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89 Cards in this Set
- Front
- Back
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Acute vs. Chronic Pain |
Acute pain: caused by tissue damage Chronic Pain: Caused by nervous sensitivity, can by dealt with by retraining the brain. |
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5 Elements to consider when dealing with pain. (The "hand" from the little video. :) ) |
1. Medical factors and therapies. —surgery not always good.
2. Thoughts and emotions—reduce stress 3. Diet and lifestyle 4. Life story—environmental factors, things that happened at the onset of the pain. Understand deeper emotions. 5. Physical activity and functions. |
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Classification of Pain by TYPE: Superficial |
pain sensed by nerve endings---e.g. a paper cut. |
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Classification of Pain by TYPE:
Visceral pain |
Sensed by deep pain receptors in the abdomen, cranium, thorax
e.g. menstrual cramps, labor pains, bowel malfunctions |
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Classification of Pain by TYPE:
Deep somatic |
Pain that stimulates the sympathetic nervous system. Manifests as rigid posture, dilated eyes, increased respirations, and other sympathetic nervous responses. Originates in ligaments, tendons and nerves and lasts longer than superficial pain.
e.g. bone cancer, arthiritis. |
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Classification of Pain by TYPE: Radiating |
Pain starts at site and extends to other locations. Manifests as a myriad of symptoms.
e.g. Sore throat extending to ears, sinus pressure. |
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Classification of Pain by TYPE: Referred |
Pain felt in areas distant from original site. Brain interprets pain signals as coming from an area close to the actual area, since it isn’t used to getting signals from the real area.
e.g. heart-attack, ischemia. |
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Classification of Pain by TYPE: Neuropathic |
Caused by damaged nerves, due to injury or illness.
Described as a dull, burning pain. Manifests as hypersensitive areas. Gabapentin, Neurontin, anticonvulsants and muscle relaxants are all used as therapy. Why: Nerves sometimes just keep spiraling out if they remember hurting. Most difficult pain to treat and manage because it doesn’t go away. |
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Classification of Pain by CAUSE: Nocioceptive vs. Neuropathic |
Nocioceptive: More treatable, related to obvious injuries and disorders, more acute. Neuropathic: related to dysfunctions in the nervous system, more chronic. |
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Classification of pain by QUALITY (Key words) |
Sharp, dull,
Aching, throbbing , Stabbing, burning. |
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Classification of pain by PERIODICITY (Key words) |
Intermittent, constant.
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Classification of pain by INTENSITY (Key words) |
Mild, moderate
Severe, intolerable. |
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Physiology of pain—Transduction
Mechanical stimuli |
Mechanical stimuli---friction and shearing effects.
E.g. moving patients in bed. Casts and braces—assess for pressure areas. |
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Physiology of pain—Transduction
Thermal stimuli |
Client is pretty reactive and responsive as long as the nerve endings maintain integrity.
e.g. hand on hot stove. ---think of diabetics, who can’t always sense those stimuli. |
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Physiology of pain-- Transduction
Chemical stimuli |
Internal responses to chemical stimuli---- e.g. alcohol pad or lemon juice on a finger with a cut.
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Physiology of pain-- Transmission. |
A-delta fibers—faster means of transport, carries acute, mechanical pain.
Pleasureable sensations travel on A-delta fibers too. A-delta fibers use substance P, sensation is sent to the thalamus for an emotional response and sent to the frontal cortex for a motor response to the pain/pleasurable sensation. C fibers.----transmit slower, dull, diffuse pain. |
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Pain management for circumcisions |
50% sugar solution on the end of a pacifier gives a little "carb coma" for circumcisions.
Note: Babies given a "carb coma" may miss a feeding because of the “happy juice” effects. (Hey, she said it, not me. :P ) Needle with lidocaine on penal nerve-- also effective. |
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Effect of pain and pain therapy on vital signs. |
Vital signs go up for pain and stress
Vital signs go down for pain suppressants. |
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Pain threshold vs. Pain tolerance |
Pain threshold---what it has to be to even register
Pain tolerance—what a person is willing to endure/can endure. |
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Pain modulation—
Endogenous analgesia system vs. Gate control theory. |
Endogenous analgesia system----Body’s response to pain, chemicals are released.
