Pain Assignment
Pain Assignment
Order Instructions:
In this assignment we are going to look at Mrs Gwendolyn Harris. Mrs Gwendolyn Harris is an 82 year old war widow who has presented to the nurse practitioner wound management clinic after being referred by her GP Dr Greenwood. Six weeks ago she was scratched on the lower right leg by her cat Whiskers. The wound has not healed well. She has had increasing pain over the past six weeks which has been relieved to some degree after her daughter advised her to elevate her leg in the evenings. She has also been applying a small crepe bandage, which she has been washing every other day, to her lower leg daily to reduce the exudate soiling her clothes. Julia (the daughter) drives her mother to the vascular nurse practitioner (VNP) clinic. He reviews her bilateral Doppler ultrasound and bilateral ankle brachial pressure index (ABPI) results which confirm R) lower leg venous insufficiency and deep venous disease.
Mrs Gwendolyn has a Past medical history of ;Congestive cardiac failure (CCF), bilateral leg varicose veins, R) leg deep vein thrombosis (DVT) five years ago, gastrointestinal bleed (GI) bleed 10 years ago
She has a Past surgical history of; Cholecystectomy 40 years ago
Her Past family history include ;Sister, Jessie (deceased), cardiovascular disease (CVD), macular degeneration.
She is Allergic to Penicillin, Voltaren
In this assignment we are to discuss in-depth the pathophysiology of Gwendolyn’s condition firstly, therefore pathophysiology of pain and wound healing. We are then to identify objective and subjective data & formulate relevant actual or potential four (4) nursing issues based on the data presented in the scenario. The four (4) nursing issues identified for Gwendolyn are;
1) Chronic wound healing
2) Chronic pain
3) Poor eyesight
4) Hearing loss.
For each of the nursing issues identified above, we are to provide a brief pathophysiology for each one, provide excellent understanding of current evidence based practice and patient centred care. We are also to discuss the inter-professional roles likely involved, discuss/link pharmacology (Macuvision for her poor eyesight, antibiotics for her wounds and chronic pain management medication like Metronidazole, Ciprofloxacin), discuss lifespan issues (how her age can affect wound healing, Poor eyesight and hearing loss because of her age), discuss also briefly her psychosocial issues (she is a 82 yr. old widow living independently) This should be included for each of the nursing issues. We should demonstrate clear links between these concepts and the case scenario and nursing practice.
SAMPLE ANSWER
Pain has a warning damage as well as a protective function in nature, which calls for adequate medication and treatment of the affected areas as in the case of Mrs. Gwendolyn. Wounds resulting to pain is identified to have failed to heal in an orderly reparative process. The wounds lead to poor functional, and anatomy integrity due to pain that follows. Pain influences poor perfusion and low oxygen tension reduces the rate of collagen deposition in the tissues. Consequently, vasoconstriction follows due to severe pain which also impairs the healing of wounds. Infection, ischemia, nerve damage or the severe injury on the skin are the major causes of wound pain similar to the case of Mrs. Gwendolyn. The decrease of oxygen in the tissues results to production of low leucocytes which causes infection as the bacteria is given a chance to colonize the wound (Robb, 2016, pg. 56). In this case, the patient suffers severe pain and makes the healing process of the wound cumbersome. However, pain is identified to be a personal thing that is dependent on what the patient would express.
Etiology and pathology of pain dictate the sort of pain experienced by the patients. In this case, Mrs. Gwendolyn suffers from severe pain since the deep venous disease is a peripheral vascular problem which affects the healing process (Roberts et al, 2016, pg. 88). The deep venous disease in the patient also causes the venous ulcers which need to be addressed carefully through the right treatment and management strategies. Provision of a moist wound environment, compression therapy necrotic tissues’ debriment is essential during the pain and wound healing process of a patient (Bester & Van, 2015, pg. 79).
