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NRSG126 > Lecture Week 4: Comfort & Mobility > Flashcards

Lecture Week 4: Comfort & Mobility Flashcards

1
Q

What is pain? Purpose?

A

Pain: a general term describing uncomfortable sensations in the body
Activation of the nervous system
Subjective
6th vital signs

Purpose of pain: defense

Pain is NOT normal and not normal with aging
Most common reason individuals seek medical care

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2
Q

Pain in older adults?

A

Pain is NOT normal and not normal with aging
Most common reason individuals seek medical care

Older persons experiencing pain:
Experience of pain changes with age
May have atypical presentation
Pain or pain treatments can have increased negative effects
May have misconceptions re: pain management
Response time slows down (increases risks of burns)

37% at home and 41% in institutions live with chronic pain

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3
Q

What are the 4 phases / pathway of pain “nociception”?

A
  1. Transduction
  2. Transmission
  3. Perception
  4. Modulation
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4
Q

What occurs during transduction?

A
  1. Transduction

First phase: injury and response initiation
Refers to how the pain nerve fiber recognizes the signal of tissue or cell damage
Nociceptors are sensory nerve cells that react to noxious stimuli by sending signals to the spinal cord and brain

  • noxious stimuli causes cell damage with the release of sensitizing chemicals
    (prostaglandins, bradykinin, serotonin, substance P, histamine
  • these substances activate nociceptors and lead to the generation of action potential

damaged cells > chemical release > nociceptor activation

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5
Q

What occurs during transmission?

A

Second phase: pain moves from PNS to CNS

Peripheral nerves: types of fibers
A-delta fibers: myelinated, sharp, well localized, and short in duration
C fibers: unmyelinated, dull, aching, diffuse nature, slow onset, and relatively long duration

  • action potential continues from site of injury to spinal cord, spinal cord to brainstem and thalamus, thalamus to cortex for processing
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6
Q

What occurs during perception?

A

Third phase: conscious awareness of pain and interpretation

  • conscious experience of pain

pain interpretation > somatosensory cortex > association cortex

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7
Q

What occurs during modulation?

A

Fourth phase: altered signals and response

  • neurons originating in the brainstem descend to the spinal cord and release substances (e.g. endogenous opioids) that inhibit nociceptive impulses
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8
Q

What is mobility?

A

Mobility:
ROM—passive & active
Passive: nurse assisting in limb movement
Active: moving self
Gait (the way a person moves)
Exercise
Activity tolerance
Affected by baseline fitness, COPD, cardiovascular conditions, pain

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9
Q

What is proprioception?

A

Proprioception: awareness of the body position and its parts. Proprioceptors are in muscles, bones, and joints. The ability to walk without watching our feet. Controlled by our nervous system

Balance: cerebellum and inner ear

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10
Q

What are the functions of the skeletal system? What are the types of bone?

A

Skeletal System: 206 bones

5 functions:
Support (e.g. all of our feet bones)
Protection (e.g. all our ribs & sternum)
Movement (e.g. arms & legs)
Mineral storage (e.g. femur)
Hematopoiesis (e.g. hip bones)

Characterized by shape:
Long (e.g. femur)
Short (e.g. carpels)
Flat (e.g. sternum)
Irregular (e.g. vertebrae)

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11
Q

What are the types of joints?

A

Support: Joints: connections between the bones

Synarthrotic: bone on bone
Cartilaginous: joints with little movement; cartilage found in between bones
Fibrous: a joint where 2 bony surfaces meet with a ligament
Synovial: freely moving joint covered by articular cartilage and connected by ligaments

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12
Q

What are ligaments, tendons, and cartilage?

A

Support: Ligaments, tendons, & cartilage

Ligament: flexible bands of fibrous tissue. They connect bones and cartilage; or bone to bone
Tendons: fibrous bands of tissue that connect bone to muscle
Cartilage: supporting connective tissue, used for shock absorption

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13
Q

What are skeletal muscles? What are the functions?

A

Skeletal Muscles: muscles are made from fibers that contract when stimulated by impulses that travels from one nerve to the muscle across the neuromuscular junction

Functions of muscles:
Moving, stabilizing, posture
Heat, circulation, organ protection

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14
Q

What are the two types of muscle contraction?

A

2 types of contraction:
Isotonic: muscles contraction and change in length (muscle contracts and shortens)
Ex. weight lifting
Isometric: muscles being tightened/tense without moving body parts (muscle contracts but does not shorten)
Ex. yoga

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15
Q

Alignment, Postures, and Balance:

A

Together these reduce risk of injury and facilitate proper function of other organs
Body alignment is relationship from one body part to another (e.g. distal, medial, proximal)
Body balance (equilibrium) happens when your center of gravity is balanced over a stable base

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16
Q

4 common postural tendencies?

