Culturally acquired patterns of pain responses may also influence the neurophysiological and verbal responses to pain. Answer the following questions in regards to the above concept.
Response to pain may be limited by what 2 factors?Pain-coping strategies may be influenced by what?
As a support worker, what 8 things should you be aware of when managing pain for a client with differing views on pain?
NURSING CARE PLAN Acute Pain ASSESSMENT DATA NURSING DIAGNOSIS DESIRED OUTCOMES’ Nursing Assessment Acute Pain related to tissue in- Pain Control [1605] as evi- Mr. C. is a 57-year-old businessman who was admitted to the sur- jury secondary to surgical inter- denced by often demonstrating gical unit for treatment of a possible strangulated inguinal hernia. vention (as evidenced by ability to Two days ago he had a partial bowel resection. Postoperative or- restlessness; pallor; elevated Use analgesics appropriately dees include NPO, intravenous infusion of D51/2 NS at 125 cc/hr pulse, respirations, and systolic Use nonanalgesic relief left arm, nasogastric tube to low intermittent suction. Mr. C. is in a blood pressure; dilated pupils; measures dorsal recumbent (supine) position and is attempting to draw up and reports of 7/10 abdominal Report uncontrolled his legs. He appears restless and is complaining of abdominal pain) symptoms to health care pain (7 on a scale of 0-10). professional Pain Level [2102]
As evi- Physical Examination Diagnostic Data denied by mild to no Height: 188 cm (6′ 3") Chest x-ray and urinalysis neg- Reported pain Weight: 90.0 kg (200 lb) ative, WBC 12,000 Protective body positioning Temperature: 37’C (98.6’F) Restlessness Pulse: 90 BPM Pupil dilation Respirations: 24/minute Perspiration Blood pressure: 158/82 mm Hg Change in BP, HR, R from Skin pale and moist, pupils di- normal baseline data lated. Midline abdominal inci- sion, sutures dry and intact. continued on page 1224 NURSING CARE PLAN Acute Pain continued NURSING INTERVENTIONS* /SELECTED ACTIVITIES RATIONALE Pain Management [1400] Perform a comprehensive assessment of pain to include location, Pain is a subjective experience and must be described by the characteristics, onset, duration, frequency, quality, intensity or client in order to plan effective treatment. severity, and precipitating factors of pain. Consider cultural influences on pain response (e.g, cultural beliefs Each person experiences and expresses pain in an individual about pain may result in a stoic attitude). manner using a variety of sociocultural adaptation techniques. Reduce or eliminate factors that precipitate or increase Mr. C’s Personal factors can influence pain and pain tolerance.
Factors pain experience (e.g. fear, fatigue, monotony, and lack of that may be precipitating or augmenting pain should be reduced knowledge). or eliminated to enhance the overall pain management program. Teach the use of nonpharmacologic techniques (e.g, relaxation, The use of noninvasive pain relief measures can increase the re- guided imagery, music therapy, distraction, and massage) before, lease of endorphins and enhance the therapeutic effects of pain after, and if possible during painful activities; before pain occurs or relief medications. increases; and along with other pain relief measures. Provide Mr. C. optimal pain relief with prescribed analgesics. Each dient has a right to expect maximum pain relief. Optimal pain relief using analgesics includes determining the preferred route, drug, dosage, and frequency for each individual Medica- tions ordered on a prn basis should be offered to the client at the interval when the next dose is available. Medicate before an activity to increase participation, but evaluate Turning and ambulation activities will be enhanced if pain is con- the hazard of sedation. trolled or tolerable. Assessing level of sedation should precede the activity to ensure nece precautions are put in place. Evaluate the effectiveness of the pain control measures used Research shows that the most common reason for unrelieved through ongoing assessment of Mr. C’s pain experience. pain is failure to routinely assess pain and pain relief. Many clients silently tolerate pain if not specifically asked about it. Analgesic Administration [2210]
Check the medical order for drug, dose, and frequency of anal- Ensures that the nurse has the right drug, right route, right gesic prescribed. dosage, right client, right frequency. Determine analgesic selections (narcotic, nonnarcotic, or NSAID) Various types of pain (e.g, acute, chronic, neuropathic, notice based on type and severity of pain. tive) require different analgesic approaches. Some types of pain respond to nonopioid drugs alone, while others can be relieved by combining a low-dose opioid with a nonopioid. Institute safety precautions as appropriate if Mr. C. receives nar- Side effects of opioid narcotics include drowsiness and sedation. cotic analgesics. Instruct Mr. C. to request pr pain medication before the pain is Severe pain is more difficult to control and increases the client’s severe. anxiety and fatigue.
