WEEK 9 Flashcards
as well as flashcards from the two slide shows from week 8
1
Q
pain
A
Subjective and can be caused by stimuli that are actual or anticipated; official IASP definition: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
2
Q
Merkel’s definition of pain
A
not only subjective, but also linked to both the physical and emotional–psychological experiences of individuals.
3
Q
pain threshold
A
the point at which a stimulus causes the client perceive pain
4
Q
pain tolerance
A
how much of a stimulus the client is willing to accept
5
Q
biopsychosocial model categories of pain
A
biological- diesase severity, nociception, inflammation, brain function
psychological- mood/affect, catastrophizing, stress, coping
social-cultural factors, social environment, economic factors, social support
6
Q
Descriptive characteristics of pain
A
Aching
Throbbing
Stabbing
Pounding
Sharp
Gripping
Dull
Tearing
Radiating
Cutting
Burning
Scalding
7
Q
types of pain
A
duration (acute versus chronic)
by origin (nociceptive versus neuropathic)
by the disease or condition that causes it (e.g., cancer)
8
Q
acute pain vs chronic pain
A
acute- has a sudden or slow onset of any intensity and an anticipated or predictable end. By definition, acute pain is pain that lasts less than six months. Examples include pain that results from tissue damage caused by trauma or injury, incisional pain from surgery, and pain from environmental factors such as heat or cold
chronic pain- has a sudden or slow onset of any intensity and is constant or recurring without an anticipated or predictable end. By definition, chronic pain usually has a duration of lasting longer than six months. Examples of chronic pain include arthritis, back pain, and headaches. Chronic pain can be both physically and emotionally debilitating. If acute pain is not addressed, it can become chronic.
9
Q
nociceptive pain
A
Pain that is felt in the tissue, an organ, a damaged part of the body, or a referred pain.
nociceptors- Found in multiple parts of the body (skin, joints, muscles, viscera) and activated by many different chemical substances, extreme temperature and pressure changes, and tissue damage
10
Q
types of nociceptive pain
A
somatic (with pain occurring in the skin, bones, joints, muscles, or connective tissues)
visceral (with pain occurring in the internal organs and referring to other locations of the body,
cutaneous (with pain occurring in the skin or subcutaneous tissue).
11
Q
neuropathic pain
A
Nerve pain that arises from the somatosensory system, described as intense, burning, and shooting.
nclude diabetic neuropathy, phantom limb pain, and pain associated with a spinal cord injury. Neuropathic pain is frequently described as intense, shooting, or burning. Some clients may describe the pain as numbness, “pins and needles,” and even an intense itching.
12
Q
pins and needles pain
A
neuropathic pain
13
Q
examples of neuropathic pain
A
trigeminal neuralgia
sciatic pain
below-the-knee amputation
14
Q
examples of nociceptive pain
A
back pain
broken rib
15
Q
three categories of pain
A
acute, chronic, and cancer pain
16
Q
cancer pain
A
A newly recognized category of pain that can involve tumor pain, bone pain, and treatment-associated pains such as chronic post-surgical pain.
include tumor pain, bone pain, and treatment-associated pain such as chronic postsurgical pain, radiation-induced pain, and neuropathies related to chemotherapy. Each type of cancer pain requires special considerations and treatments.
17
Q
subjective indicators of pain vs objective indicators of pain
A
Subjective indicators of pain: pain scale score, along with quantity and quality of pain
Objective indicators of pain: grimacing, guarding, crying
18
Q
PQRST Mnemonic
A
nurses use to determine client’s pain
Precipitating cause
Quality
Region
Severity
Timing
19
Q
questions of statements with PQRST
A
P: “What were you doing when the pain started?”
Q: “Describe what your pain feels like.”
R: “Show me the location where you are experiencing pain.”
S: “On a scale of 1 to 10, how would you rate your pain?” (Use one of the pain scales discussed in the next section.)
