...Acute Pain in the High-Acuity Patient Objectives:...
...Objectives: 1. Explain the multidimensional nature of...
...issues related to the under treatment of...
...acute pain in the high-acuity adult patient...
...of pain for the high-acuity adult patient....
...focused assessments of the patient receiving opioid...
...populations. 8. Discuss the nursing management of...
...sedation populations. I. The Multifaceted Nature of...
...acute pain 1. The International Association for...
...International Association for the Study of Pain...
...its presence. (4) Patient’s report of pain...
...of pain 1. The multifaceted conceptualization of...
...is based on the theoretical model by...
...pain behaviors 2. The First Facet: Nociception—refers...
...Facet: Nociception—refers to the activation of special...
...activate nociceptors in the affected tissue. a)...
...(2) Begins in the peripheral nervous system...
...system and initiates the exchange of sodium...
...and potassium across the neuronal membranes, causing...
...to conduction of the pain impulse through...
...pain impulse through the nervous system once...
...impulses rapidly along the myelin sheath, causing...
...(2) Role of the central nervous system...
...(i) Can decrease the patient’s pain threshold,...
...Can decrease the patient’s pain threshold, causing...
...and to prolong the duration of pain....
...sensitization (i) Is the increased excitability of...
...of neurons in the CNS and is...
...c) Modulation (1) The body’s attempt to...
...perception refers to the patient’s subjective experience...
...refers to the patient’s subjective experience surrounding...
...subjective experience surrounding the pain. 3. The...
...the pain. 3. The second facet: Pain...
...are transmitted to the brain along multiple...
...(3) Upon reaching the lamina marginalis in...
...lamina marginalis in the dorsal horn, the...
...the dorsal horn, the impulse excites second-order...
...immediately crosses to the opposite side of...
...opposite side of the spinal cord. (4)...
...broad area of the brainstem. c) Person...
...(1) Transmission of the noxious stimulus terminates...
...stimulus terminates within the brain. d) Unknown...
...d) Unknown whether the patient’s ability to...
...Unknown whether the patient’s ability to perceive...
...chemically altered. 4. The third facet: Suffering...
...nervous centers of the brain. b) Closely...
...Closely connected to the personal meaning of...
...personal meaning of the pain. c) Clinician’s...
...chronic pain. 5. The fourth facet: Pain...
...lessen or control the pain PowerPoint Slides...
...PowerPoint Slides 1. The International Association for...
...International Association for the Study of Pain...
...prove its presence. Patient’s report of pain...
...that patient. 3. The first facet: Nociception...
...Beta-endorphins Dynorphins 8. The Second Facet: Pain:...
...are transmitted to the brain along multiple...
...Paleospinothalamic tract 9. The Third Facet: Suffering...
...Closely connected to the personal meaning of...
...personal meaning of the pain Clinician’s assessment...
...Chronic pain 10. The Fourth Facet: Pain...
...Acute Pain in the High-Acuity Patient A....
...Acute pain of the initial insult. (1)...
...of receptors in the viscera 3. Neuropathic...
...signal processing in the nervous system C....
...nervous system C. The effects of stress...
...and pain on the body 1. Tissue...
...muscle spasm. 2. The stress response is...
...events that increase the body’s chances of...
...organ damage. When the sympathetic nervous system...
...Acute pain of the initial insult Invasive...
...chronic conditions 2. The three major types...
...Stress associated with the hospital environment 4....
...useful in evaluating the effectiveness of interventions,...
...(3) Patient self-reports the level of pain...
...10 cm). (4) The point is then...
...(1) Variation of the VAS. (2) Uses...
...numbers from which the patient chooses. (3)...
...proven NRS is the 0–10 scale. (4)...
...within any of the pain dimensions (2)...
...Using a list, the patient chooses the...
...the patient chooses the adjective that best...
...that best describes the pain: (a) E.g.,...
...choose words from the middle. d) Wong-Baker...
...Patient points to the face that represents...
...face that represents the current level of...
...pain 2. Adapting the Unidimensional Pain Assessment...
...Assessment Tool for the Severely Ill Patient...
...VAS to indicate the “point.” b) Point...
...b) Point to the number on an...
...NRS or to the location on the...
...the location on the line of a...
...VAS. c) Raise the number of fingers...
...fingers that indicate the level of pain:...
