exam 1 - AH

medical issues requiring long-term management and lasting 3 months or longer

persistent symptoms, noncurable, lifestyle adaptation for patient and families

chronic conditions

live with one or more chronic condition

129 million Americans

adults manages two or more distinct chronic health conditions simultaneously.

One in four

Chronic care accounts for how much of annual U.S. national healthcare expenditures.

86%

is identified as a primary major driver for secondary chronic health conditions globally.

obesity

holistic conceptual framework used to understand phases of a chronic illness. anticipate changes and optimize the patient’s quality of life across the entire timeline of the disease

The Trajectory Model

Care extends far beyond episodic acute problems.

Complex Management

Key Characteristics of Chronic Illness

Complex Management:

evolving phases

lifelong adherence

secondary risks

health uncertatinty

The primary nursing goal in chronic care is

1. Direct and Supportive Care:

skilled communication

holistic approach

any stage of illness

improve QOL and symptom burden

based on patient needs and goals

palliative care

terminal comfort care EOL

6 months of less to live

Medicare

shift away from cure

hospice care

Nursing Responsibilities in EOL Care

Advocacy: Protecting patient autonomy and ensuring their values are respected. •

Objective Assessment: Evaluating advance directives without personal bias. •

Sensitivity: Integrating the patient’s unique cultural, religious, and spiritual beliefs into the terminal goals of care.

3. Why is the chronic illness trajectory described as non-linear?

unpredictable because patients may move back and forth between phases, skipping stages or repeating them a

. According to the Trajectory Model, what is the primary goal of nursing management?

proactively apply targeted management strategies to shape and guide the illness trajector

7. Identify two major barriers that prevent patients from receiving quality end-oflife care.

biases toward curative treatments and clinician discomfort with the topic of death

What is the specific prognosis requirement for a patient to qualify for the Medicare Hospice Benefit?

six months or less.

What are the nurse's primary ethical responsibilities when a patient has an advance directive?

assess them objectively and advocate for the patient's autonomy. ensuring that their own personal biases do not influence the family's or patient's decisions.

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

IASP defintion of- pain

pain is a multidimensional experience produced by complex neural patterns, rather than a simple physical reflex

Neuromatrix Theory:

Triggers systemic stress response (sympathetic activity affecting cardiac, GI, and immune systems)

sudden onset

acute pain

Lacks sympathetic activity; suppresses immune function.

Persistent; lasts >3 months beyond expected healing.

chronix pain

Fast transmission of crisp, sharp pain signals

• A-delta Fibers

Slow transmission of dull, aching, persistent signals.

C-fibers

The peripheral source of the pain signal.

Nociception

The route pain signals take to the brain for conscious perception. Inhibitory pathways function to block or decrease this transmission

Ascending Pathway:

: Endorphins modulate and inhibit ascending pain impulses.

(Endogenous Opioids)

. Nursing Assessment of Pain include

biological, psychological, and demographic variables.

minimum stimulus to feel pain

Threshold

maximum pain one can endure

Tolerance

Key Assessment Domains of Nursing Assessment of Pain

Past & Psych:

. Biology & Demographics

intensity/tolerance/timing

Qualities

Gold standard for alert, cognitively intact adults.

0-10 Numeric Scale

Patient marks intensity along a continuum.

Visual Analogue Scale (VAS)

Preferred for pediatric populations or adults with communication barriers.

Faces Pain Scale (FPS-R)

Utilized for patients with cognitive impairment.

Behavioral Indicators

When objective data (e.g., guarding, grimacing) conflicts with subjective data (e.g., patient rates pain as "1/10"), the priority is

clarify scale usage and reinforce education.

The Nursing Process: Planning and Implementation

Goal Identification: Establishing realistic, measurable goals for functional recovery, such as the ability to cough, deep breathe, or ambulate. •

Patient Education: Proactive information on options, prophylactic dosing, PCA operation, and debunking addiction myths.

• Direct Care & Comfort: Holistic physical care, environmental modification, and nonpharmacologic measure

Act on CNS receptors to alter perception.

Opioids

Inhibit COX-1/COX-2; decrease peripheral prostaglandins.

Nonopioids (NSAIDs)

Block sodium channels; inhibit nerve conduction.

Local Anesthetics

what is opioids used for

Severe acute or cancerrelated pain.

risk of opioids

Respiratory depression, sedation

what is nsaids used for

Mild-moderate inflammatory pain; opioid-sparing adjunct

what is local anesthetics used for

Targeted regional block (topical, epidural)

risk of nsaid

GI bleeding, renal impairment, CV risks.

risk of local anesthetic

Systemic toxicity; numbed areas need protection

4 opioid adverse affect

respiratory depression—most dangerous

n/v

pruritus urinary retention

constipation

Programmed with a basal rate and strict lockout intervals to prevent overdose.

