Additional Assessments Flashcards

- pain assessment - nutrition assessment - violence assessment

1
Q

Pain Perception

A

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

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2
Q

Nociceptors

A

located in he skin, connective tissue, muscles, and thoracic, abdominal and pelvic viscera
- identify and transmit pain stimuli to the CNS

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3
Q

Older Adults: Experience of Pain

A

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

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4
Q

Sources of Pain

A
  1. Nociceptive Pain
    a. Somatic Pain
    b. Visceral Pain
  2. Neuropathic Pain
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5
Q

Nociceptive Pain

A

pain caused by tissue injury
- well localized
- often described as throbbing, or
aching

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6
Q

Somatic Pain

A

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
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7
Q

Visceral Pain

A

pain originating from larger interior organs
- can be constant or intermittent
- poorly localized/ referred to another
area

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8
Q

Neuropathic Pain

A

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)

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9
Q

Referred Pain

A

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

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10
Q

Types of Pain (duration)

A
  1. Acute
  2. Chronic
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11
Q

Acute Pain

A

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

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12
Q

Chronic Pain

A

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

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13
Q

Pain Behaviour: Acute

A

high risk of undertreatment
- cognitively intact but non-verbal
- use pain assessment tools + body
language to determine pain

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14
Q

Pain Behaviour: Chronic

A

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)

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15
Q

Pain Behaviour: Unconscious Patient

A

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

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16
Q

PQRSTUV

pain assessment

A

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

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17
Q

The Initial Pain Assessment is: (2)

A
  1. Timely - investigate pain immediately if
    detected
  2. Ongoing - continue to monitor and
    treat (especially if chronic or
    requiring meds)
18
Q

Nutritional Assessment (3)

A
  1. Optimal Nutritional Status
  2. Undernutrition
  3. Overnutrition
19
Q

Optimal Nutritional Status

A

nutrition consumed meets body’s metabolic demands
- tend to have fewer physical illnesses
- tend to live longer

20
Q

Undernutrition

A

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

21
Q

Overnutrition

A

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

22
Q

Older Adult Considerations of Nutrition

A
  • 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

23
Q

Types of Nutritional Assessments

A
  1. 24h recall
  2. food diary
  3. food frequency questionnaire
  4. direct observation
24
Q

24-h Recall

A

recall everything consumed in the last 24 hours
- patient may not remember

25
Food Diary
record everything consumed over a period of 3 days - patient may forget to log food - patient may alter food intake
26
Food Frequency Questionnaire
questions about the frequency of consumption of certain types of food - patients may not remember - patients may lie about frequency
27
Direct Observation
nurse watches the patient eat their food - patient might be uncomfortable and alter eating habits
28
Types of Violence
1. Interpersonal Violence 2. Structural Violence 3. Gender-Based Violence
29
Interpersonal Violence
ALWAYS an abuse of power with traumatic consequences
30
Structural Violence
harmful societal distribution of power that puts certain people and populations at risk
31
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
32
Intimate Partner Violence (3 types)
1. Intimate Partner Terrorism 2. Resistant Violence 3. Situational Couple Violence
33
Intimate Partner Violence (IPV)
violence committed by current or former partners in a relationship - can be physical, sexual, psychological, or financial abuse
34
Intimate Partner Terrorism
type of IPV involving coercive control, in which once partner tries to control the other - has the most serious health consequences
35
Resistant Violence
type of IPV in which a partner experiencing intimate partner terrorism, responds with violence
36
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
37
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
38
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**
39
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
40
Trauma and Violence Informed Care (5 steps)
1. Assume - patients have a history of abuse 2. Assume - patients may currently be experiencing abuse 3. Know - all forms of abuse are an abuse of power 4. Anticipate - what might be traumatizing 5. Routine Screening - of the impact of home and work on health
41
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