The preventive approach to pain manage- ment can reduce the total 24-hour analgesic dose. Evaluate the effectiveness of analgesic at regular, frequent inter- The analgesic dose may not be adequate to raise the client’s vals after each administration and especially after the initial doses, pain threshold or may be causing intolerable or dangerous side also observing for any signs and symptoms of untoward effects effects or both. Ongoing evaluation will assist in making neces- (e.g. respiratory depression, nausea and vomiting, dry mouth, and sary adjustments for effective pain management. constipation). Document Mr. C’s response to analgesics and any untoward effects. Documentation facilitates pain management by communicating effective and noneffective pain management strategies to the entire health care team. Implement actions to decrease untoward effects of analgesics Constipation is a common side effect of opioid narcotics, and a (e.g, constipation and gastric irritation). treatment plan to prevent occurrence should be instituted at the beginning of analgesic therapy. For Mr. C, constipation could re- sult from his primary condition or his analgesia. Assess for overall GI functioning, possible complications of surgery (e.g., ileus), as well as opioid-induced constipation or NSAID-induced gastritis. NURSING CARE PLAN Acute Pain continued NURSING INTERVENTIONS/SELECTED ACTIVITIES* RATIONALE Simple Relaxation Therapy [6040) Consider Mr. C’s willingness and ability to participate, preference, The client must feel comfortable trying a different approach to past experiences, and contraindications before selecting a specific pain management. To avoid ineffective strategies, the client relaxation strategy. should be involved in the planning process. Elicit behaviors that are conditioned to produce relaxation, such as Relaxation techniques help reduce skeletal muscle tension, which deep breathing, yawning, abdominal breathing, or peaceful imaging will reduce the intensity of the pain. Create a quiet, nondisruptive environment with dim lights and Comfort and a quiet atmosphere promote a relaxed feeling and comfortable temperature when possible permit the dient to focus on the relaxation technique rather than external distraction. Individualize the content of the relaxation intervention (e.g., by Each person may find different images or approaches to relax- asking for suggestions about what Mr. C. enjoys or finds relaxing). ation more helpful than others. The nurse should have a variety of relaxation scripts or audiovisual aids to help clients find the best one for them. Demonstrate and practice the relaxation technique with Mr. C.
Return demonstrations by the participant provide an opportunity for the nurse to evaluate the effectiveness of teaching sessions. Evaluate and document his response to relaxation therapy. Conveys to the health care team effective strategies in reducing or eliminating pain. EVALUATION Outcomes partially met. The dient verbalizes pain and discomfort, requesting analgesics at onset of pain. States "the pain is a 2" (on a scale of 0-10) 30 minutes after a parenteral analgesic administration. Requests analgesic 30 minutes before ambulation. States willingness to try relaxation techniques; however, has not attempted to do so. "The NOC # for desired outcomes and the NIC # for nursing interventions are listed in brackets following the appropriate outcome or intervention. Outcomes, indicators, interventions, and activities selected are only a sample of those suggested by NOC and NIC and should be further individu- alized for each client. APPLYING CRITICAL THINKING 1. Is there any other assessment data you would want to gather to 3. What kind of data would you gather prior to having a discus- help plan Mr. C’s pain management? sion with the primary care provider about options for improv- 2. Mr. C. does not have a PCA. What nursing interventions are im- ing pain control in this dient? portant? See Critical Thinking Possibilities in Appendix A
Mars and Venus are at very different distances from the Sun and Venus is twice the size of Mars, yet their atmospheric compositions are nearly identical. How can this be given their dramatic physical differences? Explain using the data and equations above. (Note: you may need to do some calculations here to back up your reasoning).
