Lesson 4

.
Assessing Pain: The Fifth

Vital Sign
Slide 1
.1 The Chapter 8 PPTs have only two clicker questions.

Jerry Ralya, 27/04/2009
Definitions
 comes from the Greek word

poinē meaning “penalty,”
implying the person is paying
for something.
 McCaffery and Pasero: “Pain
is whatever the person says it
is, existing whenever he or
she says it does”
 International Association for
the Study of Pain (IASP):
Unpleasant sensory and
emotional experience which
we primarily associate with
tissue damage or describe in
terms of such damage, or
both.
Copyright © 2018 Wolters Kluwer · All Rights Reserved

Theories of Pain
 Specificity theory: Explains the complexity of
pain.
 Pattern theory: Maintains that individuals will
respond in a different manner to a similar
stimulus.
 Gate control theory: Peripheral nerve fibers
carrying pain impulses to the spinal cord can
have their input modified at the spinal cord
level before transmission to the brain. Synapses
in the dorsal horns act as gates that close to
keep impulses from reaching the brain or open
to permit impulses to ascend to the brain.
Figure 9.1 Gate Control Theory: A. Open
Gate, B. Closed Gate

Physiology - Nociception
Nociceptors -receptors that transmit pain
sensation
Transduction
A-delta primary afferent fibers
Transmission
Perception
Modulation

Responses to Pain
 Pain responses incorporate both

physiologic and psychological aspects.
 Initially, sympathetic nervous system
stimulation triggers the fight-or-flight
response.
 Eventually, as the body adapts to the
pain, the parasympathetic nervous
system takes over, reversing many of
the initial physiologic responses.
 This adaptation to pain occurs after
several hours or days of pain.
 A proprioceptive reflex also occurs with
the stimulation of pain receptors.
Impulses travel along sensory pain fibers
to the spinal cord where they synapse
with motor neurons.
 The impulses travel back via motor
fibers to a muscle near the site of the
pain resulting in the muscle contracting
in a protective action.

Types of Pain (1 of 2)
• Acute pain
– Pain lasts through
expected recovery period
from illness, injury, or
surgery.
– Acute pain may last for a
few minutes up to several
weeks, but usually it does
not last longer than 6
months.
Copyright © 2020, 2016, 2012 Pearson Education, Inc. All Rights Reserved
Types of Pain (2 of 2)
Chronic pain
• Prolonged, usually recurring or
persisting over 6 months or longer,
and it interferes with functioning.
• Classified as chronic malignant
pain (cancer pain) when
associated with cancer or other life-
threatening conditions, or as
chronic nonmalignant pain, when
the etiology is a non-progressive
disorder (American Pain Society,
2016).
Pain Descriptors
 Cutaneous pain: skin or subcutaneous
 Visceral pain: abdominal cavity, thorax, cranium
 Deep somatic pain: ligaments, tendons, bones, blood vessels,
nerves
 Radiating: perceived both at the source and extending to other
tissues
 Referred: perceived in body areas away from the pain source
 Phantom pain: perceived in nerves left by a missing,
amputated, or paralyzed body part
 Neuropathic pain: causes an abnormal processing of pain
messages and results from past damage to peripheral or
central nerves due to sustained neurochemical levels

Figure 9.5 Sites of Referred Pain
Physiologic Responses to Pain #1
 Anxiety, fear, hopelessness, sleeplessness, thoughts

of suicide
 Focus on pain, reports of pain, cries and moans,
frowns and facial grimaces
 Decrease in cognitive function, mental confusion,
altered temperament, high somatization, and
dilated pupils
 Increased heart rate; peripheral, systemic, and
coronary vascular resistance; and blood pressure

Physiologic Responses to Pain #2
 Increased respiratory rate and sputum retention,
resulting in infection and atelectasis
 Decreased gastric and intestinal motility
 Decreased urinary output, resulting in urinary retention,
fluid overload, depression of all immune responses
 Increased antidiuretic hormone, epinephrine,
norepinephrine, aldosterone, glucagons, decreased
insulin, testosterone
 Hyperglycemia, glucose intolerance, insulin resistance,
protein catabolism
 Muscle spasm resulting in impaired muscle function and
immobility, perspiration
Seven Dimensions of Pain
 Physical - physiologic effects

 Sensory – quality and severity
 Behavioral – verbal and nonverbal behavior
 Sociocultural – social and cultural background
 Cognitive - beliefs, attitudes, intentions, and
motivations
 Affective - feelings, sentiments, and emotions
 Spiritual - meaning and purpose

