N212 GERO EXAM 2 HIGHLIGHTABLE MOMENTS. A+ RATED STUDY GUIDE

N212 GERO EXAM 2 HIGHLIGHTABLE MOMENTS. A+ RATED STUDY GUIDE.CHAPTER 14 PAIN Understanding Pain  Pain is individual and can be very different for different persons with the same disease or injury  “Whatever the expe ...

N212 GERO EXAM 2 HIGHLIGHTABLE MOMENTS. A+ RATED STUDY GUIDE.CHAPTER 14 PAIN Understanding Pain  Pain is individual and can be very different for different persons with the same disease or injury  “Whatever the experiencing person says it is, existing whenever he or she says it does”  “A subjective**, personal, unpleasant experience involving sensations and perceptions that may or may not relate to bodily or tissue damage” Aronoff (2002) Pain Classification  Acute pain: rapid onset**, relatively short duration** and a sign of a new health problem requiring diagnosis and analgesia  Treat underlying cause—short-term analgesia  Other types of pain  Conditions such as conversion reaction*** or psychologic disorders*** Pain Assessment  Cultural pain assessment**** ACUTE PAIN – HIGHER DOSE CHRONIC – LOW AND SLOW TITRE UP Pain is an individual experience Pain intensity and pain distress are related to factors such as culture, past pain experiences, individual attributes, and pain threshold History and Physical Examination Page 1 of 22 N212 GERO EXAM 02 HIGHLIGHTABLE MOMENTS  Address: the onset, location, duration, intensity, characteristics, aggravating and alleviating factors, and self-treatment or other prescribed treatments that either helped or did not help  P, Q, R, S, T, U (mnemonic***)  PROVOKES  QUALITY  RADIATION  SEVERITY  TIME – HOW LONG?  U - HOW DO U FEEL? Additional Evaluations  Evaluation for depression  High incidence of depression associated with chronic pain  Persistent depression** affects person’s ability to cope with pain,  it must be treated  Geriatric depression scale The nurse has just started a hospital job where the majority of her patients are older adults. It is important that the nurse remember which of the following regarding older adults and pain? (Select all that apply.)  a. They may have several chronic illnesses that cause them pain.  b. They tend to overuse pain mediation.  c. They believe pain is natural outcome of cancer.  d. When they are confused, they may not respond pain in the usual way.  e. They do not understand pain scales.  Answers are a, c, d Pharma cologic Treatment  ***Nurses must be knowledgeable of the physiologic changes of aging that can alter drug absorption, metabolism, and excretion in the older adult Non-Opioid Analgesics  First-line approach to pain management  Acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve)  IBUPROFEN = DAMAGE STOMACH**  ACETAMINOPHEN = DAMAGE LIVER **  Acetaminophen is drug of choice for musculoskeletal pain; does not affect platelet levels  Maximum dosage is 4000 mg/24 hours  **TX: CHARCOAL AND GASTRIC LAVAGE Opioid Analgesic Side Effects  Nausea, vomiting, constipation, and urinary retention***  STOOL SOFTENER, HIGH FIBER DIET, WATER, INCREASE RISK FOR FALLS, CRANBERRY, Adjuvant Medications  Anticonvulsants, antidepressants, and some sedatives***  Alter or modulate the perception of pain Page 2 of 22 N212 GERO EXAM 02 HIGHLIGHTABLE MOMENTS Complementary and Alternative Medicine (CAM)  Two subgroups  Natural products: include herbals and botanicals, as well as vitamins and minerals  Mind and body practices: include acupuncture, massage therapy, meditation, movement therapies, relaxation techniques, spinal manipulation, tai chi, healing touch, and yoga Other Therapies  Exercise and physical therapy prevent stiffness, maintain function, relieve muscle spasms, and increase one’s sense of well-being  Peripheral nerve stimulation is a chronic pain management technique in which electrical leads are placed subcutaneously into the area of a person’s pain  Music therapy  Hypnosis  Education PAIN MEDS – LOOK FOR CONSTIPATION, RESP DEPRESSION, HYDRATION, ADJUVENT MEDICATION – ADDED TO OTHER MEDS NON-ANALGESICS USED TO TREAT PAIN, - ANTIDEPRESSANTS/ANTICONVULSANTS***. SOMETIME SEDATIVES (AND ANTIANXIETY) CHAPTER 15 – INFECTION Chain of Infection  For infection to occur, there must be a  reservoir of an infectious disease,  A PORTAL OF ENTRY***  susceptible HOST**  NOSOCOMIAL infections: acquired in the hospital  COMMUNITY ACQUIRED: acquired outside the healthcare facility Age-Related Changes in the Immune System  As age increases, so does production of auto antibodies  Increased auto antibodies causes an increase in autoimmune disease***  Skin becomes more fragile and prone to breakdown or abrasion***  INCREASE LIKELIHOOD OF INFECTION Factors Affecting Immunocompetence  Protein-energy (caloric) malnutrition***  Deprivation of protein and energy nutrients ***has been shown to result in alteration in immune function  Psychosocial factors***  Chronic and acute stress, depression, bereavement, and social relationships  Risks associated with the development of a nosocomial infection include poor nutrition, unintentional weight loss, low serum albumin levels, decreased fluid intake, poor oral hygiene, and altered mental status  Factors contributing to inadequate nutrition include altered taste, social isolation, physical inability to prepare food, altered absorption, and poverty Page 3 of 22 N212 GERO EXAM 02 HIGHLIGHTABLE MOMENTS Common Problems and Conditions  Common infections in older adults include influenza, pneumonia, tuberculosis, urinary tract infections, and shingles***  Influenza and Pneumonia  Community-acquired pneumonias are caused by bacteria: Streptococcus pneumoniae or pneumococcal pneumonia  PNEUMOCOCCAL VACCINE is recommended for everyone over the age of 65 Cancer  Presence of the cancer reveals presence of decreased immune response KNOW THE DIFFERENCE BETWEEN RA AND OSTEOARTHRITIS