Chronic Exam 2

Populations at highest risk for inadequate pain control

Older adults, Substance abusers & those whose primary language differs from that of the health care provider.

What is the number one reason someone will seek care?

Pain

Definitions of pain

Unpleasant sensory/emotional experience associated with actual or potential tissue damage. Whatever person experiencing it says it is; exists whenever person says it does

Acute pain

Serves as a biological response, Acts as a warning sign

• Activation of sympathetic nervous system

• “Fight-or-flight” reactions

Short-lived, Results from sudden, accidental trauma; surgery; ischemia; Inflammation

Chronic Pain

Cancer pain, Non-cancer pain, 3 months or more never really goes away

Acute pain responses

Usually well localized, Increased heart rate

• Increased blood pressure

• Increased respiratory rate

• Dilated pupils

• Sweating

Nociceptive pain

Normal pathways of pain

Somatic

Skin, muscular, (non-opioids, nor-steroids)

Visceral

Deep, organs, (opioids)

Neuropathic pain

Nerve pain, CNS & PNS

Antidepressant, Anti seizure med, Diabetes (neuropathy, burning, pins and needles)

Pain assessment

• Location

• Intensity

• Quality

• Onset and duration

• Aggravating and relieving factors

• Effect of pain on function and quality of life

• Comfort-function outcomes

Analgesic agents

are first-line therapy

Opioids (IV Fast 5 minutes)

Multimodal Analgesia

Preferred 2 meds lesser dose (Narcotic & steroids)

Preemptive analgesia

Giving meds before pain starts

Non-opioids

For mild to moderate pain

Acetaminophen (Tylenol, Abenol) All ages effects liver

• NSAIDs (Inflammation perifrial nervous system)

> Ibuprofen (Motrin, Novo-Profen)

> Naproxen (Naprosyn, Nu-Naprox)

> Celecoxib (Celebrex)

Side effects of opioids

Constipation

• Nausea

• Vomiting

• Pruritus Itching

• Sedation

• Respiratory depression (less common, most feared

Nonpharmacological Interventions

Should be used to complement, not replace,

pharmacologic therapies

> Physical modalities

> Cognitive-behavioral strategies

Physical Interventions

Physical therapy

• Occupational therapy

• Aqua therapy

• Functional restoration

• Acupuncture

• Low-impact exercise such as walking or yoga

• Cutaneous stimulation – example, TENS (Electrodes around the area of pain)

Local Adaptation System LAS

Involves only one specific body part

General Adaptation System

biomedical model of stress

Whole body response

Alarm reaction (Fight or Flight)

Stage of resistance (Try to resist what is happening)

Stage of exhaustion (Body can no longer repair its self)

Physiologic Stressors

• Inside/external challenges homeostasis, equilibrium

• Chemical agents

• Physical agents

• Infectious agents

• Nutritional imbalances

• Hypoxia

• Genetic or immune disorders

Psychosocial Stressors

Cant see it fear of something happening

• Accidents

• Stressful or traumatic experiences of family members and

friends

• Horrors of History

• Fear of aggression or mutilation

• Events of history that are brought into our homes through tv and internet

Rapid changes in the world

Emotional Responses to Stress

• Mind-body interaction

• Coping mechanisms

• Anxiety (most common)

Mild

Moderate

Severe

Panic

Defense mechanisms

unconscious reactions to stressors

• Useful in mild to moderate anxiety

• Can become maladaptive (Denial)

Effects of stress

Stress and Basic Human Needs

• Stress in Health and Illness

• Long-Term Stress

• Family Stress

Factors Affecting Stress and Adaptation

• Sources of Stress

• Developmental Stress

• Situational Stress

• Personal Factors

Complimentary Health Approaches

(CHA)

Alternate cut out salt so they dont have to take medicine

• refers to interventions that can be used with

conventional medical interventions and thus compliments them.

• The term integrative health (IH) refers to the combination

of complementary health and conventional health approaches in a coordinated way.

• If there is a non-mainstream practice that is used instead

of conventional medical care, it is considered an

alternative modality; however, it is rare that people use

only alternative approaches.

Allopathic medicine

: traditional medical care

• Integrative health care: combination of

allopathic and complimentary

Holism

connection and interactions between Parts of the whole

Treating the body as a whole not separate parts

• Integrative health care

combination of allopathic and complimentary and alternative modalities

Allopathic Medicine (Biomedicine)

Medical view

• Illness occurs in either the mind or body, which are

separate entities.

• Health is the absence of disease.

• The main causes of illness are pathogens

Reasons for Using Complimentary Health Approaches

• People are looking for ways to improve them self

Used in children so they dont have to take medicine

Seeking ways to improve health and well-being or relieve

symptoms associated with chronic, even terminal illnesses

or the side effects of conventional treatments for them.

• Having a holistic health philosophy.

Transformational experience.

• Greater control over own health.

• Altruism

– concern for welfare and well-being of others

• Autonomy

right to self-determination

• Human Dignity

respect for the inherent worth and uniqueness of individuals and populations

• Integrity

– acting according to code of ethics and standards of practice

• Social Justice

Upholding moral, legal, and humanistic

rights

Values clarification

A process by which people come to understand their own

values and value system.

• Clinical Application

Utilitarian

What is going to happen/ result if I do this

the rightness or wrongness of an action depends on the consequences of the action

Deontologic

Doesn’t matter the consequence “I always tell the truth”

an action is right or wrong independent of its consequences

• Nonmaleficence

avoid causing harm.

• Beneficence

benefit the patient. Doing good

• Fidelity

keep promises.

Justice

give each his/her due and act fairly.

Advocacy in Nursing Practice

• Primary commitment to the patient

• Prioritization of good of individual patient rather than

society in general

• Evaluation of competing claims of patient’s autonomy and

patient well-being

Licensure

Reasons for suspending or revoking a license

• Due cause for revoking a license

• Defense of license investigation

Torts

Wrong doing of someone else

Intential- Assult and battery, restraint, forcing pt, invasion of privacy

Unttential- didn’t intend to happen but did

Elements of Liability

Have to be proven to prove negligence

• Duty

• Breach of Duty

• Causation

• Damages

Assult

Threat

Battery

Actual harm