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166 Cards in this Set
- Front
- Back
Serotonin and endorphins are morphine-like substances activated by pain and stress
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Sources of stress of older adults
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* rapid environmental changes that require immediate reaction
* changes in lifestyle resulting from retirement or physical incapacity * acute or chronic illness * loss of significant others * financial hardships * relocation |
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Any cellular damage caused by _____, _____, _____, or _____ stimuli results in the realease of pain producing substances.
Mechanical - stretching of soft body tissues (ex. passing a kidney stone) Chemical - perforated visceral organ (ex. burst appendix, duodenal ulcer). Chemical secretions touch sensitive nerve endings. Thermal (hot or cold) - causing inflammatin or loss of superficial layers of epidermis. Increased sensitivity of nerve endings. Electrical - skin layers are burned invloving the muscle and subcutaneous tissue, causing injury to nerve endings. |
thermal,
mechanical, chemical, electrical |
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Hispanic Americans
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* Fastest growing cohort in USA
* Expected to be largest minority * High birth rates * Major issue - lack of citizenship is a barrier to availability of services * Family is most significant social organization * Family needs prevail over individual needs * Dishonor and shame reflect on whole family * Tend not to seek help from outsiders * Father is dominant * Strong sense of MACHISMO * Belief in external LOCUS * Good health implies proper balance * Folk medicine / healers are usually female |
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Culture aspects of dealing with death
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1 - People want to die with dignity (in all cultures)
2 - Cultural and religious traditions help people cope with death 3 - Nurses are often present at time of death 4 - knowledge of patent's religious and cultural background helps nurses provide individualized care to patient and family 5 - dying alone is usually unacceptable in all cultures 6 - Some cultures - dying at home is preferable 7 - Some cultures patient should know what's going on, others don't feel patient should know what's going on 8 - Nurses need to know who to call and when 9 - Organ donation, autopsies, cremation, preparation of the body 10 - Rituals |
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Four categories of old
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* Young Old = 65-74
* Middle Old = 75-84 * Old Old = 85-99 * Elite Old = 100+ |
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"Reception Substances" released by the body include -
* Histamine * Bradykinin * Potassium These combine with receptor sites. Not all tissues contain receptors that transmit pain signals, ex. Brain and alveoli. |
* Histamine
* Bradykinin * Potassium These combine with receptor sites. |
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Characteristics of Intimacy (Stage 6)
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- Need for marital intimacy
- Possessing capacity to love and express that love - Involvement with other generations in family - Maintaining a sense of self |
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KNOW -
Even with acceptance hope is still present and needs to be supported realistically |
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Erikson's Stage 6 - Young Adulthood
? vs ? Main Issue? |
Intimacy vs. Isolation
Primary issue is love. |
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Mechanical
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stretching of soft body tissues (ex. passing a kidney stone)
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Implementing the following nursing interventions for all patients regardless of risk -
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* Monitor the patient's activities and behavior as often as possible, preferably every 30 to 60 minutes
* Remind the patient to call for help * Help the patient to get out of bed or chair * Provided, or remind the patient to use, walking devices * Remind the patient to wear glasses * Toilet the incontinent every 1 to 2 hours * Clean up spills immediately * Arrange furniture accordingly * Provide adequate lighting * Observe for side effects * Orient the patient to the environment * Keep the call light within reach * Place the bed in lowest position with the brakes locked * Place objects within reach * Ensure adequate handrails * Have physical therapies assess the patient for mobility and safety |
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Apnea =
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not breathing
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Age-related changes that can potentially affect drug absorption from an oral route include -
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* an increasing gastric pH
* a decrease in gastric blood flow * a decrease in gastrointestinal motility |
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If pain is severe, or deep, typically involving visceral organs, the _____ nervous system goes into action
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parasympathetic
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Erikson's Stage 7 (Adulthood) -
? vs. ? Primary Issue |
Generativity vs. Self-absorption/Stagnation
Primary issue is CARE |
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Caring
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The essence of nursing is caring.
