A patient with a suspected myocardial infarction reports experiencing pain in their jaw and left arm. The nurse correctly identifies this type of pain as:

1. A

   Radiating pain

2. B

   Referred pain

3. C

   Deep visceral pain

4. D

   Superficial pain

Appeared in: HSSC Staff Nurse - 2015

Explanation

• Referred pain is pain perceived at a location other than the site of the painful stimulus.
• This occurs because sensory nerves from the affected organ (the heart) and the area where pain is felt (jaw, arm) converge on the same nerve pathways in the spinal cord.
• The brain cannot easily distinguish the exact source and interprets the visceral pain from the heart as coming from a somatic area like the arm or jaw.
• Pain from a myocardial infarction being felt in the jaw and left arm is a classic clinical example of referred pain.

Why Other Options Were Wrong

• Option A: Radiating pain spreads from a source along a specific nerve path. While MI pain can be described as radiating, 'referred pain' is the more precise physiological term for pain felt in a completely separate anatomical area due to shared spinal segments.
• Option C: Deep visceral pain describes the pain originating from the internal organ itself. In this case, the crushing, heavy sensation in the chest is the visceral pain, not the pain felt in the jaw and arm.
• Option D: Superficial pain, also known as cutaneous pain, originates from the skin or mucous membranes. It is typically sharp and well-localized, which is inconsistent with the symptoms of a myocardial infarction.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Classification of pain by location and mechanism to guide bedside assessment, documentation, and the next nursing action.
• Recognizing referred pain patterns is a critical nursing skill for the early identification of life-threatening conditions. For example, right shoulder pain can indicate gallbladder inflammation (cholecystitis).
• A nurse's thorough pain assessment can provide crucial diagnostic clues. Always ask, 'Does the pain travel anywhere else?'.
• What if? If the patient described a sharp pain on the left side of the chest that worsened with deep breaths and was tender to touch, the nurse should suspect a musculoskeletal or pleuritic cause rather than cardiac referred pain.

How to Approach the Question

• First, identify the source of the problem described in the stem: a suspected myocardial infarction, which affects the heart.
• Next, note the location where the pain is being experienced: the jaw and left arm, which are distant from the heart.
• Analyze the relationship between the source of the problem and the location of the symptom. The pain is felt in a part of the body remote from the affected organ.
• Recall the definitions of different types of pain. The phenomenon where pain is perceived at a location remote from its origin due to shared neural pathways is known as referred pain.
• Evaluate the options. 'Referred pain' perfectly matches the clinical scenario. Differentiate it from 'radiating pain,' which follows a more direct path, and 'visceral pain,' which is the pain at the source.

Concept Tested & Keywords

• Concept Tested: Classification of pain by location and mechanism
• Stem keywords: myocardial infarction, pain, jaw, left arm
• Lead-in keywords: identifies this type of pain as
• Clinical cues: Pain in jaw and left arm with suspected MI is a classic sign of referred pain.

Question ID

QmmMM4rw7BDnuPZPg_ufJM

Copy ID

Reference Book

E6 Physiology Guyton 4SAE Part 3 p. 107-109

E6 Medicine Davidson Principles Practice 24e p. 197-199

E6 Medicine Macleod Clinical Examination 15e p. 52-54