N212 GERO EXAM 2 HIGHLIGHTABLE MOMENTS. A+ RATED STUDY GUIDE.CHAPTER 14 PAIN
Understanding Pain
Pain is individual and can be very different for
... [Show More] different persons with the same disease or injury
“Whatever the experiencing person says it is, existing whenever he or she says it does”
“A subjective**, personal, unpleasant experience involving sensations and perceptions that may
or may not relate to bodily or tissue damage” Aronoff (2002)
Pain Classification
Acute pain: rapid onset**, relatively short duration** and a sign of a new health problem
requiring diagnosis and analgesia
Treat underlying cause—short-term analgesia
Other types of pain
Conditions such as conversion reaction*** or psychologic disorders***
Pain Assessment
Cultural pain assessment****
ACUTE PAIN – HIGHER DOSE
CHRONIC – LOW AND SLOW TITRE UP
Pain is an individual experience
Pain intensity and pain distress are related to factors such as culture, past pain experiences, individual
attributes, and pain threshold
History and Physical Examination
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N212 GERO EXAM 02 HIGHLIGHTABLE MOMENTS
Address: the onset, location, duration, intensity, characteristics, aggravating and alleviating
factors, and self-treatment or other prescribed treatments that either helped or did not help
P, Q, R, S, T, U (mnemonic***)
PROVOKES
QUALITY
RADIATION
SEVERITY
TIME – HOW LONG?
U - HOW DO U FEEL?
Additional Evaluations
Evaluation for depression
High incidence of depression associated with chronic pain
Persistent depression** affects person’s ability to cope with pain,
it must be treated
Geriatric depression scale
The nurse has just started a hospital job where the majority of her patients are older adults. It is
important that the nurse remember which of the following regarding older adults and pain? (Select all
that apply.)
a. They may have several chronic illnesses that cause them pain.
b. They tend to overuse pain mediation.
c. They believe pain is natural outcome of cancer.
d. When they are confused, they may not respond pain in the usual way.
e. They do not understand pain scales.
Answers are a, c, d
Pharma cologic Treatment
***Nurses must be knowledgeable of the physiologic changes of aging that can alter drug
absorption, metabolism, and excretion in the older adult
Non-Opioid Analgesics
First-line approach to pain management
Acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve)
IBUPROFEN = DAMAGE STOMACH**
ACETAMINOPHEN = DAMAGE LIVER **
Acetaminophen is drug of choice for musculoskeletal pain; does not affect platelet levels
Maximum dosage is 4000 mg/24 hours
**TX: CHARCOAL AND GASTRIC LAVAGE
Opioid Analgesic Side Effects
Nausea, vomiting, constipation, and urinary retention***
STOOL SOFTENER, HIGH FIBER DIET, WATER, INCREASE RISK FOR FALLS, CRANBERRY,
Adjuvant Medications
Anticonvulsants, antidepressants, and some sedatives***
Alter or modulate the perception of pain
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N212 GERO EXAM 02 HIGHLIGHTABLE MOMENTS
Complementary and Alternative Medicine (CAM)
Two subgroups
Natural products: include herbals and botanicals, as well as vitamins and minerals
Mind and body practices: include acupuncture, massage therapy, meditation,
movement therapies, relaxation techniques, spinal manipulation, tai chi, healing touch,
and yoga
Other Therapies
Exercise and physical therapy prevent stiffness, maintain function, relieve muscle spasms, and
increase one’s sense of well-being
Peripheral nerve stimulation is a chronic pain management technique in which electrical leads
are placed subcutaneously into the area of a person’s pain
Music therapy
Hypnosis
Education
PAIN MEDS – LOOK FOR CONSTIPATION, RESP DEPRESSION, HYDRATION,
ADJUVENT MEDICATION – ADDED TO OTHER MEDS
NON-ANALGESICS USED TO TREAT PAIN, - ANTIDEPRESSANTS/ANTICONVULSANTS***. SOMETIME
SEDATIVES (AND ANTIANXIETY)
CHAPTER 15 – INFECTION
Chain of Infection
For infection to occur, there must be a
reservoir of an infectious disease,
A PORTAL OF ENTRY***
susceptible HOST**
NOSOCOMIAL infections: acquired in the hospital
COMMUNITY ACQUIRED: acquired outside the healthcare facility
Age-Related Changes in the Immune System
As age increases, so does production of auto antibodies
Increased auto antibodies causes an increase in autoimmune disease***
Skin becomes more fragile and prone to breakdown or abrasion***
INCREASE LIKELIHOOD OF INFECTION
Factors Affecting Immunocompetence
Protein-energy (caloric) malnutrition***
Deprivation of protein and energy nutrients ***has been shown to result in alteration
in immune function
Psychosocial factors***
Chronic and acute stress, depression, bereavement, and social relationships
Risks associated with the development of a nosocomial infection include poor nutrition,
unintentional weight loss, low serum albumin levels, decreased fluid intake, poor oral hygiene,
and altered mental status
Factors contributing to inadequate nutrition include altered taste, social isolation, physical
inability to prepare food, altered absorption, and poverty
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N212 GERO EXAM 02 HIGHLIGHTABLE MOMENTS
Common Problems and Conditions
Common infections in older adults include influenza, pneumonia, tuberculosis, urinary tract
infections, and shingles***
Influenza and Pneumonia
Community-acquired pneumonias are caused by bacteria: Streptococcus pneumoniae or
pneumococcal pneumonia
PNEUMOCOCCAL VACCINE is recommended for everyone over the age of 65
Cancer
Presence of the cancer reveals presence of decreased immune response
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