The dominant distinctive and unifying feature of nursing is caring. 1 - supportive and assistive acts for another individual 2 - Serves to improve human conditions 3 - Essential to human development, growth, and survival 4 - Caring behaviors include - * comfort * compassion * concern * empathy * involvement * love * nurturance * sharing * support * tenderness * touch * trust |
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Erikson's Stage 8 (Old Age)
? vs. ? Primary Issue? |
Integrity vs. Despair
Primary Issue = Wisdom |
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Pain is influenced by interaction between ...
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emotional, behavioral, cotnitive and physiologic sensory factors
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Age-related changes affecting metabolism include -
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* a decrease in liver size
* a decrease in liver blood flow * a decrease in liver enzyme activity |
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Kubler-Ross
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1 - Denial - may be partial or complete; may occur during first stages of illness and later on from time to time. (Used as a buffer zone - allowing time to deal with)
2 - Anger - r/t giving up life - may be projected at others 3 - Bargaining 4 - Depression - Two kinds - Preparatory (with impending loss) - Reactive (reaction to the news just received) 5 - Acceptance |
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Three most common cognitive problems among older adults
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1 - depression
2 - dementia 3 - delirium |
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Chemical
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perforated visceral organ (ex. burst appendix, duodenal ulcer). Chemical secretions touch sensitive nerve endings.
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Two forms of competence -
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1 - Legally competent
2 - Clinically competent |
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Serotonin and endorphins are found in the ...
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brain, spinal cord, and GI tract
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Depression is thought to result from a lack of what two neurotransmitters?
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norepinephrine
serotonin |
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Thermal (hot or cold)
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causing inflammatin or loss of superficial layers of epidermis. Increased sensitivity of nerve endings.
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Characteristics of Despair
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Despair = sense of hopelessness and dread
- Overwhelming regret over past mistake - Worry about the future and unknown - Feelings of loneliness and possible abandonment Sense of not being missed when dead |
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Influences -
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* Personal Values/Beliefs
* Life Review * Family and friends reactions/attitudes * Personal coping skills * Health care staff |
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Define Cultural Competence
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ability to understand and respond effectively to the cultural and language needs of patients.
- Respect the culture - Be careful of discrimination - Resources/protocol to address cross cultural legal and ethical conflicts |
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Gate Control Theory of Pain -
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Pain impulses can be regulated or blocked by the gating mechanism along CNS. Pain impulses pass through when the gate is open and not while the gate is closed.
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Characteristics of Integrity
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Integrity = sense of satisfaction and fulfillment
- Knowledge developed from life experiences - Ability to use all resilience and toughness learned - Willingness to learn new coping skills - Sense of humor |
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Hospice
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1 - specialized care for the dying including emotional and spiritual support
2 - may alleviate a lot of stress for family 3 - hospice personnel are educated to treat pain aggressively 4 - Hospice philosophy is as pain-free as possible and as alert as possible 5 - Doctor says that patient is less than six months |
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Characteristics of Stagnation
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Stagnation
- Little involvement in adulthood activities - Regret over putting aside personal interests for family - Difficulty expressing feelings of affection Lack of concern for family, country and mankind |
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Threshold of pain =
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minimum level of stimulus intensity required to evoke a nervous impulse
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Without treatment, depression may result in ?
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1 - worsening medical condition
2 - risk of physical illness 3 - alcoholism 4 - increased pain and disability 5 - delayed recovery from illness 6 - suicide |
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Pain Pathways
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1 - Source of pain
2 - Stimulation of pain receptor (may be mechanical, chemical, thermal, electric, or ischemic) 3 - Sensation travels along the sensory pathways and ascends the spinal cord to the thalamus 4 - The autonomic nervous system is activated 5 - Sensations travel to the sensory area of the cerebral cortex 6 - Pain reception occurs in the thalamus 7 - Pain interpretation occurs in the cerebral cortex 8 - The person become aware and the response patterns are activated |
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Medical Indications of Elder Abuse
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1 - Possibly bruising - old and new bruises at the same time
2 - Skin Tears 3 - Malnutrition/Dehydration -decrease in thirst, appetite, and sense of smell 4 - Bed sores 5 - Fractures 6 - Patient History |
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Factors influencing pain...