...Pain Assessment provides the patient with a...
...means to expresses the affective and evaluative...
...evaluative aspects of the pain experience. a)...
...descriptive words. d) Patient’s word choice determines...
...from which category the pain is originating...
...of pain in the adult with altered...
...Patients rely on the nurse to advocate...
...c) Review of the patient’s medical history...
...Review of the patient’s medical history provides...
...pain adapt to the stress response. (2)...
...frequently subjectively interpret the patient’s self-report of...
...subjectively interpret the patient’s self-report of pain....
...attitudes frequently alter the assessment of pain....
...inappropriate use of the self-report tools. d)...
...self-report tools. d) The patient might be...
...coping skills. e) The patient’s use of...
...skills. e) The patient’s use of distraction...
...(cues) to indicate the presence of pain....
...with stimulation of the sympathetic nervous system...
...useful in evaluating the effectiveness of interventions...
...tools Patient expresses the affective and evaluative...
...evaluative aspects of the pain experience. Work...
...imaginable.” Patient self-reports the level of pain...
...along this line. The point is then...
...(NRS) Variation of the VAS. Uses a...
...numbers from which the patient chooses. Most...
...proven NRS is the 0–10 scale. 6....
...within any of the pain dimensions. Useful...
...Using a list, the patient chooses the...
...the patient chooses the adjective that best...
...that best describes the pain. Potential disadvantages....
...Patient points to the face that represents...
...face that represents the current level of...
...pain 8. Adapt the scale for the...
...the scale for the severely ill patient....
...VAS to indicate the “point.” Point to...
...“point.” Point to the number on an...
...NRS or to the location on the...
...the location on the line of a...
...VAS. Raise up the number of fingers...
...fingers that indicates the level of pain....
...of descriptive words. Patient’s word choice determines...
...from which category the pain is originating....
...Patients rely on the nurse to advocate...
...them. Review of the patient’s medical history...
...Review of the patient’s medical history provides...
...(cues) to indicate the presence of pain....
...with stimulation of the sympathetic nervous system...
...pain. Use of the sympathetic response criteria...
...pain management 1. The World Health Organization...
...choices based on the level of pain:...
...working peripherally at the site of injury....
...in combination (6) The epidural route (a)...
...small catheter into the space located just...
...located just before the dura mater. (b)...
...combination. (d) Minimizes the potential for side...
...small catheter into the cerebrospinal fluid (CSF)...
...Opioid flows through the CSF and rapidly...
...nerve path transmitting the pain is located)...
...injected medial to the point of pain...
...(2) Duration of the analgesia depends on...
...analgesia depends on the half-life of the...
...the half-life of the local anesthetic. (3)...
...nerves medial to the insertion site of...
...is placed into the pleural space, and...
...to incorporate into the care plan. b)...
...Choices based on the level of pain...
...of analgesic. Minimizes the potential for side...
...Small catheter into the CSF space. Opioid...
...Opioid flows through the CSF, binds to...
...Duration depends on the half-life of the...
...the half-life of the local anesthetic. 14....
...catheter placed in the pleural space. Local...
...physical adaptation of the body to the...
...the body to the presence of opioids...
...are less than the duration of action...
...Administering less than the physician orders (2)...
...Taking less than the amount prescribed (4)...
...Refusing to take the drug at all...
...dependence). a) Probably the major cause of...
...interval or increasing the dose. 5. Fear...
...depression. b) In the majority of hospitalized...
...close observation of the patient’s response. (1)...
...observation of the patient’s response. (1) Sedation...
...are administered before the patient complains of...
...of analgesic in the bloodstream. c) Diminishes...
...bloodstream. c) Diminishes the likelihood of undertreatment...
...based on effects the drug is having...
...than based on the milligrams being administered...
...b) Goal: Gain the desired level of...
...respiratory depression. In the majority, it is...
...should closely observe patient’s response. 9. Effective...
...based on effects the drug is having....
...are unfamiliar with the patients’ needs. (2)...
...Sedation assessment a) The nurse’s recognition of...
...tone and depresses the response to hypoxia...
...(1) POSS and the RASS are valid...
...order to facilitate the identification of trends....
...changes in ventilation (the exchange of air...
...of air between the lungs and the...
...the lungs and the atmosphere) earlier than...
...which simply measures the oxygen saturation of...
...Nursing interventions 1. The plan of care...
