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NSG2317 - health assessment > Additional Assessments > Flashcards

Additional Assessments Flashcards

- pain assessment - nutrition assessment - violence assessment

1
Q

Pain Perception

A

pain is a highly complex and subjective experience
- it can originate from the PNS, CNS, or both
- if the patient says they have pain, they have pain –> SUBJECTIVE

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2
Q

Nociceptors

A

located in he skin, connective tissue, muscles, and thoracic, abdominal and pelvic viscera
- identify and transmit pain stimuli to the CNS

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3
Q

Older Adults: Experience of Pain

A

older adults experience pain the same way everyone else does

–> pain IS NOT a normal aging process, it is indicative of an underlying disease or condition

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4
Q

Sources of Pain

A
  1. Nociceptive Pain
    a. Somatic Pain
    b. Visceral Pain
  2. Neuropathic Pain
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5
Q

Nociceptive Pain

A

pain caused by tissue injury
- well localized
- often described as throbbing, or
aching

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6
Q

Somatic Pain

A

Superficial - pain derived from superficial tissues and/or cutaneous tissues

Deep - pain derived from joints, tendons, muscle or bone

  • often easier to identify exact locations
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7
Q

Visceral Pain

A

pain originating from larger interior organs
- can be constant or intermittent
- poorly localized/ referred to another
area

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8
Q

Neuropathic Pain

A

pain originating from a lesion or disease of the nervous systems
- not well localized (may refer)
- described as burning, shooting,
lancing pain
- intensifies at night (no more stimuli to
distract)

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9
Q

Referred Pain

A

pain that originates at one location but is experienced at another

spinal nerves share pathways, thus pain along the nerve is experienced at the locations the nerve inervates –> brain cannot differentiate point of origin

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10
Q

Types of Pain (duration)

A
  1. Acute
  2. Chronic
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11
Q

Acute Pain

A

short term (3-7 days)
- follows a predictable trajectory –>
pain dissipates when injury heals
- serves a purpose - warns of actual or
potential tissue damage

unrelieved acute pain can lead to persistent (chronic) pain through peripheral and central sensitization
- increase in sensitivity of nociceptors to
stimuli that normally would not elicit
pain

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12
Q

Chronic Pain

A

long term, persistent (3+ months)

3 potential causes:
1. malignant - cancer related (worsens
with the progression of the disease)
2. non-malignant - not cancer related
(often musculoskeletal)
3. neuropathic - lesion or disease of the
somatosensory nervous system

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13
Q

Pain Behaviour: Acute

A

high risk of undertreatment
- cognitively intact but non-verbal
- use pain assessment tools + body
language to determine pain

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14
Q

Pain Behaviour: Chronic

A

high risk of under-detection
- have adapted to the pain
- understand patient’s perspective of
pain (what does it feel like, how is this
compared to your normal pain)

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15
Q

Pain Behaviour: Unconscious Patient

A

high risk of under-detection AND under treatment
- not cognitively intact and nonverbal
- unable to use body language, verbal
communication, or normal pain
assessment tools

use specialized tools + vital signs to detect pain
- patients will still experience pain when
unconscious

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16
Q

PQRSTUV

pain assessment

A

P - palliative/ provocative
Q - quantity/ quality
R - region/ radiation
S - severity (scale of 1-10)
T - timing (onset, consistency of pain)
U - understand the patient + their
understanding of pain
V - vitals

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17
Q

The Initial Pain Assessment is: (2)

A
  1. Timely - investigate pain immediately if
    detected
  2. Ongoing - continue to monitor and
    treat (especially if chronic or
    requiring meds)
18
Q

Nutritional Assessment (3)

A
  1. Optimal Nutritional Status
  2. Undernutrition
  3. Overnutrition
19
Q

Optimal Nutritional Status

A

nutrition consumed meets body’s metabolic demands
- tend to have fewer physical illnesses
- tend to live longer

20
Q

Undernutrition

A

insufficient nutritional intake in comparison to body’s metabolic needs
- nutritional reserves are depleted
- inadequate nutritional intake
Risks:
- impaired growth and development
(esp. children)
- impaired immune-system
- more frequent illness, delayed wound
healing

