NURS 3120 MODULE 1

Pulse:

• Normal heart rate for adults: 60-100 beats/ min

How to measure:

• Most common= radial pulse

• Count for 30 secs and multiply by 2

Abnormal findings:

• Tachycardia- exceeds normal pulse

• Bradycardia- slower pulse

• Asystole- no pulse

Normal findings:

• Regular rhythm

• Strength (0-4+) scale:

  • 0 = nonpalpable or absent

  • 1+ =weak, diminished, and barely palpable

  • 2+ = normal, expected

  • 3+ = full, increased

  • 4+ = bounding

Respirations

• Act of breathing 

• 1 inspiration +1 expiration= 1 respiration

• Respiratory rate= 12-20 breaths/min, regular adult

• Dependent upon various factors

• DON'T TELL PATIENT THAT YOU ARE COUNTING THEIR BREATHS

Abnormal findings:

• dyspnea= difficulty breathing

• Bradypnea = lower than expected 8-12 breaths/min ( caused by changes in pressures in cranium; sedation)

• tachypnea=rapid persistent increase in respiratory rate (20 breaths/min)

• Apnea= no breaths for greater than 10 seconds

Oxygen Saturation

• Percentage hemoglobin is filled with oxygen

• Normal pulse oximetry (SpO2): 92 % to 99%

• SpO2 < 85%; inadequate oxygenation; possible emergency

• SpO2 of 85% to 89%; possibly acceptable for patients with chronic conditions, such as emphysema

• Pulse oximetry readings of 100% may be an indication of hyperoxemia

• Potential measurement error causes- nail polish

• Documentation

• Oxygen order should not be over used

Blood Pressure:

• Measurement of force exerted by blood blow against arterial walls

Systolic blood pressure: SBP

• Left ventricular contraction: maximum pressure

Diastolic:

• Left ventricular relaxation; minimum pressure

Adult ranges: 90-120mm Hg SBP; 60-80 Hg DBP

Adult average: 120/80 mm Hg

Things that affect BP:

• Cardiac output: peripheral vascular resistance

• Patients position

• Crossed legs

• Males after puberty

• Smoking-vasoconstriction

• Using the wrong size cuff

Orthostatic : change in BP (drops) and heart rate changes

Reflects the Relationship between cardiac Output and Peripheral resistance

Cardiac Output= volume of blood ejected from heart each minute

Pain:

1. Acute =  sudden onset related to injury

   1. Recent tissue damage

2. Chronic= lasts for greater than 3 months in duration

3. Visceral = originates from abdominal organs

4. Somatic = pain that originates from bones, muscles, joints, - sharp pain

5. Cutaneous = skin- sharp/ burning

6. Referred = originates from a specific site but comes from another area

7. Phantom = neuropathic pain (missing limb)

8. Neuropathic:

   1. More constant stimulus resulting in neuronal plasticity

   2. Peripheral sensation

      1. Result of inflammatory process

      2. Nonpainful touch/ pressure becomes painful 

9. Nociplastic:

   1. Pain that has no identifiable cause- chronic low back pain

SBAR: sharing informaiton

Situation

Background 

Assessment

Recommendation

Role of Nurse:

• Health promotion, illness prevention, treating human response, and patient advocacy

Values:

• Caring, diversity, integrity, excellence

ADPIE

• Assessment

• Diagnosis

• Planning

• Implementation

• evaluation

Assessments:

• Emergency :medical evaluation of a patient’s condition during an emergency

• Comprehensive: systematic process of gathering and analyzing information to determine an individual's needs

• Focused: detailed evaluation of a specific body system 

Subjective data:

• Patients perception

• Anything that comes out of the patient's mouth or family’s mouth

Objective data:

• Collected by the physical assessment

• Observed by the nurse

Prioritization

• Maslow's, urgent, safety, Nursing Process, Survival Potential and least restrictive

Chapter 2:

Phases of interview:

1. Pre Interview

   1. Data collection

2. Beginning phase

   1. Introductions

   2. Discuss purpose of interview

3. Working phase

   1. Close-ending questions/ direct questions

   2. Open-ended questions

4. Closing phase

   1. End of the interview

OLDCARTS:

O nset =  when did it start; acute, chronic, in between ?

L ocation =  where is it ?

D uration =  how long has this lasted?

C haracter = pain; dull, sharp  ?

A ggregation/ Alleviation =  what makes it feel better/worse ?

T iming = does it occur after certain situations?

