Wk 4: older adults/ pain and comfort Flashcards
what age does old age start at ?
65+
what has lead to the increase in the aging population?
longer life span, baby boomers getting to this age group, better diagnostic testing
what are some universal signs of aging when looking at a patient
facial wrinkles, grey hair, BMI changes
physiological changes of aging: neurological system
degeneration of nerve cells
decrease in neurotransmitters
decreased impulse conduction
slower voluntary reflexes
less ability to respond to multiple stimuli
alterations in sleep
physiological changes of aging: facial features and vision
loss of SQ fat and skin
visual acuity declines
presbyopia
difficulty adjusting to light changes
yellowing of eyes lens
altered color perception
sensitivity to glare
smaller pupils (react slower)
Dz: cataract, macular degeneration, diabetic retinopathy, retinal detachment
physiological changes of aging: hearing
changes subtle
presbycusis
physiological changes of aging: taste
salivary secretion reduced
taste bud atrophy
difficult to recognize between salt/sweet/sour
health conditions and meds can alter taste
physiological changes of aging: smell
loss of smell
this causes nutritional issues
physiological changes of aging: heart and vascular
decreased cardiac output d/t low contractile strength of myocardium
slight cardiomegaly
stiffening heart wall
HR changes (lower)
heart valves thicken/stiffer
lower extremity pulses weaker but palpable (less perfusion)
HTN (not nml)
physiological changes of aging: lungs
lung strength and expansion decreases (cough not as effective)
more susceptible to PNA/infections
AP diameter increases
decreased # of alveoli and cilia
physiological changes of aging: thorax
kyphosis
calcification of costal cartilage (causing decreased mobility of ribs)
chest wall stiffens/ less recoil
severe kyphosis can lead to what?
respiratory issues
pain
physiological changes of aging: GI and abdomen
increased fatty tissue
protuberant abd
slowed peristalsis
decreased production of saliva and digestive enzymes
delayed gastric emptying
less tolerant of foods
physiological changes of aging: urinary system
BPH causing urinary retention, frequency, incontinence, UTI’s
decreased bladder capacity
urinary incontinence
women are more susceptible to what kind of incontinence?
stress incontinence (when coughing, sneezing, laughing or lifting objects)
what are some risk factors for urinary incontinence?
age
menopause
DM
hysterectomy
stroke
obesity
physiological changes of aging: skin
decreased turgor / SQ fat/ connective tissue
loss of resilience & moisture
thinning of epithelial tissue
wrinkles
what happens to hair and nails with age
hair thins and grays, sparse distribution
nails grow slow and thicken
senile lentigo
age spot / liver spot
who is at higher risk for developing osteoporosis
postmenopausal women
they should take in more calcium
physiological changes of aging: female reproductive system
reduce estrogen and progesterone
vaginal drying, pain with intercourse, decreased libido
physiological changes of aging: male reproductive system
weaker erection, weaker ejaculation
less testosterone
decreased libido
no definite cessation of fertility
physiological changes of aging: breasts
lower estrogen
tissue firmer
lower muscle mass/ tone/ elasticity
gynecomastia in males
men and women at risk for breast cancer
physiological changes of aging: immune system
slowed response and healing
reduced production of B&T cells
decreased body temp
decreased stress response
decreased response to immunizations
what does the functional changes in older people refer to?
the capacity and safe performance of ADL and IADL’s
PT/OT can help in assessment
physiological changes of aging: cognitive changes
reduction of brain cells and changes in neurotransmitter levels.
misconceptions: confused, disoriented, forgetful, loss of language skills, poor judgement
psychosocial changes of aging
retirement
social isolation
sexuality
housing and environment
death
what are some nursing considerations for elderly ?
developmental tasks
setting in which you are caring for the older adult
variability of older adults
health considerations
disease presentation in older adults
health promotion
psychosocial concerns of the older adult
how can nurses help with placement decisions
encourage collaborative involvement
answer questions
educate on options
encourage to visit facility to determine quality
what are some things to look for when finding a placement home for elders ?
