Freud’s Psychosocial Development

Early adulthood Intimacy vs. Love

Theory
(20-25 years) isolation
Stage Age Sexual Focus Key FIxation Results in
Developmental
Tasks Adulthood (26-64 Generativity Care
years) vs. stagnation
Oral Birth - 1 Mouth Weaning Obsessive eating,
Year (chewing, Old age smoking
(65- Integrity vs Wisdom
ot drinking
sucking) death) despair
(alcoholism)

Anal 2 - 3 years Anus Toilet training Obsession with

cleanliness, sexual
Piaget’s Cognitive Development Stages
anxiety

Phallic 4 - 5 years Genitals Identifying

Birth towith Difficulty
2 years with intimate
Sensorimotor Uses sen
(masturbation) gender role relationships motor ski
models (oedipus known by u
or electra
complex)2 - 6 years Pre-operational Symbolic
language
Latency 6 - 12 years None Social interaction No fixation occurs (this egocentric
stage does not occur in
7-11 years all societies)
Concrete Logic app
operational objective o
Genital Puberty Genitals Intimate Previous fixation = low interpretati
and later (Sexual relationships sexual interest or no
Intimacy) productivity
12 years previous
to Formalfixation = Thinks a
adulthood normaloperationalsexual hypothetica
motivation. (broader is

Moral Development Stages

Stages of Psychosocial Development Level or Stage Age Range

Age Conflict Resolution I: Culmination

Obediencein oldorageInfancy
or virtue Punishment

Infancy (0-1 Basic trust vs. Hope Appreciation of interdependence

year) mistrust I: Self-Interest
and relatedness Pre-school

Early childhood Autonomy vs. Will Acceptance of cycle of life, from

(1-3 years) shame integration and disintegration.
II: Conformity and School-age
Play age (3-6 Initiative vs. Purpose Interpersonal Accordresilience
Humor; empathy;
years) Guilt

