Pain Control
the nurse determines the client's pain level as ...
whatever the client says it is
Describe the cause of rheumatoid arthritis
What is a progressive autoimmune disorder, inflammatory response?
Name one nonpharmacological treatment for OA?
Heat, ice, weight control, swimming
name a food or drink that can lower uric acid levels
strawberries, pineapples, oranges, bell pepper, water
A patient is taking a bisphosphonate for osteoporosis. What must the patient do after taking the medication?
Sit up for 30 minutes
Neuropathic pain is caused by a ____ and Nocioceptive pain is caused by ____.
neupopathic: a lesion or disease of the central or peripheral somatosensory nervous system
nocioceptive: from actual or threatened damage to nonneural tissue from somatic sources, such as osteoarthritis
Name 2 tests that can be aid in the diagnosis
Erythrocyte sedimentation rate (ESR; sed rate) and C-reactive protein are markers for inflammation but are nonspecific for RA
Rheumatoid factor is present at some time in 80% of those with RA
Antibodies to cyclic citrullinated peptide (CCP)
Name a complication of OA
decreased quality of life, joint degeneration/deterioration, pain
Name 3 foods that can cause gout
Herring, mackerel, sardines, scallops, mussels, anchovies
Asparagus, mushrooms
Animal organs
Dried peas and beans
Gravy
Foods sweetened with high-fructose corn syrup
What type of radiology exam is completed to assess bone density?
What is a dexa scan
Name 2 tools that can be used to measure pain
Numeric pain rating (0-10)
visual rating scale (0-10 listed on a line)
Faces pain scale (sad to happy faces)
Name at least 2 joints that are typically affected
several joints and is symmetrical, most often in both hands or feet, but also affects the large joints such as the knees - generally bilaterally
Heberden nodes affect the ___ ___ ___ joints and Bouchard nodes affect the ___ ___ ___ joints.
What is the DIP (distal interphalangeal) and PIP (proximal interphalangeal) joints?
Name 3 linked associations
obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides), and diabetes
What kind of exercise is recommended to increase bone density?
What is weight-bearing exercise. Lower impact is better if there is already bone deterioration
name 4 consequences of pain
Falls and other accidents
Functional impairment
Slowed rehabilitation
Mood changes: depression, anxiety, fear
Caregiver strain: increased dependency
Sleep disturbance
Anorexia
Impaired cognition
Decline in social and recreational activities
Increased health care use and costs
Loss or worsening of physical function and fitness
Potential for drug or alcohol abuse or misuse
The first line medication or class of medication
Methotrexate - DMARDs (disease-modifying antirheumatic drugs)
Name one medication recommended for mild OA pain and one medication for moderate to severe OA and an option for intractable OA pain.
mild to moderate, a 3-day course of Tylenol moderate to severe pain, an NSAID, tramadol
intractable pain, injections with either steroids or intraarticular hyaluronans(knees only)
The pharmacological treatment of acute gout pain
oral anti-inflammatories such as NSAIDs and short courses of steroids or colchicine
Name 2 health consequences associated with OP
a fracture and a heightened risk for post-fracture morbidity and mortality
multiple fractures, require long-term care, or never walk unassisted again
identify 4 pain cues in a non-communicating client specially one in behavior, ADL, vocalization, physical changes (name one pain cue in each of these areas)
Changes in Behavior
Restlessness and/or agitation or reduction in movement
Repetitive movements
Physical tension such as clenching teeth or hands
Unusually cautious movements, guarding
Activities of Daily Living
Sudden resistance to help from others
Decreased appetite
Decreased sleep
Vocalizations
Person groans, moans, or cries for unknown reasons
Person increases or decreases usual vocalizations
Physical Changes
Pleading expression
Grimacing
Pallor or flushing
Diaphoresis (sweating)
Increased pulse, respirations, or blood pressure
name 3 potential side effects of methotrexate
Hepatic cirrhosis
Interstitial pneumonitis
Severe myelosuppression (rare)
Stomatitis and oral ulcers
Mild alopecia and hair thinning
Headache
Fatigue
Nausea or diarrhea
Name 3 modifiable risk factors and 2 non modifiable risk factors
Modifiable: Obesity, Joint injury, Infection, Joint overuse in activities or occupation, Muscle weakness
Non modifiable: female gender, age 50 - 75, race, genetics
The pharmacological treatment of long term gout
decrease uric acid production, such as xanthine oxidase inhibitors (e.g., allopurinol, febuxostat)
increase uric acid excretion (e.g., probenecid)
name 4 risk factors for osteoporosis
Small body frame
Race and gender: White women
Broken bone before 50 years of age
Family history of osteoporosis
Estrogen deficiency
Inadequate calcium and vitamin D intake
Lack of weight-bearing activities
Excess alcohol use (>1 drink/day for women and >2 drinks/day for men)
Smoking or exposure to tobacco smoke
Eating disorders
Chronic use of glucocorticoids