Final ch 8 - 14

sleep, pain, substance use disorders, inflammation, immune sys

obstructive sleep apnea

partial or complete upper airway obstruction

usually occur during REM cycle (airway muscle tone is lowest here)

occur repeatedly throughout the night

apnea & hypopnea

no single cause

most diagnosed SDB problem

apnea

≥ 90% cessation of respiratory airflow lasting > 10 sec

hypopnea

30 - 90% decrease in airflow

sleep apnea risk factors

obesity → BMI > 30kg

65+ yrs

neck circumference ≥ 16in

male

postmenopausal women

sleep apnea consequences

HTN

T2DM

dysrhythmias

CHD

HF

mortality

impacted ADLs

continuous positive airway pressure (CPAP)

nasal or oral - nasal mask attaches to a high - flow blower

benefits are dose dependent based on length of use

effective but poor adherence

bilevel positive airway pressure (BiPAP)

delivers higher inspiration pressure & lower expiration pressure

may be better tolerated

older age associated with

overall shorter total sleep time

decreased sleep efficiency

more awakenings

gerontologic considerations

amt of sleep does not change w/ age

some sleep disorders increase w/ age

circadian sleep timing can shift w/ age

• sleepy earlier in evening; awaken earlier in morning

↑ fall risk, injury, cognitive disturbances

Neuropathic pain

damage to peripheral nerves or CNS

described as numbing, burning, shooting, stabbing or electric shock like pain

neuropathic pain causes

sudden, intense, short-lived or lingering trauma, inflammation and/or metabolic diseases

diabetic neuropathy

acute pain

sudden onset

< 3 months or time it takes for normal healing or occur

mild - severe pain

cause can usually be identified

acute pain manifestations

sympathetic nervous system activation

increase HR, RR, BP

diaphoresis, pallor

chronic pain

gradual or sudden onset

> 3 months, pain continues past normal recovery time

mild - severe

cause may be unknown

does not go away w/ increasing & decreasing pain

chronic pain manifestations

decreased physical activity

fatigue

withdrawal from others & social interaction

chronic pain

what pain focuses on enhancing function & quality of life

nociceptive pain

described as sharp, aching, throbbing, dull and cramping

nonopioids

acetaminophen, aspirin, salicylates & NSAIDS

DOES NOT produce tolerance or physical dependence

used in conjunction w/ opioids for an opioids-sparing effect

analgesic ceiling

aspirin

mild pain

limited use d/t anti platelet effects - bleeding esp GI bleed risk

AE: GI problems (stomach pain), renal insufficiency (processed through kidney), & HTN

acetaminophen

analgesic (pain) & antipyretic (fever reducing) effects

no antiplatelet or anti-inflammatory effects

processed through the liver - potential for hepatoxicity

also available via parenteral route

NSAIDS

inhibit cyclooxygenase (COX)

COX 1 many side effects (EX: ibuprofen)

COX 2 associated w/ therapeutic, anti-inflammatory effects (EX: celecoxib)

more gentle to the stomach

nondrug therapy

massage

exercise (swimming)

transcutaneous electrical nerve stimulation (TENS) - usually for shoulder

acupuncture

heat or cold therapy

cognitive therapies (distraction, hypnosis, relaxation)

acute withdrawal syndrome manifestations

agitation

anxiety

high HR & BP

sweating

nausea

tremors

insomnia

hyperactivity

acute withdrawal syndrome treatments

benzos

thiamine

multi vits (bc poor nutrition, absorption)

magnesium (bc usually now mag lvls)

IV glucose

a- or B blockers

opioid withdrawal

early sympt - craving, anorexia, anxiety, sweating, increased resp & bp, tremor & irritability

symptoms progress after 2 - 3 days - V/D, insomnia, tachy, abd cramps, muscle spasms

• subside after 5 - 7 days

• craving, depression & irritability can last for months

short acting - begin 6 - 12 hrs after last dose

long acting - begin 24 - 48 hrs, may last for 3+ wks

smoking risks

most harmful method

harms nearly every organ in the body

vaping risks

EVALI → e-cig associated lung injury

lung & CV problems

harm adolescent brain development

neg influence preg outcomes

NOT FDA approved for smoking cessation

inflammatory response s/sx

redness

heat

pain

swelling

loss of function

↑ WBC

fever

skin breakdown risks

advanced age

diabetes

incontinence

obesity

pain

prolonged surgery

immobility

friction

stage 1 PI

localized area of non-blanchable erythema

skin intact

stage 2 PI

dermis only

partial-thickness skin loss

exposed dermis

wound bed is viable, pink / red & can be moist shiny or dry

stage 3 PI

full thickness skin loss

adipose (fat) tissue is visible

stage 4 PI

full thickness skin & tissue loss

exposed fascia, muscle, tendon, ligament, cartilage or bone

beyond fat tissue

deep tissue PI

skin can be intact or non-intact

non-blanchable red/purple discolouration/bruise

RICE

Rest → stop activity & limit movement

Ice (during 1st 24hrs)

Compression → elastic bandage; apply distal to proximal

Elevate → reduce edema & pain

unstageable PI

obscured full thickness skin & tissue loss

tissue damage cannot be graded bc it is obscured by slough or eschar

IgG

most abundant antibody

in all body fluids & protect against bacterial & viral infections

most common

IgA

found in high concentrations in mucus membranes esp. in resp passages, GI tract, saliva & tears

FIRST line of defense

IgM

mainly in blood & lymph fluid

first antibody to be produced

learning antibody

IgE

‘E’ llergic reactions

in lungs, skin & mucous membranes

IgD

found in blood

T1 hypersensitivity

anaphylactic reactions

• d/t genetic predisposition

• localized & systemic

IgE mediated

immediate

T2 hypersensitivity

wrong blood type given

immediate

T3 hypersensitivity

autoimmune reaction

immune sys attacks self

immediate

T4 hypersensitivity

delayed hypersensitivity reactions

24 - 48 hrs

T1 hypersensitivity cause

environment

‘E’llergy

T3 hypersensitivity cause

autoimmune disorder

T4 hypersensitivity

transplant rejections

drugs