Study Guide - N2/Exam 1 - Part 2 by Frank

Study Guide - N2/Exam 1 - Part 2 from Frank
4. Be able to select the best responses to patient statements about their experiences and concerns about their cancer and related treatment.
- Best response to pt. statements about their experiences & concerns about their cancer & related treatment ( REQUIRES GROUP DISCUSSIONS)

5. Review information in your text about death and dying. Be able to identify responses to news of impending demise as they are described in the text and lecture material. ( Page 169 Table 10.7)
1. Withdrawal
- Pt. near death may seem to be withdrawn from the physical environment, maintaining the ability to hear while not able to respond.
- The RN should converse as if the pt. is alert, using a soft voice & gentle touch.

2. Unusual Communication :
- Pt. may become restless & agitated or perform repetitive tasks. Unusual communication may indicate that an unresolved issue is preventing the dying person from letting go.
- Encourage the family to tell the dying person, " It's okay to go. I will be fine"

3. Vision-like experience
- Pt. may talk to persons who are not there or see places & objects not visible. Vision-like experiences assist the dying person in coming to terms with meaning in life & transition from it.
- Affirm the dying person's experience as a part of transition from this life.

4. Saying Goodbyes
- It is important for the pt. & family members to acknowledge their sadness, mutually forgive one another, and say goodbye.
- Encourage the dying person & family members to verbalize their feelings of sadness, loss, forgiveness : To touch, hug or cry .
- Allow the pt. & family privacy to express their feelings & comfort one another.

6. Develop an awareness of the effects of end-stage illness on family members, significant others, and care givers. Recognize appropriate responses vs. those that are less than optimal.
1. Family members & significant others entail a holistic approach when planning for EOL (end of life) care. Education, counseling advocacy & support are priorities for pt. & family.
2. Caregivers need support systems to deal with the grief process of the pt. this will ease the physical & emotional stress for the RN.
3. Appropriate response of the RN/Caregiver is to listen to the pt. & family members, even in time of silence it is appropriate to listen to the sounds of silence with the pt., significant other and family members.

7. Review pain assessment, medication practices, and goals of pain treatments. Understand the World Health Organization's schematic for pain control. Understand combinations of medications and therapies than have a synergistic effect to relieve pain. (Page 140)

A. Pain assessment - pain is what pt. says it is, influenced by genetic, psychosocial & cultural factors.

B. 5 Dimensions of pain :
1. Physiologic : (Transmission of Nociceptive stimuli)
- Nociceptive pain originates when tissue is injured
2. Affective : (Emotions, Suffering) Anger, fear, Depression & Anxiety
3. Behavioral : (Behavioral responses) Observable
4. Cognitive : (Beliefs, Attitudes, Evaluations, Goals)
5. Sensory : (Pain perception) Pattern, Area, Intensity & Nature

C. Physiologic Dimension & Knowledge of neural Anatomy & Physiology : (4 steps) Page 133 Fig. 9.2 1. Transduction 2. Transmission 3. Perception 4. Modulation

D. Systems affected by pain (pg 132 Table 9.1) EndocrineMetabolic Cardiovascular Respiratory Genitourinary Gastrointestinal MusculoskeletalNeurologic Immunologic

E. Pain assessment goals : - Describe the pt. sensory, affective, behavioral, cognitive & sociocultural to implement pain management techniques & goals.
1. Sensory component (PAIN) includes :
a. Pattern b. Area c. Intensity d. Nature

Medication Practices (Drug therapy Pg. 136 Table 9.3)
In relation to interrupting the pain pathway :
1. Transduction : Use NSAID'S to block prostaglandin production. - local anesthetics, antiseizure agents (i.e. gabadentin [neurotin]) & corticosteriods - block the action potential initiation.
2. Transmission : Use opioids, blocks release of substance P
3. Perception : Use Opioids, NSAID'S, Adjuvants (i.e. antidepressants) to decrease conscious experience of pain.
4. Modulation : Tricyclic Antidepressants (i.e. Amitriptyline [Elavill]) to interfere with reuptake of serotonin & norepinephrine.

World Health Organization (Page 142 fig. 9.8)
Step I - Mild pain : use non-opioids ( i.e. Aspirin, Acetaminophen, NSAIDS)
Step II - Mild to Moderate pain : use opioids (i.e. Codiene, Oxycodone)
Step III - Moderate to Severe pain : use opioids (i.e. Morphine, Hydromorphone, Methadone)

8. Review the physiology of pain, as well as how complimentary and alternative therapies assist in relief of pain. Be able to select the best definition of pain. Study !

1. Pain is described as whatever the pt. experiencing the pain says it is, existing wherever the pt. says it does.
2. Physiology of pain (pg 133) neural mechanisms by which pain is perceived consists of
4 steps :
1. Transduction
2. Transmission
3. Perception
4. Modulation
Page 150 - Therapies for Pain Relief !