Pain Management & Loss, Grieving and Death Flashcards
a sensation where a person experiences discomfort, distress or suffering due to overstimulation of sensory nerves
Pain
the 3 major components of the nervous system
Peripheral nerves (transmission stage)
Spinal cord (transduction stage)
Brain (interpretation stage)
The brain responds to pain by sending messages that moderate the pain in the spinal cord the descending control system.
This system is active through out to inhibit pain by producing endorphins
Descending Control System
Pain may be described in terms of what
location
duration
intensity
etiology
For ex-ample, cardiac pain may be felt in the shoulder or left arm, with or without chest pain
referred pain
often perceived in an area remote from the organ causing the pain
visceral pain
When pain lasts only through the expected recovery period
acute pain
also known as persistent pain, is prolonged, usually recurring or lasting 3 months or longer, and interferes with functioning
chronic pain
may result from the direct effects of the disease and its treatment, or it may be unrelated
cancer pain
mild pain are what numbers from 1-10
1-3
moderate pain are what numbers from 1-10
4-6
severe pain are what numbers from 1-10
7-10
Designating types of pain by etiology can be done under the broad categories of
nociceptive pain and neuropathic pain
experienced when an intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care
Nociceptive pain
originates in the skin, muscles, bone, or connective tissue. The sharp sensation of a paper cut or aching of a sprained ankle are common examples
somatic pain
results from activation of pain receptors in the organs and/or hollow viscera tends to be characterized by cramping, throbbing, pressing, or aching qualities
Visceral pain
associated with damaged or malfunctioning nerves due to illness typically chronic; it is described as burning, “electric-shock,” and/or tingling, dull, and aching
Neuropathic pain
follows damage or sensitization of peripheral nerves
Peripheral neuropathic pain
results from malfunctioning nerves in the central nervous system
Central neuropathic pain
FACTORS AFFECTING PAIN
Ethnic and Cultural Values
Developmental Stage
Environment and Support People
Previous Pain Experience
an actual or potential situation in which something that is valued is changed or no longer available
loss
can be recognized by others
actual loss
experienced by one person but cannot be verified by others
perceived loss
often perceived losses because they are not directly verifiable. For example, a woman who leaves her employment to care for her children at home may perceive a loss of independence and freedom
Psychological losses
experienced before the loss actually occurs. For example, a woman whose husband is dying may experience actual loss in anticipation of his death
anticipatory loss
the total response to the emotional experience related to loss, manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow
grief
the subjective response experienced by the surviving loved ones
Bereavement
the behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom
Mourning
experienced in advance of the event such as the wife who grieves before her ailing husband dies
Anticipatory grief
occurs when a person is unable to acknowledge the loss to other people
Disenfranchised grief
exists when the strategies to cope with the loss are maladaptive and out of proportion or inconsistent with cultural, religious, or age-appropriate norms
pathologic or complicated grief
commonly known as the five stages of grief
The Kübler-Ross model
list the 5 stages of grief
Denial
Anger
Bargaining
Depression
Acceptance
usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of situations and individuals that will be left behind after death
denial
person is very difficult to care for due to misplaced feelings of rage and envy. Any individual that symbolizes life or energy is subject to projected resentment and jealousy
anger
hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle
bargaining
individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect oneself from things of love and affection
depression
individual begins to come to terms with their mortality or that of their loved one
acceptance
Factors Influencing the Loss and Grief Responses
Age
Childhood
Early and Middle Adulthood
Late Adulthood
disorder that occurs after the death of a significant other, in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment
Complicated Grieving/Risk for Complicated Grieving
if the loss has such impact on the individual and family that usual effective roles and interactions are negatively affected
Interrupted Family Processes
if the client has great difficulty placing the loss in appropriate perspective to his or her other life activities
Risk-Prone Health Behavior
related to the loss of relationships with others
Risk for Loneliness
does not understand the concept of death, what ages
infancy-5 years
understands that death is final
believes own death can be avoided, what ages
5-9 years
understands death as the inevitable end of life
begins to understand own morality, what ages
9-12 years
fears a lingering death, may seem to reach “adult” perception of death but be emotionally unable to accept it, what ages
12-18 years
has attitude toward death influenced by religious and cultural beliefs, what ages
18-45
accepts own morality
encounters death of parents and peers
experiences peaks of death anxiety, what ages
45-65 years
fears prolonged illness
sees death as having multiple meanings, what ages
65+ years
Nurses need to ensure that the client is treated with _______
dignity
3 types of awareness
closed awareness
mutual pretense
open awareness
the client is not made aware of impending death. The family may choose this because they do not completely understand why the client is ill or they believe the client will recover. The primary care provider may believe it is best not to communicate a diagnosis or prognosis to the client. Nursing personnel may experience an ethical problem in this situation
Closed Awareness
the client, family, and health care personnel know that the prognosis is terminal but do not talk about it and make an effort not to raise the subject. Sometimes the client refrains from discussing death to protect the family from distress
Mutual Pretense
the client and others know about the impending death and feel comfortable discussing it, even though it is difficult. This awareness provides the client an opportunity to finalize affairs and even participate in planning funeral arrangements
Open Awareness
signs of impending clinical death
loss of muscle tone
slowing of the circulation
changes in respirations
sensory impairment
List the Dying Person’s Bill of Rights
-right to be treated as a living human being until death
-right to maintain a sense of hopefulness
-right to participate express feeling and emotions about the approaching death
-right to participate in decisions concerning care
-right to expect continuing medical and nursing attention
-right not to die alone
-right to be free from pain
-right to have questions answered honestly
-right not to be decieved
-right to have help from and for family in accepting death
-right to die in peace and with dignity
-right to retain individuality and judged for their decisions
-right to be cared for by people who will attempt to understand my needs and will be able to gain some satisfaction in helping them face their death
