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CNUR 103 > Unit 12: Pain, comfort, & End-of-life care > Flashcards

Unit 12: Pain, comfort, & End-of-life care Flashcards

1
Q

Pain

A
  • Psychosocial and emotional response to trauma or disease
  • Defense mechanism
  • Perception of pain impacts the neural and chemical mediators of pain
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2
Q

Pain as a subjective experience

A
  • What the person says it is
  • Displayed by crying, fatigue, and depression
  • Verbal communication does not mediate pain meds/management
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3
Q

Classification of pain: Time

A
  • Chronic = More than 6 months
    + Parasympathetic nervous system response
    + Often multifactorial
  • Acute = Less than 6 months
    + Usually sudden
    + Resolves within days or weeks
    + Usually nociceptive
    + Sympathetic nervous system response
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4
Q

Classification of pain: Characteristic

A 
- Nociceptive
          \+ Somatic
          \+ Visceral
- Referred
- Neuropathic (Caused by illness, injury, or undetermined reasons)
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5
Q

Pain threshold

A

Minimum pain level of noxious stimulation that reliably evokes pain. It is consistent throughout life.

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6
Q

Pain tolerance

A

Maximum pain a person is willing or able to withstand varies.

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7
Q

Contributors to perception of pain

A
  • Ethnic and cultural values
  • Development stage
  • Environment and support people
  • Past pain experience
  • Meaning of pain
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8
Q

Assessment

A

PQRSTUV

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9
Q

Pain can lead to other Nursing diagnoses

A
  • Ineffective airway clearance
  • Hopelessness
  • Anxiety
  • Ineffective coping
  • Ineffective health maintenance
  • Self-care deficit (be specific)
  • Deficient knowledge of pain control measures
  • Disturbed sleep patterns
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10
Q

Four comfort needs

A
  • Social
  • Environmental
  • Spiritual/psychological
  • Physical
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11
Q

Barriers to effective pain management

A
  • Lack of knowledge about adverse effects of pain
  • Misinformation about use of analgesics
  • Misconceptions about pain
  • No one can really feel another’s pain
  • Religion
  • Lack of communication d/t illness
  • “nothing can be done”
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12
Q

Non-pharmacological interventions

A
  • Physical: Cutaneous stimulation, immobilization, therapeutic exercises, TENs machine.
  • Cognitive-behavioural: Provide comfort, elicit relaxation, repattern thinking, coping with emotions
  • Lifestyle management: Stress management, exercise/nutrition, pacing activities, disability management.
  • Spiritual
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13
Q

Comfort measures include what and what are their effects?

A

Heat:

  • Muscle relaxation
  • Relieve pain
  • Increase circulation
  • Psych relaxation
  • Counter irritant
  • Decrease stiffness and increase ROM

Cold:

  • Relax muscles and decrease contractility
  • Vasoconstriction
  • Decrease blood flow and capillary permeability = decrease edema
  • Slows cellular metabolism
  • Decrease pain by slowing nerve conduction
  • Increase pain threshold

Turning and positioning

Complimentary therapy: Ensure there are no contraindications

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14
Q

Loss

A

Actual or potential situation in which something that is valued is changed, no longer available, or gone.

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15
Q

Situational loss

A

Loss of job, child, functional ability from active illness.

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16
Q

Developmental loss

A

Child leaves home, retirement of career, loss of parent.

17
Q

First theory of grief (Founder, year of founding, and description)

A 
Founder: Kubler-Ross
Year: 1969
Description:
- Stages of death and dying
             \+ Denial and isolation
             \+ Anger
             \+ Depression
             \+ Bargaining
             \+ Acceptance
18
Q

Factors that impact grief response

A
  • Significance of loss
  • Culture
  • Spiritual beliefs
  • Socioeconomic status
  • Support systems
19
Q

What problems does complicated grief cause?

A
  • Unusual sleep disturbances
  • Loss of interest in personal activities
  • Avoid tasks that remind them of deceased
  • Intrusive thought, severe emotion, distress, feeling lonely and empty
20
Q

What palliative care?

A
  • Care designed for people who are dying

- Focused on improving quality of life

21
Q

What does palliative care encompass?

A
  • Pain management and symptom control
  • Knowledge of psychosocial, social, spiritual aspects of dying and grieving
  • Self-knowledge on part of caregivers (personal beliefs about death and loss)
22
Q

Who determines the living will and advanced care directive, and what does it include?

A
  • Determined by family and patient

- ID type of care pt wishes to receive at the end of life.

23
Q

What is a proxy?

A

Person who speaks on patient’s behalf regarding medical wishes.

24
Q

Compassionate terminal care

A

Treatments that alleviate suffering.

25
Q

Someone may receive MAID if…

MAID is covered under what bill?

A
  • Patient is 18
  • Patient has health insurance
  • Grievous irremediable conditions
  • Told alternative options
  • Bill C-14
  • We can say no to aiding in it!!!!
26
Q

Physiological signs of impending death: CVS

A
  • Cyanosis
  • Cold skin periphery to central
  • Decrease BP and pulse
27
Q

Physiological signs of impending death: Respiratory

A
  • Rapid, shallow, irregular breathing, or abnormally slow breathing
  • Cheyne- Stokes resps
  • Noisy breathing
28
Q

Physiological signs of impending death: Sensory

A

Sensory impairment

29
Q

What should you do if there are impending signs of death?

A
  • Contact family
  • Notify doctor, if necessary
  • Contact spiritual advisor
30
Q

Nursing interventions to prepare for peaceful death

A
  • Provide spiritual support
  • Provide post mortem care
  • Help patient die with dignity (wash them, brush their hair, give them privacy):
    + Be authentic
    + Don’t advise or impose own beliefs
    + How does client cope?
    + Maintain loneliness and provide company
    + Be honest and direct
    + Prepare client and family = nm. expectations
    for death and dying.
31
Q

Once dead, nurse must…

A
  • Notify family
  • Respect body
  • Prepare body
    + Wash
    + Prepare for viewing
    + Put in dentures
    + Put in absorbent pad under and clean gown
    on patient.
    **** If unexpected, do not remove anything until coroner reviews COD.
32
Q

When does a death become a coroner’s case?

A
  • Unusual death or unexpected death
33
Q

The coroner determines…

A
  • ID
  • Date/time
  • Where they died?
  • Manner they died?
  • Medical of death
34
Q

Postmortem care for hospital…

A
  • Send body to morgue

- Possibly funeral home

35
Q

Postmortem care for LTC…

A
  • Call funeral home
36
Q

Prepare body for transport

A
  • Attach ID tag to great toe or ankle/wrist
  • Place body in mortem bag
  • Attach ID label and death notice to zipper of bag
  • Label if pt on any precautions, such as clear fluids or
    NPO
  • Transport body to morgue
  • Send chart with body if autopsy is being performed

CNUR 103 (11 decks)

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