...Working collaboratively with the prescribing health care...
...provider to consider the omission of, or...
...effective in reducing the risk of advancing...
...be required if the patient develops severe...
...respiratory depression. b) The half-life of naloxone...
...time during which the patient may be...
...extreme pain. c) The exact PCA opioid...
...be specified by the prescribing health care...
...frequently administered in the ICU and contribute...
...after discharge from the ICU. e) Decreasing...
...ICU. e) Decreasing the mean doses of...
...accomplished by individualizing the care of each...
...analgesia POSS and the RASS 3. Use...
...Working collaboratively with the prescribing health care...
...large doses Decreasing the mean doses of...
...metabolized primarily in the liver. b) Kidneys...
...b) Kidneys have the major responsibility for...
...be reduced and the patient monitored closely....
...C. Management of the tolerant patient with...
...1. Management of the tolerant patient with...
...b) Consider a patient’s home routine opioid...
...titrated to manage the incidence of acute...
...acute pain. d) The continuous dose and...
...continuous dose and the incremental dose can...
...Hyperalgesia a) Both the use of high...
...prolonged time and the effects of chronic...
...chronic pain on the CNS can produce...
...opioids only makes the pain worse. d)...
...when appropriate. D. The known active or...
...(1) Experts in the fields of pain...
...substances abusers, have the right to pain...
...pain temporarily overrides the problem of addiction....
...exist to determine the level of monitoring...
...symptoms e) Consider the impact of tolerance...
...analgesics that have the same pharmacologic basis...
...pharmacologic basis as the abused drug. b)...
...2. Pharmacology and the effect of aging...
...metabolized primarily in the liver. Kidneys have...
...liver. Kidneys have the major responsibility for...
...be reduced and the patient monitored closely....
...monitored closely. 6. The opioid-tolerant patient—management of...
...opioid-tolerant patient—management of the tolerant patient with...
...tolerance. Consider a patient’s home routine opioid...
...titrated to manage the incidence of acute...
...of acute pain. The continuous dose and...
...continuous dose and the incremental dose can...
...substances abusers, have the right to pain...
...pain temporarily overrides the problem of addiction....
...exist to determine the level of monitoring...
...withdrawal symptoms Consider the impact of tolerance...
...analgesics that have the same pharmacologic basis...
...pharmacologic basis as the abused drug. Choose...
...clear understanding of the different stages of...
...assesses sedation in the intensive care unit....
...being performed outside the operating room. C....
...Nursing management of the patient undergoing moderate...
...unstable) 2. Before the procedure a) Before...
...procedure a) Before the conscious sedation procedure:...
...b) Verify that the patient has given...
...c) Verify that the physician has explained...
...physician has explained the procedure to the...
...the procedure to the patient. (1) E.g.,...
...Do not leave the patient unattended or...
...Have knowledge of the legal liability of...
...sedation. f) Understand the principles of respiratory...
...available. 3. During the procedure. a) Continuously...
...a) Post-procedure (after the conscious sedation procedure):...
...procedure): b) Monitor the patient’s level of...
...b) Monitor the patient’s level of consciousness...
...it’s necessary for the patient to go,...
...patient to go, the nurse must accompany....
...intravenous lines. c) The patient’s level of...
...lines. c) The patient’s level of pain...
...as indicated by the patient’s condition. E....
...indicated by the patient’s condition. E. Possible...
...conscious sedation. b) The nurse must be...
...a call to the Rapid Response Team...
...does not meet the standard. d) It...
...acceptable to continue the procedure if the...
...the procedure if the patient is oversedated....
...assesses sedation in the ICU. Sedation definitions....
...training 5. Before the conscious sedation procedure:...
...sedation procedure: Verify the patient has given...
...informed consent. Verify the physician has explained...
...physician has explained the procedure. Do not...
...Do not leave the patient unattended. Have...
...Have knowledge of the legal liability. Understand...
...legal liability. Understand the principles of respiratory...
...available. 6. During the conscious sedation procedure:...
...7. Post-procedure (after the conscious sedation procedure):...
...sedation procedure): Monitor the patient’s LOC and...
...procedure): Monitor the patient’s LOC and vital...
...separate IV lines. Patient’s level of pain...
...does not meet the standard. Do not...
...Classroom Activities Read the original AHCPR guideline...