Concepts Associated with Pain (1 of 3)
• Pain threshold: The amount of pain stimulation

the person requires to feel pain.
• Hyperalgesia: Excessive sensitivity to pain.
• Pain sensation is considered the same as pain

threshold.
• Pain reaction: Includes the autonomic nervous

system and behavioral responses to pain
– The autonomic nervous system response is
the automatic reaction that often protects the
individual from further harm.
– Behavioral response is a learned response
used as a method of coping with pain.
• Pain tolerance: The maximum amount and

duration of pain that an individual is willing to
endure.
– Widely influenced by psychological and
sociocultural factors.
– Women tend to experience more chronic and
clinical pain and demonstrate higher levels of
pain sensitivity when compared with males.
Hierarchy of Pain Assessment Techniques
 Self-report
 Search for potential
causes of pain
 Observe client
behaviors
 Surrogate reporting
 Attempt an analgesic
trial

Tips for Collecting Subjective Data
 Maintain a quiet and calm environment that is comfortable for

the client being interviewed.
 Maintain the client’s privacy and ensure confidentiality.
 Ask the questions in an open-ended format.
 Listen carefully to the client’s verbal descriptions and quote
the terms used.
 Watch for the client’s facial expressions and grimaces during
the interview.
 DO NOT put words in the client’s mouth.
 Ask the client about past experiences with pain.
 Believe the client’s expression of pain.

Objective Data
 Visual Analog Scale (VAS)

 Numeric Rating Scale (NRS)
 Numeric Pain Intensity Scale (NPI)
 Verbal Descriptor Scale
 Simple Descriptive Pain Intensity Scale
 Graphic Rating Scale
 Verbal Rating Scale
 Faces Pain Scale

VISUAL ANALOG SCALE

NUMERIC RATING SCALE

VERBAL DESCRIPTOR SCALE

Face, Legs, Activity, Cry, Consolability
(FLACC) Behavioral Scale

MEMORIAL PAIN ASSESSMENT CARD

McCaffrey Initial Pain Assessment Tool

Skin, Hair, and
Nails
ANATOMY OVERVIEW
The skin is composed of

three layers, the epidermis,
dermis and subcutaneous
tissue. The skin is a physical
barrier that protects the
underlying tissues and
structures.
Hair consists of
layers of
keratinized cells
found over much
ANATOMY of the body
except for the
OVERVIEW lips, nipples, soles
of the feet, palms
of the hands,
labia minora and
penis.
The nails located at the distal phalanges of
fingers and toes, are hard, transparent plates
of keratinized epidermal cells that grow from a
root underneath the skin fold called the cuticle.
ANATOMY
OVERVIEW
Special Considerations
• Lifespan Considerations: A
patient’s age and developmental
stage have a tremendous
influence on the appearance and
functioning of all parts of the
integumentary system.
• Psychosocial Considerations:
– The appearance of the skin,
hair, and nails impacts the self-
concept of the individual.
– Skin disorders may interfere
with social relationships, roles,
and sexuality.
Special Considerations
• Psychosocial Considerations :
– Stress may also be a factor in compulsive behaviors such as hair
twisting or plucking (trichotillomania) and nail biting, signaled by nails
that have no visible free edge or that have short, jagged edges.
– A lack of cleanliness of the skin, hair, or nails also may result from
emotional distress, poor self-esteem, or a disturbed body image.
• Social and Environmental Conditions:

– A patient’s living situation, including socioeconomic status, home
environment, and type of employment or daily activities, may affect the
health of the skin, hair, and nails.
– Environmental influences on the skin, hair, and nails include sunlight,
temperature, and work with the hands.
– The skin’s response to stressors such as ultraviolet radiation is similar in
all races. Therefore, assessment of color, texture, moles, and other
lesions should be thorough for all patients.
Subjective Health History
Focused Interview
• The nurse must consider age, gender, race, culture, environment,
health practices, and past and current problems and therapies when
forming questions and using techniques to elicit information.
• Appearance of the skin impact on self-image, patients with changes
in the skin from disease or even the normal aging process may be
anxious about the way they appear to others.
• Categories of questions for skin include:
– General questions
– Questions related to illness or infection
– Questions related to symptoms, pain, and behaviors
– Questions related to the environment—internal and external
– General questions about hair, nails
Objective Data: Physical Assessment
HELPFUL HINTS
•A warm, private environment will reduce patient anxiety.
•Provide special instructions and explain the purpose for removal of
clothing, jewelry, hairpieces, nail enamel.
•Maintain the patient's dignity by using draping techniques.
•Monitor one's verbal responses to skin conditions that already threaten
the patient's self-image.
•Be sensitive to cultural issues. In some cultures, touching or examination
by members of the opposite sex is prohibited.
•Covering the head, hair, face, or skin may be part of religious or cultural
beliefs. Provide careful explanations regarding the need to expose these
areas for assessment.
•Direct sunlight is best for assessment of the skin; if it is not available,
lighting must be strong and direct. Tangential lighting may be helpful in
assessment of dark-skinned patients.
•Use Standard Precautions throughout the assessment.