S everity = scale of 1-10 ?

Therapeutic Communication:

• Caring

• Empathetic

• Verbal vs non-verbal

• Active listening: non verbal cues

• Restatement: “So you want to address your depression today with your doctor?”

• Reflection: “you sound pretty nervous about surgery”

• Elaboration: “tell more about that… go on”

• Silence: presentations are communication tools that can be sued as demonstrations

• Focusing: “you mentioned you had an allergy to penicillin, lets talk about that”

• Clarification: “tell me what you mean when you say a heaviness in your chest”

NON-THERAPEUTIC VERBAL COMMUNICATION:

• False reassurance

  • “You wont feel any pain after surgery”

• Sympathy

  • “I know how you feel”

• Unwanted advice

  • “I think you should have this surgery”

• Biased questions

  • “You don't use viagra, do you?”

• Changes of subject

  • “We cant talk about your headaches right now we need to focus on your meds”

• Distraction

• Technical language:

  • “When were you incontinent of urine?”

Chapter 2 Summary:

• Nurses exude empathy and caring, while utilizing verbal and nonverbal skills

• There are therapeutic and non-therapeutic ways to verbally communicate with your patients

• Maintaining professionalism during your interactions with your patients is critical

• Primary data= comes from patient

• Secondary data= family or chart

• 4 phases of the interview process

• Components of the health history is inclusive from demographics, medical history, meds, and ROS

Chapter 3: Infection Control, Safety

• Hand hygene

  • Most important transmission prevention strategt

  • Use alcholol-based hand sanitizer or wash with soap and water, depending on situation

  • Possible skin reactions

• PPE

  • Depends on type of anticipated exposure

  • Durability and approptirateness for task

  • Must properly fit user

• Gloves

  • Important transmission prevention strategy

  • Five sequential steps for patient-to patient pathogen transmission

• Respiratory precautions

  • Wearing masks/repsitaorts

• Eye protection

  • Goggles, face shields

• Gowns

  • Fluid resistant, fluid proof, neither

• Source control

  • Where pathogens are and how they move

  • Contact, splash, inhalation, sharps injuries

  • Can include masks, hand hygiene

• Transmission-based precautions

  • Contact precautions

    • Appropriate patient placement

    • PPE

    • Limit transport and movement of patients

    • Disposable or dedicated patient care equipment

    • Prioritize cleaning and disinfection of rooms

  • Droplet precautions

    • Source control

    • Appropriate patient placement

    • PPE

    • Limit transport and movement of patient

  • Airborne precautions

    • Source control 

    • Appreciate patient placement in airborne infection isolation room

    • Restrict susceptible healthcare personnel from entering room 

    • PPE

    • Limit transport and movement of patient

    • Immunize susceptible persons as soon as possible following unprotected contact

Inspection: what is seen

• Gain overall impression of patient and to assess the severity of the situation

• Consciously observing patients, gathering data

• Only technique used for every body part, system 

• Overall observation = general survey

• Adequate exposure of each body part is necessary, maintaining modesty is very important

• Devices may limit visibility: adjust device to facilitate complete inspection

• Accurate documentation of findings are important for communication; are legally binding

• Note if data is consistent; identify patterns or clusters

• Characteristics for inspection

  • Physical characteristics and behaviors

  • Odors

  • Age, gender

  • Level of alertness

  • Body size, shape

  • Skin color

  • Hygiene

  • Posture

  • Level of comfort/anxiety

• Details:

  • Following general survey, process to specific body areas and systems

  • Adequate exposure is necessary, maintain comfort and privacy of patient

  • Ensure adequate lighting

  • Ask permission before exposing body parts, especially sensitive areas

  • Accurate descriptions vital 

  • Pay attention to individual details

Palpation

• Use of touch with the hands to assess texture, temp, moisture, size, shape, location, position, moisture, size, shape, location, position, vibration, crepitus, tenderness, apin edema

• Finger pads: fine discrimination for pulses, small lumps, skin texture, edema

• Finger palmar surfaces, finger oints: firmness, contour, position, size, pain, tenderness

• Palm: abdominal assessment

• Dorsal surface of hand: temperature

• Ulnar surface of hand: vibratory tremors, air movement in lungs

• Levels of Palpations:

  • Light palpation (1cm)

    • Appropriate for surface characteristics

  • Moderate (1-2cm)

    • Assess abdominal organ characteristics

    • Use pressure form both hands, palmar surface of fingers

  • Bimanual deep palpation (2-4cm)