...definition document. Discuss the AHCPR guideline definitions...
...or thoughts on the undertreatment of pain,...
...have personally experienced the undertreatment of pain—and...
...are found within the class? Suggestions for...
...pain. Ask about the four common misconceptions...
...play out in the actual clinical setting—how...
...avoided, etc. Obtain the pain management policies...
...management policies for the clinical facility. Discuss...
...clinical facility. Discuss the policy with the...
...the policy with the clinical group. What...
...group. What are the specific nursing responsibilities?...
...nursing responsibilities? Do the students feel they...
...they are seeing the guidelines in the...
...the guidelines in the policy upheld on...
...regular basis on the clinical unit? Wagner...

...Acute Pain in the High-Acuity Patient Objectives:...
...Objectives: 1. Explain the multidimensional nature of...
...issues related to the under treatment of...
...acute pain in the high-acuity adult patient...
...of pain for the high-acuity adult patient....
...focused assessments of the patient receiving opioid...
...populations. 8. Discuss the nursing management of...
...sedation populations. I. The Multifaceted Nature of...
...acute pain 1. The International Association for...
...International Association for the Study of Pain...
...its presence. (4) Patient’s report of pain...
...of pain 1. The multifaceted conceptualization of...
...is based on the theoretical model by...
...pain behaviors 2. The First Facet: Nociception—refers...
...Facet: Nociception—refers to the activation of special...
...activate nociceptors in the affected tissue. a)...
...(2) Begins in the peripheral nervous system...
...system and initiates the exchange of sodium...
...and potassium across the neuronal membranes, causing...
...to conduction of the pain impulse through...
...pain impulse through the nervous system once...
...impulses rapidly along the myelin sheath, causing...
...(2) Role of the central nervous system...
...(i) Can decrease the patient’s pain threshold,...
...Can decrease the patient’s pain threshold, causing...
...and to prolong the duration of pain....
...sensitization (i) Is the increased excitability of...
...of neurons in the CNS and is...
...c) Modulation (1) The body’s attempt to...
...perception refers to the patient’s subjective experience...
...refers to the patient’s subjective experience surrounding...
...subjective experience surrounding the pain. 3. The...
...the pain. 3. The second facet: Pain...
...are transmitted to the brain along multiple...
...(3) Upon reaching the lamina marginalis in...
...lamina marginalis in the dorsal horn, the...
...the dorsal horn, the impulse excites second-order...
...immediately crosses to the opposite side of...
...opposite side of the spinal cord. (4)...
...broad area of the brainstem. c) Person...
...(1) Transmission of the noxious stimulus terminates...
...stimulus terminates within the brain. d) Unknown...
...d) Unknown whether the patient’s ability to...
...Unknown whether the patient’s ability to perceive...
...chemically altered. 4. The third facet: Suffering...
...nervous centers of the brain. b) Closely...
...Closely connected to the personal meaning of...
...personal meaning of the pain. c) Clinician’s...
...chronic pain. 5. The fourth facet: Pain...
...lessen or control the pain PowerPoint Slides...
...PowerPoint Slides 1. The International Association for...
...International Association for the Study of Pain...
...prove its presence. Patient’s report of pain...
...that patient. 3. The first facet: Nociception...
...Beta-endorphins Dynorphins 8. The Second Facet: Pain:...
...are transmitted to the brain along multiple...
...Paleospinothalamic tract 9. The Third Facet: Suffering...
...Closely connected to the personal meaning of...
...personal meaning of the pain Clinician’s assessment...
...Chronic pain 10. The Fourth Facet: Pain...
...Acute Pain in the High-Acuity Patient A....
...Acute pain of the initial insult. (1)...
...of receptors in the viscera 3. Neuropathic...
...signal processing in the nervous system C....
...nervous system C. The effects of stress...
...and pain on the body 1. Tissue...
...muscle spasm. 2. The stress response is...
...events that increase the body’s chances of...
...organ damage. When the sympathetic nervous system...
...Acute pain of the initial insult Invasive...
...chronic conditions 2. The three major types...
...Stress associated with the hospital environment 4....
...useful in evaluating the effectiveness of interventions,...
...(3) Patient self-reports the level of pain...
...10 cm). (4) The point is then...
...(1) Variation of the VAS. (2) Uses...
...numbers from which the patient chooses. (3)...
