Physiologic measurements to assess the intensity of pain such as topographic mapping of the brain and analyses of blood or urine for determination of changes in circulating neurotransmitters and other chemicals have been made. These modalities still need much refinement and are not currently appropriate for clinical application. Two observational tools based on the behavioral response have been proposed for the assessment of pain in neonates and young children. For the neonatal group, five behavioral responses were chosen for observation—brow bulge, Case study 4 A 41-year-old male with no significant history past medical history was rushed to the emergency section of a tertiary medical facility in La Paz. The patient, Azante, had complained of excruciating pain in the lower abdomen about 36 hours before the presentation. On admission, he explained how the pain had worsened progressively and radiated to the mid-abdomen about 24 hours before the presentation. He explained how a few posture changes had initially helped relieve pain radiation to the abdomen, but reliefs were not sustained. As a manual labor worker in a cement factory, Azante lifts heavy tools and raw materials in an average excess of 50-75kg. He had initially presented at a local clinic with complaints of a possible hernia and was administered a slow-release formulation of diclofenac sodium 100 mg. However, the pain worsened acutely and resulted in nearly fainting spells a few hours before the presentation. On admission, Azante described how the pain comes on suddenly, radiates to the mid-abdomen section, and dissipates subsequently. The cycle of pulsating pain had occurred
eye squeeze, nasolabial furrow, open mouth, and crying. Each response is given a score of 1 if present, with a maximal score of 5. For the pediatric group, behavioral responses were assessed. A pediatric pain chart is another model proposed for the observation of behavior after surgery. Mechanical methods of reporting pain intensity have been proposed, such as squeezing a piece of calibrated equipment to demonstrate the intensity of pain. However, such methods generally prove inferior to verbal report methods. Case summary Although admitted on account of an acute pain sensation, Azante’s case appeared to require intensive laboratory investigations before a conclusive diagnosis can be made. Self-Assessment Quiz Question #16 What examination conclusively eliminated a possible hernia from Azante’s case? a. Physical examination. b. Lab investigation. c. An X-ray. d. A CT scan. Self-Assessment Quiz Question #17 Which of the following might be considered a risk factor in the Azante case?
a. Smoking habit. b. Daily walking. c. Bowel sounds. d. Diclofenac use.
repeatedly over the past few weeks. Review of signs and symptoms ● Respiratory Rate: 19. ● Body Temperature: 36.6 deg.C. ● Oxygen Saturation: 72% on room air.
Self-Assessment Quiz Question #18 In Azante’s therapy plan, a combination of diclofenac + misoprostol is considered beneficial compared to diclofenac only due to which of the following reasons? a. Diclofenac is contraindicated in Africans. b. This combination reduces the risk of gastric erosions. c. Diclofenac is contraindicated in people with no recreational drug use history. d. Azante’s medical condition does not require diclofenac. Self-Assessment Quiz Question #19 Which of the following pain assessment methods was deployed in this case study? a. Smiley face survey. b. American Pain Society Sensation Scale. c. The Pain Numerical Scale. d. The South African Pain Classification Scale. Self-Assessment Quiz Question #20 Which of the following vital signs in Azante’s case can be considered non-optimal? a. Heart rate. b. Oxygen saturation level. c. Heart rate. d. Body temperature.
● Weight: 72 kg. ● Height: 168 cm. ● Heart Rate: 76 b/min. A CT scan showed no conclusive evidence of a hernia in
progress or healing. Past medical history
Azante has had no prior abdominal surgery. He walks at least 7,500 steps per day and smokes just over a pack of cigarettes daily. He drinks alcohol at social events but insists he is no heavy drinker. When queried about recreational drug use, Azante denied ever trying out any recreational drug and denied any form of OTC abuse. Physical exam report On admission, Azante is alert and oriented and in apparent distress. His abdomen was tender to palpitation without a rebound in the right power quadrant. No rigidity or guarding and bowel sounds are present throughout. Azante also showed no signs of cerebrovascular tenderness or focal deficits. Therapy plan In addition to a department-wide effort to take consults on Azante’s case, a review request was sent to the pain management team for pain assessment. This was considered a first-step approach in stabilizing Azante before considering the possible administration of antibiotics. On the pain numerical scale, Azante described his pain as a 7 out of 10. Pain management The pain assessment team recommended the following medications for acute pain management: ● IV Pentazocine 30 mg stat (can be repeated any other day). ● IV Diclofenac titrated to effect pain relief. ● PO Diclofenac + Misoprostol (When switched from IV medications).
Book Code: PYFL4024
EliteLearning.com/Psychology
Page 143
Powered by FlippingBook