Endorphins smother the pain synapses. Can’t always tap into this resource. Utilized when life-threatening situation is detected. Gate control theory------send enough sensations to the “gate” so that pain can’t get through as fast. Obviously, we can tap into this resource. :) Manipulate A fibers against C fibers---send more "pleasures" than "painfuls" e.g. Put a cold-pack on the area, cold travels faster and closes the brain to the pain. Use a trans unit to “trick “ the brain into getting busy processing the little electrical impulses. Utilize sitz bath after the pain of labor. |
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Factors that influence pain
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• Past experience with pain
• Emotions • Developmental stage—toddlers are quite resilient—be honest with them, offer and deliver lots of hugs and bribes.(Miss Shaw said so!!) • Sociocultural factors--some express it loudly, others are very stoic. • Communication skills • Cognitive impairments • Other illnesses contributing to pain. |
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Pain Management Techniques: Non-Pharm measures |
Cutaneous stimulation—tems unit, massage.
Immobilization and rest---good for sprains. Cognitive behavioral interventions—tv, music therapy, videogames. |
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Pain Management Techniques: Pharmacological Measures |
Non opioid analgesics: NSAIDS—tylenol, advil, etc.
Opioid analgesics: a) Mu agonists b) Agonist-antagonist. ---mixed combinations, stimulate some receptors and block others. For use in moderate to severe pain. We can’t give morphine with these. |
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***HOW DO OPIATES WORK?*** |
***Opiates bind to opiate receptors in the brain and mimic the brain's own endorphins.
Endorphins reduce pain and cause euphoria.*** |
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***The pain scale, and what to give for each level. *** |
*Severe—7-10---->opioid analgesics: e.g. sufentanyl, fentanyl, morphine, oxycontin, dilaudid.
*Moderate—4-6--->opioid analgesics: e.g. lortab, Vicodin, Ultram. *Mild—1-3—> non-opioid and adjuvants: Tylenol, advil, Celebrex, toradol, (aspirin, sparingly) |
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Chemical Pain Relief Measures |
• Nerve blocks
• Local anesthesia • Topical anesthesia • Radiofrequency ablation therapy---not used often. For nerves that are angry and responding all the time (neuropathic), doctors will go in and cauterize the nerve endings—basically take them out. Nerves will rebuild, and pain can/will come back, but often without the same intensity. • Surgical interruption of pain conduction pathways. Very rare. Induce extreme paralysis to avoid any messages e.g. epidural Very temporary fix. |
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Tolerance VS. addiction
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Tolerance---body has developed a resistance to this drug and therefore needs higher dosages to achieve same therapeutic effect.
Addiction— "have to have it, even though it is damaging my body." Compulsive psychological thing, behavioral sequence of events, purposefully manipulating others, desires it for reasons other than what it was therapeutically intended for. |
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Adjuvants-- Definition and examples |
Definition: in addition to, does not eradicate pain alone. e.g. relaxants, anti-nausea pills, nerve blocks, prednisone, heat, anticonvulsants. Basically, "moves civilians from the road" so that the "elite troops" (e.g. opiates, NSAIDS) can move in and take care of the real enemy. |
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The four dimensions of self-concept
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Self knowledge—what I think of myself.
Self expectation—that which we expect of ourselves. Social self—that which other perceive about us. (There needs to be a congruence between self knowledge and social self.) Social evaluation----analysis and evaluation of ourselves. |
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Personal Identity |
Conscious sense of individuality and uniqueness, evolves throughout life, includes name, sex, age, race, ethnic origin or culture, occupation, talents.