A

normal, kyphotic-, sway back (lordotic), flat back

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17
Q

What is chronic pain?

A
  • lasts over 3 months and often not resolved
  • causes-illness or injury- cancer treatment, RA, OA fibromyalgia
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18
Q

What is acute pain?

A
  • sudden and typically resolves
  • cause- illness or injury- trauma, surgery, infection, angina, etc
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19
Q

What is the definition of mild, moderate, severe?

A

Mild: not a problem, can deal with it
Moderate: starting to be a problem
Severe: ouch!

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20
Q

What are factors affecting pain? (Physiological, psychological, social)

A

Physiological:
Age
Sleep
Heredity
Neurological function

Psychological:
Anxiety
Meaning of pain
Spiritual
Cultural

Social:
Attention
Previous experiences
Family & social support

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21
Q

What are the types of pain

A
  1. Nociceptive
    a. Somatic:
    Bones, joints
    Connective tissues
    Muscles
    b. Visceral:
    Organs: heart, liver, pancreas, gut, etc

2.Neuropathic
a. Deafferentation - centrally generated pain: injury to either the peripheral or central nervous system.

b. Sympathetic maintained - centrally generated pain: associated with dysregulation of the autonomic nervous system

c. Peripheral - peripheral nerves

22
Q

What is somatic pain? Medications?

A

Somatic Pain:
Most common
Skin, bone, joint, muscle & connective tissue
Increases with movement
Described well i.e. “throbbing”
Localized

Non opioids and opioids, heat/cold, topical

23
Q

What is visceral pain? Medications?

A

Visceral Pain:
Internal organs
Tends to be diffuse (not localized)
Not as easy to describe: more vague
Can also radiate (ex. Myocardial infarction aka heart attack)

Non opioids and opioids

24
Q

What is neuropathic pain? Medications?

A

Neuropathic Pain:
Injury to the nerve or abnormal processing of stimuli by the peripheral or central nervous system
Illness, injury may be undetermined
May be described as burning, shooting, electrical, or prickling
Not localized
Chronic in nature