T: “When did your pain first begin? Have you experienced this pain before?”
20
Q
A nurse is discussing the challenges of assessing pain in children with a group of parents. Which of the following statements should the nurse include?
A
Children may deny pain to avoid IM injection or bad tasting oral medicine.
21
Q
Nonpharmacological Pain Interventions: Positioning
A
reposition every 2 hours
pad bony prominences (coccyx, sacrum, heels, and scapula)
22
Q
Nonpharmacological Pain Interventions: Cutaneous Stimulation
A
Therapy applied to the skin such as heat and cold, touch, massage, acupuncture, acupressure, or TENS.
cold therapies: no more than 15-30 mins at a time and up to 2-3 times per day
23
Q
Nonpharmacological Pain Interventions: Cognitive Strategies
A
Therapy to help clients learn to manage and target negative thoughts to help reduce pain, especially chronic pain.
distraction to reduce pain in recieving IM injections in little kids, music for intraoperatively and postoperatively in decreasing postoperative pain
24
Q
Nonpharmacological Pain Interventions: Therapeutic Touch
A
modality in which the nurse utilizes the hands either on or near the body of the client to balance the client’s energy and thereby promote healing
cancer or fibromyalgia
25
Pharmacological Interventions: Opioids
The most common pain medications, which have the risk of sedation and depression, e.g.. morphine, hydromorphone, fentanyl.
hese agents suppress pain by activating opioid receptors in the brain, spinal cord, and central nervous system. Because opioids can lead to addiction if misused, careful titration and monitoring are required.
26
how to administer opioid medications
PO, IV, IM, PR, TOP
27
Pharmacological Interventions: Pain controlled analgesia (PCA)
A computerized pump controlled by the client capable of delivering pain medication through a syringe to their IV line.
28
Naloxone
given IV to quickly reverse adverse effects of opioids
29
Pharmacological Interventions: Nonopioids
Can be administered for the treatment of pain by the nurse and include local anesthetics, nonsteroidal anti-inflammatory medications (NSAIDs), and acetaminophen.
30
how do NSAIDS work
a complex process of inhibiting prostaglandin synthesis by blocking two cyclooxygenase enzymes (COX 1 and COX 2). Prostaglandins play a major role in the inflammatory process.
reduce inflammation and fever
31
Pharmacological Interventions: Adjuvant Analgesics
Aid in pain relief by working on underlying pain generators, such as antidepressants, corticosteroids, and botulinum toxin.
corticosteriods, antidepressents, and botulinum toxin
32
Adjuvant analgesics: Corticosteriods
that are used as adjuvants for the relief of pain include hydrocortisone, cortisone, and prednisone.
Although these medications can be helpful in reducing the inflammation associated with pain, corticosteroids can have many adverse effects, such as increased blood glucose levels, suppression of immunity, weight gain, mood swings, fluid retention, and elevated blood pressure.
33
adjuvant analgesics: antidepressants
can also be used as adjuvants and often work well for nerve-related pain, migraines, and arthriti
Antidepressants can cause sedation, cardiac problems, and dry mouth, and should be used cautiously. Nurses should educate clients that consistent use, as prescribed, may produce positive results in time.
34
examples of opioids
morphine
fentanyl
codeinee
35
examples of nonopioids
acetaminophen
36
examples of adjuvant
carbamazepine
gabapentin
37
SBIRT
mnemoic method to screen clients for opiod addiction
Screening
Brief
Intervention
Referral to
Treatment
38
hospice care
Care services for clients and families that focus on comfort and support; not curative when it is determined the client has less than six months to live.
39
center of medicare and medicaid services for eligible hospice services
(1) a hospice provider and the primary care provider must officially state the client is terminally ill, (2) the client must agree to palliative care as opposed to curing their illness, and (3) the client is required to sign a statement that they are choosing hospice care in place of other benefits to treat their illness.
40
respite care
A service or agency that provides primary caregivers with a short-term break from the responsibilities of client care.