...proven NRS is the 0–10 scale. (4)...
...within any of the pain dimensions (2)...
...Using a list, the patient chooses the...
...the patient chooses the adjective that best...
...that best describes the pain: (a) E.g.,...
...choose words from the middle. d) Wong-Baker...
...Patient points to the face that represents...
...face that represents the current level of...
...pain 2. Adapting the Unidimensional Pain Assessment...
...Assessment Tool for the Severely Ill Patient...
...VAS to indicate the “point.” b) Point...
...b) Point to the number on an...
...NRS or to the location on the...
...the location on the line of a...
...VAS. c) Raise the number of fingers...
...fingers that indicate the level of pain:...
...Pain Assessment provides the patient with a...
...means to expresses the affective and evaluative...
...evaluative aspects of the pain experience. a)...
...descriptive words. d) Patient’s word choice determines...
...from which category the pain is originating...
...of pain in the adult with altered...
...Patients rely on the nurse to advocate...
...c) Review of the patient’s medical history...
...Review of the patient’s medical history provides...
...pain adapt to the stress response. (2)...
...frequently subjectively interpret the patient’s self-report of...
...subjectively interpret the patient’s self-report of pain....
...attitudes frequently alter the assessment of pain....
...inappropriate use of the self-report tools. d)...
...self-report tools. d) The patient might be...
...coping skills. e) The patient’s use of...
...skills. e) The patient’s use of distraction...
...(cues) to indicate the presence of pain....
...with stimulation of the sympathetic nervous system...
...useful in evaluating the effectiveness of interventions...
...tools Patient expresses the affective and evaluative...
...evaluative aspects of the pain experience. Work...
...imaginable.” Patient self-reports the level of pain...
...along this line. The point is then...
...(NRS) Variation of the VAS. Uses a...
...numbers from which the patient chooses. Most...
...proven NRS is the 0–10 scale. 6....
...within any of the pain dimensions. Useful...
...Using a list, the patient chooses the...
...the patient chooses the adjective that best...
...that best describes the pain. Potential disadvantages....
...Patient points to the face that represents...
...face that represents the current level of...
...pain 8. Adapt the scale for the...
...the scale for the severely ill patient....
...VAS to indicate the “point.” Point to...
...“point.” Point to the number on an...
...NRS or to the location on the...
...the location on the line of a...
...VAS. Raise up the number of fingers...
...fingers that indicates the level of pain....
...of descriptive words. Patient’s word choice determines...
...from which category the pain is originating....
...Patients rely on the nurse to advocate...
...them. Review of the patient’s medical history...
...Review of the patient’s medical history provides...
...(cues) to indicate the presence of pain....
...with stimulation of the sympathetic nervous system...
...pain. Use of the sympathetic response criteria...
...pain management 1. The World Health Organization...
...choices based on the level of pain:...
...working peripherally at the site of injury....
...in combination (6) The epidural route (a)...
...small catheter into the space located just...
...located just before the dura mater. (b)...
...combination. (d) Minimizes the potential for side...
...small catheter into the cerebrospinal fluid (CSF)...
...Opioid flows through the CSF and rapidly...
...nerve path transmitting the pain is located)...
...injected medial to the point of pain...
...(2) Duration of the analgesia depends on...
...analgesia depends on the half-life of the...
...the half-life of the local anesthetic. (3)...
...nerves medial to the insertion site of...
...is placed into the pleural space, and...
...to incorporate into the care plan. b)...
...Choices based on the level of pain...
...of analgesic. Minimizes the potential for side...
...Small catheter into the CSF space. Opioid...
...Opioid flows through the CSF, binds to...
...Duration depends on the half-life of the...
...the half-life of the local anesthetic. 14....
...catheter placed in the pleural space. Local...
...physical adaptation of the body to the...
...the body to the presence of opioids...
...are less than the duration of action...
...Administering less than the physician orders (2)...
...Taking less than the amount prescribed (4)...
...Refusing to take the drug at all...
...dependence). a) Probably the major cause of...
...interval or increasing the dose. 5. Fear...
...depression. b) In the majority of hospitalized...
...close observation of the patient’s response. (1)...
...observation of the patient’s response. (1) Sedation...
...are administered before the patient complains of...
...of analgesic in the bloodstream. c) Diminishes...
...bloodstream. c) Diminishes the likelihood of undertreatment...
