Unit 12: Pain, comfort, & End-of-life care Flashcards
Pain
- Psychosocial and emotional response to trauma or disease
- Defense mechanism
- Perception of pain impacts the neural and chemical mediators of pain
Pain as a subjective experience
- What the person says it is
- Displayed by crying, fatigue, and depression
- Verbal communication does not mediate pain meds/management
Classification of pain: Time
- 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
Classification of pain: Characteristic
- Nociceptive
\+ Somatic
\+ Visceral
- Referred
- Neuropathic (Caused by illness, injury, or undetermined reasons)Pain threshold
Minimum pain level of noxious stimulation that reliably evokes pain. It is consistent throughout life.
Pain tolerance
Maximum pain a person is willing or able to withstand varies.
Contributors to perception of pain
- Ethnic and cultural values
- Development stage
- Environment and support people
- Past pain experience
- Meaning of pain
Assessment
PQRSTUV
Pain can lead to other Nursing diagnoses
- Ineffective airway clearance
- Hopelessness
- Anxiety
- Ineffective coping
- Ineffective health maintenance
- Self-care deficit (be specific)
- Deficient knowledge of pain control measures
- Disturbed sleep patterns
Four comfort needs
- Social
- Environmental
- Spiritual/psychological
- Physical
Barriers to effective pain management
- 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”
Non-pharmacological interventions
- 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
Comfort measures include what and what are their effects?
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
Loss
Actual or potential situation in which something that is valued is changed, no longer available, or gone.
Situational loss
Loss of job, child, functional ability from active illness.
Developmental loss
Child leaves home, retirement of career, loss of parent.
First theory of grief (Founder, year of founding, and description)
Founder: Kubler-Ross
Year: 1969
Description:
- Stages of death and dying
\+ Denial and isolation
\+ Anger
\+ Depression
\+ Bargaining
\+ AcceptanceFactors that impact grief response
- Significance of loss
- Culture
- Spiritual beliefs
- Socioeconomic status
- Support systems
What problems does complicated grief cause?
- 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
What palliative care?
- Care designed for people who are dying
- Focused on improving quality of life
What does palliative care encompass?
- 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)
Who determines the living will and advanced care directive, and what does it include?
- Determined by family and patient
- ID type of care pt wishes to receive at the end of life.
What is a proxy?
Person who speaks on patient’s behalf regarding medical wishes.
Compassionate terminal care
Treatments that alleviate suffering.
Someone may receive MAID if…
MAID is covered under what bill?
- Patient is 18
- Patient has health insurance
- Grievous irremediable conditions
- Told alternative options
- Bill C-14
- We can say no to aiding in it!!!!
Physiological signs of impending death: CVS
- Cyanosis
- Cold skin periphery to central
- Decrease BP and pulse
Physiological signs of impending death: Respiratory
- Rapid, shallow, irregular breathing, or abnormally slow breathing
- Cheyne- Stokes resps
- Noisy breathing
Physiological signs of impending death: Sensory
Sensory impairment
What should you do if there are impending signs of death?
- Contact family
- Notify doctor, if necessary
- Contact spiritual advisor
Nursing interventions to prepare for peaceful death
- 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.
Once dead, nurse must…
- 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.
When does a death become a coroner’s case?
- Unusual death or unexpected death
The coroner determines…
- ID
- Date/time
- Where they died?
- Manner they died?
- Medical of death
Postmortem care for hospital…
- Send body to morgue
- Possibly funeral home
Postmortem care for LTC…
- Call funeral home
Prepare body for transport
- 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