21
Q

Overnutrition

A

consumption of nutrients in excess of metabolic requirement
- associated with the development of
obesity –> although obesity may not
always result from over nutrition
Risks:
- development of type 2 diabetes
- development of hypertension
- development of CVD

22
Q

Older Adult Considerations of Nutrition

A
  • growth and nutrition requirements
    stabilize in adulthood (children have
    increased requirements)
  • after the age of 50, energy requirements
    decrease by 5% per decade –> reflects
    normal physiological effects of aging
    and lifestyle changes

more prone to undernutrition or overnutrition

23
Q

Types of Nutritional Assessments

A
  1. 24h recall
  2. food diary
  3. food frequency questionnaire
  4. direct observation
24
Q

24-h Recall

A

recall everything consumed in the last 24 hours
- patient may not remember

25
Q

Food Diary

A

record everything consumed over a period of 3 days
- patient may forget to log food
- patient may alter food intake

26
Q

Food Frequency Questionnaire

A

questions about the frequency of consumption of certain types of food
- patients may not remember
- patients may lie about frequency

27
Q

Direct Observation

A

nurse watches the patient eat their food
- patient might be uncomfortable and
alter eating habits

28
Q

Types of Violence

A
  1. Interpersonal Violence
  2. Structural Violence
  3. Gender-Based Violence
29
Q

Interpersonal Violence

A

ALWAYS an abuse of power with traumatic consequences

30
Q

Structural Violence

A

harmful societal distribution of power that puts certain people and populations at risk

31
Q

Gender-Based Violence

A

violence that is committed against someone because of their gender identity
- dangerous but often does not meet
the threshold for criminal behaviour

32
Q

Intimate Partner Violence (3 types)

A
  1. Intimate Partner Terrorism
  2. Resistant Violence
  3. Situational Couple Violence
33
Q

Intimate Partner Violence (IPV)

A

violence committed by current or former partners in a relationship
- can be physical, sexual, psychological,
or financial abuse

34
Q

Intimate Partner Terrorism

A

type of IPV involving coercive control, in which once partner tries to control the other
- has the most serious health
consequences

35
Q

Resistant Violence

A

type of IPV in which a partner experiencing intimate partner terrorism, responds with violence

36
Q

Situational Couple Violence

A

type of IPV in which conflicts and arguments turn to aggression that progresses into violence
- does not involve attempts to control
- gender symmetric in terms of
perpetration

37
Q

Health Effects of IPV

A

a. Direct/ Physical - bruises, soft tissue damage, fractures/ breaks, unintended pregnancy, STIs

b. Chronic - chronic pain, arthritis, CVD, neurological complaints, STIs/ HIV, UTIs, GI complaints

c. Mental Health - depression, anxiety, PTSD, sleep disturbances, suicide, substance use/ dependence

38
Q

Elder Abuse and Neglect

A

IPV that occurs in older adulthood –> either continued or new
- can be verbal, physical, psychological,
sexual, financial
** a single or repeated act of abuse or neglect within a relationship that harms or distresses an older person**

39
Q

Elder Abuse and Neglect Health Effects

A

a. Stress - cardiac complications
b. Friable Vaginal Musocal Tissue - vaginal
trauma, tearing, STIs
c. Localized Infections - generalized
sepsis, death
d. bleeding from trauma - changes in BP
and HR can lead to shock or death

40
Q

Trauma and Violence Informed Care (5 steps)

A
  1. Assume - patients have a history of abuse
  2. Assume - patients may currently be experiencing abuse
  3. Know - all forms of abuse are an abuse of power
  4. Anticipate - what might be traumatizing
  5. Routine Screening - of the impact of home and work on health
41
Q

How to Document Violence

A

detailed, objective, and unbiased
- include statements that specify the perpetrator and threats made
- do not sanitize language
- use direct quotations
- use injury maps if needed
- provide photographic evidence if consent is obtained

NSG2317 - health assessment (18 decks)

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