pain sleep and stress

med surg exam 1

stress definition

inability to cope with perceived (real or imagined) demands or threats to ones mental, spiritual, or emotional wellbeing

physiologic stressors

pain

infection

excessive noise

starvation

psychologic stressors

diagnosis of cancer

death of spouse

caring for disabled child

marital problems

internal factors that impact stress response

age

attitiude

genetic background

previous stresser experience

resilience

sleep

optimism

hardiness

health status

nutritional status

external factors that impact stress response

social support

cultural and ethnic influence

number of stressors

religious or spiritual influences

socioeconomic status (SES)

stressor timing

components of hardiness

commitment

control

openness to change

physiologic stres response

SNS (flight or flight)

increased:

• BP

• HR

• RR

• BG (blood glucose) due to increased glycogenolysis

• norepinephrine and epinephrine

decreased peristalsis and secretions so decreased digestion

chronic stress causes

decreased:

• number and function of natural killer cells

• lymphocyte proliferation and function

• phagocytosis by neutrophils and monocytes

increased risk of infection and disease progression due to immunosuppression

stress outcomes

illness - eating disorders

disease

death

dec cognitive function

behavior

infection

telomere length - (telomere are protective coating at end of chromosomes and naturally diminish with age) but also susceptible to stress and stress can accelerate cell death and changes so conditions can have earlier onset, such as dementia and other age related disease

what type of coping is most helpful for patients

problem focused coping

different types of coping and how they work

problem-focused coping: addresses the source of stress

emotional-focused coping addresses feelings

example: you fail an exam

problem focused coping would be meeting up with professor

emotion focused coping would be crying

assessment as part of nursing care

previous coping methods

stress symptoms

support systems

previous stress experiences

physical symptoms of stress such as HTN, HA, weight gain (chronic) or weight loss (acute stress)

teaching as part of nursing care

exercise

relaxation techniques

humor

journaling

social support

sleep definition

state in which a person lacks conscious awareness of environmental surroundings but can be easily aroused

sleep effects

memory

mood

glucose metabolism

immune function

hormone secretion

what can result in sleep deprivation

not enough sleep

frequent awakenings (sleep fragmentation)

insomnia definition

difficulty

• falling asleep

• staying asleep

• early awakenings

• feeling unrefreshed

acute vs chronic insomnia

acute - less than 3 months

chronic - greater than 3 months

reasons for insomnia

poor sleep hygiene

alc/drugs/meds

life altering events

pain

anxiety/depression

meds that can cause insomnia

corticosteriods

antidepressants

diuretics

stimulants

first line of treatment for insomnia

CBT

meds for insomnia

Goal of meds is to treat sleep onset and sleep maintenance so stay asleep

ambien

melation agonists

antihistatmines

antidepressants

obstructive sleep apnea OSA definition

partial or complete upper airway obstruction during sleep

• narrowing or air passage w muscle tone relaxation

• tongues/soft palate falling backward and partially/completely obstructing pharynx

10-90 seconds resulting in hypoxemia and/or hypercapnia causing brief arousal

PMH that could lead to insomnia

BPH

mental health issues

pain

meds

drugs

alc

risk factors for OSA

obesity (BMI >30)

>65 yrs

neck circ greater than 16

male

postmenopausal women

S/S of OSA

frequent awakenings during sleep

insomnia

loud snoring

daytime sleepiness

witnessed apnea

morning headaches (AM headaches)

long term effects of OSA

over activation of SNS

increased vascular resistance

reduced O2 to heart leading to HTN

DM type two

dysrhythmias

coronary heart disease

arteriosclerosis

HF

CV related mortality

diagnosis of OSA

STOP-BANG

berlin questionnaire

sleep study (gold standard)

apnea hypopnea index (AHI) measures the amount of apneic episodes per hour

treatment for OSA

weight loss

side sleeping (positional therapy)

CPAP - 5 days a week for at least 4 hrs a night

oral appliances

surgery - UPPP or GAHM

UPPP or UP3 is removal of obstructive tissue

GAHM is attachment of muscular part of tongue to mandible so holding down tongue so cant fall back in mouth while sleeping

definition of pain

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

acute pain definition

sudden onset

less than 3 months

associated with healing

signs of acute pain

increased HR

increased BP

increased RR

diaphoresis

anxiety

chronic pain definition

lasting longer than 6 months

may persist after healing

gradual or sudden onset

signs of chronic pain

depression

fatigue

social withdrawal

flat affect

nociceptive pain

somatic and visceral

somatic pain

skin

muscles

bone

visceral

organs

localized or diffuse, often radiates

neuropathic pain

nerve damage

descriptors:

• burning

• tingling

• shooting

• electric shock

examples:

• diabetic neuropathy

• herpes zoster

pain transmission

transduction - stimuli into an electrical signal

transmission - from peripheral nerves to the central nervous system to the brain

perception - the brain identifies the signal

modulation - sent back to the body part and warrants a reaction

what to assess for pain

location

quality

severity

timing

radiation

breakthrough pain

when there is a sudden spike in pain that isnt controlled by their normal pain med regiment

pain in older adults

not normal aging

often underreported

often described as aching or soreness

nonpharmacologic pain management

TENS - electrode stimulating things

heat/cold

massage

repositioning

mediation

exercise

nonopioids pain management

acetaminophen

NSAIDS

aspirin

key adverse effects for pain meds

acetaminophen - liver toxicity if greater than 4g/day

NSAIDS - GI bleed or CV risk

aspirin - bleeding risk

opioids for pain management

morphine

dilaudid

oxycodone

hydrocodone

SE:

• constipation

• sedation

• respiratory depression

• falls

tolerance definition

need increasing dose

pseudoaddiction definition

behaviors that seem like addiction to pain meds resolve when pain is treated

so seems like addiction but isnt