PCA

A normal physiological response where increasing doses are required to produce the same analgesic effect over time

tolerance

An expected physiological state manifesting in withdrawal symptoms if medication is abruptly stopped.

Physical Dependence

A chronic neurobiological disease characterized by impaired control and compulsive use despite harm

addiction

The Balanced Analgesia Model- base

Nonpharmacologic (Thermal, TENS, Acupuncture).

The Balanced Analgesia Model- middle

Nonopioids & Locals (NSAIDs, nerve blocks).

The Balanced Analgesia Model- top

Opioids (Reserved for severe breakthrough or acute pain).

The Balanced Analgesia Model- last resort

Invasive modalities (Neurologic stimulation or neurosurgical ablation).

4 parts of evaluation loop

timely reassessment

functional recovery

regimen adjustment

clear documentation

when to reassess after post iv

15–30 min

when to reassess after post oral

60 minutes

what to document- evaluation loop

Record initial assessment, intervention, reassessment score, and patient tolerance.

pain is a multidimensional experience produced by complex neural patterns, rather than a simple physical reflex.

Neuromatrix Theory

. Which side effect of opioid therapy is considered nearly universal and requires proactive, daily intervention because patients do not develop a tolerance to it?

constipation

Conscious perception of pain occurs as a direct result of the

activation of the ascending sensory pathway.

Which of the following is an expected physiological response to long-term opioid use, rather than a sign of addiction?

tiolerance and dependance

A medication (like an NSAID) used alongside a primary medication (like an opioid) to enhance pain relief.

adjuvant

The use of multiple classes of medications (multimodal) to maximize pain control and minimize side effectsq

balanced analgesia

The ability of a patient to perform essential tasks (coughing, walking) as a measure of pain management success.

functional recovery

Naturally occurring substances in the body (endorphins) that inhibit pain impulses.

endongeoys opioid

Pain perceived at a location other than the site of the painful stimulus

referred pain

TBW constitutes approximately how much of adult body weight.

60

This fluid is located inside tissue cells.

intracellulat fluid

key ions of intracellular fluid

Potassium (K^+) and Phosphate (PO_4^{3-}).

Intracellular Fluid (ICF): Represents how much of total body weight

~40%

Extracellular Fluid (ECF): Represents how much of total body weight

~20% \

interstitial fluid

surrounds the cells

interstitial fluid is made up of

15% body weieght

ecf is divided into

interstitial fluid

intravascular -plasma

intravascular plsama is located

Located inside blood vessel

intravascular plasma makes up

5% of body weight

key ions of ECF

Sodium (Na^+) and Chloride (Cl^-).

Fluid movement between plasma and the interstitial space is governed by

Starling Forces:

Pushes fluid out of the vessels.

Hydrostatic Pressure:

Pulls fluid back into the vessels,

Osmotic/Oncotic Pressure:

Osmotic/Oncotic Pressure: Pulls fluid back into the vessels, primarily via

protein albumin

movement of water from lower solute concentration to higher solute concentration across a semipermeable membrane. Driven by tonicity.

osmosis

Natural shift of solutes down a concentration gradient (from high to low concentration).

diffusion

active- Pressure-driven shift of water and solutes together from high to low hydrostatic pressure across a capillary membrane.

filtration

Uses ATP to move substances against a concentration gradient (low to high), such as the Sodium-Potassium (Na^+/K^+) Pump.

active transport

Low solute-to-water ratio in the plasma. Water is pulled into the cell from the ECF, causing the cell to swell

Hypotonic (e.g., 0.45% NS)

High solute concentration in the intravascular space. Water is pulled out of the cell into the ECF, causing the cell to shrink.

Hypertonic (e.g., 3% NaCl)

the lungs eliminate how much of water vapor (insensible loss).

~400 mL/day

the kidneys produce

~1.5L of urine/day (minimum 0.5–1 mL/kg/hr)

Regulate volume and pH over hours or days. and adjust the excretion of H^+ and HCO_3^

the kidneys

Adjust carbonic acid levels within minutes by altering respiratory rate and depth. They "blow off" or retain CO_2

lungs

Promotes Na^+ and water retention and K^+ excretion.

Aldosterone (Adrenal)

Causes pure water reabsorption

Antidiuretic Hormone (ADH - Pituitary):

Regulates Ca^{2+} and Phosphate balanc

Parathyroid Hormone (PTH - Parathyroid

normal serum osmololity

275–295 mOsm/kg

low serum osmolality means

fluid overload

high serum osmolality means

Dehydration/Hemoconcentration.

normal range Urine Specific Gravity

1.010–1.025

low Urine Specific Gravity means

dilute urine