Chapter 11, Problem 1CCS

Nursing Student with Neuropathic Pain

Tamara Costa broke her right tibia and has undergone two separate surgeries to repair it. Although the bone has healed, she suffers increasing pain around the incision sites. The painful area covers the lateral surface of her right leg. She can't stand wearing anything over it or even having a sheet touch it. Her diagnosis is postsurgical neuropathic pain. Pain medication has not helped.

Tamara is a second-year nursing student and has done some reading to try to understand her problem and perhaps find a solution. She has found an article that says neuropathic pain may be caused by a decreased threshold for action potential generation in pain-detecting neurons. However, she has forgotten some of her physiology and needs some help in understanding what she is reading. She has logged into the “Ask a Nurse" chat line–and she got you!

1. NCLEX-STYLE Tamara asks about action potential thresholds, so you begin by asking her what she knows about the topic. Which statement indicates an area where she needs further instruction?

a.“Threshold is the voltage at which the nerve actually fires an action potential.”

b.“Sodium is entering the nerve cell at threshold, but it was entering before too.”

c.“They call it threshold when the pain gets so bad the painkillers won't stop it, but I always have that!”

d.“I know that what happens at threshold is called depolarization.”