Exam 3 Flashcards
What is comfort?
A release from suffering, free from pain.
It is relative and everyone describes and experiences pain differently
Pain is affects comfort the most.
How many patients 65+ are affected by pain?
3 out of 5
How many patients 65+ suffer day-long bouts of pain?
1 in 4
What are the two types of pain?
Nociceptive pain
Neuropathic pain
What is Nociceptive pain?
Pain that comes from mechanical, thermal, or chemical stimuli
It can be either somatic or visceral
What is somatic pain?
Pain that is in the bone and soft tissue
It is localized/throbbing/ aching
Examples: bones, joints, muscles, connective tissue,
What is visceral pain?
It is associated with injuries or disorders to the interns organs
It can be generalized or referred.
Described as deep, cramping, pressing, aching.
Examples: heart, liver, pancreas, gut
What is neuropathic pain?
The abnormal processing of sensory stimuli from the central or nervous system. It had a sudden onset and is high intensity.
Described as sharp, stabbing, tingling, burning
What are some long term effects of unrelieved pain?
-limited mobility
-pressure ulcers
-pneumonia
-constipation
-poor appetite
-depression/hopelessness
-spiritual distress
What are general observations that show a patient is in pain?
-grimacing
-crying
-moaning
-clutching fists
-limited movement
-withdrawing
-restless
What 3 tools are used to assess pain?
1) numeric rating scale
2) visual analog scale
3) McGill pain questionnaire
What is the Numeric rating scale? And when would you use it?
Rating pain on a scale from 1-10
You would use this scale when a patient is coherent and able to answer questions
What is the visual analog scale? And when would you use it
Using “faces” or “horizontal line”
Uses this when patient is unable to communicate their pain
-Alzheimers
-stroke
-can’t respond
-they don’t understand
What is the McGill pain questionnaire?
Self reporting pain scale that consists of 78 descriptive words that are categorized into 20 groups. There is also a drawing of the body (front and back) the patient will use it to describe and pinpoint pain
Used for people who are cognitively normal or impaired. They must be able to read and hear
How do you create a patient pain management plan?
1) Identify what is causing the pain?
2) set SMART goals?
3) make sure plan is individualized
What is important to remember about medications for pain management?
1) always start slow and go slow
2) always use nonopioids before opioids
3) Adverse effects
4) medication interactions
What are different types of CAM therapy for pain?
-acupuncture
-acupressure
-aromatherapy
-biofeedback
-guided imagery
-massage
-relaxation
-heat/cold
-etc
What is the difference between acupuncture and acupressure?
Both are from Chinese culture to unblock and respite balance through invisible channels of energy “qi”
Acupuncture: putting needles under the skin
Acupressure: use of pressure points
What is Aromatherapy ?
Herbal medicine that uses scents from essential oils from plants to create psychological and emotional responses
note, do not us for someone who is experiencing upset stomach/nausea - such as people going through chemo
What two medications are CONTRAINDICATED in older adults?
propoxyphene
Pentazocine
Why: why are commonly used for pain but can have serious side effects in older adults
It can lead to CNS and cardiac toxicity, delirium, and seizures
What’s website provides evidence-based information that can assist in assist in assuring safe use of CAM therapies?
The national Center of Complementary and Integrative Health
What foods should be avoided that add to pain?
-Animal products/fat
-high-fat dairy
-egg yolk
-corn
-sugar
-junk food
-soy
-peanut oil
What is the most common medicine used for pain (opioid)
Morphine
If you come across a patient who is cry and upset, what is the first thing you should do?
Ask them what is wrong?
How long does pain have to last to be considered persistent?
3 months or longer
What are nursing comforting strategies for pain ?
Listening
Touch
Perceive
Explain
Give undivided attention
Safety statistics
1) women have a higher rate of injuries from falls
2) accidents rank the #6 leading cause of death
3) falls are the leading cause of injury related death
What is macro environment regarding safety?
Elements that are in the “larger world”
Example: weather, pollution, traffic noise, street lights, etc.
What is a micro environment regarding safety?
An individuals immediate surroundings that they closely interact with
Examples: furnishings, wall coverings, lighting, room temp, room sounds)
Out of Maslows hierarchy of needs which is most important regarding safety?
Physiological needs:
Shelter, air, functioning utilities, appliances, pest control
What temp should the room be kept at for older adults?
75 degrees
What is important about lighting to prevent falls
Lighting should be bright
During times of calm and relaxation, what kind of lighting is better?
Several diffused lighting sources are better than a few bright lights
What kind of lighting should be avoided and why?
Fluorescent lights as they can cause eye strain and glare
What is important about floor coverings and safety
Carpets and rugs are tripping hazards/fall risk.
Avoid clothes that lead to static electricity
What is important about furniture regarding safety ?
-appealing
-functional
-comfortable
-proper height and fit
-furniture should not be scattered
What is sensory stimulation regarding safety?
It is when you create an environment that is pleasing to the senses.
Textured walls
Soft blankets
Pictures
Plants/ flowers
Soft music
What is important about noise control and safety?
Sounds effect both emotions and physiologic
Sounds can create difficulty for older adults
Noise can be building design, landscape, paging system, street noise, animals, neighbors, etc.
Risk factors related to falls
History of falls
Female (75 and older)
Impaired vision
Gait disturbance
Postural hypotension
What percentage of adults 65+ experience a fall each year?
