Chronic Pain Syndrome

A severely challenging condition threatening patients today is chronic pain syndrome. This occurs when various parts of the body and mind come together is a constantly recurring cycle of pain throughout the body. When it occurs, chronic pain syndrome can also affect certain areas of the body after they have been injured, wounded, or operated upon. The pain can be general or it may be concentrated, such as in the temples, legs, hands, or chest and back. A skilled physician experienced in observing chronic pain syndrome can assign this diagnosis and track the symptoms in their quality, severity, and consistency.
The hard part about treating chronic pain syndrome is that to many people it sounds like the typical complaining any patient might do. But the persistence of this kind of pain, its general presence, and the way it avoids being treated by drugstore or over-the-counter painkillers is one clue that chronic pain syndrome is present. Another trait of chronic pain syndrome is that it can subsume after a burst of general health, but then after a period the overall condition can suffer. The patient’s health will weaken and then the chronic pain syndrome can re-emerge when the patient’s overall sense of well-being or general health correspondingly weakens.
For reasons such as these, people in the main confuse chronic pain syndrome with “getting run down”. People in good health maintain regular cycles of endorphins and a balance of hormone. But depression and chronic pain sufferers actually alter the chemicals in their body and brain over a period of time when their behavior alters. Self-injury and accidents can occur as patients become more clumsy and careless dealing with another day in pain. Their impulses to deal with their stress and pain do not take healthy roads and the results can be seen in the way people stop taking care of themselves.
But with chronic pain syndrome, damaged nerves can keep up live pain enactions upon the central nervous system and mind long after the flesh and other damaged or diseased areas have been repaired. The axons of neurons keep firing and “informing” the brain of pain that in fact is no longer being inflicted. The patient feels pressure and the slightest sensation with a magnification that few nurses initially can credit. Just getting dressed, driving, and/or working activities can be physically and mentally impossible for some patients with chronic pain syndrome.
This can affect patients recovering from a long disease, suffering from other conditions at the same time, or suffering from chronic pain as a complication of other conditions, wounds, or diseases of the body. The physical treatment of the chronic pain syndrome also involves attention paid to the creative fulfillment, intellectual stimulation, connection to nature and energetic physical endeavors of the patient to put balance back into their routine. But many patients suffering from chronic pain syndrome are not ready for these interventions yet.
Not by medication alone can chronic pain syndrome be treated. And in some cases, patients will report as few as a two to three hours a day or even in one week when they can handle activities such as writing, reading, reviewing accounts, discussing business affairs, or even concentrating on complex ideas or complicated matters. The patient recognizes this loss even as they battle it being lost. The mental attitude of a chronic pain syndrome patient cannot convert chronic pain into nothingness, but a sharpened perspective and a better-motivated alertness to the positive side of things can assist in keeping the chronic pain from controlling and ruining one’s life.
Nurses taking care of patients with chronic pain syndrome will have some difficulty moving them out of a mode of lethargy and into a spirit of motivated exercise. Movement is a key way to change the ingrained tendencies toward “moping” and dwelling on the pain that chronic pain syndrome involves. Patients such as this need to be urged to get out once in a while, make lists of things they like to do and schedule them. Sufferers of chronic pain syndrome must take an active role in combating the wear and tear of the disease. The behavioral aspect of their choices can overtake their neurobiological symptoms.