Examination light
Penlight, wood light
Mirror for client’s self-examination of
skin
Magnifying glass
Centimeter ruler
Gloves
Examination gown or drape
EQUIPMENT Braden Scale for Predicting Pressure
NEEDED Sore Risk
Pressure Ulcer Scale for Healing (PUSH)
tool to measure pressure ulcer healing
Inspect skin color, temperature,
moisture, texture.
Check skin integrity
KEY POINTS
Be alert for skin lesions
Evaluate hair condition; loss or
unusual growth
Note nail bed condition and
capillary refill.
NORMAL
FINDINGS ABNORMAL FINDINGS
Pallor (loss of color) is seen in
Inspect reveals evenly arterial insufficiency,
colored skin tones without decreased blood supply, and
unusual or prominent anemia. Pallid tones vary from
INSPECTION discolorations. pale to ashen without
underlying pink.
CULTURAL
CONSIDERATIONS Cyanosis may cause white skin
to appear blue-tinged,
Small amounts of melanin especially in the perioral, nail
Inspect are common in pale or light bed, and conjunctival areas.
Dark skin may appear blue,
skins, while large amounts of
general skin melanin are common in olive dull, and lifeless in the same
areas.
coloration. and darker skins. Carotene
accounts for a yellow cast. Jaundice is characterized by
yellow skin tones, ranging from
OLDER ADULT pale to pumpkin, particularly of
CONSIDERATIONS the sclera, oral mucosa, palms,
and soles
The older client’s skin
becomes pale due to Acanthosis nigricans is
decreased melanin velvety darkening of the skin in
production and decreased body folds and creases,
dermal vascularity. especially the neck, groin, and
axilla.
Cyanosis
Pallor
Jaundice
Acanthosis nigricans
NORMAL FINDINGS ABNORMAL FINDINGS
Common variations Abnormal findings
include suntanned areas, include rashes, such as
freckles, or white patches the reddish (in light-
known as vitiligo. The skinned people) or
variations are due to darkened (in-dark-
INSPECTION different amounts of skinned people) butterfly
melanin in certain areas. rash (also called Malar
A generalized loss of rash) across the bridge of
pigmentation is seen in the nose and cheeks,
albinism. Dark skinned characteristic of lupus
clients have lighter- erythematosus (SLE). SLE
colored palms, soles, nail is seen in a 9:1 female-to-
Inspect for beds, and lips. Freckle- male ratio and is more
like or dark streaks of common in black and
color variation pigmentation are also Hispanic people
common in the sclera and (American Autoimmune
nail beds of dark-skinned Association, 2015).
clients.
SLE prevalence is
CULTURAL higher in Asians, Afro-
CONSIDERATIONS Americans, Afro-
Pale or light-skinned Caribbeans, and
clients have darker Hispanics in the United
pigment around nipples, States, but infrequent in
lips, and genitalia. blacks in Africa (Schur &
Hahn, 2015).
vitiligo
butterfly rash
 Skin is intact, and there  Skin breakdown is initially
are no reddened areas. noted as reddened area on
Use the Braden Scale to the skin that may progress
predict pressure sore to serious and painful
risk. If any skin pressure ulcers.
INSPECTION breakdown is noted, use Depending on the color of
the PUSH tool to the client’s skin, reddened
document the degree of areas may not be
skin breakdown to prominent, although the
skin may feel warmer in
Assess skin provide a baseline to
compare degree of the area of breakdown
integrity healing or deterioration than elsewhere.
over time.
CLINICAL TIP: In the
obese client, carefully
inspect skin on the limbs,
under breasts, and in the
groin area where
problems are frequent
due to perspiration and
friction.
 Lesions may indicate local or
Skin is smooth, without systemic problems. Primary
lesions. Stretch marks lesions arise from normal skin
(striae), healed scars, due to irritation or disease.
freckles, moles, or birth Secondary lesions arise from
INSPECTION marks are common changes in primary lesions.
Inspect for lesions. findings. Freckles or moles Vascular lesions, reddish-bluish
may be scattered over the lesions, are seen with bleeding,
If you observe a lesion: skin in no particular venous pressure, aging, liver
~ Note symmetry, borders pattern. disease, or pregnancy.
and shape, color, diameter Scarifications may be used Cancerous lesions can either be
of lesion, and change in by some individuals who primary or secondary lesions
lesion over time
~ For very small lesions, use
want to have a scar or and are classified as squamous
a magnifying glass to note keloid. These scars involve cell carcinoma, basal cell
these characteristics. cutting or sometimes carcinoma, or malignant
~ Note its location, burning of the skin to leave melanoma.
distribution, and permanent scars (Bradley For abnormal lesions,
configuration. University, 2017). distribution may be diffuse
~ Measure the lesion with a
centimeter ruler.
Older clients may have (scattered all over), localized to
skin lesions associated with one area, or in sun-exposed
aging, including seborrheic areas. Configuration may be
or senile keratoses, senile discrete (separate and distinct),
lentigines, cherry grouped (clustered), confluent
angiomas, purpura, and (merged), linear (in line),
cutaneous tags and horns. annular and arciform (circular or
arcing), or zosteriform (linear
along nerve root).
ABCDE Criteria for
Melanoma Assessment.
A = Asymmetry
B = Border Irregularity
C = Color Variegation
D = Diameter greater than 6
mm
E = Evolving Changes*
*Evolving changes include
changes in size, shape,
symptoms (itching,
tenderness), surface
(bleeding), and shades of color.

