Foundations of Nursing Exam two FULL STUDY GUIDE CONTENT

Nursing Role and Responsibilities in Pain Management

• Assess and manage pain effectively using evidence-based practices.

• Advocate for adequate pain management.

• Educate patients and families about pain management options.

• Collaborate with interdisciplinary teams

Types of Pain

Acute Pain, Chronic Pain, Chronic Episodic Pain, Cancer Pain, Idiopathic Pain, Somatic Pain, Visceral Pain, Neuropathic Pain

Nursing Role and Responsibilities in Pain Management

• Assess and manage pain effectively using evidence-based practices.

• Advocate for adequate pain management.

• Educate patients and families about pain management options.

• Collaborate with interdisciplinary teams

Types of Pain

Acute Pain, Chronic Pain, Chronic Episodic Pain, Cancer Pain, Idiopathic Pain, Somatic Pain, Visceral Pain, Neuropathic Pain

Acute Pain

Sudden onset, protective, identifiable cause, short duration.

Chronic Pain

Persistent, not protective, may last longer than 3-6 months

Chronic Episodic Pain

Sporadic pain episodes over time

Cancer Pain

Related to tumor progression, treatment, or procedures

Idiopathic Pain:

Pain without identifiable cause

Somatic Pain

 Originating from skin, muscles, or bones.

Visceral Pain

From internal organs, often poorly localized.

Neuropathic Pain

From nerve damage, may involve burning or tingling

Attitudes and Beliefs About Pain

• Pain is subjective; the patient’s report is the most reliable indicator.

• Cultural beliefs and past experiences influence pain perception.

• Effective communication is essential for pain management.

Factors Influencing Pain

• Fatigue, genetics, neurological function, previous pain experiences.

• Family and social support, anxiety, spiritual beliefs, cultural factors.

Pain Scales and Assessment

• Numeric Pain Intensity Scale (0-10)

• Visual Analogue Scale (VAS)

• Wong-Baker FACES Scale

• FLACC Scale (Face, Legs, Activity, Cry, Consolability) for non-verbal patients.

• PQRSTU: Provocation, Quality, Radiation, Severity, Time, Understanding.

Pain Reassessment

• Regularly evaluate pain management effectiveness.

• Adjust interventions as necessary.

Aging and Pain

• Pain is often underreported in older adults.

• Altered metabolism and drug clearance in elderly patients require careful monitoring.

Pain Medications

• Non-Opioids: Acetaminophen, NSAIDs.

• Opioids: Morphine, fentanyl.

• Adjuvants: Antidepressants, anticonvulsants.

Nursing Considerations: Monitor for side effects, educate on proper use.

Non-Pharmacological Pain Management

• Relaxation techniques, distraction, heat or cold therapy, massage, acupuncture.

• Cognitive-behavioral therapy and guided imagery.

Physical Dependence

Normal physiological response; withdrawal symptoms possible.

Addiction

Compulsive drug use despite harm.

Tolerance

Reduced response to the same dose over time

Kinesthetic Sense

Awareness of body position

Stereognosis

Ability to perceive object characteristics by touch

Common Sensory Alterations

• Vision: Cataracts, glaucoma, macular degeneration.

• Hearing: Presbycusis, tinnitus, sensorineural and conductive hearing loss.

• Touch: Hyperesthesia, decreased sensation.

• Taste and Smell: Reduced taste bud sensitivity, anosmia.

Sensory Overload

Excessive stimuli preventing meaningful response.

Sensory Deprivation

Reduced sensory input from environment.

Sensory Deficit

Loss of normal sensory function.

Nursing Role in Sensory Assessment and Interventions

• Assess for sensory deficits using appropriate tools.

• Promote safety and independence.

• Provide sensory aids (e.g., glasses, hearing aids).

• Educate on managing sensory impairments.

Expressive Aphasia (Broca's)

Difficulty speaking or writing.

Receptive Aphasia (Wernicke's)

Difficulty understanding speech or writing.

Global Aphasia

Severe impairment in both speech and comprehension.

Communication Methods

Picture boards, writing tools, speech therapy.

Health Promotion and Prevention

• Encourage regular sensory screenings.

• Educate on safety measures (e.g., hearing protection, UV protection).

Safety Concerns with Sensory Alterations

• Ensure proper lighting for vision impairment.

• Use sound alarms and visual cues for hearing loss.

• Prevent falls using assistive devices.

• Promote oral hygiene for taste and smell preservation.

Nurses' Role in Patient Education

• Provide education on diseases, medications, procedures, and self-care.

• Empower patients for better decision-making and self-management.

• Improve patient outcomes, reduce healthcare costs, and enhance quality of care.

• Act in accordance with the Nurse Practice Act and accrediting agency guidelines.

Importance of Patient Education

• Promotes self-care and adherence to treatment plans.

• Facilitates informed decision-making.

• Enhances patient satisfaction and health outcomes.

• Reduces hospital readmissions and complications.

Teaching:

Active process where nurses communicate information to patients.

Learning:

Process where patients absorb, process, and apply the information

Effective Communication

Ensure feedback and evaluation for successful learning

Ability to Learn

• Cognitive development and intellectual abilities.

• Health literacy and existing knowledge.

• Physical and emotional states like pain, anxiety, or fatigue.

• Sensory deficits that may require adaptations.

Factors for Effective Teaching

• Assess patient learning needs and readiness.

• Create a comfortable learning environment.

• Adapt teaching methods based on developmental stages.

• Incorporate cultural and linguistic considerations.

