Additional Assessments Flashcards
- pain assessment - nutrition assessment - violence assessment
Pain Perception
pain is a highly complex and subjective experience
- it can originate from the PNS, CNS, or both
- if the patient says they have pain, they have pain –> SUBJECTIVE
Nociceptors
located in he skin, connective tissue, muscles, and thoracic, abdominal and pelvic viscera
- identify and transmit pain stimuli to the CNS
Older Adults: Experience of Pain
older adults experience pain the same way everyone else does
–> pain IS NOT a normal aging process, it is indicative of an underlying disease or condition
Sources of Pain
- Nociceptive Pain
a. Somatic Pain
b. Visceral Pain - Neuropathic Pain
Nociceptive Pain
pain caused by tissue injury
- well localized
- often described as throbbing, or
aching
Somatic Pain
Superficial - pain derived from superficial tissues and/or cutaneous tissues
Deep - pain derived from joints, tendons, muscle or bone
- often easier to identify exact locations
Visceral Pain
pain originating from larger interior organs
- can be constant or intermittent
- poorly localized/ referred to another
area
Neuropathic Pain
pain originating from a lesion or disease of the nervous systems
- not well localized (may refer)
- described as burning, shooting,
lancing pain
- intensifies at night (no more stimuli to
distract)
Referred Pain
pain that originates at one location but is experienced at another
spinal nerves share pathways, thus pain along the nerve is experienced at the locations the nerve inervates –> brain cannot differentiate point of origin
Types of Pain (duration)
- Acute
- Chronic
Acute Pain
short term (3-7 days)
- follows a predictable trajectory –>
pain dissipates when injury heals
- serves a purpose - warns of actual or
potential tissue damage
unrelieved acute pain can lead to persistent (chronic) pain through peripheral and central sensitization
- increase in sensitivity of nociceptors to
stimuli that normally would not elicit
pain
Chronic Pain
long term, persistent (3+ months)
3 potential causes:
1. malignant - cancer related (worsens
with the progression of the disease)
2. non-malignant - not cancer related
(often musculoskeletal)
3. neuropathic - lesion or disease of the
somatosensory nervous system
Pain Behaviour: Acute
high risk of undertreatment
- cognitively intact but non-verbal
- use pain assessment tools + body
language to determine pain
Pain Behaviour: Chronic
high risk of under-detection
- have adapted to the pain
- understand patient’s perspective of
pain (what does it feel like, how is this
compared to your normal pain)
Pain Behaviour: Unconscious Patient
high risk of under-detection AND under treatment
- not cognitively intact and nonverbal
- unable to use body language, verbal
communication, or normal pain
assessment tools
use specialized tools + vital signs to detect pain
- patients will still experience pain when
unconscious
PQRSTUV
pain assessment
P - palliative/ provocative
Q - quantity/ quality
R - region/ radiation
S - severity (scale of 1-10)
T - timing (onset, consistency of pain)
U - understand the patient + their
understanding of pain
V - vitals
The Initial Pain Assessment is: (2)
- Timely - investigate pain immediately if
detected - Ongoing - continue to monitor and
treat (especially if chronic or
requiring meds)
Nutritional Assessment (3)
- Optimal Nutritional Status
- Undernutrition
- Overnutrition
Optimal Nutritional Status
nutrition consumed meets body’s metabolic demands
- tend to have fewer physical illnesses
- tend to live longer
Undernutrition
insufficient nutritional intake in comparison to body’s metabolic needs
- nutritional reserves are depleted
- inadequate nutritional intake
Risks:
- impaired growth and development
(esp. children)
- impaired immune-system
- more frequent illness, delayed wound
healing
Overnutrition
consumption of nutrients in excess of metabolic requirement
- associated with the development of
obesity –> although obesity may not
always result from over nutrition
Risks:
- development of type 2 diabetes
- development of hypertension
- development of CVD
Older Adult Considerations of Nutrition
- growth and nutrition requirements
stabilize in adulthood (children have
increased requirements) - after the age of 50, energy requirements
decrease by 5% per decade –> reflects
normal physiological effects of aging
and lifestyle changes
more prone to undernutrition or overnutrition
Types of Nutritional Assessments
- 24h recall
- food diary
- food frequency questionnaire
- direct observation
24-h Recall
recall everything consumed in the last 24 hours
- patient may not remember
Food Diary
record everything consumed over a period of 3 days
- patient may forget to log food
- patient may alter food intake
Food Frequency Questionnaire
questions about the frequency of consumption of certain types of food
- patients may not remember
- patients may lie about frequency
Direct Observation
nurse watches the patient eat their food
- patient might be uncomfortable and
alter eating habits
Types of Violence
- Interpersonal Violence
- Structural Violence
- Gender-Based Violence
Interpersonal Violence
ALWAYS an abuse of power with traumatic consequences
Structural Violence
harmful societal distribution of power that puts certain people and populations at risk
Gender-Based Violence
violence that is committed against someone because of their gender identity
- dangerous but often does not meet
the threshold for criminal behaviour
Intimate Partner Violence (3 types)
- Intimate Partner Terrorism
- Resistant Violence
- Situational Couple Violence
Intimate Partner Violence (IPV)
violence committed by current or former partners in a relationship
- can be physical, sexual, psychological,
or financial abuse
Intimate Partner Terrorism
type of IPV involving coercive control, in which once partner tries to control the other
- has the most serious health
consequences
Resistant Violence
type of IPV in which a partner experiencing intimate partner terrorism, responds with violence
Situational Couple Violence
type of IPV in which conflicts and arguments turn to aggression that progresses into violence
- does not involve attempts to control
- gender symmetric in terms of
perpetration
Health Effects of IPV
a. Direct/ Physical - bruises, soft tissue damage, fractures/ breaks, unintended pregnancy, STIs
b. Chronic - chronic pain, arthritis, CVD, neurological complaints, STIs/ HIV, UTIs, GI complaints
c. Mental Health - depression, anxiety, PTSD, sleep disturbances, suicide, substance use/ dependence
Elder Abuse and Neglect
IPV that occurs in older adulthood –> either continued or new
- can be verbal, physical, psychological,
sexual, financial
** a single or repeated act of abuse or neglect within a relationship that harms or distresses an older person**
Elder Abuse and Neglect Health Effects
a. Stress - cardiac complications
b. Friable Vaginal Musocal Tissue - vaginal
trauma, tearing, STIs
c. Localized Infections - generalized
sepsis, death
d. bleeding from trauma - changes in BP
and HR can lead to shock or death
Trauma and Violence Informed Care (5 steps)
- Assume - patients have a history of abuse
- Assume - patients may currently be experiencing abuse
- Know - all forms of abuse are an abuse of power
- Anticipate - what might be traumatizing
- Routine Screening - of the impact of home and work on health
How to Document Violence
detailed, objective, and unbiased
- include statements that specify the perpetrator and threats made
- do not sanitize language
- use direct quotations
- use injury maps if needed
- provide photographic evidence if consent is obtained