Chronic pain patients, especially the elderly, develop patterns of coping with their pain that may not seem helpful to outsiders. But survivors of wounds, attacks, diseases, and other complicated life events will nurse problematic chronic pain conditions for the rest of their lives. This is in contrast to the acute care approach to many painful issues in the otherwise straightforward assistance that urgent care patients receive. But long-term care and elderly patients will usually have an onset of chronic pain syndrome with the severely worsening of arthritis, osteoarthritis, sciatica, and back pain.
Unfortunately, not a lot of physicians train or prepare their patients on how to deal with chronic pain syndrome psychologically. Pharmaceutically the plan of care can treat the pain as it occurs or worsens. But the ongoing struggle with the challenges of chronic pain syndrome, complex and long standing, are unique to the individual patient in many cases. Because many chronic pain sufferers avoid public places, noise, chaotic events like concerts or music clubs, and unpredictable and physically demanding environments, they develop a coping system of this avoidance and they become viewed as “shut-ins”. The outsider observes the behavior of avoidance and misses the fact that there is reason and a pattern of behavior behind it. The patient is just trying to avoiding trigger situations where their chronic pain can be set off.
Nurses can keep an eye on their chronic pain syndrome patients and counsel them about their health. Nurses and case managers can provide helpful advice about how to spend their free time as well as enhance the attention paid to details other than their vital statistics and medication schedules. Such patients may be suffering from depression because of their inability to deal with their chronic pain syndrome. Nurses spend a good deal of time talking with patients. They hear how the patients speak of themselves. These patients may need to learn to interrupt negative belief systems, they may need encouragement and praise, and they may need to find ways to reward themselves and learn new ways of spending their time.
Sufferers of chronic pain may give out signals that friends and relatives do not understand. And chronic pain sufferers do not like to advertise how much pain they are in. They can mask their problems with overeating, Internet surfing, “quick-hit fixes” like smoking, video games, light movies or soft drinks. These activities can hijack feelings of serious ongoing pain in extremities, the temples , in the lower back or neck, et cetera. Sufferers of chronic pain may not understand that they have a serious problem, and may simply put their issues down to emotional problems or being unsuccessful at functioning to a higher standard.
Patients dealing with chronic pain syndrome will plot ways to avoid dealings with their pain by avoiding exercise or going out, to compare themselves unfavorably with others. They know their health is in decline, they just may not understand why. Chronic pain victims will isolate themselves and often appear erratic and eccentric. Chronic pain sufferers can cope with sudden and uncontrollable pain by stomping their feet,(to displace nerve pain) drinking, (to numb the nerve pain) watching TV, (for distraction), playing music (to give the pain white noise to play against) , and/or driving too fast, (because they can’t control the pain in their limbs and leg nerves). Or, when suffering from unpredictable intensities of chronic pain patients may cancel appointments and social engagements because they can’t anticipate when the pain will peak.
The solution to a problem with chronic pain is to concoct a care plan with many moving parts . This plan then becomes the patient’s responsibility to keep those moving parts improving and going, growing and becoming better. These are significant goals that can alter the quality of life for sufferers of chronic pain syndrome. The many motifs in a successful care plan for chronic pain syndrome are simply a roadmap to access all the information involved and plot a best case scenario. A nurse can assist any patient in the parts of the care plan they feel most comfortable with. Sometimes just visualizing a better frame of mind or achieving small goals can be helpful to the health of the patient. Nurses should refer their patients showing symptoms to chronic nerve pain specialists, or care plan managers.

