The development of pressure ulcers, or bed sores, remains one of the biggest problems in nursing care for immobile patients today (Sharp, Schulz, & McLaws, 2019). It is a definite problem in the health care system, which affects both patients, their families, medical staff and healthcare facilities.

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Laura Saldivar 

                The development of pressure ulcers, or bed sores, remains one of the biggest problems in nursing care for immobile patients today (Sharp, Schulz, & McLaws, 2019). It is a definite problem in the health care system, which affects both patients, their families, medical staff and healthcare facilities. For the patient, they may experience severe pain, helplessness, as well as financial difficulties from increased cost of treatment (Gill, 2015). Unfortunately, medical staff may find great challenges to prevent these skin issues, as well and treat them after they have occurred. Pressure ulcers are also referred to as bed sores, skin tears, or deep tissue injuries that happen due to constant pressure, shearing, or friction for prolonged periods of time (Gillespie, Chaboyer, McInnes, Kent, & Whitty, 2014). These wounds are common in the geriatric population and immobile patients who spend a great amount of time laying or sitting down (Sharp, Schulz, & McLaws, 2019).

The decreased physical movement, immobility and inability to turn are the main cause of pressure ulcers, there is a variety of strategies practiced by nursing staff to prevent them from occurring (Gillespie, Chaboyer, McInnes, Kent, & Whitty, 2014). Most hospital protocols enforce staff to manually turn the patient which is the most common mode of prevention.  By shifting a patient’s position in bed every 2 hours, it promotes blood flow, which is necessary for healthy skin (MedlinePlus, 2017). Due to lack of turning, blood and waste tend to pool in the tissues which inhibits nutrient exchange from healthy tissues. Frequently turning a patient helps the release of waste build up and promotes healthy skin (Hess, 2009). Every hospital or healthcare facility has their own scheduled repositioning protocol. Although, intensive care units as well as long term care facilities whose population has decreased mobility, the standard time is two hours (John Maynard, 2015).  Unfortunately, staff tends to be unaware of the turn Q2 rules or fails to perform the task which has led to this becoming one of the largest occurrences of hospital acquired injuries or HAI’s (Fletcher, 2017).

 

 

References

Cooper, K. L. (2013). Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit. Critical Care Nurse, 57-66.

Fletcher, J. (2017). Reposition Patients Effectively to Prevent Pressure Ulcers. Wounds International, 7-10.

Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in intensive care. Biomedical Journal, doi: 10.1136/bmjquality.u205599.w3015.

Gillespie, B. M., Chaboyer, W. P., McInnes, E., Kent, B., & Whitty, J. A. (2014). Repositioning for pressure ulcer prevention in adults. Cochrane Systematic Review.

Hess, C. T. (2009). Take Steps to Prevent Pressure Ulcers. Nursing, 61.

John Maynard. (2015, November 18). Move Every Two: Repositioning Patients to Prevent Pressure Injuries. Retrieved from Shield Healthcare Community: http://www.shieldhealthcare.com/community/popular/2015/11/18/move-every-two-repositioning-patients-to-prevent-pressure-ulcers/

MedlinePlus. (2017, November 15). Turning patients over in bed. Retrieved from MedlinePlus.Gov: https://medlineplus.gov/ency/patientinstructions/000426.htm

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Pain is both an easy and complex symptom to diagnose and treat due to its subjective nature. As future practitioners, we are diagnosing pain in the era of the opioid crisis will only add to the complexity of analyzing all of the signs and symptoms while trying to provide comfort to our patients. 

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Respond  on two different days who selected different factors than you, in the following ways:

Share insights on how your colleague’s factors impact the pathophysiology of pain.

Suggest alternative diagnoses and treatment options for acute, chronic, and referred pain.

Main Post

Pain is both an easy and complex symptom to diagnose and treat due to its subjective nature. As future practitioners, we are diagnosing pain in the era of the opioid crisis will only add to the complexity of analyzing all of the signs and symptoms while trying to provide comfort to our patients. Pain confronts us with basic questions such as the tension between an objective and a subjective approach, the concept of brain disease, human consciousness, and the relationship between body and mind (Dekkers, 2017).

Pain

According to the National Library of Medicine (2018), pain is a signal activated within the nervous system signaling to an individual that something may be wrong; it is an unpleasant feeling that can be described as burning, stinging, aching, tingling, etc. It ranges from dull to severe, can be treated in a variety of ways, or can dissipate on its own. Every individual reacts differently to pain; pain can present differently in genders despite being the same disease process.