41
palliative care
A multidisciplinary care approach that is focused on the management of symptoms for chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client.
42
examples of when palliative care would be appropriate
advanced stages of cancer, refractory cardiac disease (heart failure), renal or respiratory failure, and neurodegenerative conditions such as Alzheimer’s disease and Parkinson’s disease.
43
physiological changes as death approaches
dyspnea
death rattle (retention of secretions in the respiratory tract)
Cheyne-stokes respirations
44
first choice is treating dysnpea (which is most related to what)
opioids are most likely first choice to treat
dyspnea is most related to advanced-stage cancer, ascites, chronic obstructive respiratory disease, a physical decline in respiratory functioning, and pneumonia.
45
death rattle
caused by the accumulation of secretions in the lungs and throat, causing congestion and a “rattling” sound as the secretions become trapped, and the client is unable to clear these secretions.
Death rattle is an indication of approaching death, often within hours or days.
46
how to help with death rattle
Turning the client’s head to the side or rolling the client to the side can assist with drainage of the secretions from the throat and lungs. Medications such as oral atropine drops or scopolamine patches may also be used to dry up the secretions. A moist washcloth and oral suctioning can be used to eliminate secretions from the mouth.
47
what to not do to treat death rattle
Deep suctioning is ineffective in removing the accumulated secretions that are pooled in the lungs.
48
cheyne-stokes breathing
This manner of breathing typically occurs within three days of impending death.
The client’s rate of respiration becomes irregular, fluctuating between several quick breaths, followed by periods of apnea.
49
how to help cheyne-stokes breathing
The nurse can provide relief by positioning a fan to blow lightly in the direction of the client. The family should be educated that this type of breathing pattern is typical and expected.
50
three-step latter in palliative care with pain mangement medications
1. begins with NSAIDs
2. codeine or tramadol
3. morphine
51
what causes temp changes
the use of opioids, blood transfusion reactions, pain, hypoxia, fear and anxiety, and a warm environment result in temperature change
52
mottling
Physical change of the skin marked by purple or reddish marbling; caused by the heart's inability to pump blood effectively, leading to decreased blood perfusion throughout the body.
53
vision and hearing: hallucinations
Clients may experience hallucinations, a sensation that something is there when it is not, including hearing and seeing those who have already died. Hallucinations can include all the senses: hearing, sight, taste, touch, and smell. The client may hear voices or see an item or person unseen by others.
54
how to treat at the end of life: increase in temperature
Manage with antipyretic medications and warm baths
55
how to treat at the end of life: mottling
Purple or reddish marbling of the skin tone
Managed by providing warm blankets
56
how to treat at the end of life: Cheyne-stokes respirations
An irregular breathing pattern with periods of apnea
Managed by having a fan blow in the client’s direction
57
how to treat at the end of life: hallucinations
Seeing, hearing, or experiencing something that is not reality
Manage by reassurance; avoid denial of the sensations
58
how to treat at the end of life: death rattle
Accumulation of secretions in the lungs and throat
Manage by turning the client to their side
59
The role of a nurse during the postmortem period in supporting a surrogate and family members who are considering organ donation consists of which of the following? (Select all that apply.)
consult with interfaith personnel
referral to the organ procurement coordinator
allow time for expression of family feelings
60
APA definition of grief
“the anguish experienced after significant loss, usually the death of a beloved person.”
61
examples of grief
A client may experience grief due to the loss of a loved one such as a spouse, a parent, a sibling, a child, or a close friend. Other examples of losses that may trigger grief include divorce, retirement, loss of a job, loss of friendship, loss of financial stability, a miscarriage, or moving to a new city.
62
manifestations of grief
Clients may exhibit anxiety, difficulties in concentrating, thinking about the past excessively, and agitation
63
normal grief
Also known as uncomplicated grief; caused by the death of a loved one or the ending of a relationship.
