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69:262 Medical Nursing > Lecture 1 > Flashcards

Lecture 1 Flashcards

Chronic Illness, Older Persons, Pain

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1
Q

A government-funded, universal program.
Canadian health care is continually facing restructuring and change.
Challenges remain in the areas of client safety, service delivery, fiscal restraints, age-related demographics, and cost of new technology and drugs.

A

The Canadian Health Care Context

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2
Q

ensures coverage for medically necessary procedures.

A

The Canada Health Act

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3
Q

Costs are shared by

A

the federal and provincial/ territorial governments

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4
Q

Basing health care decisions upon evidence is essential for quality care in all domains of nursing practice.

A

Evidence informed practice

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5
Q
  1. Clinical state, setting, and circumstances
  2. Client preferences and actions
  3. Best research evidence
  4. Health care resources
A

Four primary elements of evidence informed practice

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6
Q

Another method of recording a nursing care plan
A visual diagram of client problems and interventions
Primarily in nursing education
Clinical (critical) pathways

A

Concept map

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7
Q

Health promotion
Prevention and health protection
Health maintenance, restoration, and palliation
Professional relationships
Capacity building
Access and equity
Professional responsibility and accountability

A

Core expectations for CHN practice

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7
Q

Health promotion and teaching
End of life care
Rehabilitation
Support for the caregiver
Support maintenance
Currative intervention

A

Home care encompasses

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7
Q

An array of services for people of all ages
Provided in the home and community setting

A

Home care

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8
Q

The rates of disease in a population

A

Morbidity

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9
Q

The rates of deaths in a population

A

Mortality

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10
Q

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 2011)

A

Health

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11
Q

Multiple social and economic factors, the physical environment, and individual behaviour that interact to influence health

A

Determinants of health

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12
Q

is a condition that a practitioner views from a pathophysiological model.

A

Disease

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13
Q

is the human experience of symptoms and suffering

A

Illness

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14
Q

Refers to how the disease is perceived, lived with, and responded to by individuals and their families

A

Illness

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15
Q

________ and _______ illnesses can affect a person simultaneously.

A

Acute and chronic

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16
Q

presence of two or more chronic illness that are not directly related to each other in a person at the same time.

A

Comorbidity

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17
Q

simultaneous occurrence of several chronic medical conditions in the same person, may or may not be related to each other.

A

Multimorbidity

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18
Q

a complex interaction between health conditions, personal factors, and the environment.

A

Disability

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19
Q
  1. Processing emotions
  2. Adjusting to changes to self and life
  3. Integrating illness into daily life
  4. Determining the meaning of illness to base decisions
A

Four tasks of successful self-management

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20
Q

Young–old adult (_____ years)

A

65–74

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21
Q

Middle–old (______ years)

A

75–84

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22
Q

Old–old adult (older than _____ years)

A

85

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23
Q

Weak compromised health, higher risk/more risk factors

A

Frail older adult

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24
Q

Own home
Adult lifestyle communities or retirement communities
Assisted-living facilities (ALFs)

A

Independent living options

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25
Q

Mental capacity
Power of attorney
Advance directive
are all examples of

A

Legal issues

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26
Q

Adult day care programs
Home health care

A

Community-based care for those with special needs

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27
Q

Need to evaluate client’s ability to make decisions
Resuscitation
Treatment of infections
Issues of nutrition and hydration
Transfer to more intensive treatment units

are all areas of

A

Ethical concern

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28
Q

Comprehensive geriatric assessment
History using a functional health pattern format
Physical assessment
Cognitive assessment
Assessment of ADLs and IADLs
Social–environmental assessment

A

Nursing assessment: older adults

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29
Q

Whatever and whenever the person experiencing ____ says it is
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Multidimensional and entirely subjective

A

Pain

30
Q

can be experienced in the absence of identifiable tissue damage.

A

Pain

31
Q

not synonymous with suffering.
Subjective: client’s experience and self-report is essential.

