NUR2229 Exam Revision 2024 PDF

11/1/2024 NUR2229 Exam Revision 2024 Presented by Katrina Recoche Kaori Shimoinaba Sacha Purvis Sam Scott Revision layout ▪ Pain revision ▪ Oncology revision ▪ Palliative and end of life care revision 2...

11/1/2024 NUR2229 Exam Revision 2024 Presented by Katrina Recoche Kaori Shimoinaba Sacha Purvis Sam Scott Revision layout ▪ Pain revision ▪ Oncology revision ▪ Palliative and end of life care revision 2 1  11/1/2024 Pain: Learning outcomes (Weeks 4 and 6) 1. Provide definitions related to pain and the various pain types 2. Identify elements of the pain pathway and response 3. List physiological changes associated with pain 4. Discuss the processes of assessment and tools that may be utilised in assessment of pain 5. Outline the psychosocial aspects of pain 6. Outline the principles for optimal pain management 7. Discuss the use of a pain management plan 8. Outline the use of the WHO pain ladder and suggested changes 9. Discuss the use of different medications for pain management: 10. Describe the use of multi-modal analgesia 11. Identify non-pharmacological measures for management of pain 12. Discuss a range of complementary and alternative therapies that may be used 3 Transduction Response to tissue injury – Sensory receptors activated by noxious stimuli Release of chemical mediators e.g. prostaglandins, substance P, bradykinin Conversion of energy types Generation of action potential 2  11/1/2024 Transmission Three phases: 1. Injury site to spinal cord (Dorsal Horn) – Carried by A‐delta and C fibres – Crossover at dorsal horn to interneurons Neurons carry impulse to 2. spinal cord to brain stem and thalamus 3. Thalamus to cortex (and other structures) Perception Ouch factor!! Conscious experience of pain Related structures in the brain activated: Reticular activating system (RAS) Somatosensory system Limbic system Cortical structures 3  11/1/2024 Modulation ▪ Signals from brain travelling downwards ▪ Release of chemicals, e.g. enkephalins, endorphins, serotonin, noradrenaline ▪ Dampens pain experience ▪ Signals may be either enhanced or inhibited ▪ Influences pain perception and variability in pain experience 7 Gate theory ▪ Existence of “gate” (at dorsal horn) that facilitates/inhibits transmission of pain signals ▪ Descending & ascending fibres meet at gate ▪ Gate open/closed depending on information received from various sources ▪ Activity such as rubbing can close the gate: reduce pain ▪ Emotions or past experience can open gate: increase pain 8 4  11/1/2024 Pain Terms Allodynia Pain that occurs from a stimulus that does not normally provoke pain. For example, stroking the skin lightly with clothes or cotton wool will produce pain Analgesia Absence of sensitivity to pain/no pain Pain terms Hyperalgesia Excessive pain sensitivity, perception of a painful stimulus as more painful than normal Paraesthesia Abnormal burning, tingling, or numbing sensation (pins & needles), typically associated with neuropathic pain 5  11/1/2024 Elements of the pain pathway 11 Pain terms Pain threshold The point at which a person feels pain Pain tolerance The level of pain a person can endure 6  11/1/2024 Pain origins Visceral Organs Nociceptive Connective tissue, e.g. skin, muscles, blood vessels Neuropathic Nerve damage Assessment and tools associated with acute pain Uni-dimensional: numerical, visual analogue and verbal rating scales, behavioural, functional Multidimensional :Acute – PQRST –OPQRTSUV – Initial pain assessment tool 14 7  11/1/2024 Persistent pain ▪ Persistent pain assessment=acute assessment + other ▪ Numerical Visual analogue scale Verbal rating scale ▪ Brief pain Inventory: long and short forms McGill Pain Questionnaire: long and short forms 15 8  11/1/2024 Oncology nursing: Learning outcomes (Week 4 & 6) 1. Discuss the changes that occur in carcinogenesis, tumour growth and staging of neoplastic conditions 2. Identify common neoplastic conditions within populations 3. Discuss associated physical and psychosocial issues for the person with cancer 4. Describe related sexuality or cultural/diversity issues related to a cancer diagnosis 5. Outline the clinical management of neoplastic conditions, including side effects and complications of treatment 6. Identify non-pharmacological measures in cancer management 7. Identify the role of the nurse/midwife in the interprofessional oncology team 17 Oncology: Definition Cancer is a disease that is characterised by the uncontrolled growth and spread of abnormal cells. Cancer cells are derived from normal cells that have undergone neoplastic transformation ie. An irreversible process leading to the transformation