NURS 1112 - Module 11 - Cognitive & Sensory function, Pain.

Auditory

hearing

What area of the arm and leg (dermatome) must be touched in order to assess C 3 - 8 spinal nerves

lateral side of arm (all the way from neck to end of thumb, C3-C6, C7 is middle of hand from wrist to tip of middle finger, C8 is from wrist to tip of pinky finger).

Describe each of the following aspects of a cognitive assessment

level of conciousness, behavior and appearance, language, intellectual function.

Pain threshold

minimal intensity of a stimulus that is perceived as painful. Stress, exercise, other factors increase the release of endorphins, raising an individual's pain threshold

Glaucoma

second most common cause of vision loss in Canadians over 65yr, one of the most common causes of blindness, it can develop at any age, but affects 1 in 100 Canadians over 40yrs of age. Results in increased fluid pressure inside the eye that can eventually damage the optic nerve. If untreated= result in visual field loss, decreased visual acuity, a halo effect seen around objects, and blindness. Can be idiopathic in origin or may be caused by eye injury, inflammation, tumours, diabetes, or medications such as steroids.

What area of the arm and leg (dermatome) must be touched in order to assess T1 spinal nerve

the antebrachial area of the forearm and the Brachial (inside of the upper arm and forearm)

Dermatomes of the body

the body surface areas innervated by particular spinal nerves

Acute pain

usually has an identifiable cause, either omatic, visceral, or nociceptive. Has a predictable ending and an identifiable cause, and eventually resolves with or without treatment after a damaged area heals.

Define sensory deficit. How does a sensory deficit impact health?

A loss in the normal function of sensory reception and perception. Prevalence is a concern with people reaching 65yrs and older. When sensors are impaired the sense of self is affected, a person may withdraw by avoiding communication or socialization with others in an attempt to cope with the sensory loss. Its difficult for the individual to interact safely with the environment until new skills are learned.

Expressive aphasia

A motor type of aphasia, is the inability to name common objects or express simple ideas in words or writing. For example, a patient understands a question but is unable to express an answer

Nursing Intervention for Pain

ABCDE! A- ask B- believe C- choose D- deliver E- empower

Cerumen accumulation

Accumulation of cerumen (earwax) that can cause symptoms of hearing loss, fullness, otorrhea, tinnitus and dizziness.

behavioural indicators of pain the nurse may observe on inspection

Anxiety(initial response to pain), depression, irritability, chronic fatigue often accompany persistent pain. Nonverbal and verbal behaviours indicators include body movements, facial expressions, vocalizations. Bracing, splinting, protecting the painful part, rocking, body stiffening, jaw clenching, grimacing, frowning, crying, moaning, screaming may indicate pain is present. Affective responses can include social withdrawal, changes in eating or sleeping patterns, stoicism, fear, anxiety, anger, or feeling of hopelessness.

Subjective Pain Assessment Tool

COLDSPAA! C-character O-onset L-location D-duration S-serverity P-pattern A-affect on client A-assotiated factors

Taste alteration

Decrease in salivary production that leads to thicker mucus and a dry mouth. It may result from the adverse effects of medication. Can interfere with the ability to eat and nutritional problems.

steps in objective assessment of the extremities for tactile sensation temperature

Equipment; Two test tubes, one filled with hot water and the other with cold. Method; touch skin with tube. Ask patient to identify hot or cold sensation. Precautions; omit test is pain sensation is normal.

steps in objective assessment of the extremities for tactile sensation of pain

Equipment; broken tongue blade or wooden end of cotton applicator. Method; ask patients to voice when they feel dull or sharp sensation. Alternately, apply sharp and blunt ends of tongue blade to skin surface. Note areas of numbness or increased sensitivity. Precautions; Areas where skin is thick, such as heel or sole of foot, are less sensitive to pain.

steps in objective assessment of the extremities for tactile sensation light touch

Equipment; cotton ball or cotton tip applicator. Method; apply light wisp of cotton to different points along skins surface. Ask patient to voice when they feel sensation. Precautions; Apply to areas where the skin is thin or more sensitive. (e.g face, neck, inner aspect of arms, top of feet or hands).

Cataract

Every individual will develop cataracts if they live long enough. Gradually develops without pain, resulting in blurring, decreased vision, and glare. Associated with aging, it can also be caused by diabetes, injury or medication, especially steroids.

Visual

Eyesight

behaviours that an adult might exhibit that indicate a deficit in Smell

Failure to react to noxious or strong odour, increased body odour, decreased sensitivity to odour.

Global aphasia

Inability to understand language or communicate orally

What area of the arm and leg (dermatome) must be touched in order to assess L1 - 5 spinal nerves

L1 at the top of the hips and genital area, L2 upper and inner thigh, L3 middle of thigh carried down into the inside of the calf, L4 outside bottom of thigh and most of the front of the calf, L5 lateral side of calf and top of foot.

Nociceptor

Nocireception has four specific processes: transduction, pransmission, perception and modulation. Transduction: When tissue cells are damaged, the cells release pain sensitizing and inflammatory substances which activate nocireceptors, resulting in transduction, which is the generation of electrical activity in the peripheral terminals (an action potential). Transmission: the second process. The pain sensitizing or inflammatory substances surround the pain nerve fibres in the ECF, creating the spread of the pain message via the afferent peripheral nerve fibres to the dorsal horn of the spinal cord. Within the dorsal horn, a synaptic transmission from the afferent (sensory) peripheral nerve to the spinothalamic tract nerves occurs through a complex neurophysiological and neurochemical mechanism, resulting in the relay of the signal to various higher brain centers. Perception is the conscious awareness of the pain. Modulation is the final nocireceptive phase and refers to the increase of decrease in pain signal intensity that can occur before, during and after pain is percieved.

scales used to rate intensity of pain

Numeric scale, visual analog, faces, northern pain scale.