    • Similar to moderate

    • Apply pressure with both hands, non dominant hand over dominant hand 

Percussion: 

• Produce sound or elicit tenderness

• Conducted sounds via:

  • Dense tissue: quiet or flat tones

  • Quietest over bones

• Air, fluid: louder tones

  • Loudest over lungs, hollow stomach

• Direct percussion: tap finers directly on skin

• Indirect percussion: use dominant hand as barrier on which to strongly tap

Percussion tones:

• Flat, dull, resonant, tympanic

Percussion sounds

• Intensity or loudness: volume of sound

• pitch/frequency: vibration oscillation speed

• Duration: length of time sound lasts

• Quality: subjective description of sound

Ausculation

• Listening sounds of movement form organs and tissues, to assess function

• Stethoscope and quiet environment

• Common foci

  • Blood pressure, lungs, heart, abdomen

• Descriptors

  • Intensity, pitch, duration, quality

  • Crackles, gurgles, swooshing, knocking, intermittent, lub-dub, rhythmic, rustling, wispy

• Stethoscope

  • Conducts (does not amplify sound)

  • Blocks environmental noise

  • Light contact to hear low-frequency sounds

  • Firm contact to hear high-frequency sounds

  • Diaphragm- used for most sounds (heart and lungs)

  • Bell- low pitched sounds- heart sounds

  • Disinfect between patients

  • Make direct contact with skin

  • Avoid listening over clothing

  • Place endpiece between the index and the middle fingers, not on top of the stethoscope

  • Moisten body hair to avoid crackly noise as hair and stethoscope make contact

Advanced Techniques and Special Equipment:

• Ophthalmoscope

  • Visualizes interior eye structures

• Visual acuity chart

• Otoscope

  • Enables visualization of ear canal, tympanic membrane

• Tuning fork

  • Conductive versus sensorineural hearing loss

  • Neuromuscular vibration sense

Equipment for a Complete Physical Assessment:

• Thermometer; alcohol; electronic or manual BP machine; watch with second hand; stethoscope

• Scale; flashlight

• Materials for recording findings

*** Older Adults:

• May chill more easily, offer additional blanket or drape

• May fatigue quickly, perform most important assessments in the beginning

• When postiiong, slight elevation of the head of bed or examination table may help facilitate breathing

Techniques of Physical Assessment: 

1. Inspection

   1. Assists with objective physical data

   2. Only technique used for EVERY BODY PART

   3. Physical characteristics

   4. Behaviors

   5. gender/age

   6. Alertness

   7. Body size/ shape

   8. Skin color

   9. hygiene/posture

2. Palpation

   1. Purpose

   2. Finger pads

   3. Palmar surfaces

3. Percussion

   1. Sound generation/ to identify tenderness

   2. Dense.quiet tones occur over bone

   3. Air fluid loud over lungs, stomach

Summary of Chapter 3:

• There are 4 techniques: inspection, percussion, palpation, and auscilation

• Hand hygiene first!

• Inspection relies on our sense and we look at the entirely of our patient

• Palpation assists with identifying temperature, swelling, pain, moisture and shapes of lumps

• Percussion elicits different sounds that assist with organ identification (resonant sound over organs), dull sound over 

• Auscultation assist with cardiac/lung and GI assessment

• The stethoscope has the diaphragm where bell is used for more lung/heart sounds

• Best techniques for auscultation directly over skin and not disturbing the tubing

• Other equipment such as ophthalmoscope, otoscope, tuning fork and reflex hammer assist with other system exams

Chapter 4: Documentation and Interprofessional Communication

Patient Medical Record #1:

• Purpose of medical record:

  • Legal document

  • Used in civil or criminal courts for evidence

  • Sentinel event

    • An unexpected occurrence involving death or serious physiological or psychological injury

    • Almost ¾ of all serious, often life-threatening error in healthcare involve failures in communication

  • Communication and care planning

  • Quality assurance

    • Audit

      • Internal

      • The Joint COmmission

    • Financial reimbursement

      • Medicare, medicaid, worker’s compensation insurance, third-part insurance companies

      • Never events

      • Meaningful use

  • Education

    • Enhance clinical learning

  • Research

    • Strict policies to protect privacy and rights of individuals 

Never Events

• Medicare and medicaid have stopped reimbursement for some hospital-acquired complications, referred to as never events, because they are preventable through the use of evidence-based guidelines and should never occur

Components of Medical Record:

• Nursing admission assessment 

• History and physical examination (H &P) by primary healthcare provider

• Advanced directive, power of attorney

• Primary provider’s orders

• Care plan or clinical pathway

• Flow sheets

  • Vital signs; intake and output (I&O)

  • Routine assessments

• Components

• Focused assessment sheets

  • Medication administration record (MAR)

  • Laboratory, diagnostic test results

  • Progress notes: members of the healthcare team

  • Consultations

  • Discharge or transfer summary

** Electronic medical record

• Software programs allow entry of assessment data quickly

• Electronic medication administration record

  • Interface with pharmacy; direct computer charting of medication administration

• Computerized provider order entry (CPOE)

  • Direct entry of all orders by healthcare providers to laboratory, pharmacy, nursing personnel

  • All entries are legible, time dated

  • Automated clinical surveillance tools

Priority Urgent Assessment:

• Warrant immediate attention and interventions

  • Respiratory rate <8 or > 28 breaths/min

  • Acute change in oxygen saturation <90%

  • Threatened airway

  • Acute change in systolic blood pressure (<90 mm Hg or diastolic blood pressure) (>110 mm Hg)

  • New-onset chest pain; signs of acute MI

  • Acutely cold, cyanotic, or pulseless extremity

  • Confusion, agitation, or delirium

  • Unexplained lethargy or acute altered mental status

  • Difficulty speaking or sings of acute stroke

  • New seizure

  • Temperature > 102.2 

  • Uncontrolled pain

  • Acute change in urine output (<50 ml over 4 hours)

  • Acute bleeding

  • Suspected severe sepsis

Principles Governing Documentation:

• Confidentiality

  • Health Insurance Portability and Accountability Act (HIPAA, 1996)

    • Rules require protection of specific health information

    • Keeping clients health information private

    • Applies to computerized and written medical records; any information pertaining to health status or care received

    • Severe penalties for violations

• Accuracy and completeness

  • Must precisely reflect assessment data

  • Subjective data: client’s exact words whenever possible

  • Correct medical terminology

  • Legally accepted abbreviation use

    • The Joint COmmission “Do Not Use” abbreviations

  • Proper format for noting record corrections

  • Handwritten entries must be clear and legible

• Logical organization

  • Systemic grouping for information

• Timeliness

  • Follow agencies policy 

  • Avoid batch charting

  • Point of care documentation

  • Enables up-to-date assessment information to make clinical decisions

• Consciousness

  • Avoid lengthy sentences, use sentence fragments

Documentation

• Agency policy governs precise documentation of assessment data in client’s record

• Nurse will use critical thinking and clinical judgement to determine focus

• Nursing admin assessment (nursing history and physical)

• Flow sheet- vital signs, I&O, routine care

• Plan of care and clinical pathway

• Progress or case note

  • Consolidation of all team members’ entries in one place

  • STEP: status of client team members, environment, progress toward goal 

• Formats:

  • Narrative notes: unstructured paragraph, based on time

  • SOAP (IE) notes: subjective; objective; analysis; plan; intervention; evaluation 

  • PIE notes: problem; interventions; evaluation

  • DAR note: data; action; response

• SOAP Notes

  • S: subjective assessment finding

  • O: Objective assessment findings

  • A: Analysis of the assessment data to identify a problem or indicate whether the problem is improving or worsening

  • P: plan for treating or improving the problem

• Charting by exception

  • Predetermined standards and norms to record only significant assessment data

  • Nurse checks box if client meets designated norms

  • Any abnormal assessment findings require additional documentation

• Discharge note

  • Indicate client’s status, received necessary education, discharge instructions, condition and time of discharge

• Written handoff summary

  • Transfer of care for a client 

  • “I PASS the BATON”

    • Introduction; Patient; Assessment; Situation; Safety; (the) Background; Actions; Timing; Ownership; Next 

    • To minimize potential errors from lack of information, agencies often provide specific assessments on written transfer summary in addition to verbal report 

Verbal Communication

• Verbal handoff summary

  • Transition of care

  • National Patient Safety Goals 

  • Handoff reporting

  • Call outs

• Reporting

  • Occurs at handoffs, during patient rounds, during patients and family care conferences, when calling or texting a provider to report a change in status or provide requested information

  • Potential barriers: lack of structured format and standards and policies for communication: uncertainty about who is responsible and should be contacted; power differences; cultural background differences; poor clinical decision making regarding what needs to be reported; different communication styles