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* age
* sex * culture * meaning of pain * attention * anxiety * fatigue * previous experience * coping style * family/social |
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Largest subculture in USA?
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Disabled
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Types of breakthrough pain
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1 - Incident pain - caused by movement or activity
2 - Spontaneous pain - does not seem to be linked to any specific source |
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Delirium may be casued by...
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- infection
- medications - fever - nutritional - grief/stress - change of environment |
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Sensory discriminative
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* nerve transmission occurs between the thalamus and sensory cortex
* person perceives the location, severity, and character of pain |
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Characteristics of Delirium (vs. Dementia)
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- Short term
- Reversible - Acute stage of confusion - Agitation |
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Techniques for Pain Control
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1 - PCA (Patient-controlled analgesia)
2 - Epidural pain control 3 - Direct IV pain control 4 - Breakthrough pain control |
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Characteristics of Dementia
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- cognitive decline
- can be slow and progressive - irreversible |
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Examples of two tissues that don't contain receptors that transmit pain signals
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Brain and alveoli
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Common errors in drug self-administration
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* may forget
- writing the drug regimen on the top of the bottle with large letters and numbers is helpful * errors in taking medication may result from poor communication with health care professional * attitude and long-ingrained feelings about taking medicine - when obtaining a medication history, it is very important that the nurse ask patients about all OTC drugs, including herbal and food supplements |
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Electrical
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skin layers are burned invloving the muscle and subcutaneous tissue, causing
injury to nerve endings. |
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Define restraint
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any device or medication that prevents the patient from moving freely
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Perception =
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point at which a person is aware of pain
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Examples of things cultures share...
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* Food/nutrition * Dress
* Language * Morals * Treatment of illness * Laws * Art * Customs * Rituals * Economics * Family systems |
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Characteristics of Acute Pain
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* rapid onset
* it is self-limiting; with an end in sight * an episode that lasts for seconds to fewer than about six months |
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What is the single most important predictor of falls?
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a history of falling
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Motivational-affective
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* interaction between the reticular formation and limbic system results in pain perception
* limbic system controls emotional response and coping with pain |
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What is goal of Healthy People 2010?
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Goal is to eliminate disparities with healthcare delivery among racial and ethnic minorities.
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Behavioral reactions to pain...
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1 - Anticipation
2 - Sensation 3 - Aftermath |
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Common causes of undernutrition include
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- drugs
- chewing problems - immobility - infections - alzheimer's disease |
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Superficial
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* short duration
* sharp sensation * localized |
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Characteristics of Generativity (Stage 7)
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Generativity
- Creative - Giving of self to world - Perpetuating - Helping and giving to next generation - Vital involvement in adulthood activities - Participation in caring for what one truly believes in Nurturing and maintaining relationships - Care for the present and concern for the future |
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Characteristics of Deep Visceral
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* diffuse
* radiating * sharp or dull or unique to organ involved |
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Older people tend to have more short term or more long term memory loss?
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short term
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Locations of Pain
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1 - Superficial or Cutaneous
2 - Deep Visceral 3 - Referred 4 - Radiating |
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Types of Elder Abuse (8)
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Physical Abuse
Emotional Abuse Financial Abuse Sexual Abuse Active Neglect Passive Neglect Denial of Civil Rights Self Abuse / Neglect |
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Characteristics of Chronic Pain
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* an episode of pain htat lasts for six months or longer
* pain may be limited, intermittent, or persistent * difficulty describing the pain because it is poorly localized |
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Characteristics of Isolation (Stage 6)
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Isolation
- Inability or unwillingness to express feelings - Dissatisfaction with long term marriage - Feelings of bitterness toward life events - Refusing assistance from family, friends, neighbors |
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Characteristics of Referred
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* pain felt in part of body separate from source of pain
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Older patients with a pressure ulcer need additional ...
