Geriatrics: Pain, Perioperative Complications Flashcards
What does immobility exacerbates?
Pain
*under diagnosed and undertreated
*fifth vital sign
What are acute and chronic types of pain?
Acute:
1. Sudden onset
2. Decreases or ceases as healing occurs
Goal: pain goes away with treatment
Chronic:
1. Insidious onset
2. Lasts more than 3-6 months
Goal: Maintain function and quality of life
What is nociceptive pain?
- Somatic pain
*skin, bone, joint, connective tissue - Visceral pain
*Arises from internal organs
What is neuropathic pain?
Burning
Tingling
Shock-like
What are pain scale ratings?
Numeric rating scale
Verbal descriptor scale
Faces pain scale-revised
What are some physical therapies for pain?
- Heat or cold therapy
- Positioning
- Massage
- Acupuncture
What are some psychological therapies?
- Distraction
- Music
- Relaxation
If an elderly patient has mild pain how do you treat it?
With non-opioids
1. Acetaminophen
2. NSAIDs
3. Cox-2 inhibitors
4. Non-systemic therapies
What are some side effects of NSAIDs
- GI side effects
- HTN
- CHF
- Renal failure
If an elderly person has moderate pain how to treat it?
Mild opioids
1. Codeine
2. Hydrocodone
3. Oxycodone
4. Tramadol
*DO use if you have a history of seizures
*2 and 3 have Tylenol no extra Tylenol
What to use for severe pain?
Strong opioids
1. Morphine
2. Oxycodone
3. Hydro morphine
4. Fentanyl
5. Oxymorphone
What are drugs to avoid in elderly?
Meperidine
*Demerol
What are the safest drugs to use with renal failure?
Fentanyl
Methadone
What are drugs to avoid with renal failure?
Merperidine
Codeine
morphine
What are common opioid side effects?
- Constipation
- Dry mouth
- Nausea/vomiting
- Sedation
What opioid side effect can cause overdose?
Respiratory depression
How to aid constipation?
Usually never resolves
*use stool softeners plus stimulants
*avoid bulking agents (Metamucil)
How to treat nausea/vomiting?
- Metoclopramide
- Serotonergic blocking agents (Odansetron)
- Dopamminergic blocking agents (haloperidol, metoclopramide)
What is the ASA score?
Subjective assessment of a patients overall health
What is ASA I, ASA II, ASA III
ASA I: A normal healthy patient
ASA II: A patient with mild systemic disease
ASA III: A patient with severe systemic disease
What is ASA IV, ASA V, ASA VI
IV: A patient with severe systemic disease that is a constant threat to life
V: A moribund patient who is not expected to survive without operation
VI: A patient who is already declared brain-dead
When does neurological function return after a stroke?
First month
What is acute phase of stroke rehbilitation?
- Change patient postilion every 2 hours
- Positioning to prevent contractures
- Positioning to prevent pneumonia
What is later phase of stroke rehabilitation
- ADL training
- Ambulation training
3, Muscle re-education
What does occupational therapy focus on?
Functional abilities
*helps patients improve or adapt to their abilities to reform basic IADLs
What does speech therapy help with?
Diagnoses and treats cognitive-communication and swallowing deficits
What are pressure ulcers?
Damage caused to the skin and underlying soft tissue by unrelieved pressure
*compressed between bony prominence and external surface
How to treat stages I and II pressure ulcers?
- Clean w/ warm saline or water
- Avoid pressure and moisture
- Cover open wounds with occlusive dressing
How to treat stage III pressure ulcers?
- Debrief necrotic tissue
- Cleanse and dress
- Topical ATB
- Systemic ATB is cellulitis or sepsis
How to treat stage IV pressure ulcer?
- Tissue biopsy for culture
- Systemic ATB
- May need surgical repair
How to document pressure ulcers?
- Type, duration, setting
- Size
- color
- Exudate
- Odor
- Peri-wound tissues