35%-40%
What things do older adult do that increase their risk for falls?
-dizziness
-Get up too quickly
-impared judgement
-not using or misusing mobility devises
-medications
-hypotension
-environmental hazards
-caregiver
What things can we promote patients to do to prevent falls?
-have them wear their glasses
-change positions slowly
-wear proper fitting shoes
-uses proper mobility aids
-make sure there is good lighting
What are alternative to restraints for safety?
-room by the nurses station
-one to one supervision
-alarms
-repositioning, soothing communication, touch
-frequent reality orientation
-diversions activities
What is Beers criteria?
It is an evidenced based list of medications that carry high risk for older adults and give criteria for potentially inappropriate medication use
What is biological half life?
The time it takes for half of a drug to be excreted from the body
What is Pharmaco- kinetics
4 stages meds
1) absorption
2) distribution
3) metabolism
4) excretion
What is pharmaco-dynamics ?
This is the biological and therapeutic effect of drugs at the site of action (on the target organ).
What is poly pharmacy ?
Use of multiple medications
What are the most commonly used drugs
Top 3:
-antihypertensives (for high blood pressure)
-analgesics (pain)
-antacids (reflux)
-cardiovascular agents
-sedatives
-tranquilizers
-laxatives
What is absorption
(Pharmacokinetics)
The movement of drug from the site of administration to various tissues of the body.
What route of administration is absorbed the fastest?
Injected medication
What route of administration is the most common?
Orally
What is distribution
(Pharmaco kinetics)
Movement of drug by circulatory system to intended site of action
*it can be difficult to predict due to changes in circulation, membrane permeability, body temp, and tissue structure.
What can decrease drug distribution?
Dehydration and hypoalbuminemia
What is metabolism
(Pharmaco kinetics)
The change that occurs in a drug into a more or less potent form of the drug (more soluble form or inactive form)
*renal system excretes drugs
*liver influenced drug detoxification and excretion
What conditions will decrease a drugs metabolization ?
-dehydration
-hyperthermia
-immobility
-liver disease
What is excretion
(Pharmaco kinetics)
Elimination of drug or metabolizes thru various parts of the body
Liver / kidneys
What are ways to promote drug safety ?
-avoid potentially inappropriate drugs
-review Beers criteria
-identify drugs that are high risk
-review necessity of drugs: why were they ordered? Is this the smallest dose? Any allergies? Any other drugs that may interact?
What can be an issue with suppositories in older adults?
Their decreased body temp may affect the ability to melt the suppository
What factors influence self-administration
-functional/physical limits
-cognitive limits
-educational limits
-sensory limits
-financial limits
-choice
Why is it important to monitor lab values?
-blood tests show what the medication levels are in the blood
-be sure to assess limits for older adults being able to have lab testing
What are analgesics used for?
1) relieve minor / moderate pain
2) administer regularly (to maintain constant blood level)
Analgesics (aspirin vs Tylenol)
Both drugs are: -NSAID (nonsteroidal anti inflammatory drugs
Aspirin:
-processed through kidneys
-can lead to kidney failure
-can cause GI bleeding
-anti inflammatory
Acetaminophen:
-processes through liver
-no anti inflammatory activity
-can cause false results in blood glucose levels
M
What is the maximum amount of acetaminophen that a person can take a day?
4000 mg
What are the signs of toxicity for analgesics ?
Dizziness
Confusion
Vomiting
Fever
Sweating
Hearing loss
Tinnitus
Burning in mouth and throat
Convulsions
Coma
What are the nursing guidelines for analgesics
1) assess pain and symptoms for underlying cause
2) explore all non pharmacological means first
3) observe for infection
What can long term aspirin use lead to?
Bleeding and delayed clotting time. Observe for anemia, bleeding, and altered hemoglobin and prothrombin time
What can a patient with diabetes who takes aspirin with sulfonylureas lead to?
Hypoglycemia
What are antacids?
-used to decreased acid secretion
-used to increase intolerance to fatty and fried foods
Nursing guidelines for anti acids
-determine underlying cause as reflux may not be issue
-always ask patients if they are taking antacids (sometimes they forget to mention them)
-antacids can interfere with other drugs, so try to avoid them
-do not give meds within 2 hours after taking antacid
What is a concern for antacids that are sodium bicarbonate
should not be given to patients in a low sodium diet
Antibiotics
-used for treating infections
Risks for excessive antibiotic use
1) leads to antibiotic resistant bacteria
2) can lead to secondary infections
3) superinfections
Nursing guidelines for antibiotics
-obtain cultures to figure out specific bacteria / virus to focus antibiotic type
-Make sure antibiotics are given completely and on a regular schedule.
(To maintain constant levels)
Antibiotic interactions
-if penicillin and high-protein-bound drugs (aspirin, phenytoin, valproate, etc) then the effects of penicillin will be reduced.
-doxycycline can be decreased by aluminum, calcium, or magnesium -based laxatives, antacids, iron preparations, phenobarbital, and alcohol
-ampicillin and carbenicillin can be decreased by antacids, chloramphenicol, erythromycin, and tetracycline
-probenecid delays the excretion of most antibiotics with the risk that their levels will accumulate in the blood and increase side effects
Anticoagulants
Used to prevent arterial and venous thrombosis (blood clots)
Used for patients with history of blood clots, strokes, coronary disorders, prophylaxis if a patient has had hip surgery and mitral valve replacement