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protein
vitamen C zinc |
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Characteristics of A-beta neurons -
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* mechanoreceptor
* thicker * when released inhibit the other neurotransmitters (close the gate) |
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Define active neglect
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the intentional failure to perform a care giving function in order to inflict pain or injury
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Three Physiological Components of Pain
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1 - Reception
2 - Perception 3 - Reaction |
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Define passive neglect
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the unintentional failure to perform a care giving function which results in pain or injury
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Types of Pain
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* acute
* chronic - Intractable pain (malignant pain) - Nonmalignant pain |
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Effects of drugs on older adults
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Older adults are at a high risk for side effects and toxic effects from drug.
Elders have less reserve capacity in most organ systems |
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Signs of pain ...
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* facial expression
* clenching teeth * holding the painful part * bent posture * grimaces, cries, groans * restlessness * frequent rests |
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Age-related changes of the renal system include -
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* decreased renal blood flow
* reduced glomerular filtration rate |
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Reaction is a physiological and behavioral response to pain.
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Age-related changes that affect drug distribution include -
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* smaller amounts of total body water
* an increased ratio of adipose tissue * a decreased albumin level * a decreased cardiac output |
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Cognitive-evaluative (intellect)
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* higher cortical centers in the brain influence perception
* helps the person to interpret the intensity and quality of pain so that action can be taken |
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Which is the most potent group of psychoactive drugs?
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antipsychotics
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Non malignant pain
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* Pain such as low-back pain results from nonprogressive or healed tissue injury.
* Pain is still ongoing and often does not respond to treatment. * Frequently the cause is unknown. |
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The minimal nutritional requirements of the human body remain consistent from youth through old age, with a few exceptions.
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Three interactional systems of pain... |
1 - sensory-discriminateive 2 - motivational-affective 3 - cognitive-evaluative |
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The most common accident among older patients in a hospital or LTC is?
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falling
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Methods for Intractable Pain
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* restorative care - nurses continue to use nonpharmacological measures that are effective for individual patients.
* hospice * pain clinics |
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Older adults need an increased dietary intake of calcium, vitamin D, vitamin C, and vitamin A because alteration with age disrupt the ability to store, use and absorb these substances.
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The central processing of pain occurs at three different levels of the brain
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1 - thalamus
2 - midbrain 3 - cortex |
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Oversedation, isolation, an unsafe environment are all types of what?
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Neglect
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To manage delirium, the nurse should ...
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use a calm voice in reorienting the patient and try to divert attention away from devise or tubes
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Lack of privacy and involuntary servitude are types of ?
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Abuse
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Characteristics of Radiating
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* sensation of pain extending from initial site of injury to another body part
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Define Culture
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body of learned beliefs, traditions, and guides for behavior that are shared among members of a particular group
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The sympathetic nervous system response is usually stimulated by superficial pain.
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What are the six target areas of Healthy People 2010?
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Infant Mortality
Cancer Screening Cardiovascular Disease Diabetes HIV Immunizations |
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Non-pharmalogic relief measures
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* distraction
* imagery (therapeutic touch) * relaxation * cutaneous stimulation * TENS (transcutaneous electrical nerve stimulation) * acupuncture * hypnosis |
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Older adults experience a greater decline in the ability to taste sweet and salt than in the discrimination of bitter and sour |
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Physical dependent =
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a physiologic adaptation of the body tissues so that continued administration of the drug is required for normal tissue function
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Native American Indians
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* 10 Tribes
* 1.9 million * Cherokee and Navajo have largest populations * Each tribe has own language * Equal number of Native Americans live on reservations as in cities * Bureau of Indian Affairs (1954) now called Indian Health Services * Family oriented * Some tribes are MATRIARCHAL * Same household with wife's relatives * Religion and healing are blended together * Values and basic beliefs to culture and religion are day to day * Value harmony with earth * Native American healers are respected |
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Larger peptide (ENDORPHINS) exert more prolonged analgesic (pain-relieving) effects than do the enkephalins (smaller peptides)
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Approximately 80-85% of older adults are relatively healthy and live in the community at home, in assisted-living facilities, or in retirement complexes.
