Nursing 330 ch5, 10, 17, osteoarthritis – Flashcards

Prevention - exercise, good nutrition, mental health, being physically active, avoiding tobacco or harmful substances. Primary - preventing (diet exercise immunization) Secondary-detection of disease, screenings Tertiary - after disease process (chronic illness) Most common chronic illnesses in older adults: HTN, arthritis, heart disease, cancer, DM and co-morbidities Prevention of Chronic Illness: most preventable: adopt healthy behaviors such as eating nutritious foods, being physically active and avoid tobacco. So, major causes would be sedentary lifestyle, unhealthy food, smoking, drug use, alcohol (excessive)

• debilitating • preventable • rapid onset • need long term therapy • Permanent impairments of deviations from normal • Nonreversible pathologic changes • Residual disability • Special rehabilitation required • Need for LT medical and or nursing management

Older Adult women • more likely to live alone, • less likely to have health insurance • Have lack of formal work experience • Care for an ill spouse • Have a higher incidence of chronic health problems Cognitively impaired adult • May exp a memory lapse or benign forgetfulness that is not r/t a cognitive impairments (sometimes just forgetful) Rural Older Adult • 5 barriers: • Transportation, limited supply of HC workers and facilities, lack of quality HC, social isolation, financial limitations • Homeless • r/t low income, reduced cognitive capacity, living alone, lack of affordable housing

Maintain disease, STOP progression; work with what we've got

"what the pt says it is" and "unpleasant sensory and emotional experience associated with actual or potential tissue damage.

IV PO IM and topical, epideral, transmucosal. IV is the quickest. For pain scale of acute vs chronic you will probably will not get less than 3/10 for pain. Want them to be able to do what they want to do: GOLF. Evaluate them by them being able to do what they want to do. It also shows you care.

Consequences of untreated pain: unnecessary suffering, physical and psychosocial dysfunction impaired recovery from acute illness and surgery, immunosuppression, sleep disturbances. Pain relief is essential step in relieving suffering. If believe pain is uncontrollable and overwhelming more likely to have poorer clinical outcome.

Subjective-what they say Objective what you see

Sudden onset Less than 3 months time for norm healing to occur Mild to severe Generally a precipitating event or illness identified Pain decreases over time/goes away as recover Postoperative, labor, and trauma pain TREATMENT GOAL Pain control with eventual elimination MAINIFESTATIONS reflect SNS activation Heart rate Respiratory rate BP ASSESSMENT Assess pain in all pts/always subjective Not controlledphysiologic changes that chance of developing persistent pain

Gradual or sudden onset More than 3 month duration/may start acute Cause may be unknown Does not go away; waxing and waning Can be disabling with anxiety & depression TREATMENT GOAL Control to extent possible Focus on enhancing function and quality of life MAINIFESTATIONS Behavioral physical movement Fatigue Withdrawal from others and social interaction ASSESSMENT Assess pain in all pts/always subjective May be more sensitive to pain and other stimuli

Massage, relaxation, imagery, distraction (TV, radio, games) what they LIKE Drug Therapy for Pain (from Evolve KEY POINTS) • Pain medications generally are divided into three categories: nonopioids, opioids, and coanalgesic or adjuvant drugs. o Mild pain often can be relieved using nonopioids alone. o Moderate to severe pain usually requires an opioid. o Neuropathic pain often requires adjuvant drug therapy alone or in combination with an opioid or another class of analgesics. Treatment is typically augmented with adjuvant therapies including tricyclic antidepressants, anticonvulsants, and α2- adrenergic agonists.

• Nonopioids are characterized by an analgesic ceiling, lack of ability to produce tolerance or dependence, and availability without a prescription. • Nonopioid pain medications include acetaminophen, aspirin, and NSAIDs. • NSAIDs are associated with a number of side effects including bleeding tendencies, gastrointestinal (GI) ulcers and bleeding, and renal and CNS dysfunction.

• Opioids are the strongest analgesics available. Opioids produce their pain- relieving effects by binding to receptors in the CNS, inhibiting the transmission of nociceptive input from the periphery to the CNS. • Common side effects of opioids include constipation, nausea, vomiting, sedation, respiratory depression, and pruritus. • Concerns about sedation and respiratory depression are two of the most common fears associated with opioids. o Sedation is usually seen in opioid-naive patients in the treatment of acute pain. o Patients most at risk for respiratory depression include those who are opioid naive, are elderly, have underlying lung disease, have a history of sleep apnea, or are receiving other CNS depressants.

Has a preset limit on how much the patient can administer by pressing a button. Patient cannot overdose. Pt needs to be aware enough to self-administer. o With patient-controlled analgesia or demand analgesia, a dose of opioid is delivered when the patient decides a dose is needed

DKA

COPD, hyperventilating, abdominal surgery (from taking sallow breaths) they aren't giving off enough CO2

pregnant mother who id dehydrated from nausea and vomiting, Pt. w/ and NG tube because of drawing residual

Lungs will try to correct quicker than kidneys who take 3 days

7.35- 7.45

RISKS: -Age (but NOT a normal part of aging) -Women (and more severe than men) -may be related to estrogen reduction at menopause MODIFIABLE RISKS: -obesity (hip and knee) -regular moderate exercise (decrease disease dev and progression) -anterior curciate ligament injury (quick stops and pivoting as in football and soccer- increase risk) -occupations requiring frequent kneeling and stooping increase risk

most common form of joint disease in N America -slowly progressive NONinflammatory disorder of diathrodial joints -21 millon American's affected (expected to greatly increase as population ages) -NOT a normal part of aging -cartilage destruction can begin b/t 20yr-30yr -majority of adults affected by age 40 -Occurs as: -Idiopathic disorder (unknown) -Secondary disorder -trauma, mechanical stress, inflammation, joint instability, neurologic disorder, skeletal deformities, hemtologic/endocrine disorders, use of selected drugs)

-results from cartilage damage that triggers a metabolic response at level of chondrocytes -Cartilage becomes: -dull, yellow, granular -soft, less elastic -less able to resist wear with heavy use -Inflammation NOT characteristic of OA -Secondary synovitis may result -phagocytic cells try to ride joint of small pieces of cartilage torn from joint surface. -Inflammatory change contributes to early pain and stiffness

-bone scan, computer tomography (CT) can, magnetic resonance imaging (MRI) early OA tests and detect joint changes -x-ray in progressed OA detect joint space narrowing, boney sclerosis, osteophyte formation -there are no lab abnormalities or biomarkers yet identified -routine blood tests are useful in -screening for related conditions -establishing baselines from therapy

Systemic (fatigue, fever, organ involvement) ASYMMETRICALLY, joint pain, stiffness, crepitation, deformity,

Focuses on: -Managing pain and inflammation -preventing disability -maintaining and improving joint function -Foundation for OA management is NONPHARMACOLOGIC interventions -Drug therapy serves as an adjunct -Arthroscopic Surgery -debridement is usually not recommended -effective in reducing pain and improving function when it is used to: -repair ligament tears -remove bone bits or cartilage -Rest and Joint Protection -must balance rest and activity -during acute inflammation, affected joint should be: -rested -maintained in a functional position (splints or braces if necessary) -immobilization should not exceed 1 week -Heat and Cold Therapy -may help reduce pain and stiffness -HEAT used more than ice -ice appropriate for acute inflammation -HEAT especially helpful for STIFFNESS -hotpacks -whirlpool baths -ultrasound -paraffin wax baths

PP pg 5 - 9