A

Pain

32
Q

Can be problematic when dealing with clients who are nonverbal or cognitively unable to rate
Nonverbal information such as behaviours aids the assessment of ____

A

Pain

33
Q

Transformation of stimuli into electrochemical energy
Release of pain-medicating chemicals
Nociceptors

A

Transduction

34
Q

Large-diameter, A-delta fibres, and small diameter
C fibres

A

Transmission

35
Q

Subjective phenomenon of pain (pain varies person to person)
“How is it felt?”
Complex behavioural, psychological, and emotional factors

A

Perception

36
Q

Neural activity that controls pain transmission to neurons
Both peripheral and central nervous systems
Descending pain system
Enkephalins and endorphins

A

Modulation

37
Q

The recognition of the sensation as painful
Sensory-pain elements include pattern, area, intensity, and nature (PAIN).

A

Sensory-Discriminative

38
Q

Emotional response to pain experience:
Anger
Fear
Depression
Anxiety

Are examples of ________-Affective factors

A

Motivational-Affective

39
Q

Observable actions used to express or control the pain

A

Behavioural

40
Q

Beliefs, attitudes, memories, and meaning attributed to pain
The meaning of pain to the client is important in individual response to pain.
The meaning of pain and related responses are critical aspects of nursing pain assessment.

A

Cognitive

41
Q

Includes demographics, support systems, social roles, past pain experiences, and cultural aspects

A

Sociocultural

42
Q

Referred
Neuropathic
Phantom
Cancer
Central
Vascular

A

Classifications of pain

43
Q

Equianalgesic dose
Scheduling analgesics
Titration

are all examples of

A

Drug therapy for pain

44
Q

Dose of one analgesic equivalent in pain-relieving effects compared with another analgesic

A

Equianalgesic dose

45
Q

Fast-acting drugs for breakthrough
Long-acting drugs for constant pain

A

Scheduling analgesics

46
Q

Dose adjustment based on assessment of the analgesic effect versus adverse effects
Use the smallest dose to provide effective pain control with fewest adverse effects

A

Titration

47
Q

“Step 1” drugs
Nonopioid analgesics (Aspirin and other salicylates, other nonsteroidal anti-inflammatory drugs [NSAIDs], and acetaminophen [Tylenol])

A

Mild pain

48
Q

“Step 2” drugs
Mu: morphine, oxycodone, hydromorphone, methadone
Opioid agonists (morphine)
Antagonists (naloxone)
Mixed (pentazocine, butorphanol)

A

Mild to moderate pain

49
Q

“Step 3” drugs
Most are mu-receptor agonists
Potent
No analgesic ceiling
Can be delivered via many routes

A

Moderate to severe pain

50
Q

Synthetic drugs that bind to the opiate receptors to relieve pain
Mild agonists: codeine, hydrocodone
Strong agonists: morphine, hydromorphone hydrochloride, oxycodone, meperidine, fentanyl, methadone
Meperidine: not recommended for long-term use because of the accumulation of a neurotoxic metabolite, normeperidine, which can cause seizures.

A

Opioid drugs

51
Q

Drug reaches a maximum analgesic effect.
Analgesia does not improve, even with higher doses.
Codeine phosphate
Pentazocine
Nalbuphine

A

Opioid ceiling effect

52
Q

Three classifications based on their actions:
Agonists
Agonists–antagonists
Antagonists (nonanalgesic)

A

Opioid analgesics: mechanism of action

53
Q

Ability to provide equivalent pain relief by calculating dosages of different drugs or routes of administration that provide comparable analgesia
Examples: morphine, hydromorphone, oxycodone, hydrocodone bitartrate, fentanyl
Continuous release vs. immediate release formulations

A

Equianalgesia

54
Q

Mainly used to alleviate moderate to severe pain
Often first line agents analgesic in immediate post operative setting
Often given with adjuvant analgesic drugs to assist primary drugs with pain relief
Balanced anaesthesia
Opioids are also used for:
Cough centre suppression
Treatment of diarrhea

A

Opioid analgesic: Indications

55
Q

Known drug allergy
Severe asthma
Use with extreme caution in patients with the following:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy

A

Opioid analgesic: contraindications

56
Q

Central nervous system (CNS) depression
Leads to respiratory depression
Most serious adverse effect
Nausea, vomiting, constipation, biliary tract spasm
Urinary retention
Hypotension, palpitations, flushing
Itching, rash, wheal formation
Pinpoint pupils indicating a possible overdose

A

Opioid analgesics: adverse effects

57
Q

A common physiological result of chronic opioid treatment
State of adaptation
Result: larger dose is required to maintain the same level of analgesia

A

Tolerance

58
Q

Physiological adaptation of the body to the presence of an opioid
Opioid tolerance and _________ are expected with long-term opioid treatment and should not be confused with psychological dependence (addiction).