School age (6-12 Industry vs. Competence Humility; acceptance of the course
years) inferiority II: of
Authority
one’s lifeand
andSocial School-age
unfulfilled hopes.
Order
Adolescence Identity vs Fidelity Sense of complexity of life;
(12-19 years) Confusion merging of sensory, logical and
aesthetic perception.
III: Social Contract Teens
III: Universal Principles Adulthood
Pain
Definition of Pain
● An unpleasant sensory and
emotional experience which we
primarily associate with tissue
damage or describe in terms of
such damage.
● Pain is whatever the person says it
is.
● It exists whenever the patient says
it does.
● Is it subjective in nature, only the
person experiencing it may
describe it.
● It provides warning signal for
tissue injury.
Nature of Pain
● Involves physical, emotional and
cognitive components.
● Pain is subjective and
individualized.
● Reduces quality of life.
● Not measurable objectively.
● May lead to serious physical,
psychological, social and financial
consequences.
Physiology Process
1. Transduction
● Converts energy produced by
these stimuli into electric energy.
● Begins in the periphery when a
pain producing stimulus sends an
impulse across a sensory
peripheral pain nerve fiber
(nociceptor), initiating an action
potential.
● Once transduction is complete,
transmission of the pain impulse
begins.
Mutual benefit, reciprocity. Morally
right and legally right are not always
the same. Utilitarian rules that
make life better for everyone.
Morality is based on principles that
transcends mutual benefit.
2. Transmission
● Sending of an impulse across a
sensory pain nerve fiber
(nociceptor).
● Nerve impulses
● Pain impulses
3. Perception
● The point at which a person is
aware of pain.
● The somatosensory cortex
identifies the location and intensity
of pain, whereas the association
cortex, primarily the limbic system,
determines how a person feels
about it. There is no single pain
center.
4. Modulation
● Inhibits pain impulse.
● A protective reflex response
occurs with pain reception.
Theories of Pain
1. Gate Control Theory of Pain (Melzack
and Wall)
● Pain has emotional and cognitive
components, in addition to a
physical sensation.
● Gating mechanisms in the CNS
regulate or block pain impulses.
● Pain impulses pass through when
a gate is open and are blocked
when a gate is closed.
● Closing the gate is the basis for
non-pharmaceutical pain relief
interventions.
2. Pattern Theory
● It states that pain is perceived
whenever the stimulus is intense
enough.
3. Specificity Theory
● States that there are specific nerve
receptors for particular stimuli.
4. Affect Theory
● The intensity of pain perceived
depends on the value of the organ
affected to the individual.
Physiological Responses
● anxiety , fear, hopelessness,
thoughts of suicide.
● Cries and moans, frowns, and
facial grimacing
● Mental confusion, decrease in
cognitive function.
● Increase heart rate, respiratory
rate and blood pressure (HR, RR,
BP).
Pain
● Decrease gastric and intestinal
motility.
● Decreased urinary output.
● Muscle spasm
Types of Pain
Based on location:
● Cutaneous pain
● Visceral pain
● Deep somatic pain
● Radiating pain
● Referred pain
● Phantom pain
Duration
1. Cutaneous Pain
● Superficial somatic pain is caused
by stimulation of structures in the
skin that sense pain or pain
receptors.
2. Visceral Pain
● Result from the activation of
nociceptors of the thoracic, pelvic
or abdominal viscera (organs).
● Visceral structures are highly
sensitive to distention (stretch),
ischemia and inflammation _____
relatively ______.
3. Deep Somatic Pain
● Second form of somatic pain.
Occurs when stimuli activate pain
receptors deeper in the body,
including tendons, joints, bones
and muscles. Deep somatic pain
usually feels more like “_______”
than superficial somatic.
4. Radiating Pain
● Pain that starts in one area and
spreads until a larger area hurts.
Sometimes this is due to the
nerves.
● Example: if a nerve gets pinched
or pulled, it may hurt all along the
nerve instead of just at an area
that hurt.
5. Referred Pain
● Pain perceived at a location other
than the site of the painful stimulus
or origin. It is the result of a
network of interconnecting
sensory nerves, that supplies
many different tissues.
6. Phantom Pain
● Feels like its coming from a body
part that’s no longer there. Doctors
once believed this post-
amputation phenomenon has a
psychological problem but
experts…
7. Nociceptive Pain
● Sensory nervous system’s
response to certain harmful or
potentially harmful stimuli. Intense
chemical, mechanical or thermal
stimulation of sensory nerve cells
called nociceptors produces a
signal that…
8. Neuropathic
● Damage or disease affecting the
somatosensory nervous system.
May be associated with abnormal
sensations called dysesthesia or
pain from normally non-painful
stimuli (allodynia).
9. Inflammatory
● Inflammation is the body’s attempt
at self-protection to remove
harmful stimuli and begin the
healing process.
● Inflammation is part of the body's
immune response. Infections,
wounds, and any damage to
tissues.
Factors Influencing Pain T - Timing
● Agesex ● Does it occur in association with
● Childhood something else
● Cultural background
● Previous experience COLDSPA
● Religious belief ● refers to pain, used in assessment
● Setting ● Character - describe symptoms
● Diagnosis ● Onset - when did it begin?
● Physical or mental status ● Location - where in the body?
● Knowledge or understanding ● Duration - how long does it last?
● Severity - how bad is it?
Assessment ● Pattern - what makes it better or
● Patient's expression if pain worse?
○ Pain is individualized ● Associated Factors - what other
● Characteristics of pain symptoms occur?
○ Timing
○ Location
○ Severity
○ Quality
○ Aggravating and
precipitatory factors
○ Relief measures
● Effects of pain to patient
○ Behavioral effects
○ Influence on ADL
● Concomitant symptoms
○
○ Usually increases pain
severity.

FLACC
(Check previous notes)

PQRST
P - provocative or pallative
● What makes the pain better or
worse
Q - quality
● Describe the pain
R - region or radiation
● Where in the body does pain
occur?
● Is there radiation or extension of
the symptoms to another area of
the body?
S - Severity
● On a scale of 1 to 10 (10 being the
worst) how bad is the pain?
● Another visual scale may be
appropriate pat unable to identify
with this scale.