nursing 121 comfort and fatigue (mod 3) set #18

A patient with chronic pain will be using acetaminophen (Tylenol) for pain relief when discharged. Which information found in the patient's history should the nurse identify as increasing the risk for hepatotoxicity from the use of this medication? ANSWER Concurrent anticoagulant therapy Chronic ingestion of alcohol Use of temazepam for sleep Concurrent use of morphine at times

Chronic ingestion of alcohol Acetaminophen causes hepatotoxicity; thus, individuals who consume alcohol have an increased risk of hepatotoxicity with acetaminophen use. Nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, should be used cautiously in those who are on anticoagulant therapy. Concurrent use of temazepam or morphine does not necessarily increase the risk for hepatotoxicity. (muscle relaxation technique involves contracts muscle groups progressively from toe to head. each muscle for 5-15 seconds)

The nurse prepares to assess a patient who has been experiencing pain for several months. Which statement correctly describes what the nurse should recall about chronic pain? ANSWER Triggers a sympathetic nervous response Has been present for 2 months May cause depression Ends once healing is complete

May cause depression Chronic pain, also referred to as persistent pain, is pain that lasts longer than 6 months. The pain may vary in intensity and location. Chronic pain may cause depression. Acute, not chronic, pain triggers a sympathetic nervous response.

A patient in the clinic complains of fatigue. Which question should the nurse ask to differentiate acute fatigue from chronic fatigue? (pay attention to the conditions: 3 choices ore for one type of fatigue and 1 for the other) "Have you had a recent change in your life?" "Do you have any chronic medical conditions?" "Are you currently caring for any other family members?" "What medications are you taking for your congestive heart failure?"

"Have you had a recent change in your life?" The question, "Have you had a recent change in your life?" will differentiate acute fatigue from chronic fatigue. Acute fatigue is mental or physical exhaustion associated with a temporary change in life and can normally be resolved by the completion of the event or a good night's sleep. The questions, "Do you have any chronic medical conditions?" "Are you currently caring for any other family members?" and "What medications are you taking for your congestive heart failure?" are all reflective of chronic situations. Chronic fatigue is mental or physical exhaustion associated with a chronic condition or situation that is not resolved quickly. (older patients with liver cirrhosis are at high risk for fatigue)

During a visit at the health clinic, a patient says, "I just can't understand why I can't get a good night's sleep. I am so tired." Which assessment question should the nurse ask to support or rule out consideration of chronic fatigue syndrome? ANSWER "How long have you had difficulty sleeping?" "Does your spouse have any sleeping difficulties?" "Do you remember your dreams when you wake up?" "Do you have heart disease?"

"How long have you had difficulty sleeping?" Considerations of chronic fatigue syndrome depend on the duration of the difficulty (more than 6 months), the absence of a primary health condition, and no response from stress reduction exercises. A spouse's sleeping difficulties and recalled dreams are not relevant. Chronic fatigue syndrome is not caused by a primary condition such as heart disease. (sleep studies are ordered after physiological, psychological disorders have been ruled out and psychosocial stressors have been assessed.)

The nurse completes an assessment of a patient who is experiencing discomfort. Which question should the nurse ask that will best identify a lifestyle issue that may contribute to the discomfort? (notice what the question ask about; lifestyle, diet, motivation or pt history?) "Is your discomfort possibly related to exercising?" "Does your discomfort decrease your motivation to participate in daily activities?" "Does eating make the discomfort better or worse?" "Have you had past experiences that affect the way you view this current discomfort?"