does not feel like a hospital
personal room with privacy
medicare & medicaid certified
qualified staff with background checks
quality of care & activities
quality of food
staff encourage family involvement
what are some acute care considerations for elderly
basic needs of comfort
nutrition/ hydration
skin integrity
identify and treat cause
promote independence
include them in care
what are some complications of acute care with elderly
delirium
malnutrition/ dehydration
HAI’s
urinary incontinence
falls
what are some nursing care interventions for an elderly patient with delerium?
encourage family visits
memory cues
compensate for sensory deficits
reality orientation
what is the goal of restorative care for elderly ?
the regain or improve prior level for independence , ADL, instrumental activities for daily living (IADL)
what is the leading cause of death?
heart disease (including HTN and CVD)
what are the factors affecting nutrition in older adults?
lifelong eating habits, tradition, cultural habits, preferences, religious beliefs, situational factors, chronic illnesses, medications
some overall nutritional recommendations for elderly
increase vitamins (D,B12,E, folate, fiber, Ca)
increase fluid intake
limit sodium / fat/ refined sugar/ alcohol
how to improve nutritional intake when an elderly person is hospitalized
eat with others
ensure food is accessible during the day
pt is comfortable
good hygiene
environment
dietician consult
promote activity
intrinsic risk factors for falls in older adults
H/o falls
fear of falling
Wk
vision issues
postural hypotension
balance /gait issues
medication reaction
chronic conditions (stroke, DM, dementia, arthritis)
extrinsic risk factors for falls in older adults
poor lighting
no handrails
poorly designed stairs
no grab bars or nonslip surfaces
hazards / obstacles
slippery / uneven ground
improper use of assistive devices
inappropriate footwear
what are some illness indicators in elderly
metal status changes
occurrence / reasoning behind falls
dehydration
decreased appetite
loss of function
dizzy
incontinence
anxious
if an elderly adult that is staying in the hospital starts to act acutely confused, what are some possible sources of it?
acute illness
neurological event (stroke?)
new medications
risk factors for delirium
if an elderly adult that is staying in the hospital obtains an infection, how would it present
may not have a fever
tachypnea
falls/ increase in falls
incontinence
confusion
loss of appetite with late stage heart disease is an early symptom of what ?
impending failure
what is a large concern when checking an older adults EMR and seeing multiple providers involved in their care?
polypharmacy
drug-drug interactions
drug-food interactions
what are some generalized preventative measures that the nurse should recommend to older adults
frequent screenings
exercise regularly
weight reduction as needed
low fat, well balanced diet
moderate alcohol
smoking cessation
stress management
socialization
good hand washing
regular checkups with HCP
immunizations
when teaching older adults be sure to..
assess readiness to learn
speak clear / slow/ normal tone
one idea at a time
allow time to process info
minimal environmental distractions
teach back method
teaching older adults with hearing deficits
get their attention
reduce background noise
speak clearly
speak loudly
repeat yourself
good lighting
which is not a description of pain
A. pain is objective
B. pain is an individual experience
C. pain is often misunderstood and inadequately treated
D. pain is an individual experience
A.
rationale: pain is a purely subjective experience only the person experiencing it rate
nociception
observable activity in the nervous system in response to an adequate stimulus
pain
the four phases of pain pathophysiology
transduction
transmission
perception
modulation
acute pain
protective mechanism
short duration (3-6Mo)
limited damage
can progress to chronic pain
VS changes
chronic pain
not protective
not same outwards Sx as acute pain
lasts longer than 3-6 months
what is the goal of treatment for someone with chronic pain ?
to improve functional status
is chronic pain and cancer pain the same?
no
cancer pain arises from damaged pain nerves r/t cancer care
what are some observable signs of acute pain ?