of a healthy cell into a cancer cell 18 9  11/1/2024 Cancer cell biology and cancer differentiation: A common feature of all cancers is the loss of cellular proliferation ie. cancer cells are not subject to the usual restriction on cell growth and proliferation imposed by the host Normal cells acquire certain specialized characteristics of their tissue of origin – ie.. DIFFERENTIATION Well differentiated – tumour cells reproduce these features well – ie.. Breast cells Poorly differentiated – tumour cells reproduce these features poorly– ie.. Difficult to tell the cell of origin Undifferentiated – cannot tell – no maturation 19 Tumour growth: ▪ From a single cell, cancer may take months/years to become detectable ▪ DOUBLING TIME is the time a tumour takes to double its size ▪ Solid tumour is usually palpable at approx 30 doublings ▪ Death from cancer usually occurs at around 40 doublings 20 10  11/1/2024 Oncogenes ▪ Oncogenes are the mutated form of proto-oncogenes ▪ Proto-oncogenes are the normal growth promoting genes In normal cells, proto-oncogenes are – Growth factor – Cell survival genes – Cell cycle controlling genes 21 Cancer cell biology Body cells are exposed to personal and environmental conditions that can mutate the genes and alter how the cells grow or function. Once transformed cancer cells are always abnormal and harmful. Can you think of what some of these personal or environmental (carcinogenic) factors might be? 22 11  11/1/2024 Apoptosis ▪ Programmed death of cells. ▪ Maintenance of healthy tissues and organs is dependant upon the proper balance of cell division with apoptosis. 23 The Metastatic Cascade: 8 stages 1. Tumour initiation 2. Progression 3. Proliferation 4. Angiogenesis 5. Invasion / Intravasation 6. Extravasation 7. Colony Formation 8. Evasion of host defences 24 12  11/1/2024 TNM staging ▪ T (Tumour ) - Size and Extent of Primary Tumour ▪ N (Nodes) - Number of nearby lymph nodes that contain cancer/cells ▪ M (Metastasis) - Spread to other sites and organs 25 Cancer Screening and Statistics 26 13  11/1/2024 Modifiable risk factors: 1 2 3 4 Quit smoking, Eat for health Be Sun Smart Maintain a limit alcohol healthy body weight, exercise regularly 27 Cancer treatments: Surgery Radiation (brachytherapy vs. external radiotherapy) Chemotherapy Targeted therapy (e.g. herceptin, hormonal therapy) Immunotherapy (e.g.pembrolizumab) 28 14  11/1/2024 Chemotherapy: Chemotherapy cannot distinguish between normal cells and malignant cells Chemotherapy targets rapidly dividing cells It works by interfering with the process of DNA replication or by damaging the DNA so badly that the cell must go through apoptosis (programmed cell death) 29 Adjuvant versus neoadjuvant Neoadjuvant refers to all treatments that are administered before the primary cancer treatment (e.g. radiotherapy or chemotherapy used to shrink a tumour prior to surgery) Adjuvant refers to therapy that is administered after the primary treatment (e.g. chemotherapy administered after radiation treatment when radiation is the primary treatment. 30 15  11/1/2024 Chemotherapy drugs: ▪ Classified according to their cell cycle activity: cell cycle phase specific cell cycle phase non-specific 31 Cell kill hypothesis: chemotherapy concentration for a defined period of time, kills a constant fraction of the cells in the population, independent of the number of cells. only a fraction of the cancer cells are killed with each treatment, repeated doses must be administered to reduce the size of the tumour. The goal is to reduce the tumour size to 0 with successive fractional kills. The fractional killing of tumours in response to treatment is due to the cell-cycle specificity of the chemotherapy. 32 16  11/1/2024 Radiotherapy: controlled dose of radiation kills or damages cancer cells is a localised treatment given internally or externally 33 Cancer treatment side effects and care considerations: Radiotherapy 34 17  11/1/2024 Other treatments: 1. Psychoeducational interventions 2. Cognitive behavioral methods 3. Exercise and complementary therapies 4. Multimodal interventions 35 Chemotherapy side effects, nursing considerations: 18  11/1/2024 Oncology emergencies: 1. Neutropenic Sepsis (also known as febrile neutropenia) 2. Spinal Cord Compression (SCC) 3. Tumor Lysis Syndrome (TLS) 4. Superior Vena Cave (SVC) obstruction 5. Hypercalcaemia 37 Interprofessional oncology team: 38 19  11/1/2024 39 Palliative and End-of-life care learning outcomes (Weeks 3 and 5) 1. Describe the principles of assessment and management of clinical and supportive care needs. 2. Discuss palliative care management issues, symptom control and health promotion. 