1
Which historical event should nurses understand because of its significant and ongoing impact on the health and well-being of Indigenous peoples in Canada?
RESIDENTIAL SCHOOL SYSTEM
If an Indigenous patient or their family requests the inclusion of traditional healing practices as part of the patient's care, what should the nurse do?
Say no? Facilitate the visit? Get the physician involved to sign a waiver? Get them to do their traditional healing away from the hospital?
Provided their is no clear contraindication with the patients current treatment, facilitate the visit.
When caring for patients receiving palliative care, what condition should nurses routinely assess in themselves to maintain their own well-being and provide safe, compassionate care?
Compassion fatigue
Compassion fatigue is a state of physical, emotional, and psychological exhaustion that can occur in healthcare providers and other caregivers as a result of prolonged exposure to patients’ suffering, trauma, or distress.
How long does chronic pain typically last?
How long does acute pain typically last?
Define Breakthrough pain.
Chronic
Persists beyond normal healing
Intermittent or persistent
>3 months
Acute
Identifiable cause
Resolves after healing orintervention
<3 months
Noiciceptive Pain
Somatic - from bone, joint, muscle
Usually aching, throbbing
Visceral - from organs
Tumor involvement - aching, localized
Obstruction - cramping, localized
Neuropathic Pain
Centrally generated - injury to PNS/CNS
Ex: phantom pain
Peripherally generated- felt in many peripheral nerves
Ex: Diabetic neuropathy
Breakthrough Pain!
"Breakthrough pain refers to a temporary flare-up of pain that occurs despite a patient receiving regular scheduled pain medication. In other words, their baseline pain may be reasonably well controlled, but they still experience episodes of more intense pain.
This is particularly common in patients with cancer or those receiving palliative care, although it can occur in other situations as well.
For example, a patient may be prescribed morphine 10 mg every four hours as their regular medication, with an additional morphine 1 mg every hour as needed for breakthrough pain. The scheduled medication manages the baseline pain, while the PRN medication treats those unexpected increases in pain.
Mrs. Kaur lost her husband 3 months ago. You notice that she is unusually quiet, is picking at her meals, and withdrawn. Which stage of grief is Mrs. Kaur going through (according to Kubler Ross Theory)?
1.Denial
•Individual acts as though nothing has occurred
•May refuse to believe /understand that loss has occurred
2.Anger
•Resists loss and may strike out at everyone/thing
3.Bargaining
1.Postpones awareness of the reality of the loss
2.May attempt to deal with situation as if loss can be prevented
4.Depression
•Realizes full impact & significance of the loss
•Individual may feel lonely & withdraw from interactions
5.Acceptance
•Accepts loss & begins to look forward to the future
What is the goal of palliative care?
Palliative care aims to reduce the symptoms of a disease. Do not necessarily have to be hospice care.
Aim – relieve suffering & improve quality of living & dying
Palliative care allows patients to make more informed choices, alleviate symptoms & manage unfinished business
WHO
Palliative care:
Provide relief from pain & other distressing symptoms
Affirm life & regard dying as a normal process
Neither hasten or postpone death
Integrate psychological & spiritual aspects of patient care
Offer support system to help patients live as actively as possible until death
Offer support system to help families cope during patient’s illness & bereavement
Enhance quality of life
palliative care is provided in many different healthcare settings, including hospitals, clinics, long-term care facilities, and the community. Patients may still be receiving treatments directed at their illness while also receiving palliative support.
Hospice care, on the other hand, usually refers to care provided in a hospice facility or within the community when the focus is entirely on comfort during the final stages of life.
Shivani is working a shift at the Edmonton Remand Centre. An inmate was stabbed in the leg two days ago. He received treatment in hospital and has since returned to the Remand Infirmary. He is prescribed Hydromorphone (Dilaudid) 1 mg every hour PRN for pain. Despite appearing comfortable, having stable vital signs, and not grimacing, he reports that his pain remains severe. When Shivani contacts the provider to request an order for breakthrough pain medication, her colleague says, "He looks fine. Why are you getting another order?" What is an appropriate response? Do you believe the patient?