Patients with chronic wounds require quick management to prevent its progression to fatal stages causing severe pain. The accurate assessment of the patient’s pain progression is vital before the adoption of treatment strategies for chronic wounds. Venous insufficiency as identified in Mrs. Gwendolyn is one of the major causes that leads to the progression of wounds to be chronic. Other factors include arterial perfusion, unrelieved pressure, and immunosuppression. The chronic wound healing issue as identified is affected by many systematic and local factors (Robb, 2016, pg. 105). Age factor affects wound healing. The altered inflammatory process is related to impaired healing of chronic wounds among the elderly. Delayed infiltration of T-cell and chemokine production influence the delayed healing of chronic wounds among the elderly. Exercise is proved to enhance faster wound healing among the elderly. Elimination of the noxious stimuli and identifying the underlying cause is crucial while managing the chronic wound issues. Chronic wounds healing is closely associated with the high intensity of the acute postoperative pain.
It is essential to follow the patient centered care and evidence-based practices while treating patients with chronic wounds. While addressing chronic wound healing complications, there are various elements identified using TIME mnemonic device (Mehmood et al, 2015, pg. 112). The device is set to identify elements of chronic wound healing impairment. These elements include tissue surrounding the wound, infection or inflammation, moisture balance and edges blood supply. Preserving vital tissue is essential as there are many impediments that hinder optimal healing. Sharp debridement as an effective evidence-based practice used in the treatment of chronic wounds arising from venous related ulceration such as the patient in our case study. Topical antibiotics such as Vitamin A& D ointments, antacids, regranex, and collagen are used to enhance the faster and more efficient healing of chronic wounds (Mehmood et al, 2015, pg. 60). Silver-containing dressings are used in improving the healing rates for wounds. Nurses and other medical practitioners are supposed to treat the patient through proper dressing of wounds, enhancing adequate nutrition, ensuring proper tissue oxygenation as well as treating underlying infections. It is the role of the nurse to follow-up even after debriment and treatment of infections to ensure wound care is efficient to control chronic contamination of the wound (Rhee et al, 2015, pg. 109).
It is the professional role of nurses to provide wound management education and training to patients and their family members. Such measures and practices have been seen to improve the efficacy and quality of the treatment strategies used thus preventing the complication of situations. Optimal care should be provided to the patients, especially the elderly who have numerous cases of malnutrition which affects their wound healing process (Hosseini et al, 2016, pg. 93). The collaboration between the physician and patient enhances the better management of the chronic wounds.
The chronic pain is another nursing issue identified and requiring the quick address to prevents further complications experienced by the patient. The initiating causes and the patient’s threshold for pain is used in differentiating whether the pain is chronic or not. Multiple neurobiological mechanisms are said to contribute to pain making its categorization cumbersome (Lee et al, 2014, pg. 156). Nevertheless, some of the most common types of pain include nociceptive pain, central pain augmentation, and inflammatory pain. Aberrant somatosensory processing which occurs in the central nervous system is used to explain the chronic pain. Inflammation or damage to the tissue sensitizes nociceptors which are the nerve ending transmitting signals of pain in the nervous system (Scherer et al, 2016, pg. 112). Chronic pain is identified to be a persistent maladaptive response where psychological comorbidities are common.
Better pain management is made possible through adherence to the right evidence-based practices as well as the provision of patient-centered care to the patient. Such strategies would include understanding the pathophysiology of chronic pain appropriately before the administration of management strategies. Interventional and behavioral therapy should be combined as practices by the nurses while offering professional assistance to patients experiencing chronic pain (Fox et al, 2016, pg. 145). Full involvement of the family members and the patient would ensure they also contribute to making of clinical decisions towards their treatment making management of situations such as chronic pain more efficient in nature. Rehabilitation practices such as occupational, physical and cognitive therapy are used in the management of chronic pain reducing medication needs (Lukewich et al, 2015, pg. 92). Various drugs such as simple analgesics, opioid, and tricyclic antidepressants are used as the medication for treating patients with chronic pain (Scherer et al, 2016, pg. 156). It is the role of the nurse to offer proper clinical guidance to the patient as well as the prescriptions of drugs. Anti-inflammatory drugs are used in the management of pain among patients. Other medication drugs include ciprofloxacin and metronidazole (Patel et al, 2016, pg. 135).