Most common type
Squamous Cell
Basal Cell Carcinoma MALIGNANT KAPOSI'S
Carcinoma
MELANOMA SARCOMA
Malignant Skin Lesions

Secondary Lesions
Atrophy Crust Erosion Fissure
Ulcer
Scar
Scales
Keloid Lichenification
Ecchymosis
Configurations and Shapes of Lesions
Discrete
Annular
Confluent Zosteriform
Target
Zosteriform
Polycyclic
Linear Grouped
Infectious Skin Lesions
Rubella
(German
measles)
Rubeola (measles)
Tinea corporis.
Herpes zoster
Oral herpes simplex Impetigo
(shingles)
Varicella
CONTACT
ECZEMA PSORIASIS
DERMATITIS
Common Allergic or Inflammatory Skin

Lesions
Skin is smooth and Rough, flaky, dry

even. skin is seen in
PALPATION
Palpate skin to hypothyroidism.
assess texture. Obese clients often
Use the palmar report dry, itchy
surface of your three skin.
middle fingers to
palpate skin texture.
Skin is normally thin Very thin skin may
but calluses (rough, be seen in clients
thick sections of with arterial
epidermis) are
Palpate to assess common on areas of insufficiency or in
thickness. the body that are those on steroid
exposed to constant therapy.
pressure (e.g. the
heels).
PALPATION
If lesions are noted No lesions palpated Infected lesions may
when assessing skin be tender to palpate.
thickness, put gloves Nonmobile, fixed
on and palpate the lesions may be cancer.
lesion between the
thumb and index
finger for size,
mobility, consistency,
and tenderness.
Observe for drainage
or other
characteristics.
Skin surfaces vary  Increased moisture

from moist to dry or diaphoresis
depending on the (profuse sweating)
PALPATION area assessed. Recent may occur in
activity or a warm
environment may conditions such as
Palpate to assess cause increased fever or
moisture. moisture. hyperthyroidism.
Check under skin Some nurses believe Decreased moisture
folds and in that using the dorsal occurs with
unexposed areas. surfaces of the hands dehydration or
to assess moisture hypothyroidism.
leads to a more Clammy skin is
accurate result.
typical in shock or
hypotension.
NORMAL ABNORMAL FINDINGS
FINDINGS
PALPATION  Skin is normally a  Cold skin may