Acute Pain

Acute pain is brief and can last several seconds or up to three months; acute pain occurs in an attempt to protect the body from harm by causing withdrawal from painful stimuli and encourages individuals to avoid painful stimuli in the future (Huether & McCance, 2017). The damage to the tissue is usually easily seen, with the naked eye or imaging that can reveal the source. Acute pain also involves biological functions that protect against further injury. For example, pain produces protective reflexes, including an unconscious withdrawal from the noxious stimulus, muscle spasms, and other autonomic reactions such as flight (Rodriguez, 2015). Noxious stimulation in the periphery leads to activation of nociceptors and the transmission of signals to the central nervous system, which will lead to the perception of acute pain (Berger & Zelman, 2016).

Chronic Pain

Chronic pain persists for at least three months or greater, despite intervention to relieve the injury, surgical, holistic, or medicinal, when the treatment does not control the original issue. Chronic pain is disruptive to sleep patterns and activities of daily living, and as a pain syndrome, it serves no protective or adaptive function (Rodriguez, 2015). Anwar (2016) acknowledges that there are three ascending pathways: the first-order neuron; start from the periphery (skin, bone, ligaments, muscles, and other viscera) travels through the peripheral nerve reaches the dorsal horn of the spinal cord, second-order neuron: start at the dorsal horn cross over to the contralateral side and then ascend in the spinal cord to the thalamus, and other brain areas like dorsolateral pons and third order neuron: starts at the thalamus and then terminates in the cerebral cortex. The descending pathway begins in multiple areas of the brain, sending signals across nerve fibers.

Referred Pain

Referred pain is felt in an area removed or distant from its point of origin-the area of referred pain is supplied by the same spinal segment as the actual site of pain (Huether & McCance, 2017). Making the diagnosis difficult for practitioners, referred pain also presents differently in men and women. It is fairly common in some conditions, such as heart attacks and osteoarthritis (Ungvarsky, 2019). Impulses from many cutaneous and visceral neurons converge on the same ascending neuron, and the brain cannot distinguish between the different sources of pain (Huether & McCance, 2017).

Impact of Gender and Age on Pain

Focusing on the factors of age and gender and the effects on the experience of pain showed the importance of understanding different factors relating to pain. Persistent pain affects the elderly disproportionally, occurring in 50 % of elderly community-dwelling patients and 80 % of aged care residents (Veal & Peterson, 2015). In the United States, the fastest growing population is the baby boomers generation, and in ten years they will represent one out of five citizens. Pain is also increasingly difficult to manage in the elderly patient population as drug interactions, absorption rates and drug clearances begin varying as a result of the aging process. With the opportunity of placing a high fall risk population in even more danger, dosing for the elderly population can become difficult for a  practitioner. Petrini, Matthiesen, and Arendt-Nielsen (2015) acknowledged that the experience of pain in the elderly may differ from the experience in younger populations on multiple dimensions (sensory, affective, and cognitive). As the body physically wears down, so does the nervous system. In many patients seeking pain relief, the number of neurotransmitter cell receptors decreases with age-associated cortical and subcortical atrophy of brain tissue (Kaye et al., 2014). The practitioner must take into account all of the aging population’s comorbidities plus, fully assess the patient to determine if they are accurately representing their pain description.

Females have always been associated with a higher threshold for pain, and I can attest to this as I would gladly take an open heart female patient over a male patient but, this is not fair to assume those female patients have a higher tolerance for pain. Practitioners must still assess their patients, monitor their vital signs, and ask questions that can reveal answers that patient may not know themselves until the question is asked. Women do have more difficulty when attempting to have their pain managed. The tendency to underdiagnose and undertreat the pain of certain groups of patients, especially women, is greater when patients present with symptoms that are less objective and more grounded in complaints of pain (coronary artery disease, collagen vascular disease, nonspecific abdominal or pelvic pain) (Becker & Mcgregor, 2017). While pain does not differentiate between genders, male masculinity has taught generations of men to accept pain as normal while at the same time, women who complain of pain are frequently underdiagnosed.

Conclusion

Pain can be acute or chronic, and it can be referred or direct, practitioners must take into account all the factors that can mask or enhance the pain experience of their patients. Understanding the role the pain experience has can vary due to age or gender and pain is whatever the individual states it is or in some cases, fail to state. High-quality physical assessments and asking the appropriate questions can help practitioners manage their pain, taking into account the aging process and comorbidities that present throughout life.