Chronic pain

Pain that persists past the normal time of healing. Chronic pain can be intermittent or persistent.

What area of the arm and leg (dermatome) must be touched in order to assess S1 - 2 spinal nerves

S1 lateral posterior side of leg from top of butt to ankle to the lateral side of the top of foot. S2, Medial posterior side of leg from top of butt to heel all the way along the bottom of the foot.

Gustatory

Sense of taste

Perception of pain

The conscious awareness of pain. Once a pain stimulus reaches the cerebral cortex, the brain interprets its intensity, quality and character of the pain

Receptive aphasia

The inability to understand written or spoken language, a patient is able to express words but is unable to understand questions or comments of others

cognition

Thinking skills including language usage, calculation, perception, memory, awareness, reasoning, judgment, learning, intellect, and social skills, imagination.

normal sensory function

Three components if any sensory experience: reception, perception, reaction. Normal sensation allows us to enjoy pleasurable sensations and warns us of potential ot acute tissue damage.

Define sensory deprivation. How does sensory deprivation impact health?

When a patient experiences an inadequate quality or quantity of stimulation. Three types of sensory deprivation; 1. Reduced sensory input ie caused by sensory defect from visual or hearing loss. 2. Illumination of pattern or meaning from input ie exposure to strange environment. 3. Restriction of the environment, producing boredom and monotony ie bed rest or reduced environmental variation. Impacts health negatively by causing delirium.

Tinnitus

affects about 10-15% of the population. Described as ringing. Buzzing, or pulsating sound in the ear. It can be intermediate or constant. Have one or more tones, and vary in volume. (does not always include hearing loss).

Pain tolerance

affects how a patient may respond to pain and discomfort, to avoid judgments on your part, you must take into consideration your own beliefs about pain, and consider the immediate context of the clients situation (especially if they appear to have a low pain tolerance.

Delirium

an acute, short term mental disorder characterized by confusion, disorientation, and restlessness. Disturbance of consciousness that may last a few hours, will become permanent if not detected and treated. It is characterized by acute onset of inattention, disorganized thinking, hallucinations, and agitation.

behaviours that an adult might exhibit that indicate a deficit in Taste

change in appetite, excessive use of seasoning and sugar, complaints about taste of food, weight change

Peripheral neuropathy

common disorder-especially people with diabetes and older persons. Sensations such as tingling or pins and needles, numbness, weakness, and pain are felt, often starting in lower legs and feet. Difficult to diagnose early on.

Macular degeneration

deterioration of the retina in people over the age of 60, causes irreversible vision loss.

behaviours that an adult might exhibit that indicate a deficit in Hearing

in children; frightened when unfamiliar people approach, no reflex or purposeful response to sound, failure to be awakened by noise, slow or absent development of speech, greater response to movement than to sound, avoidance of social interaction with other children In adults; blank looks, decreased attention span, lack of reaction to loud noises, increased volume of speech, positioning of head toward sound, smiling and nodding of head toward sound, smiling and nodding of head in approval when someone speaks, use of other means of communication such as lip-reading/writing, complaints of ringing in ears.

behaviours that an adult might exhibit that indicate a deficit in Touch

in children; inability to perform developmental tasks related to grasping objects or drawing, repeated injury from handling of harmful objects (hot stove or sharp). In adult; Clumsiness, overreaction or underreaction to painful stimulus, failure to respond when touched, avoidance of touch, sensation of pins and needles, numbness.

Otitis media

infection of the middle ear that is common in infants and children. Recurrent or chronic otitis media can cause damage to the eardrum or middle ear, results in permanent hearing loss

Presbyopia

is a visual deficit; difficulty reading small print.

Vertigo

is the sudden loss of balance. Characteristic of Meniere Disease.

Presbycusis

most common type of sensorineural hearing Loss caused by the natural aging of the auditory system. It occurs gradually and initially affects the ability to hear higher pitched (higher frequency) sounds.

Hyperesthesia

over sensitivity to tactile stimuli

Cancer pain

pain in a patient with cancer by be acute, chronic or both. It may also be nociceptive, neuropathic or both. It may be caused by tumour progression, invasive procedures, toxicities of treatment (chemo, radiation), infection or physical limitations.

behaviours that an adult might exhibit that indicate a deficit in Position sense

poor balance and spatial orientation, shuffling gait, reduced response to brace self when falling, slow and deliberate movements, a history that includes falls

Stroke

poor blood flow to the brain results in cell death

behaviours that an adult might exhibit that indicate a deficit in Vision

poor coordination, squinting, underreaching or overreaching for objects, persistent repositioning of objects, impaired night vision, accidental falls

Olfactory

sense of smell

Tactile

sense of touch

Stereognosis

sense that allows a person to recognize an objects size, shape, and texture

Kinesthetic

sense that enables a person to be aware of the position and movement of body parts without seeing them.

Diabetic retinopathy

the result of pathological changes that occur in the blood vessels of the retina, resulting in decreased vision or vision loss caused by hemorrhage and macular of age. Leading cause of vision loss in Canadians under 50yrs of age. Long term or poorly managed diabetes can lead to progressive damage to the blood vessels that feed the retina ( blood vessels leak into the retina and result in severe vision loss or blindness.

Dementia

umbrella term for a variety of diseases that cause irreversible changes in the brain

Aphasia

varied abilities of the ability to speak, interpret, or understand language

Define sensory overload. How does sensory overload impact health?

when a person receives multiple sensory stimuli and cannot perpetually disregard or selectively ignore some stimuli. Prevents the brain from appropriately responding to or ignoring certain stimuli. Prevents meaningful response from the brain; thoughts race, attention moves in many directions, and anxiety or restlessness may occur.