Question 5 (4 pts): Calculate how far (distance in AU) the Moon would have to be from the Sun for it to retain a nitrogen atmosphere. Hint: set both vegas equations equal to each other and solve for the missing variable. Does your result make sense? Hint: think about velocities (velocity refers to speed and direction) and temperatures to explain.
Astronomy is all about observation. A lot of significant discoveries were made by “amateurs” who were dedicated to their passion for looking at the night sky. The advent of space-based and large automated telescopes has brought with it a constant stream of data – far too much for professional astronomers to look at and catalog. But, the computerized analysis may miss things only a human observer would notice. And so, there is a renewed need for interested citizen scientists who have time and a passion for discovery. Zooniverse is a website that helps connect scientists with large sets of data to citizen scientists who may be able to help them analyze it. Your assignment is to visit the website (http://www.zooniverse.org/ ), join a project that interests you, and report back on your experiences. There are several space-oriented projects, but in order to maintain relevance to the material we are covering in this class, please limit your choice to one of the following: 1. Galaxy Zoo: How do galaxies form? 2. Solar Jet Hunter
3. Dark Energy Explorers 4. Citizen ASAS SN 5. Zwicky Chemical Factory 6. Bursts from Space 7. Gravity Spy 8. Supernova Hunter Keep a log of your work including information about the project you chose, a basic description of the tasks you worked at, the hours you spent, and what you accomplished. Be sure to also document your thoughts as you go along to assist you in writing your final report. Your report should include the following sections: 1. Introduction: a description of the project you joined, including background on what is being studied and why. 2. Methods: this should include information about the source of the data you worked with and a description of the task(s) you performed to analyze it. 3. Results: a summary table of your work and a description of what you accomplished. ● Example table (make your own table for your specific observing projects, and feel free to make the columns that make sense to summarize your specific work)
In class, we discussed how the small angle approximation can be used to simplify a lot of math in astronomy. This approximation says that for “small” angles that are expressed in radians, we can say sinθ≈tanθ≈θ.
a) (2 pts) Assume θ=0.00012345 radians. Directly calculate sin(θ) and tan(θ), quoting the values you get to 5 significant digits. Discuss whether you think the small angle approximation does an OK job in this situation.
b) (1 pt) Look at this plot, which shows θ, sin(θ), and tan(θ) as a function of θ (with all angle units in radians). Based on these curves, up to how large of an angle does the small angle approximation still, does a pretty good job?
c) (3 pts) Astronomers commonly use units of “arcseconds” or “arcminutes” to measure small angles in the sky. These are defined so that 60 arcseconds=1 arcminute and 60 arcminutes=1˚. Calculate sin(1 arcsecond). State whether or not the small angle approximation is accurate for this angle.
String Theory is an approach to realizing Einstein’s dream of a unified theory of physics, a single overarching framework that would be able to describe all the forces at work in the universe. The central idea of string theory says that if you examine any piece of matter ever more finely, at first you’ll find molecules and then you’ll find atoms and subatomic particles. But the theory says that if you could probe smaller, much smaller than we can with existing technology, you’d find something else inside these particles — a little tiny vibrating filament of energy, a little tiny vibrating string. Just like the strings on a violin, they can vibrate in different patterns producing different musical notes. These little fundamental strings, when they vibrate in different patterns, they produce different kinds of particles — so electrons, quarks, neutrinos, photons, all other particles would be united into a single framework, as they would all arise from vibrating strings.
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It’s called inflationary cosmology, which identified a particular kind of fuel that would naturally generate an outward rush of space. The fuel is based on something called a quantum field, but the only detail that matters for us is that this fuel proves to be so efficient that it’s virtually impossible to use it all up, which means in the inflationary theory, the Big Bang giving rise to our universe is likely not a one-time event. Instead, the fuel not only generated our Big Bang, but it would also generate countless other Big Bangs, each giving rise to its own separate universe with our universe becoming but one bubble in a grand cosmic bubble bath of universes.
Which of the following is consistent with current literature regarding the epidemiology of dependent personality disorder? I” A Dependent personality is more common in men than in women. A dependent personality disorder is more common in young children than in I" older ones. C Persons with chronic physical illness in childhood may be most susceptible to t" this disorder. It… DElandConly
Considering what you learned about groups if you or someone you knew had a choice to be tried by either a judge or a jury, which would you choose, and why?
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