64
common manifestations of normal grief
sadness
guilt
yearning
anger
regret
65
anticipatory grief
defined as grief that is experienced before the loss of someone or something.
This kind of grief arises when a loss is expected: A loved one is still living, but a substantial diagnosis has been made, the client’s health is worsening, or death is imminent.
client having a terminal illness
66
common finding of anticipatory grief
sadness, anger, loneliness, guilt, anxiety, fear, fatigue, and poor concentration
67
prolonged grief disorder
Previously known as complicated grief; experienced by clients who are unable to accept the death of the loved one; lasts longer than 6 months
68
example of PGD
Clients who are experiencing prolonged grief are unable to accept the death of the loved one.
Their behavior is marked by a persistent need to find the deceased person, and they are preoccupied with thoughts of the deceased person.
69
manifestations of PGD
feelings of guilt (self-blame), anger, and difficulty participating in new and different activities.
70
disenfranchised grief
Grief related to a relationship that does not coincide with what is considered by society to be a recognized or justified loss.
71
how can disenfranchised grief occur
as a result of a loss being unrecognized as significant (e.g., loss of a pet or miscarriage), an unrecognized relationship (e.g., an extramarital affair), an unrecognized griever (e.g., a young child), or the loss itself being disenfranchised (e.g., suicide).
72
Kubler-Ross's five stages of grief
denial
anger
bargaining
depression
acceptance
73
dual process model of grief
Suggests that the process of grieving "oscillates" (shift back and forth) between two types of stressors: loss-oriented and restoration grief. During the loss-oriented process, grief is conveyed through intense thoughts and feelings. The restoration grief process involves coping with other losses that come from the death of a loved one (secondary losses) and rebuilding one's life without the loved one.
74
worden's four tasks of grieving
Suggests that there are four tasks a mourner completes to avoid the risk of developing complicated grief. The four tasks to complete in order are to accept the reality of the loss, experience the pain of grief, adjust to an environment with the deceased not there, and find an enduring connection with the deceased while embarking on a new life.
75
bereavement
The period of time in which a person experiences grief and mourning after a loss.
76
mourning
The expression of grief in public.
77
common reactions of infants and toddlers when they suspect grief
rritability, changes in eating or sleeping patterns, or increased crying. The infant or toddler may be clingy, jumpy or anxious, or less active, or may experience weight loss.
78
common reactions of preschoolers suspecting of grief in someone
Preschoolers perceive death as temporary and reversible. They may think that they are to blame for a person’s death, as they believe that thoughts or feelings can cause death. Some preschoolers may appear unaffected by death, a response caused by a child’s inability to understand that death is permanent.
Common reactions include searching for the person who has died, anxiety, clinging to people, irritability, increased tantrums, trouble sleeping, toileting problems, and changes in eating.
79
middle childhood recations to death and grief
Because they recognize that the world does not revolve around them, they can have increased fears related to death and are more preoccupied with both their own well-being and the well-being of their loved ones.
Common reactions to death during middle childhood include anger, sadness, anxiety, aggressive behavior, and potentially trouble in school. Children in this age bracket may hold back their feelings, appearing withdrawn—a response that is more prevalent in boys.
80
adolescence reactions and feelings regarding death and grief
Adolescent children have a complete understanding of death, although they may not respond to it in the same manner as an adult does. It is not unusual for adolescents to have feelings that “no one understands me,” and these feelings may become increasingly evident in the adolescent experiencing grief. Some may have difficulty revealing their feelings. The inability to express these feelings can lead to high-risk behaviors as a way of escaping emotions and reality while seeking comfort.
Adolescents may or may not overtly display their emotions, as they may fear being seen as strange or different. During this time, adolescents may rely more on their friends, or they may detach themselves from others. Adolescents must be supported during this trying time while still enabling them to maintain their sense of independence.