"Is your discomfort possibly related to exercising?" Asking the patient about physical exercise addresses a potential lifestyle reason for the discomfort. Asking if the discomfort decreases motivation or if eating makes it better or worse would be aspects of the current problem related to discomfort. Asking if past experiences affect the way the patient is experiencing the current discomfort would fit in the patient history related to discomfort.

fatigue in older adults

-Extremely common -Increases with age -Associated with worse health, decreased physical activity, functional decline, loss of independence -Associated with increased mortality

C​ Rationale: A likely contributor to the fatigue would be the new hypertension medication. The report of fatigue did not indicate hypotension. Ongoing nocturia and lack of mobility have been a stable​ situation, rather than a recent change. (from other question)Chronic fatigue produces mental or physical​ exhaustion, with no response to a night of sleep. It does not involve sedatives or other medications. It is not a temporary​ condition, nor does it resolve quickly.

An older adult client with difficulty ambulating and nocturia reports an onset of fatigue since taking a new medication for high blood pressure. Which is a likely contributor to this​ client's fatigue? A. Lack of mobility B. Hypertension medication C. Ongoing nocturia D. Hypotension effect

A patient with chronic fatigue syndrome reports joining a gym. Which information should the nurse share with the patient? ANSWER Be cautious about beginning exercise. Take aerobic exercise classes. Plan to lift weights. Exercise in the morning.

Be cautious about beginning exercise. With a diagnosis of chronic fatigue syndrome, the patient should be cautious about beginning exercise. Graded exercise programs may be especially beneficial by helping the patient gradually build stamina for exercise. The patient should not take aerobic exercise classes or plan to lift weights. Timing exercise for the morning hours is not significantly helpful. (fatigue can be due to unbalanced diet, so tell the pt to drink more water to prevent dehydratrion)

The nurse prepares to assess a patient with fatigue. When completing the health history, the nurse should focus on which data? ANSWER (pay attention to things that can be part of history/previous to clinic visit vs thing that can be done at the moment and therefore are not part of history. also check for thing that do not cause fatigue) Skin tone Vital signs Known allergies Current medications

Current medications When completing the health history, the nurse should assess for current medications that may contribute to the fatigue. Skin tone and vital signs are a part of the physical assessment, not the health history. Allergies do not necessarily cause fatigue in adult patients but may cause fatigue in children. (pt whit depression have fatigue due to neurotransmitters dysregulation.)

The nurse is concerned that a colleague is demonstrating signs of fatigue. Which manifestation of fatigue did the nurse most likely observe? ANSWER Muscle weakness Difficulty concentrating Dyspnea on exertion Loss of appetite

Difficulty concentrating Difficulty concentrating is a neurological symptom of fatigue. Muscle weakness, dyspnea on exertion, and loss of appetite are physical symptoms of fatigue.(for these questions pay attention to what system they are referring. if question say musculoskeletal system, then the answer would be muscle weakness) (exercise is good for pt with sleep apnea whereas pt with chronic fatigue/chronic fatigue syndrome should be cautious with beginning exercise)

A patient reports experiencing back pain "for years." Which intervention should the nurse select to most directly support this patient's psychological well-being? (notice that the question is asking for Psychological) Teaching focused breathing techniques Encouraging a positive attitude Reducing environmental distractions Teaching muscle-relaxation techniques

Encouraging a positive attitude Patients who maintain a positive attitude have decreased stress, have increased cardiovascular health, and develop essential coping skills. Breathing strategies and muscle-relaxation techniques can help to reduce stress, lower blood pressure, and increase blood flow to major muscles, thereby inducing sleep, reducing pain, and calming emotions. A reduction in environmental distractions most directly impacts sleep.

The nurse is teaching a patient about risks related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. Which risk related to NSAID use should the nurse include in the teaching? ANSWER Gastric distress Hepatotoxicity Kidney toxicity Constipation

Gastric distress NSAIDs increase the risk for gastric distress and allergic reactions. Acetaminophen increases the risk for liver and kidney toxicity, not NSAIDs. Opioids, not NSAIDs, can cause constipation. (The SCN9A gene has been associated with an increased risk for fibromyalgia)

The nurse reviews the WBC count of a patient experiencing discomfort. Which information might the WBC count provide about this patient's discomfort? ANSWER Helps to identify if infection may be the cause Discerns if iron deficiency is the potential cause Provides possible support for malnutrition or an illness being the cause Indicates if leukemia or cancer might be the cause