Nursing Study Guide: Depression

One of the biggest challenges facing the adult nurturing and caregiving patient populations is depression.
Careers and unemployment can both cause toxic stress in some people. Without positive well-being, a corrosive anxiety builds. Negativity can wind itself into behavior and thinking patterns.
The nurse in the Emergency Room and the nurse in the long term care facility will see depression at work in patients. And especially the home health nurse will see private pain and suffering on the part of their primary charges. Each kind of nurse will have to develop a technique for intake, analysis, interaction and treatment with a patient diagnosed with depression.

No longer is depression a disorder without a face. Tragedies in almost every state have appeared in bold face type. As a workplace hazard, across the United States,  an incident of violence or self-harm,  involving a depressed and mentally disordered person increases every day.

Nurse intake workers must carefully evaluate patients prone to addictive habits such as smoking, drinking, abuse of controlled substances, or unchararacreristic or destructive behavior.

The use of chemical substances and pharmaceuticals the treatment of depression has given rise to is a concern for many socially oriented activist groups and health maintenance organizations.

A variety  of caregiving professions, such as nurses, counselors, physicians, specialty providers, and treatment experts have been wrestling with the health problem that depression poses for centuries.
Today depression problems can cause an airline captain to plummet his plane and its passengers to their deaths. The depressed conductor of a rail train can lose focus and wreck the train cars, throwing everyone aboard off the track to injury or worse. Depression and other mental health issues are now squarely on the public eye.

First described in the literature of Freud as a “malaise”, postJungian medical practitioners regularly recognized symptoms of the disorder as far back as the early 1900’s. What became a cocktail party anecdote at first began to gain steam in the medical community. By the time World War One, military doctors were inventing wartime medications to combat this strange phenomenon.

Depression can present similarly in persons by unusual or destructive behavior, excessive alcohol and drug use, mood swings, or chemical imbalances in the blood. Lab tests can screen for these indicators,. which is why Emergency Room admissions will usually have a toxicity panel and blood gas analysis ordered before key triage decisions are made

It is the numbing of depressive individuals’ “inner world” that leads to an addiction to sleeping pills, diet pills, pain pills. and other abuses of limited- schedule prescriptipn medication.

Also, certain incidences of depression syndromes can affect people experiencing a significant life event. PTSD survivors survive traumatic combat ecperiences even though all persons with PTSD did not share the same exact event.

Depression can be suffered among persons who live similar but disparate lives. Today, patients can employ various strategies and methods to combat depression and the behaviors it exacurbates and the condition it worsens.

The patient groups and subgroups, as well as pools of invidividuals who have shared a significant life event, can fall into varying levels of depressive behavior.

People who survived the 9/11 terrorist attack on New York, for example, may have experienced a kind of depression called “survivor’s guilt.” Sufferers of this and many other types of depression are urged tovtalk to support groups and seek treatment from a licensed and qualified healthcare provider.

Nurses will often observe the symptoms of depression in both long-term and acute-care patients. In many cases, an acute-care life event such as a stroke, a heart attack, or a seizure might be triggered from conditions linked to depression.
The patient’s health and safety are paramount at all times. High blood pressure, drinking, drug abuse, atypical personality traits and characteristics of self harm might signal the presence of a depressive person or a depression disorder. Information regarding past treatments of depression be available in the medical chart.
The professional and care plan interventions for depression also can be psychological. A trained medical professional can analyze the patient’s history and recommend coping strategies. Together with a psychologist, the patient can try exercises aimed at breaking down the supporting anxieties of the depressive condition.
One thing a medical expert on treating depression will do is examine what circumstances or scenarios trigger the patient’s depression. Gaining perspective on one’s life and using physical and mental energy can give a patient a more level understanding of exactly a threat really is.
Mental health professionals have worked hard to remove the stigma of depression.Encouraging a patientbto get treatment is a much more effectice intervention.
After a treatment referral is done, outreach to a qualified provider is made. This depressopn therapist can devise techniques that eliminate the focus on negative patterns, self-destructive behavior, and developing a sad or poor attitude that can lead to a negative spiral.

At this point ending isolation and developing resources to prevent downswings in mood is a key dual goal. Gaining control of flexibility and less destruction to extremes can allow a person with depressive tendencies to steer themselves away from harmful behavior and towards goal-centric future rewards.

Patient Care and PTSD Cases

Nurses looking to get traction in the occupational workplace should be vigilant protecting the rights, privacy, and quality of care given when a PTSD situation arises. Patient care can include special cases, patients whose fears and experiences have traumatized them. These patients come from domestic situations, armed services experiences, violence and sexual assaults, where PTSD clouds the victim’s thoughts with shame, doubt, and a negative spiral of blame and inertia.

