Pain, Health Promo, Nutrition Flashcards
Nociception
How noxious stimuli are typically perceived as pain
Phases of Nociception (4)
1) Transduction
2) Transmission
3) Perception of Pain
4) Modulation
Transduction
noxious stimuli
chemicals released that propagate pain message
action potential moves up afferent nerves to dorsal spinal cord
Transmission
pain impulse moves from spinal cord to brain
Pain Perception
in da brain
pain perception not just impacted by synapse
e.g. antidepressant will affect how pain is perceived
Modulation
neurons from brain stem release neurotransmitters to block pain impulse
Main Types of Pain (2)
1) Nociceptive
2) Neuropathic
Nociceptive Pain Description and Subtypes (2)
caused by tissue injury; well localized
described as “aching” or “throbbing”
1) Somatic
2) Visceral
Somatic Pain
Superficial from skin and subcutaneous tissue
(cutaneous pain)
Deep from joints, tendons, muscles, or bone
Visceral Pain
from direct injury or stretching of large interior
organs
result of tumor, ischemia, distension, or contraction
constant OR intermittent
may be poorly localized/referred from another part of the body
Neuropathic Pain
“Caused by lesion or disease affecting somatosensory nervous system”
results from damage to nerve pathway
e.g. nerve cut during surgery, stroke, chemo, HIV, diabetes, herpes zoster
caused by direct nerve trauma, infections, metabolic problems; may be drug induced
“burning” or “shooting”
manifestations vary among patients
referred pain
You step on a lego. What type of pain is this?
a) nociceptive, visceral
b) nociceptive, somatic
c) neuropathic
b) nociceptive, somatic
Which type of pain would cholecystitis (gallbladder disease) cause?
a) somatic
b) visceral
c) cutaneous
d) persistent
b) visceral
Types of Pain by Duration (2)
1) Acute
2) Chronic/Persistent
Acute Pain
short-term
self-limiting
follows a predictable trajectory
dissipates after injury heals
Chronic Pain
continues for 6 months or longer
malignant (cancer-related) OR nonmalignant
does not stop even after tissue has healed
T or F: Pain is a normal part of the aging process.
FALSE
PQRSTU Pain Assessment
P - provocative or palliative
Q - quality of pain, words to describe
R - region of body, radiating
S - severity, 0 to 10
T - timing and onset
U - understanding of pain
Pain Assessments Tools (3)
1) Brief Pain Inventory
2) Short-Form McGill Pain Questionnaire
3) Pain Rating Scales
Brief Pain Inventory
pain in previous 24 hours
graduated scale (0–10)
how much relief
how it interferes with activities
Short-Form McGill Pain Questionnaire
patient ranks a list of descriptors in terms of their intensity
rates the overall intensity of the pain
mental health - e.g. fear
Pain Rating Scales
Visual Analogue or Numeric Rating Scale
-0 to 10
Faces Pain Scale
-patients 4 to 5 years of age
Descriptor Scale
-no pain, mild pain, moderate pain, and severe pain
-older adults
Nonverbal/Behavioural Pain Assessment
Acute pain behaviours
-use scale, have them point
Persistent (chronic) pain behaviours
-ask patient how they behave when in pain
Unconscious patient
-grimacing, wincing, moaning, rigidity, arching, restlessness, shaking
-Critical-Care Pain Observation Tool
Facial Expressions
Vitals - HR, resp, BP
Developmental considerations for pain in neonates
behavioural and physiological cues
more than one assessment approach needed
include contextual factors (gestational age or
sleep/wake state behaviours - e.g. sleeping too much, can’t settle)
Neonatal Pain, Agitation, and Sedation Scale
Premature Infant Pain Profile – developed at University of Toronto and McGill University
Developmental considerations for pain with intellectual/cognitive disability
sensory ability to perceive pain not diminished
Scales: PAINAD scale, PACSLAC-II
discussion with family or other health care team members to identify patterns
comprehensive health assessment needed to confirm or rule out sources of pain
Which anticipated persistent pain finding should guide a nurse’s care planning?
a) Patients with persistent pain having trouble sleeping
b) Patients with persistent pain showing elevated BP
c) Patients with persistent pain needing less medication
d) Patients with persistent pain showing few or no outward signs of pain
all
A crying patient says, “Please, get me something to relieve this pain.” What should the nurse do next?