  • qualities  of effective reporting

    • Organized; complete; accurate; conside; respectful

    • Nonverbal communication

    • Difference in communication styles between nurses and providers

• SBAR Model

  • Situation 

  • Background 

  • Assessment

  • recommendation/request

  • Can be used when contacting provider or giving handoff report

  • Standardized format

• Reporting to the primary healthcare provider

  • Face to face, telephone, text messaging, fax

  • Ensure contacting correct provider 

  • Phone and urgent communication 

    • Have patient information available for reference 

    • Document call 

    • CPOE allows remote computer access for entering orders when off-site

    • “Read back”

Summary:

• Medical records are legal documents that help with communication, financial reimbursement, education, and research

• EHR contains data about patient’s condition, chart advisories, and critical elements

• HIPPA is a necessary law to uphold when it comes to documentation

• All clinical documentation must be accurate, complete, organized, concise, and completed in real time

• SBAR is the effective hand off of communication (QSEN)

• Telephone orders require read back, controversy with verbal orders

Chapter 6- Vital Signs, Pain, and General Survey

Vital signs:

• Temp

• Pulse

• Respirations

• BP

• Oxygen saturation

Establish baseline, monitor condition, evaluate responses, identify problems, monitor risks for alterations in health

Priority Urgent Assessment 

• Extreme anxiety; acute distress; pallor; cyanosis; mental status change

• Interventions begin while continuing the assessment 

• Rapid response team may be called for:

  • An acute change in mental status

  • Stridor

  • Respirations <10 or >32 breaths/min

  • Increasing effort to breathe

Questions about past medical and surgical histories 

• Medication and supplement use

• Family history

• Food and fluid intake patterns 

• Psychosocial profile

• Age

• Gender

Teaching and Health Promotion

• Instruct patients in proper ways to conduct basic actions such as weighing oneself 

• Educate about risks for certain disorders such as hypertension

• Every interaction is a teaching opportunity

• Teach proper reaction to abnormal signs or symptoms related to vital signs

Objective Cues:

• Assess general survey

• Obtain height and weight

• Obtain temp, pulse, respirations, BP

• Obtain oxygen saturation

• Evaluate pulse deficit

• Assess for orthostatic hypotension

• Doppler pulse and BP

Preparation:

• Environment

• Proper hand hygiene

• Before measuring vital signs

  • Have patient rest for at least 5 mins

  • Assure patient has not eaten, drank, or smoked in the past 30 mins

  • Remove clothing constructive to upper arm

  • Patient may be sitting or lying down

General survey:

• Begins with the first moment of the encounter with the patient and continues with each interaction that follows

• First component of the assessment

• Contributes to formation of global impression of the person

• Includes physical appearance, body structure, mobility, and behavior

Assess:

• Physical appearance

  • Overall appearance

  • Hygiene, dress

  • Skin color, body structure, development

  • Behavior, facial expressions

  • Level of consciousness; speech

• Mobility

  • Posture, range of motion; gait 

Anthropometric Measurements:

• height/weight

  • Calculation of BMI

• Vital signs

  • Often indicates changes in health

    • Assess patient medication first

    • Frequency of measurement

    • Provides baseline measurements

  • Rationale for measurement of one vital sign

    • Medication admin; elevated temp

BODY TEMP

• 97.7 to 98.6

  • Rectal, temporal artery ( a little greater than oral temp : .7-1)

• Diurnal cycle

• Thermometer types

  • Electronic; disposable; tympanic; temporal artery; rectal

• Appropriate toure selection: critical thinking

• Doccumentaiton 

Gate Control Theory:

• Theory with widest acceptance- body responds to pain by either:

  • Opening a neural gate to allow pain to be produced 

  • OR creating a blocking effect at the synaptic junction to stop the main

• Steps for pain transmission

  • Gate opens due to continued painful stimulus 

  • Pain passes from PNS to CNS

  • Pain passes from spine to limbic system, cerebral cortex

  • Stimulus identified as pain; passes through efferent pathways; reaction created

• Pain-facilitating and pain inhibiting substances

Priority Urgent Assessment

• Some pain must be assessed and treated immediately to prevent potential damage

• Chest pain→ myocardial infarction

• Worst headache of my life → cerebral hemorrhage

• Acute pain produces high BP, tachycardia, diaphoresis, shallow respiration, restlessness, facial grimacing, guardian behavior, pallor, pupil dilation

• Can cause significant, unnecessary physical, physiological, and emotional distress