• Includes beliefs, values, personality , character• Distinguishes self from others. |
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Body Image |
• Image of physical self, how person perceives size, apprearance, functioning of body and its parts
• Has cognitive aspects, has affective aspects. (emotional) • Includes clothing, makeup , hairstyle jewelry, and other things intimately connected to the person, develops from attitudes and responses of others and from self-exploration. |
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Role Performance |
• Role mastery—person’s behaviors meet social expectations
• Failure to master role-->feelings of frustration, inadequacy, lowered self-esteem. • Role development—socialization in a role • Role ambiguity—expectations unclear • Role strain—made to feel inadequate or unsuited to a role • Role conflicts—opposing expectations. |
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Self-Esteem Components |
Self Esteem--> One’s judgement of one’s own worth
• Global self-esteem—>how much one likes oneself as a whole • Specific self esteem—>how much one approves of a specific part of oneself. • Derived from self and others • Foundation established during early life experiences • May change from day to day or moment to moment. |
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Factors that affect Self-Concept |
• Stage of development
• Family and culture • Stressors • Resources • History of success and failure • Illness. |
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Erickson's Stages of Psychosocial Development Trust Vs. Mistrust |
Who: infants, birth-18 mo Good: Learning to trust others Bad: Mistrust, withdrawal, estrangement. |
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Erickson's Stages of Psychosocial Development
Autonomy vs. Shame and Doubt. |
Who: 18 mo--3 years Good: Self control without loss of self-esteem, ability to cooperate and express oneself. Bad: Compulsive self-restraint or compliance. Willfulness or defiance. |
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Erickson's Stages of Psychosocial Development
Initiative vs. Shame and Guilt |
Who: 3-5 year. Good: initiates activities, curious, begins to evaluate one's own behavior. Bad: Lack of self-confidence, pessimism, overcontrol and over-restriction of ones own activity. |
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Erickson's Stages of Psychosocial Development
Industry vs. Inferiority |
Who: 6-12 years Good: Developing sense of competence and perseverence. Devoted to interests. Bad: Loss of hope, sense of mediocrity, withdrawal from peers. |
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Erickson's Stages of Psychosocial Development
Identity vs. Role Confusion |
Who: 12-20 years Good: Coherent sense of self, plans to actualize one's abilities. Bad: Feelings of confusion, indecisiveness and antisocial behavior. |
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Erickson's Stages of Psychosocial Development
Intimacy vs. Isolation |
Who: 18-25 years Good: Intimate relationship with another person, establishment of ones home, career, schooling, family etc. Commitment to responsibilities. Bad: Impersonal relationships, avoidance of relationship, career or lifestyle commitments. |
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Erickson's Stages of Psychosocial Development
Generativity vs. Stagnation |
Who: 24-65 years Good: Creativity, productivity, concern for others (e.g. upcoming generation) Bad: Self-indulgence, self-concern, lack of interests and commitments. |
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Erickson's Stages of Psychosocial Development
Integrity vs. Despair |
Who: 65-death. Good: Acceptance of worth and uniqueness of one's own life. Acceptance of death. Bad: Sense of loss, contempt for others. |
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Stress vs. Stressors |
Stress: Condition in which a person experiences changes in the normal balanced state. Stressors: any event or stimulus that causes an individual to feel stress. |
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Internal vs. External stressors vs. Situational Stressors |
Internal stressors : originate within a person, e.g. infection or feelings of guilt and depression. External stressors: originate outside the individual, e.g. a move to another city, peer pressure or a death in the family. Situational stressors: Unpredictable, can occur at any stage of life, can be positive or negative. e.g. Marriage or divorce, birth of a child, new job |
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**Selye's General Adaptation Syndrome VS Local Adaptation Syndrome** |
G.A.S. = Reaction of the whole body to stress. (e.g. Run from the bear!) L.A.S. = Reaction of one part of the body to stress. (inflammation of a particular tissue.) |
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**Selye's 3 stages of General Adaptation Syndrome and Local Adaptation Syndrome: The Alarm Reaction** |
Consists of two phases: Shock and Countershock. Shock phase: lasts 1 minute- 24 hrs. Stressor is perceived consciously or unconsciously by a person. The stressor then stimulates sympathetic nervous system (SNS) ( which stimulates= -->) SNS--> hypothalamus to release corticotropin-releasing hormone--> anterior pituitary gland to release adrenocorticotropic hormone-->adrenal medulla to release epinephrine and norepinephrine--> body to prepare for fight-or-flight. The Countershock Phase: Changes produced in the body during shock phase are reversed--allows person best mobilization to react. (Analogy-- Shock stage= wake up! The enemy has invaded the camp! Counter-shock stage= Calm down--go grab your sword and see what's going on!) |
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** Selye's 3 stages of General Adaptation Syndrome and Local Adaptation Syndrome: The Stage of Resistance** |
The body attempts to cope with the stressor and to limit the stressor to the smallest area of the body that can deal with it. Endocrine system comes into play. (Analogy: Send a division to rebuild the wall, and order the cavalry out to destroy their right flank! Move the food stores to a more secure location--we must prepare for a siege. ) |
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**Selye's 3 stages of General Adaptation Syndrome and Local Adaptation Syndrome:
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Adaptations made in the stage of resistance cannot be maintained. If adaptation has not already overcome the stressor, the stress effects may spread to the entire body. Either victory, rest and recovery may begin, or further disorders and death will ensue. (Analogy: The cavalry was massacred, and our wall has been broken down! BAD: The enemy has invaded and taken the Middle Courtyard! They're executing the survivors! GOOD: The foe is crippled and retreating! Care for the wounded, get water to the soldiers. We'll begin re-building our defenses. ) |
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Cognitive Indicators of Stress |
Definition: Thinking processes that include problem solving, structuring, self-control or self-discipline, suppression and fantasy. |
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Cognitive Indicators of Stress: Problem Solving |
involves thinking through the threatening situation and using specific steps to arrive at a solution. |
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Cognitive Indicators of stress: Structuring |
arrangement or manipulation of a situation so that threatening events do not occur. e.g. nurse asking close-ended and direct questions so as to prevent the client from 'bunny-trailing' into negative topics. |
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Cognitive indicators of stress: Self control/discipline |
Assuming a demeanor that conveys a sense of being in control or in charge. Good when it prevents panic and nonproductive actions in a threatening situation. Bad if it delays problem-solving and prevents one from receiving help from others. |
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Cognitive Indicators of Stress: Suppression |
Consciously and willfully putting a thought or feeling out of mind. May relieve stress temporarily, but does not solve the problem. |
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Cognitive Indicators of Stress: Fantasy or daydreaming |
Like make-believe. Unfulfilled wishes and desires are imagined as being fulfilled, threatening situations are replayed and reworked to turn out differently than reality. May also fantasize about the outcome of problems--e.g. Doctor will announce that I don't have cancer. Can be helpful in playing out a situation and self-coaching good responses ahead of time. Can be dangerous when used to excess and one retreats from reality. |
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Defense Mechanisms: Compensation |
Covering up weaknesses by emphasizing a more desirable trait or overachieving in a more comfortable area. |
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Defense Mechanisms: Denial |
An attempt to screen or ignore unacceptable realities by refusing to acknowledge them. |
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Defense Mechanisms: Displacement |
Transferring emotional reactions from one object or person to another object or person. (e.g. kick the cat instead of your sister.) |
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Defense Mechanisms: Identification |
An attempt to manage anxiety by imitating the behavior or someone feared or respected. e.g. student nurse grounds herself by imitating the instructor's nurturing behavior towards clients. |
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Defense Mechanisms: Intellectualization |
Using rational explanations to evade a normal emotional response to a situation--separating a situation from any personal significance or feelings. |
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Defense Mechanisms: Introjection |
A form of identification that allows for the acceptance of others' norms and values into oneself, even when contrary to one's previous assumptions. e.g. "Well, if she doesn't believe in giving toddlers ice-cream I guess I'll quit our Saturday Baskin-Robbins tradition...." |
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Defense Mechanisms: Minimization |
Not acknowledging the significance of one's behavior. e.g. "I wasn't really cheating--we studied together, so basically that information was mine too!" |
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Defense Mechanisms: Projection |
Blame is shoved onto others or the environment for shortcomings and undesirable thoughts and mistakes. e.g. If she hadn't been such a soft-spoken teacher, my daughter wd've gotten a better grade! |
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Defense Mechanisms: Rationalization |
Justification of certain behaviors with faulty logic. Drawing on socially accepted principles which did not really inspire the behavior. "I quit asking him how he's doing because he's never positive." "I cut the call short because I had an emergency" (in reality you couldn't stand the caller.) |
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Defense Mechanisms: Reaction formation |
Causes one to act exactly the opposite of how they feel. e.g. Always volunteers to give the presentation when in reality public speaking terrifies them. |
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Defense Mechanisms: Regression |
Returning to an earlier, more comfortable level of functioning that requires less responsibility and is less demanding. e.g. An adult throws a fit when he doesn't get his own way. Client allows the nurse to bathe and feed him. |
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Defense Mechanisms: Repression |
An unconscious mechanism whereby threatening thoughts, feelings and desires are kept from becoming conscious. e.g. Teenager caught in a roll-over accident retains no memory of the day of or circumstances surrounding the accident, even though he was found fully conscious in the wrecked vehicle. |
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Defense Mechanisms: Sublimination |
Displacement of energy associated with dangerous sexual or aggressive drives into socially acceptable activities. e.g. Adolescent occupies his mind with sudoku to keep from fantasizing about a girl. |
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Defense Mechanisms: Substitution |
Replacement of highly valued and wanted, perhaps unattainable object with a less valuable, acceptable or available object. e.g. She was hoping to buy a new dress for prom, but settled with borrowing her sister's gown. |