a) Verify that the patient has an order for pain medication and administer the order, as directed.
b) Assess the level of pain and ask the patient what usually works for his or her pain; administer pain medication as needed, and then reassess pain level.
c) Assess the level of pain, give medication according to the pain level, and then reassess the pain.
d) Reposition the patient and then reassess the pain after intervention.
b)
The nurse is reassessing a patient’s pain level after pain medication administration, following a pain level of 9/10. The patient states that his pain level is now a 3/10. What should the nurse do next?
a) Verify orders for medication and offer more pain medication, if appropriate.
b) Continue to assess patient’s pain level.
c) Document the patient’s pain level in the chart.
d) There is no need for further action because the patient’s pain is manageable.
b)
Nutritional Status
degree of balance between nutrient intake and nutrient requirements
Optimal Nutritional Status
consumption of nutrients in amounts that support daily growth and any increased metabolic demands
Undernutrition
depletion of nutritional reserves or inadequate intake to meet daily requirements
Overnutrition
consumption of nutrients in excess of requirements
Developmental considerations for nutrition in infants and children
birth to 4 months –> most rapid period of growth in life cycle*
Recommendations
-exclusive breastfeeding for first 6 months
-daily vitamin D supplements until diet includes at least 10 mcg (400 IU) per day from dietary sources
-introduction of solid food (iron-fortified cereal) ~6 months
-avoid whole cow’s milk until 9 to 12 months of age
Developmental considerations for nutrition in adolescents
rapid physical growth and endocrine and hormonal changes
increased energy demands
increased calcium and iron requirements related to bone, muscle mass increase, and menarche
impact of societal importance placed on physical appearance
preoccupation with body image and disordered eating
influence of gender
Developmental considerations for nutrition during pregnancy and breastfeeding
HC recommendations for gestational weight gain for singleton pregnancies
increased nutritional risk in pregnancy
-teens) multiple pregnancies, short intervals between pregnancies, tobacco/alcohol/drugs, restrictive diets, inadequate or excessive weight gain
folic acid
Developmental considerations for nutrition in adulthood
influence of lifestyle factors
importance of nutritional counselling to prevent weight gain and obesity
Developmental considerations for nutrition in older adults
risk for undernutrition and overnutrition
energy requirements DECREASE by 5% per decade
impact of poor dentition, visual acuity, slowed GI, and diminished taste/smell
SES
polypharmaceutical challenges
Vitamin D supplementation
What is a key determinant of nutritional health?
food security
BMI Interpretation: <18.5
underweight
BMI Interpretation: 18.5–24.9
normal weight
BMI Interpretation: 25.0–29.9
overweight
BMI Interpretation: 30.0–34.9
Obesity (Class 1)
BMI Interpretation: 35–39.9
Obesity (Class 2)
BMI Interpretation: ≥40
Extreme obesity (Class 3)
Which of the following body measurements would indicate higher risk for coronary artery disease?
a) Weight 72 kg, height 175 cm
b) BMI 23
c) Gynoid obesity (waist–hip ratio) (pear)
d) Android obesity (waist–hip ratio) (apple)
d) Android obesity (waist–hip ratio) (apple)
Which of the following patients is at highest risk for nutritional deficits?
a) 5-month-old infant who is only being breastfed
b) 2-year-old toddler who is in the 50th percentile
c) 13-year-old female who is 1.6 m tall, weighs 50 kg, and thinks she is “fat”
d) 65-year-old female with Parkinson’s disease
d) 65-year-old female with Parkinson’s disease
metabolic demands of having a chronic disease
Health Promotion Concepts
changing conceptualization of meaning of health
changing patterns of disease and mortality
shift from infectious diseases to chronic conditions
WHO declaration: health is “not merely the absence of disease”
foundational concepts of disease prevention and health promotion in Canada
Primary Prevention
people and populations are prevented from becoming ill, sick, or injured
e.g. sanitation and immunization
Secondary Prevention
early detection of disease before symptoms emerge
e.g., Pap test, mammography, lipid profiles
Tertiary Prevention
prevention of complications when disease is present
e.g., teaching to avoid complications of diabetes
SDOH (12)
Income & Social Status
Employment/Working Conditions
Education & Literacy
Childhood Experiences
Physical Environments
Social Supports and Coping Skills
Healthy Behaviours
Access to Health Services
Biology and Genetic Endowment
Gender
Culture
Race/Racism
