PAIN AND FEVER

GALANG, JAMES LORD CABALDE

HEALTH ASSESSMENT
 NURSING PRELIMS
REVIEWER | FIRST SEMESTER HEALTH ASSESSMENT

PAIN 9. Diagnosis
10. Physical & mental health
• Is a sensation of physical or mental hurt or 11. Knowledge & understanding
suffering that causes distress or agony to the
one experiencing it TERMS
• It is whatever the patient says it is
• It exists whenever the patient says it does PAIN THRESHOLD (PAIN SENSATION)
• It is subjective in nature. • the amount of pain stimulation a
• It is protective – warning signal for tissue injury person requires before feeling pain.
– prevention mechanism (Generally uniform)
THEORIES OF PAIN PAIN TOLERANCE
1. PATTERN THEORY • maximum amount & duration of pain
• states that pain is perceived whenever that an individual is willing to endure.
the stimulus is intense pain (varied)
2. SPECIFICITY THEORY
• there are specific nerve receptors for PAIN PERCEPTION
particular stimuli • the actual feeling of pain
NOCICEPTORS – for noxious stimuli HYPERALGESIA
THERMORECEPTORS – for heat or cold
MECHANORECEPTORS – for pressure, • excessive sensitivity to pain
pulling, tearing sensation
TYPES OF RESPONSES TO PAIN
CHEMORECEPTORS – for chemicals
1. INVOLUNTARY RESPONSES
3. GATE CONTROL THEORY
• physiologic responses are mediated by
• there is a gate in the spinal cord called
the ANS (Autonomic Nervous System)
SUBSTANTIA GELATIN
2. VOLUNTARY RESPONSES
4. AFFECT THEORY
• crying, moaning, grimacing, splinting
• it avers that pain is emotional. The
the painful areas, assuming fetal
intensity of pain perceived depends
position (behavioral responses);
on the value of the organ affected to
withdrawal, social isolation (emotional
the individual
responses)
5. PARALLEL PROCESSING MODEL
• believes that physiologic or neurologic CLASSIFICATION OF PAIN
deciphering of the pain sensation and
the cognitive emotional properties A. TYPES OF PAIN
occur along different nerve fibers
1. CUTANEOUS OR SUPERFICIAL PAIN
FACTORS INFLUENCING PAIN EXPERIENCE • occurs over the body surface or skin
segment
1. Age
2. SOMATIC PAIN
2. Sex
• deep or superficial; occurs in the
3. Childhood
skin, muscles, or joints
4. Cultural backgrounds
3. VISCERAL PAIN
5. Psychological factors
• arises from stimulation of pain
6. Religious beliefs
receptors in the abdominal cavity &
7. Expected responses
thorax
8. Setting

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• How does pain limit your function or

4. REFERRED PAIN activities?
• arises from stimulation of pain • How do you usually behave when you are
receptors in the abdominal cavity & in pain? How would others know you are in
thorax pain?
5. INTRACTABLE PAIN • What does pain mean to you? Why do u
• it is resistant to cure or relief
think you are having pain?
6. PHANTOM PAIN
• is actual pain felt in a body part that PAIN SCALE
is no longer present
7. RADIATING PAIN
• it is felt at the source and extends to
surrounding tissues
8. PSYCHOGENIC PAIN
• primarily due to emotional factors,
with no physiologic basis
9. INTERMITTENT PAIN
• pain that stops and starts again

B. LOCATION

C. DURATION
• acute (less than 6 months)
• chronic (more than 6 months)

D. CHARACTER/QUALITY
• stabbing, dull, throbbing
FEVER
E. INTENSITY/SEVERITY
FEVER/ HYPERTHERMIA/ PYREXIA
• 0 – 10; 0 – no pain, 1 -3 mild, 4 -6
moderate pain, 7 – 10 severe pain These are conditions in which body
temperature exceed 38.5ºC or 101.5ºF.
F. FACTORS RELIEVE/AGGRAVATE PAIN
CLINICAL SIGNS:
G. EFFECTS OF ADL (ACTIVITIES OF DAILY ✓ Increased RR & PR
LIVING) ✓ Shivering
PAIN ASSESSMENT ✓ Pallor
✓ Thirst
P–Q–R–S–T–U
PATTERNS OF FEVER
• Where is your pain?
• When did it start? 1. CONTINUOUS OR CONSTANT FEVER
• What does your pain feel like? • it remains constantly high but with slight
• How much pain do you have now variation in its diurnal fluctuations.
• What makes your pain better or worse? • it remains constantly high but with slight
variation in its diurnal fluctuations.

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2. INTERMITTENT FEVER 2. COURSE

• very wide ranges between fluctuation, ✓ Absence of chills
the temperature alternately rising to ✓ Skin that feels warm
about 104˚F or 40˚C or over, and then ✓ Feeling of being neither hot nor cold
falling to or even below normal ✓ Increased PR, RR, and thirst
3. REMITTENT FEVER ✓ Mild to severe dehydration
• moderate range between the highest ✓ Drowsiness, restlessness, delirium,
and lowest points, but the temperature convulsions
is always above normal ✓ Fever blisters in mouth
• may vary more than two degrees and ✓ Loss of appetite
does not go down to normal. ✓ Malaise, weakness, aching muscles
4. RECURRENT OR RELAPSING FEVER
• pertains to a fever that follows a period 3. DEFERVESCENCE (Fever Abatement)
of normal to subnormal. (1–2 days) ✓ Skin appears flushed and feels warm
✓ Sweating
DECLINE OF FEVER
✓ Decreased shivering
CRISIS/ FLUSH/ DEFERVESCENCE STAGE ✓ Possible dehydration

• sudden decline of fever

LYSIS PADAYON NURSING!!!

• gradual decline of fever; desirable

CLASSIFICATION OF FEVER

FEVER ºC ºF
High Fever 39 – 41 ºC 103 – 106 ºF
Moderate
38 – 39 ºC 101 – 103 ºF
Fever
Slightly Febrile 37 – 38 ºC 99 – 101 ºF

CLINICAL SIGNS OF FEVER

1. ONSET (Cold or Chill Stage)

✓ Increased HR, RR, and temperature
✓ Shivering
✓ Pale and cold skin
✓ “Gooseflesh” skin appearance
✓ Cessation of sweating

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