Week 4 Patient Education, Chronic Pain, Oxygen Delivery

Knowle’s 4 assumptions about adult learners

1. dependence turns to independence

2. previous experience is resource

3. readiness to learn related to developmental task/social role

4. orientation to learning is material should be useful immediately

Assessment of learner

identify needs, assess readiness, assess learning style, assess strengths, consider motivation

4 health beliefs needed to motivate patient

1. believe they are susceptible to disease

2. disease will have serious effects on life

3. actions they can take will reduce chance of contracting or lessen its severity

4. threat of taking actions not as great as threat of disease itself

Mastery experiences

patient can demo it

Vicarious experiences

client sees you do it

Verbal persuasion

convince patient to try, coach them

Physiological and affective states

good feedback from new learning “I feel better!”

Planning

set priorities, select timing to teach, organize teaching material, teacher/learner outcomes

Behavioral learning objectives

describes what learner will be able to do after successful instruction (SMART goals)

Good behavioral verbs

defines, identifies, chooses, demonstrates, differentiates, applies, compares

Bad behavioral verbs

knows, understands, appreciates, feels

Cognitive domain

result of thinking - Client will think…

Affective domain

reflect feelings, attitudes, values - Client will express feelings about…

Psychomotor domain

state action/skill - Client will demonstrate…

Different types of learning

visual - pamphlets, movies

auditory - talking, listening to tapes

kinesthetic - doing skill, feeling

Passive learning methods

allow learner to use his/her senses to absorb info and visualize behavioral rehearsal (includes videotapes, handouts, slides, lectures)

Active learning methods

involves learner through participation, allows learner to self-appropriate and self-experience (includes performing skill, providing feedback, reinforcing skill, practicing skill)

Teaching methods for nurses

one on one, groups, demos, analogies, role play, simulation

Evaluation

helps to reinforce correct behavior and change incorrect behavior, do methods work?, can patient perform outcomes/goals?

What parts of the body does arthritis affect?

joints, bones, skeletal muscles, connective tissues

Symptoms of arthritis

pain, joint swelling, limited movement, stiffness, weakness, fatigue

Osteoarthritis

“wear and tear” “degenerative joint disease” chronic, noninflammatory slowly progressive disorder that causes cartilage deterioration in synovial joints and vertebrae

True or false: osteoarthritis is symmetrical

FALSE - asymmetrical degenerative joint disease

Clinical manifestations of OA

pain after joint use, stiffness after inactivity, loss of movement, deformities, crepitus (rice krispies), grinding upon movement, joint feels hard (due to bone spurs), reactive inflammation of synovium

OA treatment

managing pain and inflammation, preventing disability, rest, heat/cold, weight loss/exercise, nutritional supplements

Risk factors for OA

age, obesity

Risk factors for RA

female, smoking

Rheumatoid arthritis

common inflammatory arthritic disorder, autoimmune reaction between macrophages, T cells, B cells, fibroblast, chondrocytes, dendritic cells, occurs mostly in synovial tissue

Characteristics of RA

symmetric, polyarticular (several joints), begins in small joints of hands, wrists, or feet

What percentage of people with RA have rheumatoid factor?

70-80%

Clinical manifestations of RA

joint pain, swelling, warmth, erythema, lack of function, joints feel spongy, reduced motion, joint instability (falls), morning stiffness, systemic: fatigue, anorexia, weight loss, fever, anemia, lymph node enlargement, joint deformities (ulnar drift, Swan’s neck, nodules)

Treatment of RA

rest, physical therapy, assistive devices, education, referal to community agencies, intra-articular injections if only few joints affects

True or false: anti-inflammatory diets can help clients with RA.

TRUE - reduce inflammation and can decrease symptoms: mediterranean diet (olive oil, nuts, omega 3s, less omega 6s)

Fibromyalgia

chronic pain syndrome characterized by diffuse musculoskeletal achiness (not in joints), stiffness, fatigue, tenderness

Risk factor for fibromyalgia

being female

Pathophysiology of fibromyalgia

decreased ATP and ADP in muscles, less blood flow to thalamus (pain center), lower serotonin and endorphin levels, abnormal processing of sensory input with magnified pain sensation in muscles and skin

What causes onset of fibromyalgia?

viral infection, chronic stress, chronic fatigue, HIV, lyme disease, physical trauma, chronic sleep disturbance, prolonged pain going untreated

Clinical manifestations of fibromyalgia

burning pain, extreme fatigue, muscle weakness, paresthesias, tender points, chronic headaches, memory loss (fibro fog), light sleepers, mood disturbances, IBS, cold sensitivity

Treatment of fibromyalgia

validation, lifestyle management (patient education, exercise, cognitive therapy), meds (NSAIDs, antidepressants, anti-seizure, muscle relaxants, sleep aids)

What affects tissue oxygenation?

ventilation, perfusion, gas exchange and transport (vascular, cardiac)

Pulmonary ventilation

inspiration - active phase - movement of muscles to bring air into lungs

expiration - passive phase - air out of lungs

Factors influencing diffusion of gases in lungs - perfusion

change in surface area available, thickening of alveolar-capillary membrane

Gas exchange - respiration

intake of oxygen and release of CO2, occurs via diffusion (between air and blood)

Oxygen transport

blood (Hb) oxygenated with ventilation and perfusion of lungs, transports respiratory gases between lungs and tissues

Transport of respiratory gases

oxygen carried in body via plasma and red blood cells, most oxygen carried by RBC in oxyhemoglobin form, internal respiration between circulating blood and tissue cells must occur

Nasal cannula

1-6 L of oxygen, can be humidified

Oxymizers

up to 15 L of oxygen, can’t be humidified, decreased amount of O2 needed in tank

Nasopharyngeal catheter

tolerated better than endotracheal if patient is awake, not used if facial trauma/skull fracture

Transtracheal catheter

for chornic long term use of O2 therapy, delivers oxygen directly to lungs

Simple mask

delivers low volumes of O2, good for mouth breathers (but have to remove to eat), side ports allow room air to mix with delivered O2 and allow exhaled air to escape

Partial rebreather

mask with reservoir bag, delivers moderate to higher levels of O2, side port openings vent air, bag MUST remain inflated, delivered O2% varies depending on rate/depth patient breathes at

Nonrebreather

mask with reservoir bag that delivers high concentrations of O2, during inhalation: expiratory valve closes to prevent air from entering mask while inspiratory valve on top opens to provide oxygen, during exhalation: expiratory valve opens to allowed air to escape while inspiratory valve on top closes to prevent exhaled air from entering bag

Venturi mask

multiple different ports to adjust oxygen levels, delivers more precise concentration, ensure ports are unobstructed!

Tent

used for humidification and oxygen only when patient can’t/won’t tolerate tight mask, difficult to estimate how much O2 delivered

Precautions for oxygen administration

avoid open flames, no smoking signs, electrical equipment working, avoid synthetic fabrics (builds static electricity), avoid oils (ignite in oxygen)

Inhalation drug therapy

metered-dose inhalers

dry-powder inhalers

nebulizers