Adjuvants and opioids

25
What are nonpharmacological interventions?
Physical modalities: Cold Heart Massage Positioning bedding/bed Acupressure Psychological modalities: visualization/imagery Relaxation strategies Distraction techniques (TV/music) Hypnosis Controlled breathing Meditation/prayer Patient education Exercise programs Complementary, alternative, integrative approaches
26
What are pharmacological interventions?
Pain treatment: pharmacological intervention Non-opioids: mild to moderate pain Tylenol - hepatotoxicity Topical- may benefit older adult, especially with slowed/ decreased GI function NSAID: mild to moderate pain Advil - GI bleed/renal insufficiency Opioids: moderate to severe pain Codeine, morphine, hydromorphone Respiratory depression N/V, constipation, delirium, pruritis Co-analgesics: not initially intended for pain Anticonvulsants, corticosteroids, and other Decreased healing, osteoporosis
27
What are the effects of pain and pain management?
Physiological: nausea, fatigue Psychological: depression, ineffective coping, anxiety, disturbed sleep, guilt, spiritual distress Psychosocial: impaired social interactions, sexual dysfunction Fear: addiction, impact of pain Increased hospital stay, delayed healing, lead to chronic pain
28
What are Addiction, tolerance, dependence?
Addiction: disease with genetic, psychological, and environmental factors Tolerance: exposure decreases effects Dependence: class-specific drug withdrawal syndrome
29
What is osteoporosis?
A chronic disease that is primarily age associated and can be exacerbated by gender (female)other health conditions and medication. Can have a major impact on mobility and safety and increases risks of fracture. Osteoporosis: porous bones = decreased bone mass; chronic disease Primary: age-associated, post-menopausal Secondary: hyperthyroidism (untreated), medications (steroirds)
30
What is arthritis?
A chronic disease that commonly affects the knees and hips requiring surgery. Causes a lot of pain and affects mobility. Often referred to as “wear and tear” of joint Osteoarthritis (most common): progressive breakdown of joint cartilage and underlying bone Commonly affects knee, hip, big toe, hands, spine joints
31
What are pathological fractures?
An injury that occurs from a chronic condition that weakens bones Pathological fracture: break caused by disease Causes: osteoporosis, cancer, osteomyelitis
32
What is rheumatoid arthritis?
An autoimmune disorder that affects joints causing pain and deformity. Often occurs in the hands and can affect independence with ADLs Rheumatoid arthritis: autoimmune and inflammatory, painful swelling in multiple joints Injury to joint lining causes chronic pain, mobility issues, and deformity Joints commonly affected: hands, wrists, knees
33
What are the risk factors of osteoporosis?
- Gender - heavy caffeine use (Ca++) - Ca and/or Vit D deficiency - Low BMI - Certain medications / diseases - too much / little exercise - age - smoking - ETOH
34
What are the risk factors of osteoarthritis?
- Obesity (increased BMI) - trauma - genetics - overuse - gender (F>M) - age - smoking - ETOH
35
What are the risk factors of pathological fractures?
- caused by disease that weakens bone; cancer, osteoporosis, osteomyelitis - 1 in 3 women and 1 in 5 men
36
How is osteoporosis diagnosed? MSKL changes
- assessment - dual energy x-ray (bone density) - lab tests (Ca, CBC, Cr, etc) shortened height, decreased weight, fractures
37
How is osteoarthritis diagnosed? MSKL changes
- assessment - x-ray / MRI - rule out other causes: blood tests, fluid samples, arthroscopy joint pain, aching, morning stiffness lasting <30min (LESS; if MORE than 30min then it is RA), reduced ROM in affected joints and possible swelling
38
How are pathological fractures diagnosed? MSKL changes
- assessment - x-ray pain and a history increasing risk for pathological fracture; may or may not be from obvious injury
39
How is osteoporosis treated?
- exercise / fall prevention - physiotherapy - dietician - vitamin and minerals - medication
40
How is osteoarthritis treated?
- NSAIDS, non-opioids (tylenol), adjuvant (cymbalta) - TENS - exercise +/- weightloss - mobility aids - surgery
41
How are pathological fractures treated?
- surgery - pain control - palliative care
42
Effects of lack of mobility?
Deconditioning: immobile for an extended period of time Immobility leads to decreased functional capacity affecting multiple systems: Respiratory Cardiovascular Integumentary MSKL GI/GU Neuro increased risk of complications
43
What is the role of the nurse
The role of the nurse: - Knowledge of pain and mobility - Knowledge of exemplars discussed - Knowledge of ADPIE NCSBN Clinical judgement model: recognize cues > analyze cues prioritize hypotheses > generate solutions take actions > evaluate outcomes
44
Nursing process assessment: OPQRSTUV / LOTARP
Nursing process: assessment Assessment: to be reviewed and practiced in lab: - OPQRSTUV or LOTARP, MSKL assessment - Patient information: history, risk factors, etc O: onset P: Precipitating/palliating Q: Quality/quantity = type of pain and severity R: Region/radiation = location of pain S: Severity T: Timing = constant or intermittent U: Understanding patient pain and its impact on ADLs V: Values L: Location O: Onset T: Type/timing A: Aggravating, alleviating, and associated symptoms R: Radiation P: precipitating event S: severity
45
Nursing process assessment: what are possible reasons for not reporting pain?
Possible reasons for not reporting pain - Fear - Is it worth reporting - Normal part of aging (misconception) - Fear of addiction - Do not want to bother nurses - Consider the impact of understanding/knowing the pathology of pain - Consider how idiopathic pain may affect the client
46
Nursing process: assessment of pain in behavioural and nonverbal indicators
Behavioural and nonverbal indicators: Facial expressions: grimacing, furrowed brow, holding eyes, tightly shut, purses lips Guarding, holding, rubbing Moaning, crying, few sounds Restless, agitated, irritability, anger Altered sleep patterns Changes to appetite Vitals and diaphoresis (acute pain) Consider cultural differences and beliefs around pain, expression, meaning, goals, and pain treatment. Misconceptions associated with pain and ageing or gender.
47
Nursing process assessment: what to conisder for assessing the older person's ability to mobilize
Nursing process: assessment Activity and exercise Age: think back to the normal changes in older adults; what happens? Environmental issues: time, finances, physical barriers (strength, etc) Disease process (may cause limitations)
48
Nursing process: assessment of mobility
Nursing process: assessment Mobility Congenital abnormalities Bone, joint, and muscle disorders CNS damage and disorders MSKL trauma Other chronic disease
49
Nursing process diagnosis of mobility
Nursing process: diagnosis Focuses on the specific nature of pain and mobility (or lack of) Ex. Anxiety Fatigue Acute pain Chronic pain Ineffective coping Ineffective role performance Disturbed sleep pattern Impaired physical mobility Impaired walking Impaired transfer ability Activity intolerance Risk for pressure ulcer
50
Nursing process planning stage
Nursing process: planning Support pain control and encourage mobility, leads to fewer complications and increased patient benefits SMART format, consider setting, prioritize interventions, client and family educations, consult other HCP
51
Nursing process implementation and evaluation: pain and mobility
Pain - administer / support pain treatment - the client has no manageable

NRSG126 (4 decks)

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