• Always investigate underlying cause of acute pain

Subjective Data:

• Assessment of risk factors

  • Untreated or completely untreated acute pain especially after surgery or crush-type injury

  • Complex regional pain syndrome

  • Develop neuropathic pain

• Teaching and health promotion

  • Importance of reporting pain and taking pain medication

  • If continue to refuse pain medication, ask patient about it

  • Pain is what the patient says it is and where it is 

Assessment Mnemonic: OPQRST

• O: onset

• P: provocative or palliative

• Q: quality

• R: region, radiation

• S: severity

• T: timing

Objective Cues:

• Physiological effects

  • Neurological, cardiac, pulmonary, gastrointestinal, genitourinary, musculoskeletal, skin, metabolic

• Behavioral responses

  • emotional , social, vocalization, verbilation, facial expression, body actions

• Patients unable to veralize

  • Vocalizations, facial grimacing, bracing, rubbing painful areas, restlessness, vocal complaints

Pain Assessment Tools:

• One-dimensional pain scales

• Visual analog scale (VAS)

• Numeric Pain Intensity scale (NPI)

Lifespan Considerations #1:

• Newborns, infants, and children pain assessment

• Complex; challenging

• Painful for adult =  painful for child

• Common tools: FLACC (2 months to 7 years old) FACES > or equal to 3 years old 

Older Adults:

• Pain is prevalent; may be seen as natural part of aging

• Many chronic illnesses cause pain

• May be stoic and conceal pain

• May fear results of having pain, so don't say anything 

• Assess effects of pain on lifestyle

• Ask about comorbidities 

• Review all medication, vitamins, herbal supplements

Special Situations

• Patients unable to report pain

  • Attempt self-report; try to identify potential pain causes

  • Observe behaviors; ask family/care providers

  • Attempt analgesic trial 

• The opioid crisis

  • Related to misuse and abuse of opioids

  • CDC guidelines for pain management affect use of opioids

• Difficult challenges for pain assessment

• Opioid hyperalgesia

• High level of bias from healthcare providers

• Often labeled as drug seeking

• Patients with history of substance use are entitled to pain relief

• Patient provider agreement PPA

• Be aware of common aberrant behaviors

Reassessing and Documenting Pain

• Joint Commission (2021) has set standards on pain management

  • Assess and reassess pain regularly 

  • Reassess to make sure treatment has been effective

  • Proper documentaion

  • Nurses need to be aware of old ideas and misconceptions, and incorrect beliefs about pain management

Barriers to Pain Assessment

• prejudices/bias affect nurse’s perception of patient self report of pain

  • Educational values

  • Family values

  • Cultural values

• Inaccurate or ineffective pain assessment may result in

  • Incorrect medication choice

  • Incorrect treatment choice

Make Clinical Decisions

• Analyze laboratory and diagnostic testing

• Prioritize hypotheses and take action

• Determine appropriate nursing action

• Analyzing changing findings: progress notes

• Generate solutions

• Plan the care evaluate outcomes

Gate Control Theory of Pain:

• OPEN GATE= pain signals pass through the brain, you experience pain

• CLOSED GATE= pain signals are blocked from reaching the brain and you experience less pain

Chapter 6: Pain Assessment

Pain Theory:

1. Painful stimulus

2. Gates open 

3. PNS

4. CNS

5. Limbic system- cerebral cortex

6. Stimulus-efferent pathways

Pain Physiology

• Peripheral Nervous System (A delta and C fibers)

• Central Nervous System (limbic, substance P, glutamate)

• Descending nerve fiber transmission

Summary:

• Gate Control theory discusses the modality of pain transmission

• There are different types of pain including acute, chronic, neuropathic, and noci plastic

• Pain response differs across the lifespan and may utilize verbal and non-verbal objective cues

• The numeric pain scale, FLACC and Wong’s FACES are common pain scales utilized

• Interventions for pain control should do the least aggressive form 

• There can be challenging populations to treat if there is opioid tolerance

• Documentation is critical and goal development should align with SMART criteria

General Survey begins at the first interaction with the patient but it is continuous 

Difficulty breathing- call for assistance while taking vital signs

Practice questions 

1. Palmar surface of hand - high concentration of sensory receptors

*** Dorsal side of hand- temperature 

***Ulnar side of hand- vibrations

**fingertips- palpating 

2. Heart Murmur- which side of stethoscope- low pitch

   1. Bell, placed lightly against the skin

3. Hypoxia- low oxygen