A professional nurse should tread carefully and follow the charted behavioral interventions and therapeutic approaches to the letter. Some patients who have genuine elements of PTSD in their makeup may have yet to be diagnosed. Post Traumatic Stress Disorder is a  condition whereby certain other conditions may be affected, such as ulcers, high blood pressure, depression, and more. Nursing practice for such (PTSD) patients includes maintaining a calm, relaxing environment where pain and anxiety are reduced in every way possible.

Disorders like PTSD come from traumatic incidents in the patient’s past, and may be unknowingly triggered without sincere and through querying of the patient’s social profile. A nurse can request a referral from the primary care physician for a psych referral. Any nurse should be careful not to disclose any specific medical information to observers or passersby. This is a HIPPA violation. Nurses should re-orient the PTSD patient (when acting out or presenting symptoms) back to their room and make the assessment in a private setting.

Document carefully any interactions with the patient that cause you concern. Make sure that you follow the best nursing practices when a PTSD incident occurs. When dealing with a patient who is confused, lost, or suddenly bewildered by where they are, or if they forget what they are doing, be prepared. If the PTSD patient shows exaggerated reaction to noise, other patient’s conversation, amplified reaction to nearby distractions, and has poor tolerance to exterior sounds, check with the charge nurse for further instructions. .

The physician’s instructions for treatment should include necessary approaches for environmental comfort. Refer to the patient’s medical chart and care plan for instructions and advice. Patients’ response to their intake survey should indicate what likes and dislikes they will respond to and against. PTSD patients must avoid trigger incidents or scenarios to avoid recurring attacks of anxiety and panic attack crisis.

These behavioral afflictions are defensive disorders the human psyche concocts to shield a person from environmental/mental pain or abuse. This patient will be wary, vigilant, and acutely (and sometimes aggressively) combative against unknown situations. Often sufferers of PTSD are extremely vocal. Nurses can utilize this feature of the patient profile to engage them out of a negative spiral. Redirect the mental focus of the PTSD patient onto a pleasant matter or other topic, such as movies or books, poetry or sports. Avoid discussions of politics or crime.

PTSD is a misunderstood disease which many old-school nurses may scoff at or otherwise fail to evaluate a patient for. Nurses should tread carefully with diagnosed PTSD sufferers and use exceptional patient courtesies to make sure such patients feel insulated from their triggering episodes. PTSD should never be made to feel threatened or stressed. This constitutes patient abuse. Nursing or facility staff who persist in creating tense or uncomfortable incidents, or provoke the patient should be reported both directly to management and reported anonymously to the State Nursing Board or the LVN/Psychiatric Nursing Association.

Incidents which recur in the PTSD patient’s life are the situations with sounds, odors, or persons who spark the Post Traumatic Stress Disorder are responsible for triggering painful situations and outsize scenes within the patient’s room, ward, or floor. Nurses and nursing aides of such patients should make sure all patient needs are addressed during each shift. Lab technicians or phlebotomists new to the patient should be escorted by familiar staff. In this way, proper nursing patient care makes certain that the accidental triggers of a particular trauma do not become re-created and take the patient by surprise.

   PTSD patients rely on skilled nursing staff for optimum recovery outcomes. And more educated consumers will know the difference between incompetent nurses and those who just choose to disregard noted interventions.

Dealing With the “Toxic Patient”