81
adulthood reaction and feelings regarding death and grief
Manifestations experienced by adults may include depression, anxiety, anger, and rapid changes in mood. They may react to grief with emotions of shock, numbness, or doubt. Some adults experiencing grief may also have physical manifestations such as tightness in the chest similar to a heart attack, upset stomach, lightheadedness, and fatigue. Other responses to grief that may occur are known as “looking for” behaviors; they include hallucinations, dreams in which the deceased person continues to exist, “observing” the deceased person in the road, and other illusions and misconceptions.
82
stress
The mental, emotional, or physical response and adaptation to real or perceived changes and challenges. Stress response: Initiated by the nervous and endocrine systems when a stressor is perceived as a serious threat.
83
what participate in the stress response
hypothalamus
pituitary gland
sympathetic nervous system (SNS)
adrenal glands
84
what happens when a situation is determined to be stressful?
the hypothalamus secretes corticotropin-releasing factor (CRF),
which activates the SNS to release norepinephrine, epinephrine, and dopamine.
This reaction, which is also known as the fight-or-flight response, causes an increase in heart rate, blood pressure, and cardiac output; dilation of bronchial airways; pupil dilation; and an increase in blood glucose levels.
85
what does CRF also do?
CRF also signals the anterior and posterior pituitary glands to release adrenocorticotropic hormone (ACTH) from the adrenal cortex, which is part of the autonomic nervous system (ANS).
The ANS is the part of the peripheral nervous system that helps maintain homeostasis in the body and generally works without conscious control.
86
what does ACTH do
ACTH stimulates the adrenal glands to release cortisol, which triggers behavioral responses such as mental alertness, focus, and reduction of pain receptors
Cortisol also has immunosuppressive and anti-inflammatory effects.
87
general adaptive syndrome (GAS)
When an individual is disrupted by stress, the body works to maintain equilibrium by initiating the general adaptive syndrome (GAS), which consists of a three-stage response:
alarm, resistance, and exhaustion.
88
eustress vs distress
eustress is positive stress
distress is negative stress
89
GAS: alarm stage
CNS becomes aroused, body defense is mobilized
hormones are released from the adrenal corex palce the a ready minset (aka fight or flight)
rising horomones levels result is INCREASED BP and HEART RATE, BLOOD GLUCOSE, O2 INTAKE, PUPIL DILATION, AND MENTAL ALERTNESS
90
GAS: resistance stage
body resists and seeks to counter the stress
PNS attempts to return to bodily functions back to a state of homeostasis
body remains on alert while horomones and other body functions return to normal as the body repairs damage from the threat
91
GAS: exhaustion stage
the body can no longer defend itself against the stressor.
In this stage, when the body’s capacity to withstand or adapt to the stressor becomes depleted and the individual’s resources are exhausted, prolonged exposure to stress may result in illness or disease.
The chronic exposure to elevated or fluctuating endocrine or neural responses causes excessive wear and tear on the body organs, resulting in ALLOSTATIC LOAD.
This factor can, in turn, cause long-term physiological problems such as chronic hypertension, depression, and autoimmune disorders.
92
immune response
tress causes the body to produce greater levels of cortisol, often called the stress hormone. When released in short spurts, cortisol improves immunity by limiting inflammation; however, if cortisol levels are heightened for a prolonged period, inflammation increases and may result in impaired immune function, leaving the individual more susceptible to alterations in health and increased risk for infection because of a decrease in lymphocytes (the white blood cells that help fight off infection).
93
Transactional Theory of Stress and Coping
Describes stress as a dynamic process and a transaction between a person and their environment. How an individual appraises a stressor determines how they will respod to the stressor.
94
primary vs secondary appraisal
During primary appraisal, an individual evaluates a situation to determine whether the stressor poses a threat. If the stressor is determined not to be a threat, then it is dismissed. Conversely, if it is determined to be a threat, the individual assesses whether they can cope with the situation by examining the balance of situational demands such as risk, uncertainty, and difficulty with the available resources for addressing the threat, including social support, expertise, and past successes. The process of reappraisal repeats the primary and secondary appraisals; it is an ongoing endeavor that continually reassesses both the nature of the stressor and the resources available for responding to the stressor.