...based on effects the drug is having...
...than based on the milligrams being administered...
...b) Goal: Gain the desired level of...
...respiratory depression. In the majority, it is...
...should closely observe patient’s response. 9. Effective...
...based on effects the drug is having....
...are unfamiliar with the patients’ needs. (2)...
...Sedation assessment a) The nurse’s recognition of...
...tone and depresses the response to hypoxia...
...(1) POSS and the RASS are valid...
...order to facilitate the identification of trends....
...changes in ventilation (the exchange of air...
...of air between the lungs and the...
...the lungs and the atmosphere) earlier than...
...which simply measures the oxygen saturation of...
...Nursing interventions 1. The plan of care...
...Working collaboratively with the prescribing health care...
...provider to consider the omission of, or...
...effective in reducing the risk of advancing...
...be required if the patient develops severe...
...respiratory depression. b) The half-life of naloxone...
...time during which the patient may be...
...extreme pain. c) The exact PCA opioid...
...be specified by the prescribing health care...
...frequently administered in the ICU and contribute...
...after discharge from the ICU. e) Decreasing...
...ICU. e) Decreasing the mean doses of...
...accomplished by individualizing the care of each...
...analgesia POSS and the RASS 3. Use...
...Working collaboratively with the prescribing health care...
...large doses Decreasing the mean doses of...
...metabolized primarily in the liver. b) Kidneys...
...b) Kidneys have the major responsibility for...
...be reduced and the patient monitored closely....
...C. Management of the tolerant patient with...
...1. Management of the tolerant patient with...
...b) Consider a patient’s home routine opioid...
...titrated to manage the incidence of acute...
...acute pain. d) The continuous dose and...
...continuous dose and the incremental dose can...
...Hyperalgesia a) Both the use of high...
...prolonged time and the effects of chronic...
...chronic pain on the CNS can produce...
...opioids only makes the pain worse. d)...
...when appropriate. D. The known active or...
...(1) Experts in the fields of pain...
...substances abusers, have the right to pain...
...pain temporarily overrides the problem of addiction....
...exist to determine the level of monitoring...
...symptoms e) Consider the impact of tolerance...
...analgesics that have the same pharmacologic basis...
...pharmacologic basis as the abused drug. b)...
...2. Pharmacology and the effect of aging...
...metabolized primarily in the liver. Kidneys have...
...liver. Kidneys have the major responsibility for...
...be reduced and the patient monitored closely....
...monitored closely. 6. The opioid-tolerant patient—management of...
...opioid-tolerant patient—management of the tolerant patient with...
...tolerance. Consider a patient’s home routine opioid...
...titrated to manage the incidence of acute...
...of acute pain. The continuous dose and...
...continuous dose and the incremental dose can...
...substances abusers, have the right to pain...
...pain temporarily overrides the problem of addiction....
...exist to determine the level of monitoring...
...withdrawal symptoms Consider the impact of tolerance...
...analgesics that have the same pharmacologic basis...
...pharmacologic basis as the abused drug. Choose...
...clear understanding of the different stages of...
...assesses sedation in the intensive care unit....
...being performed outside the operating room. C....
...Nursing management of the patient undergoing moderate...
...unstable) 2. Before the procedure a) Before...
...procedure a) Before the conscious sedation procedure:...
...b) Verify that the patient has given...
...c) Verify that the physician has explained...
...physician has explained the procedure to the...
...the procedure to the patient. (1) E.g.,...
...Do not leave the patient unattended or...
...Have knowledge of the legal liability of...
...sedation. f) Understand the principles of respiratory...
...available. 3. During the procedure. a) Continuously...
...a) Post-procedure (after the conscious sedation procedure):...
...procedure): b) Monitor the patient’s level of...
...b) Monitor the patient’s level of consciousness...
...it’s necessary for the patient to go,...
...patient to go, the nurse must accompany....
...intravenous lines. c) The patient’s level of...
...lines. c) The patient’s level of pain...
...as indicated by the patient’s condition. E....
...indicated by the patient’s condition. E. Possible...
...conscious sedation. b) The nurse must be...
...a call to the Rapid Response Team...
...does not meet the standard. d) It...
...acceptable to continue the procedure if the...
...the procedure if the patient is oversedated....
...assesses sedation in the ICU. Sedation definitions....
...training 5. Before the conscious sedation procedure:...