 

References

Anwar, K. (2016). Pathophysiology of pain. Disease-a-Month, 62(9), 324–329. https://doi-org.ezp.waldenulibrary.org/10.1016/j.disamonth.2016.05.015

Becker, B., & Mcgregor, A. J. (2017). Article Commentary: Men, Women, and Pain. Gender and the Genome, 1(1), 46-50. https://doi-org.ezp.waldenulibrary.org/10.1089/gg.2017.0002

Dekkers, W. (2017). Pain as a Subjective and Objective Phenomenon. Handbook of the Philosophy of Medicine, 1-15. doi:10.1007/978-94-017-8706-2_8-1

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Kaye, A. D., Baluch, A. R., Kaye, R. J., Niaz, R. S., Kaye, A. J., Liu, H., & Fox, C. J. (2014). Geriatric pain management, pharmacological and nonpharmacological considerations. Psychology & Neuroscience, 7(1), 15–26. https://doi-org.ezp.waldenulibrary.org/10.3922/j.psns.2014.1.04

National Library of Medicine – National Institutes of Health. (2018). Retrieved June 7, 2019, from https://www.nlm.nih.gov/

Petrini, L., Matthiesen, S. T., & Arendt-Nielsen, L. (2015). The Effect of Age and Gender on Pressure Pain Thresholds and Suprathreshold Stimuli. Perception, 44(5), 587–596. https://doi-org.ezp.waldenulibrary.org/10.1068/p7847

Rodriguez, L. (2015). Pathophysiology of Pain: Implications for Perioperative Nursing. AORN Journal, 101(3), 338–344. https://doi-org.ezp.waldenulibrary.org/10.1016/j.aorn.2014.12.008

Ungvarsky, J. (2019). Referred pain (reflective pain). Salem Press Encyclopedia of Health. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=133861288&site=eds-live&scope=site

Veal, F., & Peterson, G. (2015). Pain in the Frail or Elderly Patient: Does Tapentadol Have a Role? Drugs & Aging, 32(6), 419–426. https://doi-org.ezp.waldenulibrary.org/10.1007/s40266-015-0268-7

The post Pain is both an easy and complex symptom to diagnose and treat due to its subjective nature. As future practitioners, we are diagnosing pain in the era of the opioid crisis will only add to the complexity of analyzing all of the signs and symptoms while trying to provide comfort to our patients.  appeared first on Infinite Essays.

  Prepare a 350-word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with “The problem is…”, and a purpose to your project. Post this as your Initial response. (Essential I-IX).

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Prepare a 350-word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with “The problem is…”, and a purpose to your project. Post this as your Initial response. (Essential I-IX).

Discussion Rubric attached, Research project attached and Master Essential.

 

This week the focus is the trustworthiness of qualitative research and validity.  The term trustworthiness of qualitative research can sometimes be interpreted as a detrimental factor in qualitative research because it based on opinions and experiences rather than on numbers on quantifiable data. Validity represents that the research findings represent the truth about the phenomenon being studied. Therefore, is extremely important in quantitative research. Please make sure to study both concepts by reading the chapters assigned and reading articles that contain those terms.  This week objectives are to demonstrate understanding of the above concepts as they relate to nursing research.

The post   Prepare a 350-word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with “The problem is…”, and a purpose to your project. Post this as your Initial response. (Essential I-IX). appeared first on Infinite Essays.

Reflective Essay- Nursing profession

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Reflective Essay- Nursing profession

 

Directions: Imagine or be sure to ask your nurse to be specific and provide examples and stories. 300 words per questions below:

 

Reminder: Respond to the following questions below.

1. Why did you choose nursing as a profession?

1. What was nursing school like for him or her? Ask them:

1. How they managed and balanced work, family and life and the difficulties.

1. The level of commitment to school required to be successful (hrs. required for studying, social life, workload)

1. What their clinical and lab experiences were like.

1. How they prepared for examinations and the NCLEX.

 

1. Describe their top three patient memories and why they are memorable.

1. What does the phrase “Nurse-Life” mean to this nurse?

1. What is the hardest thing about being a nurse?

1. Reflect and discuss what your thoughts are about the interview. Did the interview change your perspective on nursing, on nursing school or life?

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