Five percent reside in longterm care facilities. Ten to fifteen percent are ill but are being cared for at home. |
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For patients with cancer the aim of drug therapy is to _____ pain rather than cure it.
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ANTICIPATE and MINIMIZE
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African Americans
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* Many health problems closely associated with economic status
* Poverty, discrimination * Social and psychological barriers to health care * Morbidity and mortality rates are higher than general population and other minorities * Morbidity = illness * Mortality = death * Higher infant mortality rates * Families are MATRIFOCAL (no male in household) * Even when a male is present families are oriented around women * Families tend to be very supportive during times of crises and illness * Some fold medicine is used by some raised in South |
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Dyspnea
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is a subjective experience in which the patient experiences an uncomfortable awareness of breathing, breathlessness, or severe shortness of breath
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Diminished senses of taste and smell often result in a loss of appeal of food.
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Essential Data for a complete Pain History
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1 - Precipitating factors
2 - Aggravating factors 3 - Localization of pain 4 - Character and quality of pain 5 - Duration of pain |
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Asian Americans
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* Family is basic institution
* Well-defined family roles * Close-knit; tend to be in same community * Mistrust is a barrier * Eldest son has responsibilities * Women often secure jobs * Consider seek illness cures in herbs, therapeutic diets, and hygienic measures * Information is usually transmitted orally and with secrecy * Beliefs in BALANCE |
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Elders with depression may experience
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* early morning insomnia
* excessive daytime sleeping * poor appetite * a lack of energy * an unwillingness to participate in social and recreational activities |
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Common health issues and problems that may affect older adults in any setting include ...
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Health promotion
Self-management Nutritional awareness Physical fitness and mobility Stress management Accidents Drug use and misuse Mental health Elder neglect and abuse |
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Delirium
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* An acute confusional state
* Fast onset * Duration of hours to less than one month * Cause is multiple, such as surgery, infection, drugs * Usually reversible * Remove or treat the cause as management * Nursing intervention -reorient the patient to reality; provide a safe environment |
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What are the two most common nutritional problems in both hospital and LTC settings?
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Anorexia
Wight loss |
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Dementia
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* Chronic, progressive cognitive decline
* Slow onset * Duration of months to years * Cause is unknown * Non-reversible * Management includes treat signs and symptoms * Use validation therapy (acknowledge the patient's feelings and do not argue) - provide a safe environment - observe for associated behaviors (delusions and hallucinations) |
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Identify nursing interventions for common health and economic issues common to the older adult.
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Religious assistance
Community assistance Government assistance |
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The ethics of nursing includes -
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* ensuring patient confidentiality
* getting informed consent for certain procedures and surgery * respecting the right of patients to make autonomous decisions about their care |
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Most common abuse of elders is
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Financial abuse is most common
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Epidural space =
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the space between the dura mater and the vertebral column
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Pain is subjective
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When respirations fall below 10, the nurse should rouse the patient (p 75, ig).
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Neurotransmitters are the chemicals that exert inhibitory (slowing down) or excitatory (speeding up) activity at postsynaptic nerve cell membranes.
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Chapter 9
Palliative Care = |
relieving or alleviating without curing
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The best questions for cultural interviews are "semi-structured" and open-ended questions.
Examples of such questions - |
* I am interested in where you were born. Could you describe the community (or country)?
* I would like to know where your parents were born. If they are living, where are they now? * Tell me about your household. Who lives in it? Are they related to you? * Describe how you usually spend your days. What do you like to do most? * Please describe your education for me. * I am also interested in the church and religion. What do they mean to you? * Tell me about what you believe about health. What does it mean to "be healthy"? To whom do you look for health care? * Is there anything else you would like to tell me? |
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Characteristics of Pain
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* Highly Individualized experience * Invisible phenomenon * Body's defense mechanism that indicates the person is experiencing a problem |
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Elder Neglect and Abuse
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- Neglect
- Physical - Financial - Emotional |
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McCaffery definition of pain
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Pain is whatever the person experiencing it says it is, existing whenver he or she says it does.