Only he can know what his pain is, it is my job to believe him. Emphasis on believing!!!! the patient.
Don't say "I know, I am going to watch him".
While this may raise concerns about drug-seeking behaviour, we should never jump to conclusions. The patient may simply have poorly controlled pain, anxiety about pain returning, opioid tolerance, or previous experiences of inadequate pain management.
Our responsibility is to complete a thorough assessment rather than making assumptions. Evaluate the location, quality, severity, and functional impact of the pain. Review medication effectiveness, observe behaviour, and consider the patient's entire clinical picture.
If concerns remain, communicate your objective assessment findings to the interdisciplinary team. Our documentation should focus on observable behaviours and assessment findings rather than labels or personal opinions."
What is the FICA Spirituality Tool and how is it used in nursing practice to assess a patient’s spiritual needs?
What is an appropriate question to ask someone if you are assessing the "F" part of FICA.
he FICA Spirituality Tool is a brief, structured assessment framework used in healthcare to evaluate a patient’s spiritual needs and how those needs may influence their care. It supports holistic, patient-centred nursing practice.
FICA stands for:
A man with 2 children experiences the loss of his dog. The nurse caring for him suggests that "its okay, you can always get another dog". Is this response appropriate?
The man feels very confused over his sadness, upset that he is getting this upset over his dog and stops talking to others. What type of grief may he be experiencing?
NO!!!!
Disenfranchised grief
Normal Grief:
Consists of normal feelings; behaviours; & reactions to loss
Anticipatory Grief:
Process of disengaging, letting go occurs before actual loss or death
Receives terminal diagnosis – begins process of saying goodbye
Disenfranchised Grief:
Loss experienced but cannot be openly acknowledged, socially sanctioned, or publicly shared due to stigmatization – loss of partner from AIDS; suicide; loss of child in utero, loss of a pet. This term refers to grief that society fails to fully recognize, validate, or support. Because the loss of an animal is often treated as less significant than the loss of a human, mourners are frequently left feeling isolated, dismissed, or ashamed of the depth of their sorrow
Complicated Grief:
Difficulty progressing through normal phases or stages of grieving, bereavement
Loss not adequately dealt with
Different types: Chronic grief; Delayed grief; Exaggerated Grief; Masked Grief.
Which is considered the most reliable indicator for pain?
Which is the least reliable?
Patient words
Vital signs!!!
A patient has a history of heroin and cocaine use. He is admitted to orthopedic unit 3f3 at u of a hospital because he broke his right arm and leg after being hit by a car. He rates his pain 9/10 and your colleague asks you "do you realllllly think you are treating his pain of something else?" Do you administer the pain medication or withhold the pain medication and call the physician (he needs to be assessed for addiction)?
ADMINISTER PAIN MEDICATION AS ORDERED!!!
The patient's history should never prevent us from adequately assessing or treating pain. We always treat the pain we assess—not the patient's history or our assumptions."
Your patient has an order of 10mg SC morphine q6h (no prn orders) after getting hip surgery. She states that its not working and her pain is still 9/10. What are you going to do? Is explain that she can only get medication every 6 hours enough? get her a warm blanket and put on some soothing ocean noises?
CALL THE PHYSICIAN!! They need to evaluate for possible breakthrough pain medication or change the dose if possible. While awaiting the order you can get her a warm blanket and put on soothing ocean noises. But a pain level of 9/10 most likely requires more than non-pharm pain medication.
What does TENS device stand for (relates to pain), what does it do, and how does it work?
Transcutaneous Electrical Nerve Stimulation, or TENS, delivers small electrical impulses through the skin. These impulses stimulate LARGE diameter nerve fibres and help inhibit pain transmission by activating the body's natural pain-modulating mechanisms. TENS units are commonly used for musculoskeletal pain and some chronic pain conditions