Helps to identify if infection may be the cause WBC count to identify infection. Hematocrit and hemoglobin to discern if iron deficiency anemia is the cause of fatigue. Urine analysis to indicate malnutrition or illness. Polysomnography to diagnose sleep disorders. X-rays to help determine if a physical injury is present. (sleeping aid meds can cause paradoxical reactions/opposite reactions in older)

The nurse administers an opioid analgesic to a patient experiencing acute pain. Which assessment finding should the nurse address immediately? ANSWER Tachycardia Constipation Pupil dilation Respiratory depression

Respiratory depression Any patient experiencing respiratory depression after the administration of opioid analgesics requires immediate intervention. Tachycardia, constipation, and pupil dilation can occur with opioid analgesics, but these findings do not require immediate intervention.

The nurse reviews data collected during the assessment of a patient with fatigue. Which nursing diagnosis should be identified as a priority for this patient? ANSWER Activity Intolerance Insomnia Stress Overload Sleep Deprivation

Sleep Deprivation The priority nursing diagnosis for a patient experiencing fatigue is sleep deprivation. Sleep deprivation can have dangerous effects on a patient and must be addressed. An important component in treating a patient with fatigue is determining the underlying cause. Thorough assessment of a patient's symptoms and measures to promote rest are priority areas of focus. Activity intolerance and stress overload can be addressed after the patient has achieved adequate rest. Insomnia may or may not be the cause of the patient's sleep deprivation (regular use of drugs or alcohol can give fatigue)

A Rationale: Hematocrit and hemoglobin lab tests will determine whether the client has​ iron-deficiency anemia, leading to fatigue. While the client may have the additional tests​ performed, the other tests do not help to determine the cause of the​ client's fatigue. (from other question) . Typical causes of fatigue include​ anemia; changes in​ endocrine, kidney, or liver​ function; and infection. making diagnostic tests for these, will help to narrow down the cause of the fatigue.

The nurse is caring for a client who reports chronic fatigue. Which test aids in determining whether the​ client's fatigue is caused by an underlying biological​ factor? A. Hematocrit and hemoglobin tests B. Chemistry panel C. White blood cell​ (WBC) count D. Magnetic resonance imaging​ (MRI)

fatigue

is characterize by: -Tiredness -Exhaustion -Apathy -Lack of motivation that usually points to an Underlying condition, such as, -Illness -Sleep deprivation -Intense physical or mental exertion

clinical manifestations of fatigue

most common symptoms are Drowsiness, exhaustion, lack of motivation physical symptoms of fatigue: -Lethargy -Muscle weakness -Palpitations (pounding heart) -Dizziness and dyspnea on mild effort -Loss of appetite -Slow movements -Blurry vision •Neurologic symptoms of fatigue; -Difficulty concentrating -Impaired decision making -Confusion -Impaired coordination -Slow reflexes •Sleep disturbance •Loss of interest in pleasurable activities (he used to do before) •Depression •Chronic fatigue syndrome -Severe tiredness lasting >6 months -Not caused by a primary condition(depression, cancer, disease) -Not relieved by stress reduction -Not feeling rested after adequate sleep -Forgetfulness, confusion, inability to concentrate, mild headache -Joint, muscle symptoms -Sore throat, lymph nodes

pathophysiology and etiology of fatigue:

pathophysiology: •Fatigue leads to decrease in body's energy reserves affecting all basic body functions, such as: -Muscle contraction -Neural transmission -Cellular regulation •Any Physical conditions that require extracellular energy (ex: illness , infections etc) or excessive cognitive demands (study for exam etc) can cause fatigue •fatigue May be associated with chronic illness (ex: dysregulation of corticotrophin releasing hormone and serotonin and norepinephrine neurotransmitters system) in addition mood disorders, such as depression and anxiety. Etiology: •Fatigue has many causes including -Anemia -Depression or grief -Medications -Persistent pain -Sleep disorders -Hyperthyroidism, hypothyroidism -Regular use of alcohol or illicit drugs Chronic diseases -acute fatigue: Associated with temporary change in life circumstances -chronic fatigue: -Situation not resolved quickly -Caregiver for someone with chronic or terminal illness