• Engage family or support systems when appropriate.

domains of learning

cognitive, affective, psychomotor

Cognitive (Knowledge)

Intellectual understanding using lectures, discussions, or Q&A.

Affective (Attitude)

Emotional response and valuing through role-play or discussions

Psychomotor (Skills)

Physical skill development through demonstrations and practice

Verbal One-on-One

Personalized, direct communication

Demonstration

Step-by-step illustration of procedures

Role-Playing

Scenario-based learning for emotional engagement.

Analogies

Simplify complex concepts using relatable examples

Group Instruction

Encourage peer learning and discussion

Simulation

Provide hands-on practice in a safe environment

types of instructional methods

verbal one-on-one, demonstration, role-playing, analogies, group instruction, stimulation

Evaluation of Learning

• Assess whether learning objectives are met.

• Use teach-back method: Ask the patient to explain or demonstrate what they learned.

• Provide feedback and clarify misunderstandings.

• Document the teaching process and evaluation outcomes.

• Adjust teaching plans if necessary.

SMART Goals for Evaluation

• Specific: Clear objectives aligned with patient needs.

• Measurable: Track progress.

• Attainable: Realistic goals.

• Relevant: Applicable to the patient's condition.

• Timely: Set achievable time frames.

Demographic Trends of the Elderly Population

• The elderly population is growing due to increased life expectancy and lower birth rates.

• The number of adults over 65 is rising, impacting healthcare, social services, and economic policies.

• More older adults are living independently, but a significant portion requires assistance due to chronic illnesses or disabilities.

• Women generally outlive men, leading to a higher proportion of elderly women.

• Economic disparities exist; some older adults face financial insecurity, influencing their access to healthcare and quality of life

Comprehensive Gerontological Nursing Assessment

A holistic approach assessing physical, cognitive, emotional, social, and functional aspects of an older adult.

Increased Demand for Healthcare Services

More chronic disease management, long-term care, and home-based care are needed

Preventative Care

Focus on vaccinations, screenings, and lifestyle changes to prevent illness.

Need for Specialized Geriatric Nurses

More training required in gerontology to address aging-related conditions.

Physiological Changes of older adults

Integumentary, Cardiovascular, Musculoskeletal, Neurological, Sensory, Cognitive changes

Integumentary

Loss of skin elasticity, thinning hair, brittle nails

Cardiovascular

Thickened blood vessels, decreased elasticity, lower cardiac output.

Musculoskeletal

Muscle mass loss, bone decalcification, joint degeneration

Neurological

Slower nerve conduction, reduced neurotransmitters, cognitive changes.

Sensory

Decreased vision, hearing, taste, and smell.

Delirium

Acute confusion (often reversible).

Dementia

Chronic, progressive cognitive decline

Depression:

Common but not a normal part of aging.

Psychosocial Changes

retirement, social isolation, sexuality, housing and environment, death and grief

Ageism

Stereotyping and discrimination against older adults

impacts of ageism

• Can affect healthcare quality (e.g., under-treatment of pain).

• Leads to social isolation.

• Influences self-perception and mental health.

combatting ageism

• Encourage intergenerational interaction.

• Educate healthcare professionals.

• Advocate for policies supporting older adults.

4 M’s in geriatric care

what matters, medications, mentation, mobility

What Matters

 Align care with patient goals and preferences.

Medications

Optimize medication use, avoid polypharmacy.

Mentation

Address cognitive health (delirium, dementia, depression)

Mobility

Encourage safe movement to prevent falls and maintain independence

Chronic Conditions for older adults

Older adults often have multiple chronic illnesses.

Polypharmacy

Risk of drug interactions and adverse effects

Increased Risk of Complications

Falls, infections, pressure ulcers, delirium

Functional Assessment for older adults

Evaluating ability to perform daily activities (ADLs & IADLs)

Nurse’s Role in Educating Older Adults

Health Promotion, Medication Management, Fall Prevention, Chronic Disease Management, Caregiver Support

Physical Abuse

1. Hitting, slapping, restraining.

   • Signs: Bruises, fractures, burns, unexplained injuries

Sexual Abuse

1. Non-consensual sexual contact.

   • Signs: Unexplained STIs, bruises in genital areas

Emotional/Psychological Abuse

1. Verbal threats, isolation, humiliation.

   • Signs: Depression, withdrawal, fearfulness

Financial Abuse

1. Misuse of money, fraud, coercion.

   • Signs: Sudden financial changes, missing possessions

types of neglect

active, passive

active neglect

Intentional failure to provide care.

passive neglect

Unintentional failure due to lack of knowledge/resources.

signs of neglect

Malnutrition, dehydration, poor hygiene, unsafe living conditions.

Abandonment

Leaving an elderly person alone without care.

Nurses’ Role in Detecting & Reporting Abuse

Assessment, Mandatory Reporting, Support & Advocacy

Acute Wounds

Heal in an orderly process; wound edges are clean and intact

Chronic Wounds

Healing is delayed due to factors like vascular compromise and chronic inflammation

Primary Intention

Surgical incision, edges approximated, minimal scarring, heals by epithelialization.

Secondary Intention

Wound edges not approximated; heals by granulation tissue formation, contraction, and epithelialization

Tertiary Intention

Wound left open for observation due to contamination/infection risk, then later closed.

Appearance of a wound

Size, depth, edges, presence of granulation tissue, slough, or eschar

odor of a wound

Unusual smell could indicate infection

Drainage Types

serous, purulent, sanguineous, serosanguineous

Serous drainage

clear,watery