95
adventitious stressors
Stress that results from events of disaster; they are generally rare, unexpected, and can result from natural disasters.
96
emic knowledge
cultural INSIDER's perspective on a culture
EXAM QUESTION
97
etic knowledge
OUTSIDER's viewpoint on a culture
98
what are some factors related to health disparities
Access to transportation
Accessibility to health care
Health insurance
Religion
Geographic location
Sensory deficits
Physical disabilities
Mental health
Cognitive disabilities
Socioeconomic status
Race
Ethnicity
99
health equity vs equality
Valuing all individuals equally and removing obstacles to optimal health and health care across different populations is health equity.
The distribution of the same resources, including opportunities, to all individuals within a population is health equality
100
demographics
Age
English language proficiency
Household type
Population density
Race and ethnicity
Sex
101
health status
Chronic health conditions
Disabilities
Health insurance status
102
socioeconomic factors
Education level
Employment status
Household income
Poverty status
103
Complementary and integrative health
health and wellness through a broader, nontraditional lens and is combined with, ideally complementing, conventional medicine as we know it.
104
NCCIH: biological therapies
substances found in nature, nonprescriptive, herbal or botanical medicines; often sold OTC
105
NCCIH: mind-body therapies
: focus on interactions of the mind, the body, and the brain to positively affect physical functions and health promotion
106
NCCIH: manual therapies
a hands-on focus of the structures (bones, joints, soft tissue) and systems (circulatory, lymphatic) of the body
106
NCCIH: bioenergetic therapies
practices involving manipulation of human energy fields
107
NCCIH: alternative systems of care
whole medical systems (e.g., Ayurveda, traditional Chinese medicine) that have developed over time and in different cultures
108
integrative therapies
gather and use conventional, complementary, and alternative therapies, integrating the practices and knowledge to treat the client through mind, body, and spirit
109
holistic nursing
consideration of the whole person, mind, body, and spirit
client-centered approach
110
biofeedback
a mind-body regulation of bodily functions assisted by electronic devices which can regulate breathing, heart rate, and improve health by reducing stress, eliminating headaches, recondition injured muscles, or alleviate pain.
111
digestion
act of the body breaking down food into simple substances that are absorbed by the body as nutrients or eliminated by the body as waste
112
digestion
involves the
esophagus
stomach
liver
gullbladder
pancreas
small intestine
large intestine
rectum
anus
113
digestion: esophagus
muscles in the esophagus propel food down to the stomach
114
digestion: stomach
holds and digests foods into acids and enzymes
115
digestion: liver
filters toxins from the blood and produces bile that breaks down carbohydrates, protiens, and fats
116
digestion: gallbladder
stores the bile prodcued by the liver and releases it when needed
117
digestion: small intestine
breaks down food and absorbs most of the nutrients
118
digestion: large intestine
removes water and electrolytes from food particles for the body's use while turning the rest into feces
119
digestion: rectum
temporary storage area for feces
120
digestion: anus
expels feces
121
what are some common digestive problems
diarrhea
constipation
indigestion
food poisoning
flatulence
acid reflux
122
healthy eating patterns
eating a balanced diet daily,
watching calorie intake,
and consuming necessary amounts of different nutrients
123
what is the amount of calories an avereage person needs a day to maintain their weight
2000
124
macronutrients
protein
carbs
fat
eaten in large amounts and are primary building blocks of diet
125
micronutrients
composed of vitamins and minerals
and only small amounts are required in a diet
126
client with high phosphorus level
eat white bread
127
foods high in potassium
bananas
dried beans
spinach
tomatoes
128
what should daily fiber intake be
25g for women
38g for men
129
what can a diet low in vitamin C cause
gum irritation
130
measuring for NG tube
last place is xyphiod process
before that is tip of nose to chin
131