risk factors and prevention for fatigue:

risk factors •Acute or chronic illness or condition •Medications •Medical procedures •Mood disorders •Genetics •Women more at risk than men prevention: •Lifestyle choices -Balanced diet, good hydration -Daily exercise -Good sleep hygiene -Stress reduction -Good coping techniques

A female client seeks medical attention for​ fatigue, weight​ gain, muscle​ weakness, and joint stiffness. Which etiology is most likely associated with the​ client's clinical​ manifestations? A. Hypothyroidism B. Chronic fatigue syndrome C. Chronic fatigue D. ​Iron-deficiency anemiaA mild to moderate exercise program has proven to be effective in reducing​ fatigue

​A Rationale: The etiology most likely associated with this​ client's symptoms is hypothyroidism. Hypothyroidism can be confirmed with a laboratory test and treated with a thyroid hormone supplement. Chronic fatigue is mental or physical exhaustion associated with a chronic condition or situation that is not resolved​ quickly, such as a chronic illness or poor lifestyle.​ Iron-deficiency anemia is not associated with weight gain or muscle weakness. Other mental health and physiological disease processes must be ruled out prior to diagnosing a client with chronic fatigue syndrome.

The nurse prepares an educational program on the effect of exercise on fatigue for a group of staff nurses. Which medical diagnosis should the nurse identify as responding positively to exercise as an intervention to combat​ fatigue? (Select all that​ apply.) A. Fibromyalgia B. Obstructive sleep apnea C. Cancer D. Multiple sclerosis E. Chronic fatigue syndrome

​ABCD Rationale: Clients with​ cancer, obstructive sleep​ apnea, multiple​ sclerosis, and fibromyalgia respond positively to exercise to combat fatigue. Clients with chronic fatigue syndrome should use caution before beginning exercise (from other question). Poor nutritional intake and lack of exercise can contribute to fatigue in the older adult. other conditions like hypothyroidism or infection would need further testing.

The nurse plans care for an adolescent female client experiencing fatigue caused by anemia. Which independent intervention should the nurse select for this​ client? (Select all that​ apply.) A. Identify foods rich in​ nutrients, including iron. B. Point out methods of good sleep hygiene habits. C. Encourage the client to take a yoga class. D. Administer medications for​ iron-deficiency anemia. E. Suggest the use of a pedometer.

​ABCE Rationale: Independent interventions include identifying foods rich in​ nutrients, encouraging the client to take a yoga​ class, suggesting the use of a​ pedometer, and pointing out methods of good sleep hygiene habits. Administering medications for​ iron-deficiency anemia is a collaborative intervention.

The nurse prepares to complete a physical assessment of a client with fatigue. On which area will the nurse focus during this​ assessment? (Select all that​ apply.) A. Hydration B. Body mass index C. Muscle strength D. Mobility E. Health education

​ACD Rationale: The physical assessment of a client with fatigue includes assessment of​ mobility, hydration, and muscle strength. It does not measure health education or body mass index.

A client having a routine physical​ states, "I​ don't understand why I am so tired—I only work​ 8-hour days sitting at my desk and rest when I get home. What can I do to increase my energy​ level?" Which intervention should the nurse select to address the​ client's feeling of​ fatigue? A. Request a sleep study from the healthcare provider. B. Collaborate with the healthcare provider to implement a graded exercise program. C. Refer the client to an alternative healthcare provider. D. Request a referral to a neurologist.