BP change
increased HR
increased RR
dilated pupils
diaphoresis
why dont people with chronic pain have observable signs of pain?
d/t loss of adaption mechanisms
nociceptive pain
aching gnawing, pounding pain
arises from pain receptors
neuropathic pain
injury to nerves or abnormal sensory output
burning, shooting, electrical, abnormal sensations
what are some examples of neuropathic pain ?
spinal cord pain
DM neuropathy
phantom limb pain
what are the three kinds of nociceptive pain?
- somatic: bones/joint/muscles/connective tissue
- visceral: internal organs (often referred)
3.cutaneous: in skin or SQ tissue
what are two types of well localized pains?
somatic
cutaneous
idiopathic pain
chronic, unknown cause “idiot”
hard to treat
exceeds typical pain levels
acute pain activates which nervous system?
sympathetic
fight or flight
Sx: tachycardia, HTN, anxiety, diaphoresis, muscle tension
what are some symptoms of chronic pain?
fatigue
depression
decreased level of functioning
Which statement about pain is true:
A. chronic pain is psychological
B. pain is what the patient says it is and we must assess and treat it as such
C. patients who abuse substances overreact to discomfort
D. administering analgesics regularly leads to drug addiction
E.psychogenetic pain is not real
B
what are some factors that influence pain experiences
age
fatigue
genes
cognitive/neurologic function
previous pain experiences
support systems/ coping mechanisms
spirituality
anxiety/ fear
cultural aspects of pain
P&P box 44.4
what are some aspects in a persons life that pain can impact ?
quality of life
self-care
work
social support (family/friends)
what are some ways to measure a patients pain?
vertical and horizontal pain scale
visual analogy scale
simple descriptive pain intensity
face scale (3 y/o or up)
PQRSTU
provocative / palliative
quality/ quantity
region/ radiation
severity
timing/ treatment
understanding
what are some non-pharmacologic measures for pain management (4)
relaxation and guided imagery
distraction
music
cutaneous stimulation
if a patient is opioid naive, what is the best course of action when administering their medications
start with the lowest dose or lest intense medication and gradually increase as needed
what are the three main types of pharmacological treatments for pain
non-opioids
opioids
adjuvants
what are some considerations for acetaminophen?
safest
MOA unknown
analgesic, anti-pyretic
NOT antiinflammatory
watch for liver toxicity
ceiling effect
considerations for NSAIDS
ceiling effects
watch for GI bleeds
do opioids have a ceiling effect?
no
if opioids lead to respiratory depression, what are some nursing implications?
naloxone (may need multiple doses or a drip)
administer O2
maintain airway
**critical to know baseline respiratory assessment
why would around the clock dosing be utilized ?
to maximize pain relief
potentially decreases opioid use
if a patient is using ATC (around the clock) opioids for pain management, what can be used for breakthrough pain?
non-opioids, usually ibuprofen d/t most opioid already having acetaminophen in them
range order medications
orders where a dose varies over a prescribed range to provide flexibility
Ex: Morphine 2-6mg IV q2h PRN for pain
nurse responsible to know patient and follow orders appropriately
if a patient has a range order for Tylenol that is:
Tylenol 500-1000 mg q4h PRN for pain
what are some considerations to administering this?
whatever dose is given, you have to count/tally what is given and chart it so you do not go over the daily limit of 4g
PCA (patient controlled analgesia)
always IV
starts with loading dose
patient then BOLUS meds as needed
there is a frequency and limit
epidural anesthesia
regional anesthesia
must be preservative free
can be PCA or continuous
what are some side effects of epidural anesthesia
hypotension, N/V, urinary retention, constipation, respiratory depression, pruritus
nursing care for epidural anesthesia
monitor site placement
monitor infection/ bleeding
may need urinary catheter
may not be able to walk, fall risk
monitor coags
what is the difference between tolerance and dependence ?
tolerance is not a sign of addiction. dependence can also cause withdrawal symptoms if drug is not gradually decreased.
both tolerance and dependence an occur after repeated exposure to opioids