New nurses just out of nursing school can be somewhat shocked by the challenges presented by “problem children” in the patient census. While every patient may have the expectation of the full range of services and care a nursing home or hospital provides, some patients do overtax the staff to an unusual degree. It is the facility’s choice whether or not to continue offering care to these patients. But nurses should not ignore symptoms and condition risks, no matter what hullabaloo the patient causes.
What is meant by the “Toxic Patient?”
The “toxic patient” is patient who experiences limited medical problems but exhibits uncontrolled outbursts, exaggerated symptoms, and conducts themselves in an annoying and distracting manner much too much of the time. They can make life miserable for other patients, room mates, visitors, and staff at every level. If one or more exist in any floor or ward, chaos can ensure at any moment in any shift. Important charting, endorsement reporting, or assessment activities can be interrupted. Nurses and CNA workers can start to call in sick to avoid shifts that have become too much work to handle.
The Burden of a “Toxic Patient” on a Hospital or Facility
The burden of a ‘toxic patient” can creep up. Dementia can play a role. If the patient’s aim to is to disrupt or annoy, they may simply escalate behavior on an ongoing basis. Finding out just when the patient will go too far is an ugly surprise. Tension and irritation can build. Nursing supervisors may acknowledge the problem, but depend on a full shift of nurses to cope. Then, nurses start calling in sick at the last moment, and the nurses that do report for work have their hands full. Administrators can experience headaches when the housekeeping staff, nursing staff, and dietary staff start stressing out and run in circles trying to please the “toxic patient”.
Facility Requirements for Toxic Patients
Such patients can require a hospital to engage additional staff just for that one patient. Monitoring one patient is not a cost-effective way to staff a hospital or nursing home, and these costs invariably end up as part of the overall assessment for the care plan of that patient. if no improvement is within view, and no intervention will work, a stalemate occurs between the duty of care and the real-time potential of the facility. Their duty of care commits them to deliver ongoing environmental nursing care, but the pushback from nurses and patients create s a firestorm.
Student nursing textbooks cannot illustrate the challenge of a dealing with a “toxic patient” while balancing the needs of an entire floor or ward of other patients, as well as dealing with the pharmacy, running IV lines, performing dialysis, charting nursing progress notes, and tracking medicine counts. “Toxic patients” have little to no curb on their behavior, choose consistently to break accepted facility or social barriers, and insistently pester nurses and other persons within the hospital or nursing home. Such a patient is completely beyond a home health situation. The patient community of a facility or hospital can be altered negatively just by inclusion of the “toxic patient” in group patient activities.
The “toxic patient” also disrupts the well-being of other patients. On this basis, they become a liability of any facility, because they stretch the resources at any given time constantly enough to cheat other patients of their allotted times with nurses or staff. generally speaking, a “toxic patient” can absorb 9/10 of a nurse’s spare time per shift. And when this demand overlaps the allotted time for any other patient, this “toxic” individual becomes liability to other patients as well. On this basis, patients can be liable for discharge or transfer if they become too irksome a burden to staff and other patients.
The “toxic patient” is one who refuses to heed warnings or “hints’ from the institutional staff. Such behavior is charted and discussed in the care plan meetings. Often a nursing home or long term care facility will meet with the patient, guardian, family or conservator to discuss such behavioral problems, often a psychiatric consult is advised. Yet the family or the conservator of this patient may refuse this. The social stigma maybe overwhelming for the family, and the impress upon physicians to limit psychiatric intervention may weigh heavily. The times leading up to any resolution are seriously taxing for any nurse. There is only so much a place can “suck up’.
But often, even when a patient has a long history of transgressing beyond patient norms, neither medication nor physical restraints are present or advised. Either the family members are in denial, or the physician does not have an accurate assessment of the case. It is important to complete incident reports and contact supervisors when such behavior occurs. Furthermore, sometimes a nurse may have to decide for themselves when it is a good time to call the physician (or social worker) and advise him of the seriousness of the patient’s aberrant behavior.

Circumstances will arise in which a nurse or nurses will look back and wish very much that they had used all their observational skills and cited occurrences involving the “toxic patient”.

Welcome to Nursing Study Tips.com

Welcome to Nursing Study Tips.com!

Transforming a Nursing education into on-the-job professional nurse training
Nursing students often fail to make the connection between practical nursing performance and the run-up to a job nursing from the education emphasis on book-learning. New nursing employees often grapple with learning the pace and combination of skills needed to get through the day. Multi-tasking takes on new meaning, as nurses are expected to juggle answering phones, charting patient progress, doing rounds, performing needed bedside services, and dealing with physicians and family members. Not to mention the idiosyncratic needs of the patients themselves.