The inter-professional role of the nurse ensures that approach of pain management is organized in nature. The approach entails, routine chronic pain evaluation, encouraging patients to share their chronic pain experiences, adopting evidence-based practices during treatment as well as selective modification of opioid regulatory policies and practices. Adherence to Consistent pain management strategies and minimizing pain is the major role performed by those caring for the patient. The psychosocial issues should be handled effectively; it is most likely that the woman feels lonely which might also affect her recovery process (Rommem et al, 2015, pg. 137). It is essential to administer therapies and advice that a person is attached to the patient to offer her necessary support. Nurse Follow-up of her medication and treatment, while she is at home, would help alleviate the psychosocial issues that could affect her recovery.
Poor eyesight is another nursing issue identified and requires proper management. Poor eyesight causes people to have a blurry vision which makes various objects appear hazy or seems to be out of focus. Some of the poor eyesight problems include astigmatism, refractory errors and also presbyopia (Waldron, 2012, pg. 43). A comprehensive eye assessments such as Snellen eye chart and the spatial contrast sensitivity test would be helpful in identifying the particular eyesight problem. Age has been consistently identified as a factor influencing poor eyesight among patients (Wadlron, 2012, pg. 64). There is macular degeneration which is age-related and leads to blurry vision and gradual loss of vision. The elderly also experience distortions which can lead to blindness at the end. The patient in our cases study has a family history of macular degeneration which can be a cause of her poor eyesight problems due to genetic factors. Through macular degeneration, the central vision would become blurred due to damage of macula. Age is a major contributing factor since most people suffering from poor eyesight problems are above the age of 65years while the risk rises with the increase in age (Dutta et al, 2015, pg. 117). Other than macular degeneration vision impairment in the elderly patient would result due to cataract and glaucoma.
Treatment and management of poor eyesight problems to prevent the progression to severe stages is essential when caring for the patients. The diagnosis of poor eyesight problem should be done correctly before undertaking any treatment strategies. Treatment is dependent on specific causes. Psychosocial reasons such as stress and loneliness might hinder the patient from taking care of herself well even to follow the diet that helps improve eyesight (Willis et al, 2016, pg. 138). In this case, it is vital to have a caregiver who is there almost all times. Alterations in vision, especially among the old, is detected using Amsler grid (Simsek et al, 2015, pg. 143). To reduce the risks of suffering from the age-related macular degeneration (AMD), intake of foods with high levels of carotenoids is useful. Foods rich in zeaxanthin and lutein are also required to solve the problem. Mineral supplements and antioxidant vitamin are offered to the patient to manage the situation (Sismek et al, 2015, pg. 73). Complete blindness is not related to AMD, thus the management of poor eyesight is easier. Radiation therapy and provision antiangiogenic drugs are recommended among the evidence-based practices to manage poor eyesight.
Hearing loss results from poor or lack of sound transmission to the cochlea. Hearing loss is usually categorized into various levels such as slight, mild, moderate, severe and profound hearing losses. Presbycusis is one of an age-related hearing loss problem which is experienced among the elderly people like Mrs. Gwendolyn (Werfel et al, 2016, pg. 75). The hearing loss gradually progresses as one gets old with time. Equal effects are experienced in both ears when one is affected by the problem. Past medications toxic to ensory cells, past medical conditions such as hypertension or chemotherapy drugs influence hearing loss among elderly people. Hearing loss affect the functioning of the tympanic membrane (Schlauch et al, 2015, pg. 83).
It is the professional role to involve the patient and the family actively in training and educating about hearing loss. Referral of patients to special programs or audiologist to assist in improving auditory reception is important. Social workers can also be assigned to those who already suffer from hearing loss to assist them in their daily activities since elderly people have psychosocial problems which call for the caregiver to be present (Rudner et al, 2016, p.g 70). The management and provision of patient-centered care are essential for the elderly patient during prevention or treatment of the problem (Van et al, 2016, p.g 112).
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