warm temperature. accompany shock or
Palpate to hypotension. Cool
skin may
assess accompany arterial
temperature. disease. Very warm
Use dorsal surfaces skin may indicate a
of your hands to febrile state or
palpate the skin. hyperthyroidism.
PALPATION  Normally, the skin is  Decreased mobility
mobile, with elasticity is seen with edema.
Palpate to and returns to original
shape quickly. Recoil
assess is usually immediate.
mobility and
turgor.
Ask the client to lie
down. Using two
fingers, gently
pinch the skin over
the clavicle.
NORMAL ABNORMAL FINDINGS
PALPATION FINDINGS
Palpate to The older client’s skin  Decreased turgor (a

assess mobility loses its turgor slow recoil or return of
and turgor. because of a decrease the skin to its normal
Mobility refers to in elasticity and state) is seen in
how easily the skin collagen fibers.. dehydration. Recoil
can be pinched. that occurs in less than
Sagging or wrinkled 2 seconds suggest
Turgor refers to the skin appears in the
skin’s elasticity and moderate dehydration;
facial, breast, and more than 2 seconds
how quickly the skin
returns to its original
scrotal areas. suggest severe
shape after being dehydration; and more
pinched. than 3 seconds is
described as tenting.
PALPATION  Skin rebounds and  Indentations on the

does not remain skin may vary from
Palpate to indented when slight to great and
pressure is released. may be in one area or
detect edema. all over the body.
Use your thumbs to
press down on the
skin of the feet,
ankles, or pretibial
area to check for
edema (swelling
related to
accumulation of fluid
in the tissue).
Natural hair color, as Nutritional
opposed to deficiencies may
chemically colored cause patchy gray
hair, varies among
INSPECTION clients from pale
hair in some clients.
AND blond to black to gray Severe malnutrition
or white. The color is in African American
PALPATION determined by the children may cause a
amount of melanin copper-red hair color
Inspect the scalp present. (Andrews & Boyle,
and hair for
general color and 2016).
condition
Scalp is clean and dry. Excessive scaliness may
Sparse dandruff may be indicate dermatitis.
INSPECTION AND PALPATION visible. Hair is smooth and Raised lesions may
At 1-inch intervals, firm, somewhat elastic. indicate infections or
separate the hair tumor growth. Dull, dry
from the scalp and As people age, hair feels
coarser and drier. The hair hair may be seen with
inspect and hypothyroidism and
is also thinner with slower
palpate the hair growth. malnutrition. Poor
and scalp for hygiene may indicate a
cleanliness, Individuals of black need for client teaching
dryness or oiliness, African descent often or assistance with
parasites, and have very dry scalps and activities of daily living.
lesions. Wear dry, fragile hair, which the
gloves if lesions are client may condition with Pustules with hair loss in
oil or a petroleum jelly- patches are seen in tinea
suspected or if capitis, a contagious
like product. (This kind of
hygiene is poor. hair is of genetic origin disease.
and not related to thyroid Infections of the hair
disorders or nutrition. follicle (folliculitis) appear
Such hair needs to be as pustules surrounded
handled very gently.) by erythema.
dermatitis tumor
Poor hygiene
tinea capitis
folliculitis
Varying amounts of Excessive generalized hair
terminal hair cover loss may occur with infection,
nutritional deficiencies,
the scalp, axillae,
body, and pubic areas hormonal disorders, thyroid
or liver disease, drug toxicity,
INSPECTION according to normal hepatic or renal failure. It may
AND gender distribution. also result from
Fine vellus hair covers chemotherapy or radiation
PALPATION the entire body therapy.
except for the soles,
Inspect amount and palms, lips, and Patchy hair loss may result
distribution of scalp, nipples. Normal male from infections of the scalp,
body, axillae, and pattern balding is discoid or systemic lupus
pubic hair. Look for symmetric. erythematosus, and some
unusual growth types of chemotherapy.
Individuals may
elsewhere on the shave or chemically Hirsutism (facial hair on
body. females) is a characteristic of
remove axillary and Cushing disease and
genital hair. Some polycystic ovary syndrome
individuals, both male (PCOS) and results from an
and female may also imbalance of adrenal
remove all body hair. hormones, or it may be a side
effect of steroids (Mayo
Clinic, 2015a).
7 Types of Alopecia
1. Alopecia Totalis – starts with small, round patches of hair loss and progresses until there
is total scalp hair loss.
2. Alopecia Universalis – all body hair is lost.
3. Androgenetic Alopecia – also known as male-pattern baldness that occurs in both men
and women. This disorder can start after puberty in women. It develops slowly over 15
to 30 years and increases with age.
4. Alopecia Areata – people with this type of alopecia experience the sudden or sometimes
unrecognized falling out of hair in patches or spots. Patches can vary in size from 1/8
inch to 4 inches in diameter; the affected areas are usually lighter in color due to the
poor blood supply to the area.
5. Diffuse Alopecia – also known as alopecia areata incognita, is a rare form of alopecia
areata and affects primarily young females, and the hair loss on the head is radical and
sudden.
6. Postpartum Alopecia – is temporary hair loss experienced at the end of pregnancy. Very
little normal hair loss occurs during pregnancy, but the sudden and excessive shedding
takes place from three to nine months after delivery. The growth cycle generally returns
to normal within a year after the baby is delivered.
7. Traction Alopecia – the most common balding disorder among young women and girls
with highly textured hair. Baldness occurs when the hair is pulled too tight meaning the
hair is pulled out of the follicle, taking out the hair root and the bulb. Destroying the hair
shaft may cause white bumps and pus, or scaling may occur around the affected area.
Alopecia Areata Hirsutism
Dirty, broken, or jagged
fingernails may be seen with
Nails are clean and poor hygiene. They may also
INSPECTION manicured. result from the client’s hobby or
Pink tones should be occupation.
seen. Some Pale or cyanotic nails may
~Inspect nail longitudinal ridging is indicate hypoxia or anemia.
grooming and normal Splinter hemorrhage may be
cleanliness. Dark-skinned clients caused by trauma. Beau lines
may have freckles or occur after acute illness and
~Inspect nail color pigmented streaks in eventually grow out. Yellow
and markings. their nails. discoloration may be seen in
fungal infections or psoriasis.
There is normally a Nail pitting is also common in
~Inspect shape of 160-degree angle psoriasis.
nails. between the nail base
and skin. Early clubbing (180-degree
angle with spongy sensation)
and late clubbing (greater than
180-degree angle) can occur
from hypoxia. Spoon nails
(concave) may be present with
iron deficiency anemia.
cyanotic nails
Spoon nails
Splinter Hemorrhage
Beau lines
PARONYCHIA late clubbing