...sedation procedure: Verify the patient has given...
...informed consent. Verify the physician has explained...
...physician has explained the procedure. Do not...
...Do not leave the patient unattended. Have...
...Have knowledge of the legal liability. Understand...
...legal liability. Understand the principles of respiratory...
...available. 6. During the conscious sedation procedure:...
...7. Post-procedure (after the conscious sedation procedure):...
...sedation procedure): Monitor the patient’s LOC and...
...procedure): Monitor the patient’s LOC and vital...
...separate IV lines. Patient’s level of pain...
...does not meet the standard. Do not...
...Classroom Activities Read the original AHCPR guideline...
...definition document. Discuss the AHCPR guideline definitions...
...or thoughts on the undertreatment of pain,...
...have personally experienced the undertreatment of pain—and...
...are found within the class? Suggestions for...
...pain. Ask about the four common misconceptions...
...play out in the actual clinical setting—how...
...avoided, etc. Obtain the pain management policies...
...management policies for the clinical facility. Discuss...
...clinical facility. Discuss the policy with the...
...the policy with the clinical group. What...
...group. What are the specific nursing responsibilities?...
...nursing responsibilities? Do the students feel they...
...they are seeing the guidelines in the...
...the guidelines in the policy upheld on...
...regular basis on the clinical unit? Wagner...

...Holistic Care of the Patient and Family...
...Objectives: 1. Discuss the impact of illness...
...of illness on the high-acuity patient and...
...2. Identify way the nurse can help...
...event. 3. Describe the principles of patient...
...family-centered care in the high-acuity environment as...
...policies. 4. Discuss the importance of awareness...
...patients. 5. Examine the role of palliative...
...palliative care in the high-acuity environment and...
...Illnesses can cause the patients to experience...
...might respond to the losses by passing...
...accepted. e) Resolution: Patient’s identity is changed....
...Nursing considerations 1. The family is an...
...important part of the patient’s health outcome....
...part of the patient’s health outcome. 2....
...must participate in the care and recovery...
...2a. Needs of the Family of the...
...the Family of the Patient with High-Acuity...
...Communication Requirements of the Family Openness Honesty...
...stress. Humor strengthens the bonds among the...
...the bonds among the patient, family, and...
...family, and nurse. The use of humor...
...facilitate sleep. (2) The vascular, muscular, and...
...encourages relaxation. (2) The patient is asked...
...soft tissues of the body using the...
...the body using the hands Can reduce...
...used to distract the patient from painful...
...a relationship with the patient facilitates trust...
...facilitates trust in the nurse and will...
...inhibit learning in the high-acuity patient. Obstacles...
...communication and pain. The nurse must meet...
...nurse must meet the physiological needs of...
...physiological needs of the patient before attempting...
...(3) Acknowledgement of the past (4) Optimal...
...a) Transfer of the patient to a...
...transfer anxiety in the patient or family....
...or family. b) The anxiety is the...
...The anxiety is the result of a...
...of care allowing the patient and family...
...promote success of the transfer. d) Moving...
...transfer. d) Moving the patient during daytime...
...care units in the United States have...
...are unrestricted. 2. The visiting activities of...
...care units: a) The rationales for these...
...are concerns for the risk of infection...
...infection and for the emotional well-being of...
...emotional well-being of the child. b) In...
...child. b) In the event a family...
...identified benefits of the presence of the...
...the presence of the family during CPR....
...during CPR. 4. The care delivery model...
...delivery model embraces the presence of the...
...the presence of the family members at...
...family members at the bedside: a) Nursing...
...provide education to the family members regarding...
...should carefully address the facility’s stance toward...
...Slides 1. Educating the High-Acuity Patient Goals...
...a relationship with the patient 2. Barriers...
...to Learning for the High-Acuity Patient Condition-related...
...making Acknowledgement of the past Optimal learning...
...on: Concerns for the risk of infection...
...emotional well-being of the child Should be...
...Presence during CPR The ability of the...
...The ability of the family to grasp...
...family to grasp the seriousness of the...
...the seriousness of the patient’s illness. Family...
...seriousness of the patient’s illness. Family members...
...was done for the patient. Families move...
...more positively through the grieving process. Removal...
...is happening to the patient. Families experience...
...one. Facilitation of the grieving process by...
...letting them influence the care of patients...