​B Rationale: The client with a sedentary position and lifestyle may benefit from a graded exercise program. This type of exercise program gradually builds up stamina for​ exercise, which will contribute to the feeling of increased energy. It is not necessary to request a referral to a neurologist. A sleep study is prescribed for clients to rule out a sleep disorder and is not necessary at this point in time. A nurse does not make referrals to alternative healthcare providers. (from other question)For a client with chronic​ fatigue due to anemia, iron supplements is prescribed and/ or erythropoietin or is used to stimulate red blood cell production.

A client is being prescribed tests for chronic fatigue syndrome. Which is a basic characteristic required in the diagnosis of this health​ problem? A. Lasting more than​ 1-year minimum B. Response to certain sedatives C. No response to antidepressants D. Not caused by a primary health condition

​D Rationale: Chronic fatigue syndrome lasts more than 6 months​ minimum, not 1 year. It is not caused by a primary health​ condition, and it is not relieved by stress reduction. Response to medications has nothing to do with the diagnosis. (from another question) A mild to moderate exercise program has proven to be effective in reducing​ fatigue

The nurse is caring for a client experiencing chronic fatigue. The client​ states, "I​ don't know why I cannot get this under​ control, I feel​ useless." Which can the nurse implement in the plan of care to increase the​ client's self-worth? A. Establish a rapport with the​ client's family and encourage them to participate in the plan of care. B. Assess the​ client's social support network. C. Facilitate the process of setting​ long-term goals with the client. D. Encourage the client to become involved in the decision making.

​D Rationale: For clients with chronic​ conditions, inadequate coping mechanisms may contribute to prolonged feelings of fatigue.​ Therefore, the nurse should encourage the client to be involved in the​ decision-making process to increase their feelings of​ self-worth. Assessing the​ client's social support network and establishing a rapport with the​ client's family and encouraging them to participate in the plan of care are important to address ineffective coping.​ Short- and​ long-term goals are important to establish. The​ short-term goals will provide the client a sense of accomplishment.

collaborations

•Diagnostic tests -Tests to find underlying cause -Sleep study, anemia, hypothyroidism, •Surgery -Thyroidectomy for hyperthyroidism or thyroid cancer -Biopsy, tumor removal for cancer *pharm therapy: depends on the cause: ex: -if iron-deficiency anemia, which shows by pale skin SOB, light headache upon standing: give iron supplements, erythropoietin, nutrition counseling. -if hypothyroidism, which shows by increase sensitivity to cold, gain wight, muscle weakness, joint stiff, and depression. nurse give thyroid hormone supplement. -if infection, which shows by loss of appetite, fever, coughing, body aches, nausea and pain. nurse give antiviral, antibacterial, antifungal,. *non pharm therapy: -Good sleep hygiene -Mild to moderate exercise -cognitive behavioral therapy (help pt to identify stressors and to cope with them) •Complementary and alternative therapy -Acupuncture -Massage -Relaxation techniques -Herbal and dietary supplements •No alternative therapy is consistently supported by clinical studies

Nursing Process on fatigue

•Primary areas of focus -Determine underlying cause by Thorough assessment of patient and take Measures to promote rest •Observation and patient interview -Posture -Duration, quality, timing of fatigue -How fatigue affects activities of daily living (ADLs) -How fatigue affects relationships -Diet, sleep, exercise habits -Medications -Medical conditions -Cognitive effects •Physical examination -Vital signs -Mobility -Hydration status -Muscle strength, symmetry, endurance -Dyspnea •Planning Goals may include that patient will -Verbalize an understanding and practice of good sleep hygiene -Verbalize feelings of increased energy -Indicate an increased ability to perform ADLs -Participate in a mild exercise program -Experience increased motivation -Explain relationship of fatigue to disease process and activity level •implementation When caring for patients with fatigue -Give careful attention to patient's assessment of how they feel -Teach importance of adequate rest and sleep -Structure activities to coincide with peak energy levels -Assist patients with ADLs -Facilitate the process of setting long- and short-term goals -Encourage patients to be involved with the decision-making process to help increasing patient's increase self-worth (self esteem )