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Physical
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use of physical force that results in bodily injury, especially in the bathing suit zone
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Withdrawal symptoms include -
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- nausea and vomiting
- abdominal cramping - muscle twitching - profuse perspiration - delirium - convulsions |
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Factors that tend to decrease the threshold for and tolerance of pain include -
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* discomfort * insomnia
* fatigue * anxiety * fear * anger * sadness * depression * mental isolation * introversion * past experience |
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Four categories of location related pain
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1 - Localized pain is pain confined to the site of origin.
2 - Projected pain is pain along a specific nerve or nerves. 3 - Radiating pain is diffuse pain around the site of origin that is not well localized. 4 - Referred pain is pain perceived in an area distant from the site of painful stimuli. |
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Cordotomy =
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a cut in the pain pathway at the midline portion of the spinal cord
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Spirituality =
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the connections to self, others, the environment and God
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Neuromodulators are protein hormones in the brain.
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Physiologic and behavioral responses to acute and chronic pain -
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Acute Pain
* Increased blood pressure initially * Increased pulse rate * Increased respiratory rate * Dilated pupils * Perspiration * Restlessness * Inability to concentrate * Apprehension * Distress |
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QI for pain should be based on the following tenets (p. 91, ig)
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* pain should attract clinician's attention
* Information about analgesics should be accessible where orders are written * Patients should be assured of responsive analgesic care and urged to communicate pain * polices and safeguards should be implemented for the use of technology-supported pain care * Implementation of these measures should be assessed and coordinated |
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The most important type of opioid receptor is the _____ receptor.
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MU
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Giving the right drug and the required dose at the proper interval
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* alleviates the fear of pain
* protects the pateint from drug seeking behavior * reduces dependence |
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Rhizotomy =
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sensory nerve roots are destroyed where they enter the spinal cord
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Financial
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occurs when the patient's property or resources are mismanaged or misused
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Side effects of NSAIDs
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* Gastric irritation and upset
* Renal toxicity * Decreased clotting |
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Reminiscence =
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the process of randomly reflecting on memories of events in one's life
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Nociceptors =
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free nerve endings (receptors capable of responding to painful stimuli).
Nociceptors are located in various body tissues and are activated by thermal, mechanical, and chemical stimuli. |
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The ethics regarding cultural care of patients considers -
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* the values of each individual patient and his or her cultural beliefs and practices
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The most common symptoms of distress are -
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* dysphagia (impaired swallowing)
* pain * dyspnea * nausea and vomiting * agitation |
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Neuralgias =
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pain along the distribution of nerves
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Withdrawal symptoms may result when a patient who is physically dependent abruptly ceases using the drug.
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Nonpharmacologic Interventions
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* Altering the environment to facilitate the circulation of cool air
* Cooling the body * Position the patient to facilitate chest expansion * Encouraging imagery and deep breathing * Intervening to conserve patient energy * Facilitating the patient's rest |
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The activity of endorphins and enkephalins may be enhanced by prolonged strenuous activity , transcutaneous electrical nerve stimulators (TENS), and antidepressant therapy.