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Defense mechanisms: Undoing |
Actions or words designed to "cancel" wrongful thoughts, impulses or acts. Relief of guilt by reparation. e.g. Daughter who had a bad day kisses her mother goodnight to "make up" for all the stress mom endured. Student pulls several all-nighters to make up for poor studying. |
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Coping vs. Coping strategy |
Coping: dealing with change--successfully or unsuccessfully. Coping strategy/coping mechanism: natural or learned way of responding to changes. e.g. Misha decreased the frequency of his panic attacks (successful coping) by practicing deep breathing exercises(coping mechanism). |
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"Opening the case" |
The home health nurse's first visit with the client. 1. Should include client and immediate family involved with client's care. 2. Nurse develops a care plan at this visit, which must then be approved by a physician. |
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The (usual) minimum time of each period of care/visit |
1 hour |
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Durable Medical Equipment (DME) Company |
Provides health care equipment for the client at home. |
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The focus of the educator role for home health nurses |
Focus on teaching illness care, the prevention of problems, the promotion of optimal wellness or well-being. |
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The 3 main dimensions of home health care |
Assess the home for: 1. safety features 2. infection control 3. caregiver support |
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Responsibilities of home health care include: |
1. Hospice care 2. Care of both the client and his family 3. Performing physical, psychosocial and emotional interventions. |
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Leader vs. Manager |
Leader: Influences others to work together to accomplish a specific goal. Manager: Usually in the context of a company. Given authority by the employer, has power and responsibility for planning, organizing, coordinating and directing the work of others. Establishes and evaluates standards. e.g. not all leaders are managers, but all managers ought to be leaders. Leader may be short-term. Managers tend to be long term. |
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Autocratic (authoritarian) leader |
Makes decisions for the group. Views that individuals are externally motivated (driving force is extrinsic, e.g. rewards for work) and incapable of independent decision-making. Procedures are well-defined. Activity style is the most effective. Good for dealing with cardiac arrest, terrorist attacks, unit fires etc. ) |
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Democratic Leader |
Encourages group discussion and decision-making. Serves as a catalyst and facilitator. Assumes driving force is intrinsic. Allows for more creativity and self motivation. |
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Laissez-faire (permissive) leader. |
Recognizes group's need for autonomy and self-regulation. Assumes a "hands-off" approach. Presupposes an internal driving force. Group tends to be disorganized and uncoordinated. Most effective for groups whose members have high professional and personal maturity. Leader serves as a resource person. |
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Bureaucratic leader |
Does not trust self or others to make decisions. Relies on organization's rules, policies and procedures. Group members usually dissatisfied with the leader's inflexibility and impersonal relationship with them. |
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Situational Leader |
1. adapts their leadership style to the readiness and willingness of the individual or group to perform the assigned task. 2. flexes task and relationship behaviors 3. Considers the staff members' abilities 4. Knows the nature of the task to be done 5. Is sensitive to the context or environment in which the task takes place. |
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Charismatic leader |
Has an emotional relationship with group members. Evokes strong feelings of commitment towards himself, his causes and beliefs. Very inspirational. |
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Transactional leader |
Relationship with followers is based off of an exchange for some resource valued by the follower. E.g. "Come to the dark side...we have cookies!" |
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Transformational leader |
Fosters creativity, risk-taking, commitment and collaboration by empowering the group to share in the organization's vision. Inspires with a clear, attractive and attainable goal. e.g. Each nurse in St. Vincent's takes up part of the research to reduce preemie mortality rates. Servant leadership is a subtype of this group. |
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The three components of effective planning: |
a) Assessing a situation b) establishing goals and objectives based off of assessment data. c) developing a plan of action. |
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**CAN be assigned to unlicensed assistive personnel** |
1. Taking vital signs 2. Measuring and recording intake and output 3. Client transfers and ambulation 4. Postmortem care 5. Bathing 6. Feeding 7. Gastronomy feedings in established systems. 8. Attending to safety 9. Weighing 10. Performing simple dressing changes 11. Suctioning of chronic tracheostomies. 12. Performing CPR and basic life support. |
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**CANNOT be assigned to unlicensed assistive personnel:** |
1. Assessment 2. Interpretation of data 3. Making a nursing diagnosis 4. Creation of a nursing care plan 5. Evaluation of care effectiveness 6. Care of invasive lines 7. Administering parenteral medication 8. Insertion of NG tubes 9. Client education 10. Performing triage 11. Giving telephone advice. |
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The 5 Rights of Delegation: |
1. Right task, under the 2. Right circumstances, to the 3. Right person, with the 4. Right direction and communication, and the 5. Right supervision and evaluation. |