A

Physical dependence

59
Q

a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief

A

Addiction

60
Q

______ interactions:
Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Promethazine
Monoamine oxidase inhibitors
Others

A

Opioid interactions

61
Q

Natural opiate alkaloid (Schedule I) obtained from opium
Less effective
Ceiling effect
More commonly used as an antitussive drug
Gastrointestinal (GI) disturbance

A

Codeine sulphate

62
Q

Synthetic opioid (Schedule I) used to treat moderate to severe pain
Parenteral injections, transdermal patches (Duragesic Mat®), sublingual effervescent tablet (Fentora®)

A

Fentanyl

63
Q

Hydromorphone (________®): very potent opioid analgesic; Schedule I drug
1 mg of intravenous (IV) or intramuscular (IM) hydromorphone is equivalent to 7 mg of morphine.

A

Dilaudid

64
Q

Synthetic opioid analgesic (Schedule I)
Opioid of choice for detoxification treatment of opioid addicts in maintenance programs
Renewed interest in the use of methadone for chronic (e.g., neuropathic) and cancer-related pain
Prolonged half-life of the drug: cause of unintentional overdoses and deaths
Cardiac dysrhythmias

A

Methadone Hydrochloride

65
Q

Naturally occurring alkaloid derived from the opium poppy
Drug prototype for all opioid drugs; Schedule I controlled substance
Indication: severe pain
Oral, injectable, and rectal dosage forms; also extended-release forms

A

Morphine sulphate

66
Q

Pure opioid antagonist
Drug of choice for the complete or partial reversal of opioid-induced respiratory depression
Indicated in cases of suspected acute opioid overdose
Failure of the drug to significantly reverse the effects of the presumed opioid overdose indicates that the condition may not be related to opioid overdose.

A

Naloxone Hydrochloride

67
Q

Used in conjunction with opioids and nonopioids
Sometimes called coanalgesics
Enhance pain therapy through one of three mechanisms:
Enhancing the effects of opioids and nonopioids
Possessing analgesic properties of their own
Counteracting adverse effects of other analgesics

A

Adjuvant Analgesic Therapy

68
Q

Analgesic and antipyretic effects
Little to no anti-inflammatory effects
Available over the counter (OTC) and in combination products with opioids

A

Acetaminophen

69
Q

______: mechanisms of action

Similar to that of salicylates
Blocks pain impulses peripherally by inhibiting prostaglandin synthesis

A

Acetaminophen

70
Q

Maximum daily dose for healthy adults is 4 g/day, but Health Canada is considering lowering*
2 000 mg for older adults and those with liver disease
Inadvertent excessive doses may occur when different combination drug products are taken together.
Be aware of the ________ content of all medications taken by the patient (OTC and prescription).

*Note: As of the date of writing of this text, Health Canada had not yet made this decision.

A

Acetaminophen: Dosage

71
Q

Should not be taken in the presence of following:
Drug allergy
Liver dysfunction
Possible liver failure
G6PD deficiency
Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic.

A

Acetaminophen: Contraindications & Interactions

72
Q

Related to the marigold family
Anti-inflammatory properties
Used to treat migraine headaches, menstrual cramps, inflammation, and fever
May cause GI distress, altered taste, muscle stiffness, joint pain
May interact with aspirin and other NSAIDs, as well as anticoagulants

A

Feverfew

73
Q

Tolerance
Dependence
Addiction

A

Barriers to effective pain management

74
Q

Fear of hastening death by administering analgesics
Use of placebos in pain assessment and treatment

A

Ethical issues in pain management

69:262 Medical Nursing (10 decks)

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