt is superficial coming from the skin or close to the

surface of the body.surface of the body.•• It is sharp painIt is sharp pain

Deep somatic painDeep somatic pain•• Deep somatic pain originates from deep structuresDeep somatic pain originates from deep structures•• i.e. muscles, joints, blood vessels etc……..i.e. muscles, joints, blood vessels etc……..

Conti

Visceral painVisceral pain••Visceral pain refers to pain in internal organs, theVisceral pain refers to pain in internal organs, theabdomen,abdomen, oorr chestchest..••i.e. renal pain, peptic ulcer pain, pain in cholecystitisi.e. renal pain, peptic ulcer pain, pain in cholecystitisetc……etc……

Referred painReferred pain•• Referred pain is pain that is present in an areaReferred pain is pain that is present in an arearemoved or distant from its point of origin. The area ofremoved or distant from its point of origin. The area ofreferred pain is supplied by the nerves from the samereferred pain is supplied by the nerves from the samespinal segment as the actual site of pain . i.e. MI painspinal segment as the actual site of pain . i.e. MI painetc…..etc…..

Visceral painVisceral pain••Visceral pain refers to pain in internal organs, theVisceral pain refers to pain in internal organs, theabdomen,abdomen, oorr chestchest..••i.e. renal pain, peptic ulcer pain, pain in cholecystitisi.e. renal pain, peptic ulcer pain, pain in cholecystitisetc……etc……

Referred painReferred pain•• Referred pain is pain that is present in an areaReferred pain is pain that is present in an arearemoved or distant from its point of origin. The area ofremoved or distant from its point of origin. The area ofreferred pain is supplied by the nerves from the samereferred pain is supplied by the nerves from the samespinal segment as the actual site of pain . i.e. MI painspinal segment as the actual site of pain . i.e. MI painetc…..etc…..

Naturopathic Pain

• It is caused due to peripheral nerves damage .i.e.Trigeminal neuralgia.

Neuralgia• It is characterized by severe, brief, often repetitive

attacks of throbbing pain.

Postherpetic painIt is caused due to herpes virus infection (Varicella)

• It is caused due to peripheral nerves damage .i.e.Trigeminal neuralgia.

Neuralgia• It is characterized by severe, brief, often repetitive

attacks of throbbing pain.

Postherpetic painIt is caused due to herpes virus infection (Varicella)

References

• Porth, MC. (6th ED). Pathophysiology. (2002).Philadelphia. USA. Lippincott Willams&Willkins, A Wolters Kluwer Company

• McPhee, J. S., & Papadakis, A. M. (2011). CurrentMedical Diagnosis and Treatment.(50th ED). Chicago. USA: Mc Graw Hill

• Porth, MC. (6th ED). Pathophysiology. (2002).Philadelphia. USA. Lippincott Willams&Willkins, A Wolters Kluwer Company

• McPhee, J. S., & Papadakis, A. M. (2011). CurrentMedical Diagnosis and Treatment.(50th ED). Chicago. USA: Mc Graw Hill