PHYSIOLOGIC AND BEHAVIORAL RESPONSES TO ACUTE MYOCARDIAL ISCHEMIC PAIN IN MEXICAN MALE PATIENTS (PHYSIOLOGIC RESPONSES, PAIN).
Contributors: University of California, San Francisco.
Published: 1989
Number of pages: 192
Subjects: Health Sciences, Nursing.; Anthropology, Cultural.
Description: The verbal, non-verbal and physiologic responses of Mexican male patients to the pain of acute myocardial ischemia were studied as a basis for subsequent comparison with other cultural groups.

A sample of 57 patients was studied in the Emergency Department (ED) of a federal, tertiary health care facility in urban central Mexico. Inclusion criteria were: chief complaint of non-traumatic chest pain and subsequent admission to the Coronary Care Unit with a suspected acute myocardial infarction (AMI); Mexican birth and residence; male gender; 35 years or older; and, 12 or less years education. At the time of ED admission, a 12-Lead electrocardiogram, vital signs and serum creatine phosphokinase (CPK) levels were measured. Subjects were asked to describe the pain and give a numerical rating on a vertical, Spanish-language verbal descriptor pain scale. Non-verbal pain behaviors were assessed by two nurses and a negotiated score was given to each of seven categories and then totaled. The categories were: attention to pain, amount of restlessness, tenseness, anxiety, diaphoresis, facial grimacing, and vocalization, such as crying.

Higher pain scores were associated with greater amounts of non-verbal behavior ($p <$.0001), more ST segment elevation ($p <$.001), higher CPK levels ($p <$.01), and greater elevation in pressure-rate product ($p <$.05) and systolic blood pressure ($p <$.05). Patients with the discharge diagnosis of AMI had higher pain scores than those in which an AMI was ruled out ($p <$.005). However, multiple regression analysis determined that non-verbal behavior explained 42.4% of the variance in the pain score ($p <$.0001), while the physiologic variables were not significant in predicting the patient's pain intensity score.

These results indicate that nursing assessment of pain should include a behavioral assessment, which in turn requires validation with the patient and family members because of wide cultural variation in these behaviors.
Notes: Source: Dissertation Abstracts International, Volume: 50-12, Section: B, page: 5546.

Thesis (D.N.S.)--UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, 1989.

School code: 0034.