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Two specific fibers can transmit stimuli
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1 - A Delta Fibers found primarily in the skin and muscle
* myelinated * carry rapid, sharp, pricking, or piercing sensations. 2 - C Fibers which are distributed in muscle, periosteum, and viscera. * unmediated or poorly myelinated * conduct thermal, chemical, and strong mechanical impulses * usually produce constant pain |
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Various Meds and Routes for Chrnic Pain
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1 - Epidural analgesia 2 - Long acting/controlled release MS (morphine sulfate) Rectal analgesia 3 - Transdermal 4 - PCA pump 5 - Continuous drip MS 6 - Surgery Evaluation of pain therapy requires consideration of the changing character of pain, response to therapy, and the patients perceptions of a therapy's effectiveness. |
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Various Meds and Routes for Chrnic Pain
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1 - Epidural analgesia
2 - Long acting/controlled release MS (morphine sulfate) Rectal analgesia 3 - Transdermal 4 - PCA pump 5 - Continuous drip MS 6 - Surgery |
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Emotional
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intentional use of threats, humiliation, intimidation, and isolation toward older adult
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Chronic Pain
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* Normal blood pressure
* Normal pulse rate * Normal respiratory rate * Normal pupils * Dry skin * Immobility or physical inactivity * Withdrawal * Despair |
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Common Nursing Dx related to pain
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* Acute Pain
* Chronic Pain * Anxiety related to loss of control * Fear related to pain * Powerlessness related to the illness-related regimen * Ineffective role performance related to a change in health status and impaired coping * Altered sexuality patterns related to illness and pain * Impaired physical mobility related to pain and discomfort * Activity intolerance related to pain and/or depression * Sleep pattern disturbance related to pain * Self-care deficit (total or partial) related to pain * Altered health maintenance related to a feeling of hopelessness |
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Neglect
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occurs when a caregiver fails to provide for a patient's basic needs
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Religiosity =
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the acts that are practiced alone or with others to preserve spiritual understanding
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Stages of Grieving Process
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1 - Shock and disbelief
2 - Developing awareness 3 - Restitution 4 - Resolution 5 - Idealization |
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Factors that tend to increase the threshold for and tolerance of pain include -
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* symptom relief
* sleep * rest * sympathy * understanding * diversion * elevation of mood * analgesics * anxiolytic agents * antidepressants |
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Theories of Pain
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1 - Specificity Theory = certain pain receptors are stimulated by specific type of sensory stimuli that sends impulses to the brain.
2 - Pattern Theory = pain originates in the dorsal horn of the spinal cord. A certain pattern of nerve impulses is produced and results in intense receptor stimulating that is coded in the CNS and signifies pain. 3 - Gate Control Theory = * existence and intensity of pain experience depends on the particular transmission of neurologic impulses * gate mechanisms along the nervous system control the transmission of pain. * if the gate is open the impulses that result in the sensation of pain are able to reach the conscious level- * if the gate is closed the impulses do not reach the level of consciousness and the sensation of pain is not experienced |
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In addition to endorphin "keys" and receptor "locks", researchers have found antilocks, called antagonists, that keep endorphins from working
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Stages of the Dying Process
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1 - Denial
2 - Anger 3 - Bargaining 4 - Depression 5 - Acceptance |
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Endorphin receptors and antilocks have been found throughout the body
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Theories of Pain
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1 - Specificity Theory = certain pain receptors are stimulated by specific type of sensory stimuli that sends impulses to the brain.
2 - Pattern Theory = pain originates in the dorsal horn of the spinal cord. A certain pattern of nerve impulses is produced and results in intense receptor stimulating that is coded in the CNS and signifies pain. 3 - Gate Control Theory = * existence and intensity of pain experience depends on the particular transmission of neurologic impulses |
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The parasympathetic nervous system response is usually stimulated by deeper pain and results in slowing down of all systems to conserve energy.
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Common Emotional Signals
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* Withdrawal
- person is preparing to "let go" * Vision-like experiences * Letting go - may perform repetitive task * Saying goodbye |
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A beta-endorphin is 50 times stronger than morphine.
A dynorphin is 190 times stronger than morphine. |
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Addiction =
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used to describe the persistent craving for and abuse of a drug for recreational purposes. IT IS PSYCHOLOGIC PHENOMENON, NOT A PHYSICAL ONE.
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The goals of care for a patient near death are -
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* To control symptoms
* To promote meaningful interactions between the patient and significant others * To facilitate a peaceful death |
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The patient's interpretation of the physical sensation is influenced by the patient's -
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* culture
* previous experiences with and without pain * beliefs about self * interpretation of the future * present environment * persons in the environment |