Nails are hard and

basically immobile.
PALPATION Dark-skinned clients
may have thicker Thickened nails
nails. (especially toenails)
Older clients’ nails may be caused by
may appear decreased circulation
Palpate nails to and are also seen in
thickened, yellow,
assess texture. onychomycosis.
brittle because of
decreased circulation
in the extremities.
Paronychia
Nails are smooth and (inflammation)
firm; nail plate should indicates local
PALPATION be firmly attached to infection. Detachment
nail bed. of nail plate from nail
Palpate to assess bed (onycholysis) is
texture and seen in infections or
consistency, noting trauma.
whether nail plate
is attached to nail
bed.
Pink tones returns There is slow (greater

PALPATION immediately to than 2 seconds)
blanched nail beds capillary refill (return of
when pressure is pink tone) with
released. respiratory or
cardiovascular diseases
Test capillary refill that cause hypoxia.
in nail beds by
pressing the nail
tip briefly and
watching for color
change.

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Assessing Pain: The Fifth

.1 The Chapter 8 PPTs have only two clicker questions.

 comes from the Greek word

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

 Pain responses incorporate both

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

 Anxiety, fear, hopelessness, sleeplessness, thoughts

Copyright © 2018 Wolters Kluwer · All Rights Reserved

 Physical - physiologic effects

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Pain threshold: The amount of pain stimulation

• Pain sensation is considered the same as pain

• Pain reaction: Includes the autonomic nervous

• Pain tolerance: The maximum amount and

Copyright © 2018 Wolters Kluwer · All Rights Reserved

 Maintain a quiet and calm environment that is comfortable for

Copyright © 2018 Wolters Kluwer · All Rights Reserved

 Visual Analog Scale (VAS)

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The skin is composed of

• Social and Environmental Conditions:

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Malignant Skin Lesions

Atrophy Crust Erosion Fissure

Common Allergic or Inflammatory Skin

Skin is smooth and Rough, flaky, dry

Skin surfaces vary  Increased moisture

PALPATION  Skin is normally a  Cold skin may

Palpate to The older client’s skin  Decreased turgor (a

PALPATION  Skin rebounds and  Indentations on the

PARONYCHIA late clubbing

Nails are hard and

Pink tones returns There is slow (greater

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