Chapter 11. Chronic Illness And Pain

Question 0

What percentage of people over the age of 65 had multiple chronic conditions?

Answer 0

Three out of four, or 75% of persons age 65 and older.

Question 1

Chronic illnesses are defined as?

Answer 1

A condition that lasts a year or more and requires ongoing medical attention, limited activities of daily living, or both.

Question 2

What percentage of total healthcare spending is directed towards the care of older Americans with chronic illnesses?

Answer 2

66%

Question 3

The top five chronic conditions in Americans over age 65 in order of the percentage diagnosed with the condition?

Answer 3

Hypertension
Cholesterol disorder
Arthritis
Heart disease
Eye disorders

Question 4

What are the goals for treating chronic illness?

Answer 4

Managing chronic illness to maximize functionality, prevent complications, promote dignity, and limit suffering are the goals.

Question 5

What is the definition of pain?

Answer 5

Pain can be defined as what the patient himself or herself says it is. It can also be defined as a subjective, personal, unpleasant experience involving sensations and perceptions that may or may not relate to bodily or tissue damage.

Question 6

Differentiate between chronic and acute pain.

Answer 6

Acute pain is rapid onset and of short duration. It can be a sign of a new health issue that has to be addressed. Chronic pain continues after healing and cannot be cured. Chronic pain is associated with functional decline and psychological problems.

Question 7

What are the four categories of pain?

Answer 7

Nociceptive, Neuropathic, mixed or unspecified, and other.

Question 8

This type of pain is visceral or somatic, may arise from inflammation, mechanical deformity, ongoing injury, or destruction of tissues, responds well to analgesics and nonpharmacological interventions.

Answer 8

Nociceptive

Question 9

This type of pain involves the peripheral or central nervous system, does not respond well to traditional analgesics, agents such as anticonvulsants and antidepressants should be added to the regiment.

Answer 9

Neuropathic

Question 10

This type of pain has mixture unknown mechanism, treatment is unpredictable.

Answer 10

Mixed or unspecified pain

Question 11

This type of pain is rare, may include conversion reactions or psychological disorders.

Answer 11

This type of pain is referred to as “other”.

Question 12

There are many harmful effects from unrelieved pain, name some of them.

Answer 12

Increased heart rate, cardiac output, hypertension, deep vein thrombosis, reduce cognitive functioning disorientation, increased release of stress hormones, decreased gastric and bowel motility, decreased urinary output, sleep disorders, increased depression, and depressed immune function to name a few.

Question 13

Name a few barriers to adequate pain management in older adults.

Answer 13

Inadequate access to diagnostic services, pain assessment tools not validated with older adults, nurses who are overly dependent on assessment tools to determine pain, thus patients with dementia are unable to use those tools. Medical personnel underestimating patient pain. Fear of addiction and lack of acceptance of the use of opiates.

Question 14

The general principles for assessing pain in older adults as developed by the American geriatrics Society.

Answer 14

> Patient report is the most accurate evidence that pain exists.
Older patients may underreport pain and spite of severe impairments.
Older patients may use words such as uncomfortable, ache, or hurt instead of pain.
Unreleased pain can impair functional status and decrease quality-of-life.
Nonverbal cues and change in function should be used for accurate assessment of patients with cognitive or language impairments.

Question 15

This pain scale relies on activity level and may be more specific to older adults

Answer 15

PQRST Pain scale
Provocative-palliative 
Quality
Region
Severity & Timing

Question 16

Some important factors to focus on in the physical exam regarding chronic pain are (3)?

Answer 16

Functional status
Quality-of-life
Depression

Question 17

Baseline blood work is Needed in patients taking chronic pain medications. What are some tests that should be checked?

Answer 17

CBC, stool for occult blood, BUN, creatinine, and potassium.

Question 18

Drugs that are used for analgesia in older adults can be divided into three groups.

Answer 18

> Mild analgesics such as many percent, Aleve, and Tylenol, & Some week opiates such as codeine and oxycodone.
Opiate analgesics such as morphine.
adjuvant drugs Such as anti-convulsants and antidepressants or corticosteroids, sedatives.

Question 19

Your patient was recently started on a new pain medication. They Experience nausea, sedation and minor respiratory depression. What is your nursing intervention or recommendation.

Answer 19

Patient seem to adjust to these troublesome side effects within 3 to 5 days. During that time the dose may have to be adjusted downward or another agent given to help patients tolerate side effects. After initiation, Patient will become less susceptible to side effects.

Question 20

Certain analgesics have been known to have untoward effects on older adults and should be avoided. Name these analgesics.

Answer 20

Meperidine (Demerol), pentazocine (tailwin), Indomethacin (Indocin), And non-Cox selective NSAIDs (Aspirin, Advil, etc.)

Question 21

Name two examples of alternative therapies.

Answer 21

Physical therapies and cognitive behavioral therapies.

Question 22

Example of physical therapies include?

Answer 22

Heat and cold, massage, exercise, acupuncture and acupressure, transcutaneous electrical nerve stimulation, percutaneous electrical nerve stimulation.

Question 23

Name examples of common cognitive behavioral therapies for pain.

Answer 23

Hypnosis, meditation, imagery, progressive relaxation, distraction, music therapy, aromatherapy, therapeutic and healing touch, and education.

Question 24

Persons from culturally diverse backgrounds often use alternative therapies in their pain management regimens. Some of the more common alternatives include?

Answer 24

Meditation, herbal therapies, relaxation, yoga, acupuncture, acupressure, and topical application of heat, cold, or herbal packs.

Question 25

True or false, culture influences how an individual reports pain.

Answer 25

True. Professionals may assume that patients will self-report their pain if they’re not asked about it, however, culture may preclude such behavior. Responses and expression to pain very widely depending on the culture.