...and acceptance for the patient’s culture. c)...
...acceptance for the patient’s culture. c) Cultural...
...includes sensitivity to the culture, race, gender,...
...economic status of the patients. 2. Other...
...competence 1. In the quest for developing...
...developing cultural competence, the nurse must give...
...will prevent stereotyping. The nurse must assess...
...must be in the language and at...
...language and at the level needed by...
...level needed by the patient. Judgment cannot...
...be made concerning the patient’s choices. The...
...made concerning the patient’s choices. The CRASH...
...the patient’s choices. The CRASH (culture, respect,...
...Economic status 2. The CRASH Model Consider...
...suffering and improving the quality of life....
...and symptoms. c) The program includes members...
...care models allow the needs of patients...
...a) Cancer is the most common disorder...
...care exist for the high-acuity-care patient. b)...
...difficult to make the transition from a...
...palliative nature. c) The limited collaboration and...
...needed to facilitate the patient’s progression to...
...to facilitate the patient’s progression to a...
...care path. b) The team will consist...
...will consist of the high-acuity nurse and...
...High-Acuity Settings: a) The Patient Self-Determination Act...
...advanced directives. b) The American Association of...
...and appreciation of the collaborative role of...
...team members. c) The Patient Self-Determination Act...
...term implies that the patient is dying...
...done to keep the patient comfortable and...
...comfortable and allow the dying process to...
...occur naturally. (2) The goal of AND...
...individuals already in the workforce as well...
...Fragmented care 5. The Palliative Care Team...
...spiritual needs Includes the high-acuity nurse and...
...Conferences are instrumental The care plan must...
...be comprehensive 6. The Patient Self-Determination Act...
...Act Part of the Omnibus Budget Reconciliation...
...given information about the right to formulate...
...Environmental characteristics of the high-acuity care unit...
...significant impact on the patient. b) The...
...the patient. b) The patient is at...
...and deprivation. c) The individual’s normal stimuli...
...are interrupted, and the senses simultaneously are...
...unresponsive are at the greatest risk for...
...alterations (SPAs). e) The nurse must recognize...
...nurse must recognize the stressors presented by...
...stressors presented by the environment and promote...
...unnecessary noises: (1) The Environmental Protection Agency...
...disorganized thinking. b) The nurse must assess...
...assess and identify the cause of the...
...the cause of the delirium. c) Causes...
...vary. Once determined, the underlying causes must...
...are compromised in the high-acuity unit. b)...
...high-acuity unit. b) The changes in the...
...The changes in the light/dark cycle, pain,...
...are caused by the inability to speak....
...When caring for the patient who cannot...
...who cannot speak, the nurse must act...
...patient advocate. (1) The nurse will need...
...provide support for the decision of the...
...the decision of the patient or designated...
...with those of the health care provider...
...by Environmental Stressors The aged population Very...
...2. Role of the Nurse Caring for...
...Nurse Caring for the High-Acuity Patient Assess...
...High-Acuity Patient Assess the patient’s normal environmental...
...Patient Assess the patient’s normal environmental stimuli...
...Environmental Stimuli and the Unconscious Patient An...
...An assessment of the normal stimuli for...
...normal stimuli for the unconscious patient must...
...must be completed. The nurse might need...
...normal stimuli for the patient. 5a. Delirium...
...5d. Role of the Nurse Caring for...
...Nurse Caring for the Patient Experiencing Delirium...
...6a. Alterations of the Rest and Sleep...
...with changes in the light/dark cycle Causes:...
...6b. Alterations of the Rest and Sleep...
...to prevent SPA. The inability to verbally...
...behaviors needed. 8. The Patient Who Cannot...
...Nurse must represent the patient or patient...
...in-class review. Divide the class into small...
...care plans addressing the education needs of...
...education needs of the acutely ill patient....
...short time for the exercise. Once complete,...
...Once complete, ask the student groups to...
...their work with the entire class. Having...
...entire class. Having the correct learning environment...
...for educating for the acutely ill patient...
...their concepts of the optimal learning environment....
...Clinical Activities Discuss the implications of ensuring...
...high acuity. During the clinical post conference,...
...post conference, ask the students to determine...
...which Suchman stage the patient they cared...
...to visit with the clinical group. Ask...
...clinical group. Ask the massage therapist to...
...therapist to discuss the use of massage...