Week 13: Pain & Sensory Alterations, Oxygenation, Elder Abuse, Healthcare Economics Flashcards
what is healthcare economics
behavioral science that addresses how to allocate limited resources
biggest source of hospital expense is what?
personnel (59%) (paying staff etc)
new grads cost ___ to train while experienced nurses cost ___
50k, 10k
what is a DRG?
diagnosis resource group. linked to fixed payment amount based on the type of treatment given
what is the most expensive hospital unit to run?
ICU
what is the most common and expensive service of healthcare deliver system?
disease management
what is the cheapest area of healthcare services?
restorative care (rehab, nursing homes, home health)
what is continuing care?
hospice, nursing homes.
patients w disease process that won’t get better, and are functional dependent or disabled.
what are the mechanisms of oxygenation?
ventilation, perfusion, and transport of respiratory gasses
when you oxygenate, ___ goes in and ___ goes out
O2, CO2
what is ventilation
process of moving gasses into and out of lungs
what is perfusion
ability of cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood back to the lungs
what is diffusion
exchange of respiratory gasses in alveoli and capillaries
what is included in the work of breathing
inspiration, expiration, surfactant, atelectasis, accessory muscle use, lung compliance, airway resistance
what is surfactant
substance to maintain alveoli surface tension and stop collapse
what is atelectasis
when alveoli collapse.
what is lung compliance
ability of lungs to expand
what is airway resistance
the diameter of airway decreasing from mouth to alveoli
what is tidal lung volume
amount of air you can inhale
what is residual volume
amount of air left after full expiration
what is forced vital capacity
max amount of air that can be removed during forced expiration
what can influence ability of blood to carry oxygen
amount of dissolved oxygen in plasma, amount of hemoglobin, binding ability of hemoglobin
how much CO2 is transported in blood and plasma?
75% and then 25%
how is respiration regulated?
neurally and chemically
neural regulation includes
CNS and cerebral cortex regulation
chemical respiration regulation includes
chemoreceptors sensing chemical changes in blood.
factors affecting oxygenation
decreased oxygen carrying capacity (anemia, toxic inhalation) , hypovolemia, decreased oxygen concentration, increased metabolic rate
conditions affecting chest wall movement
pregnancy (less real estate due to fetus), obesity (sleep apnea, increased breathing work, less lung volume), musculoskeletal changes (trauma, neuromuscular disease, CNS alteration)
Chronic disease can ___ oxygenation
decrease (lung disease, barrel chest or overinflation, hypoxemia)
what is cyanosis?
elite hypoxia (end stage)
what is invasive ventilation?
artificial airway (tube down nose or throat) or surgical intervention such as tracheostomy and then put them on a ventilator.
what is noninvasive ventilation
purpose to maintain positive airway pressure usually through a mask (CPAP or BiPAP)
what is a chest tube?
tube put in used to drain something (usually a drainage system)
what are chest tubes used for?
pneumothorax (air buildup causing collapse) or hemothorax (buildup of blood causing collapse
special considerations for chest tube
they are a closed system, constant bubbling indicates leak in system
what category makes up the majority of elder abuse victims?
females. around 6 in 10 clients that are mistreated are female.
what does the law in Arizona state regarding abuse
illegal to abuse, neglect, or exploit a vulnerable adult.
if you suspect or are informed of abuse you must ____
report it, or face up to 1000 in fines and 6 days in jail
why does abuse grow?
police and prosecutors do not place priority. abusers often know the victim, elderly victims often make poor witness
what is physical abuse?
any infliction of physical pain/injury or physical restraint that causes these
what other things can cause physical abuse?
over/under medication and unexpected deterioration.
what is sexual abuse?
non consensual sexual contact of any kind with an elderly person or any person incapable of giving consent.
what is psychological or emotional abuse?
infliction of mental pain, anguish, or distress through verbal or non verbal acts
what is financial/material abuse
illegal or improper use of funds, property, or assets.
what is neglect? (passive and active and self)
failure or refusal to fulfill any part of a persons obligations or duties to an elderly person
(active= intentional failure or refusal) (passive= unintentional failure or refusal to care) (self= elder's behaviors result in threat to their own health)
what is abandonment
desertion of elderly person by an individual who has physical custody of elder or who has assumed responsibility for their care
what is nociception
noxious stimuli perceived as pain
what is neuropathic pain
pain that is initiated or caused by a primary lesion or dysfunction in nervous system
what is acute pain
pain lasting less than 3-6 months and directly related to tissue damage
what is chronic pain
pain lasting at least 12 weeks. can be sharp or dull, occur in nearly any part of body
what is chronic episodic pain
pain coming on quickly and severely at irregular intervals
what is cancer pain
results from treatment of cancer or the cancer itself
what is somatic pain
pain receptors in tissues are activated
what is visceral pain
pain stemming from organs
what is referred pain
pain that is felt in a different area from its actual source
what is neuropathic pain
damage or disease to the somatosensory nervous system that then causes pain
what is idiopathic pain
pain of unknown origin
when is the FLACC scale used?
for non verbal patients (babies, those that are unconscious or unresponsive)
what is PQRSTU pain assessment
provokes (what causes or makes worse)
Quality (what does it feel like, sharp, dull, stabbing)
Radiates (does it radiate or go anywhere else)
Severity (0-10 scale or faces scale)
Time (when did it start, how long did it last)
understanding (how does the pain effect you)
what are some physiologic indicators of pain?
increased HR, change in respiratory pattern or rate, increase in BP, decrease in SpO2
what are some “weird” pharmacologic drugs used for pain? (specifically in neuropathic pain)
antidepressants and anticonvulsants
what is pseudo addiction?
patient is so desperate because pain is not being relieved that they exhibit addictive signs
what is visually impaired
20/50 or worse
what is legally blind
20/200 or worse
what is totally blind
no light perception
what does cataracts look like
halos and glare in the vision
what does presbyopia look like
close objects appear blurry
what does macular degeneration look like
dark spots in the central vision
what does glaucoma look like
loss of periphery, tunnel vision
what does diabetic retinopathy look like
number of dark patches/splotches in the vision
what does hypertensive retinopathy look like
number of dark patches/splotches in the vision
what is conductive vs sensorineural hearing loss
problem in transferring soundwaves in the ear outer and middle vs. damage to inner ear/nerves
what is presbycusis
gradual loss of hearing
what is central auditory processing disorder
disorder affecting disability to understand speech
what is Menieres disease
effects membranous labyrinth of the inner ear, causing progressive deafness and attacks of tinnitus and vertigo
what is expressive (motor/brocas) aphasia
difficulty talking
what is receptive (sensory/wernickes) aphasia
difficulty undestanding and putting coherent/fluent sentences together
