STUDY - Technical - New Dacian's Medicine
Analgesia
(Classical / Allopathic Medicine)
Analgesia, the
absence of sensitivity to pain, is an important sign of
central nervous system disease that commonly indicates a
specific type and location of spinal cord lesion. It always
occurs with loss of temperature sensation (thermanesthesia)
because these two sensory nerve impulses travel together in
the spinal cord. It can also occur with other sensory deficits
(such as paresthesia, loss of proprioception and vibratory
sense, and tactile anesthesia) that are common in disorders
involving the peripheral nerves, spinal cord, and brain.
However, when accompanied only by thermanesthesia, analgesia
denotes an incomplete lesion of the spinal cord.
Analgesia can be
classified as partial or total below the level of the lesion
and as unilateral or bilateral, depending on the cause and
level of the lesion. Its onset may be slow and progressive
(such as with a tumor) or abrupt (such as with trauma), and it
may resolve spontaneously.
ALERT:
If the patient complains of unilateral or bilateral analgesia over a large body area that's accompanied by paralysis, suspect spinal cord injury and perform the following:
Immobilize the patient's spine in proper alignment, using a cervical collar and a long backboard, or keep the patient in a supine position on a flat surface and place sandbags around his head, neck, and torso.
Continuously monitor respiratory rate and rhythm, and observe the patient for accessory muscle use.
Have emergency equipment available.
When you're satisfied that the patient's spine and respiratory status are stabilized — or if the analgesia isn't severe and isn't accompanied by signs of spinal cord injury — perform a focused assessment.
If the patient complains of unilateral or bilateral analgesia over a large body area that's accompanied by paralysis, suspect spinal cord injury and perform the following:
Immobilize the patient's spine in proper alignment, using a cervical collar and a long backboard, or keep the patient in a supine position on a flat surface and place sandbags around his head, neck, and torso.
Continuously monitor respiratory rate and rhythm, and observe the patient for accessory muscle use.
Have emergency equipment available.
When you're satisfied that the patient's spine and respiratory status are stabilized — or if the analgesia isn't severe and isn't accompanied by signs of spinal cord injury — perform a focused assessment.
HISTORY:
Ask the patient when his symptoms began.
Determine if the patient suffered recent trauma.
Review the patient's medical history, noting especially recent trauma and incidence of cancer in the patient or his family.
Ask the patient when his symptoms began.
Determine if the patient suffered recent trauma.
Review the patient's medical history, noting especially recent trauma and incidence of cancer in the patient or his family.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Assess level of consciousness; pupillary, corneal, cough, and gag reflexes; speech; and ability to swallow.
If possible, observe the patient's gait and posture, and assess his balance and coordination.
Evaluate muscle tone and strength in all extremities.
Thoroughly check pain sensitivity, vibration sense, and temperature sensation over all dermatomes.
Take the patient's vital signs.
Assess level of consciousness; pupillary, corneal, cough, and gag reflexes; speech; and ability to swallow.
If possible, observe the patient's gait and posture, and assess his balance and coordination.
Evaluate muscle tone and strength in all extremities.
Thoroughly check pain sensitivity, vibration sense, and temperature sensation over all dermatomes.
SPECIAL
CONSIDERATIONS:
Focus your care on preventing further injury to the patient because analgesia can mask injury or developing complications.
Focus your care on preventing further injury to the patient because analgesia can mask injury or developing complications.
PEDIATRIC
POINTERS:
Because a child may have difficulty describing analgesia, carefully observe the patient during your assessment for nonverbal clues to pain, such as facial expressions, crying, and retraction from stimuli. Remember that infants have a high threshold for pain, so your assessment findings may be unreliable.
Because a child may have difficulty describing analgesia, carefully observe the patient during your assessment for nonverbal clues to pain, such as facial expressions, crying, and retraction from stimuli. Remember that infants have a high threshold for pain, so your assessment findings may be unreliable.
PATIENT
COUNSELING:
Discuss safety measures with the patient and his family. Advise the patient to test bath temperature using a thermometer or a body part with intact sensation to avoid injury.
Discuss safety measures with the patient and his family. Advise the patient to test bath temperature using a thermometer or a body part with intact sensation to avoid injury.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)