#hesi

Pride month may be over but that doesn’t mean I’m going to stop making everyone gay… Crackship that I liked too much and now it’s canon…

So maybe marrying Serapis had one benefit…

+Full and Lineart!

I PASSED MY HESI

i literally cried from how happy i am

this was such a huge hurdle for me and my anxiety and i finally got over it

07.01.2020

I just had my calculations exam. Personally I have never struggled with math because for me numbers make sense and I was really good at Chemistry so dimensional analysis is like second nature. HOWEVER if you struggle with math and don’t really understand what numbers to put where and conversions and such I HIGHLY recommend that you go out of your way to buy an extra dosage calculation book and you get through that baby cover to cover. 

As a nurse you may not be prescribing the medication but you do have to check the dose that the doctor prescribes and check it again before administrating. That is a part of being a good advocate as well as providing patient safety. 

This moves me onto today’s topic of review (I have a test next week and a HESI is two weeks expect quite a few more of these. They help me review so deal with it)

PAIN MANAGEMENT 

Physiology of Pain

Pain is highly subjective and individualized and has cognitive, emotional, and physical components.

Pain can be caused by thermal, chemical, or mechanical stimuli 

A fibers are Mylenated transmit very sharp and localized pain

C Fibers are smaller and unmylenated ( therefor slower than the a fibers) the kind of pain they relay is dull and achy, often times it is also harder to localize

I’m not going to explain the reflex arc because you should know it and i’m too lazy but Reflexes are often executed before pain is perceived because of the efferent’s copy that is sent to the brain notifying that there was pain. Pain is not perceived until the message reaches the cerebral cortex while the reflex only has to go as far as the spinal cord and back. 

the perception of pain requires consciousness and an intact central nervous system

Physiological responses to pain may be...

increased respiratory rate

increased heart rate 

peripheral vasoconstriction and pallor

increase blood glucose level 

diaphoresis 

muscle tension 

pupil dilation 

decreased GI motility

However in cases of severe traumatic pain a person can go into shock and physical signs  will return to normal baseline and perception of the pain will also diminish 

Types of Pain 

Acute Pain 

Acute pain is usually protective

Kind of like your body being like “hey stupid you’re stepping on a Lego, that hurts. Take you weight and foot OFF”

The pain is usually short with little to no tissue damage

Acute pain is very common after acute injury, disease, or surgery 

acute pain threatens patient recovery because it may be severe enough that they are immobilized. 

The primary goal is treat this is to provide relief that allows tha 

Chronic Non Cancer  Pain 

This kind of pain serves no purpose whatsoever 

Infringes on quality of life

It can be viewed as an individual disease

The goal of treating this pain is to improve the functional status of individuals

People with chronic pain often times don’t how physiologic signs of pain because they adapt to that constant feeling. 

Chronic Episodic Pain 

This pain occurs sporadically over time 

A good example of this is a migraine 

Cancer Pain

Not all cancer patients experience this pain 

Cancer pain is usually caused by tumor progression  and sometimes can be referred pain rather than at the location of the tumor

Factors that Influence Pain 

Culture and Gender

In different cultures men do not express pain because it is not their way and they will downplay how much pain they are actually in

In general men also do seem to report less pain than women

Physiological factors 

Age 

Toddlers and preschooler cannot recall pain 

Pain is an inevitable part of aging 

The ability of older adults to interpret pain can actually be quite complicated

Fatigue 

fatigue heightens pain 

Genes

There are some links that genetics contribute to pain tolerance or lack thereof 

Neurological function

Any factor that alters or influences perception affects a patients ability to recognize and respond to the pain 

Psychological factors 

Attention

the more a patient focuses on the pain the more it hurts 

Anxiety and fear 

the amount of anxiety of fear in a patient may enhance that pain they are feeling

Coping style

people need to allow themselves to acknowledge their pain and be able to ask for pain medication. 

If they are very obviously in pain but refuse to admit it the nurse cannot help them meaning that they will experience more pain

Effects of pain 

Quality of Life

Pain will affect a patients activities of daily living, self care, work and school performance

Pain breaks focus, limits movements, and affects mental health 

Support from other individuals is CRUCIAL for those that experience pain, chronic or acute

Nursing Process

Assessment 

When assessing the pain you have to understand how much pain the patient is in and what values and beliefs and what  they wish to achieve  

Understand that acute or very severe pain will be hard to describe as opposed to chronic pain 

Pain is dynamic so it has to be assessed regularly alongside vitals

Establish a good communication channel with the patient so that they feel comfortable enough to share how much pain they are in 

When assessing the pain use the OLD CARTS mnemonic (there’s other ones like pqrstu etc but I use old carts) 

O- onset

L- location

D- duration

C- characteristics 

A- aggravating factors 

R- relieving factors 

T- timing 

S- severity 

Make sure that you are asking open ended questions so they are prompted to tell you the absolute most

ask the patients to rate their pain on a scale of 1 to 10 

if they are children use the Wong-Baker faces

Don’t be afraid to use the faces with those that are mentally impaired, elderly individuals, and those with a language barrier

Diagnosis 

The nursing diagnosis that will be found related to pain will be:

difficulty coping

fatigue

impaired mobility

impaired sleep 

social isolation 

Planning

A patient centered plan will result in optimal results

Make sure that the patient understands that they may not get 100% pain relief but instead just reduction of pain.

The main goal should be to reduce the pain to the point that normal  (or significantly better) function can occur 

These kinds of interventions require teamwork with doctors and pharmacology 

Implementation 

Non Pharmacological Interventions 

Relaxation and Guided Imagery 

Distraction 

Music 

Cutaneous Stimulation 

Herbals 

Reducing Pain Perception and Reception 

Pharmacological Pain Therapies 

Analgesic

Opioids 

Not always necessary as they are used mainly for severe pain 

High risk of constipation 

Non- opioids

The most commonly used is Acetaminophen (Tylenol)

Patient Controlled Analgesics

AKA PCA pumps

The patient is in control of their medication and how much drug is administered 

The system has a lock so the patient cannot overdose   

Topical and Trans dermal Analgesics 

It comes in cream, patch, gel,spray, liquid, and rubs

You cannot place the cream on the open wounds or damaged skin because it can contribute to infection

Local Anesthesia via Injection,   Epidural, and Perineum Analgesia 

Used mailing during patient procedures 

reassure the patient that tingling, numbness, and coldness are common 

make sure to watch the patient because they are at risk of injuring the numbed body part and not realizing it 

Barriers to Effective Pain Management

physical dependence 

addiction 

drug tolerance  

Placebos 

It is very controversial because it betrays the patient nurse relationship and seen as deceptive  

Evaluation

ask questions like 

“Tell me how you feel since we gave you your pain medicine”

“What is your current level of pain”

A little update with an old photo 📖 👩‍💻

I GOT INTO NURSING SCHOOL. I will be attending for spring 2020 and I know for sure the year 2020 will be my fucking year. The last few years have been ok. Very anti-climatic and boring. Nothing great or life changing happened. I’ve been spending my time just working shitty jobs and bringing up my gpa for so long that I almost cracked if I didn’t get in to any school. I’m very excited to announce that I’ll also be quitting my horrible job when school starts. Already planning the day I put in my 2 weeks notice. A lot of excited things awaits. I can’t wait to be a neonatal nurse. 👩‍⚕️☕️