3. Identify the challenges associated with family and person-centred care at the end of life. 4. Identify the role of the nurse/midwife in the interprofessional team. 5. Identify the medico-legal and ethical aspects associated with supporting the person with palliative and end of life care needs. 6. Discuss contemporary end of life issues/dilemmas. 7. Explore models of loss, grief and bereavement. 8. Reflect and evaluate their own professional and personal experiences and the cumulative impact on self and others. 9. Communicate effectively to support individual and family responses to loss and grief, existential challenges, uncertainty and changing goals of care. 10. Differentiate variations in grief responses (uncomplicated/complicated). 40 20  11/1/2024 Elements of palliative care ▪ Palliative care should be available to all people living with an active, progressive, advanced disease, regardless of the diagnosis. ▪ Palliative care affirms life while recognising that dying is an inevitable part of life. This means that palliative care is provided during the time that the person is living with a life-limiting illness, but it is not directed at either bringing forward or delaying death. 41 Advance care planning ▪ Victorian Medical Treatment Planning and Decisions Act (2016) ▪ Advance Care Directive – Instructional – Preferences – Values 42 21  11/1/2024 Provision of palliative care during disease trajectory (PCA, 2018) Figure 2.4: Alignment of need for palliative care against workforce capability PERSON’S NEEDS RELATIVE WORKFORCE INVOLVEMENT Complex and persistent Increasing complexity of needs for palliative Intermediate and fluctuating care Straightforward and predictable Specialist palliative care providers Other health professionals http://palliativecare.org.au/quality 43 Where is palliative care provided? Community - based support Community-based Hospital-based People’s homes Inpatient palliative Residential aged care beds care Other inpatient beds Accommodation for Person living (acute; sub-acute; with life those experiencing other) limiting mental illness illness Outpatient services Correctional facilities Intensive care units General Practices Emergency Community palliative Palliative care consultancy departments care clinics and day centres Hospital – based support 44 22  11/1/2024 Nursing careers in palliative care ▪ Generalist nurse ▪ Specialist palliative care nurse ▪ Clinical nurse specialist palliative care ▪ Palliative care nurse consultant ▪ Nurse practitioner palliative care 45 Loss, grief and bereavement The experience of death, dying and grief may be effected by personality, social variables, culture, religion, the nature of the relationship with the patient, concurrent stresses and the way the person died. 46 23  11/1/2024 Palliative and end of life care Include the patient and the family as part of the care team Palliative care takes responsibility for care of family/carers post bereavement At admission to palliative care bereavement risk is assessment is undertaken for family and significant others Terms The following terms are often used interchangeably but they have different meanings: ▪ Grief: personal response to a loss ▪ Bereavement: the period after a loss ▪ Mourning: the outward and active expression of grief 48 24  11/1/2024 Key Theorists Theorist Model type Details Elizabeth Kubler-Ross Stage model 5 stages -inclusive of denial, anger, (1969) bargaining, depression & acceptance William Worden Task model 4 tasks- accept reality of loss; work through pain & grief; adjust to life without deceased; relocate the deceased. Margaret Strobe & Henk Stressor Dual process model Schut (1995, 1999) specific model Voluntary assisted dying On 29 November 2017, the Victorian Parliament passed the Voluntary Assisted Dying Act 2017 ] Refer to: https://www2.health.vic.gov.au/hospitals-and- health-services/patient-care/end-of-life-care/voluntary- assisted-dying From 19 June 2019, Victorians at the end of life who are suffering and who meet strict eligibility criteria became eligible to request access to voluntary assisted dying. 25  11/1/2024 Pharmacological and non-Pharmacological strategies Review use in pain management- week 6 Review application in oncology - week 2 Review practice in palliative care- week 4 Exam format 2 hour E-Assessment Domain Structure Questions Pain 1 x Short case study 7 Oncology 1 x Short case study 8 Palliative and end of life 1 x Short case study 8 care 26  11/1/2024 Questions? Thank you for working with Katrina, Sacha, Janet, Sam and Kaori this semester and we hope that your learning from this unit will enhance your future practice. 53 27