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60 Cards in this Set
- Front
- Back
How have hospitals evolved over time? |
-began as christian monasteries which also housed, poor, orphans, travellers -18th century began to help only the sick who could contribute to society (mentally ill, disabled, old were not helped) -eventually upper middle class also got treated -20th century hospitals gained more positive view |
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Describe the hierarchy of medical staff |
-chief od staff, medical director: manages physicians -doctors -nurses: manage ward, care for patients -allied workers: lab techs, therapists, dieticians -orderlies: require fewer skills |
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nosocomial infection |
infection contracted by patient while in hospital ICN nurses work to prevent these |
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Why are there more short stays in hospitals today> |
1. more outpatient procedures 2. more efficient procedures: less haling time 3. more recovery time is spent at home |
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Depersonalization |
treating patient as though they are not really present -allows doctors to disconnect emotionally, intend to avoid awkwardness, so they don't interfere with their work |
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Burnout and the Three Components |
psychsocial and physical exhaustion from prolonged stress and little personal control -depersonalizaton: callous, lack of regard for others -emotional exhaustion: unable to help others psychologically -perceived inadequacy: low self-efficacy, unable to meet their goals |
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Two Types of Problem Patients |
-thoe who are severely ill and are acting out, may be high maintenance, are usually forgiven due to their condition -those who are not super sick but may be showing reactance: anger due to loss of freedom and personal control |
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Active vs. passive Patients |
active: don't complain, stoic, may not ask for medication if they need it |
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problem focused coping |
actively seek info, asking for medication, try to change the problem with actions |
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emotion focused coping |
when believe believe they can't change a situation they will try to regulate their emotions, distraction, social support t |
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how do roommates affect patients? |
if they are paired with roommates who are also pre surgery they may talk and transfer anxiety if paired with patient who is post surgery they may have reduced anxiety |
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what 3 types of control should be enhanced to prepare patients for procedures? |
--behavioural control: train them to reduce discomfort, speed recovery -cognitive control: train to recognize and change negative thinking patterns -informational: control knowledge about procedure |
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cardiac catheterization |
a tube is threaded through vein to the heart and dye is injected to see if there are any cardiac disorders |
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of three types of control which is best? |
if procedure has little opportunity to reduce discomfort than cognitive and informational control is best |
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lamaze training |
teaching pregnant women how to give birth without pain medicaiton |
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Avoidance vs attention copers? |
avoidance: don't want info, deny fear, do best when little informational control attention: seek out information, do best with high informaitonal control -both benefit from repeated exposure to informational control |
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separation distress, when does it start? |
upset and crying experienced by young children when separated from parents or unfamiliar envionrment -starts at 9months and peaks at 15 months |
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what misconceptions may children have about hospitals? |
that treatment is punishment for being bad see other people with scars amputations and think it will happen to them |
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why are school age children more distressed by hospitals than preschool age? |
-sense of personal control: feel threatened -cognitive abilities allow them to become anxious about their illness -loneliness when separated from school, friends -more embarrassed by exposing body to strangers |
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Minnesota Multi-phasic Personality inventory |
10 scales which asses specific disorders -pateints usually measured on hysteria, hypochondriacs and depression |
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2 tests specific to medical patients |
-millon beahvoural medicine diagnostic -psychosocial adjustment to illness scale |
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how do children react to terminal illness? |
if younger than 5 likely don't understand permanence of death, at 8 years they understand dat, school age will know they are dying even if not told best to be open and honest with child |
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how do adolescents and young adults react to terminal illness? |
have more anger, distress and anxiety than older patients feel it is unjust, senseless, may worry about their young children |
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how do middle age//elderly react to terminal illness/ |
less of shock, have already made financial plans, funeral arrangements, least anxiety if they feel they have lived a satisfying life |
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Kubler Ross |
developed 5 stage model of acceptance, opened up discussion on death |
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how does palliative care affect patients? |
have higher survival rates, less depression and anxiety |
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what are advanced health care directives? |
do not resucitate orders, living wills,, help with perceived control |
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hospice |
medical and social support for enriched life quality, physical, psychological and social support for patient and families -folllow up with families after death |
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organic pain |
arises from tissue damage or pressure |
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psychogenic pain |
does not appear to have any tissue damage, psychologically induced |
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somatic symptom disorder |
chronic pain with no apparent physical cause |
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acute pain |
temporary, less than three months, generally no lasting anxiety once pain subsides |
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chronic pain |
long lasting, can lead to depression, hopelessness, |
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Describe the 3 Types of Chronic Pain |
1. Chronic Recurrent: benign cause, repeated and intense with periods without pain eg. migraines 2. Chronic-Intractable: discomfort present at all times, no underlying cause, eg. low back pain 3. Chronic-Progressive: increasingly intense, malignant cause e.g. cancer, arthritis |
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Describe how pain is perceived physiologically |
noxious stimuli causes seretoni, histamine and bradykins to be released leading to inflammation and activates nerve endings signals are carried to brain by norireceptors to spinal cord and then to brain |
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what two types of fibres carry pain signals? |
A-delta: coated with myelin for quick transmission, for sharp pain that commands immediate attention C-fibres: un coated, for transmitting diffuse, aching, longer pain, won't require immediate attention but can lead to emotional response like depression |
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Referred Pain |
pain from internal organs which may be sensed in other parts of the body eg. appendix pain on other side of abdomen |
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neuropathic pain 3 examples |
caused by current, past disease or damage to peripheral nerves -neuraligia: shooting, stabbing pain from previous infection -causalgia: burning pain from minor stimuli, caused by previous wound -phantom limb syndrome |
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specificity theory |
body has separate sensory systems for perceiving pain; set of nerves and pathways , area of brain |
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pattern theory |
no separate system for pain, comes from touch receptors, oncce certain threshold is reached the brain perceives it to be pain |
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muscle-ischemia procedure |
for inducing pain in lab, reduced blood flow causes pain, e.g.. tight cuff around arm |
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cold-pressor procedure |
for inducing pain in lab, submerging arm in cold water |
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Gate-Control Theory of Pain |
-gating mechanism in substantia gelatinosa or the spinal cords dorsal horn -signals enter the gate and activate transmission cells which led to the brain -pain is perceived once certain level is reached |
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3 things involved in opening and closing of the pain gate |
1. activity in pain fibres: stronger stimuli causes there to be more active fibres 2. activity in other peripheral fibres: a-beta fibres carry non-noxious stimuli sensation and can close the gate (why rubbing area helps) 3. Descending Messages: brainstem and cortex have efferent (moving outward) pathways which can close the gate |
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condtions tht open the gate |
physical: injury, too much activity emotinal: anxiety, depression, tension mental: focusing on pain, boredom |
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conditions that close the gate |
medication, counter stimulation (a-beta fibres) relaxation, positive emotions intene concentration, involvment in life activities |
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neuromatrix |
neural network on brain that combines emotional areas, stress regulation systems and cognitive systems |
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periaqueductal grey area |
has analgesic effect when electrically stimulated by causing serotonin to activate inhibitory neutrons which release endorphins |
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endogenous opiod |
opiate like substance produced by the body, endorphin people which chronic pain may have impaired systems |
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naloxene |
inhibits opioids ability to work, even if an endogenous opioid |
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4 pain behaviours |
1. facial/audible: groaning, grimace 2. Distorted ambulation/posture 3.negative affect: irritable 4. Avoiding activity, staying home from work |
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malingering |
fabricating, exagerating pain behaviours so they can get benefits |
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how do placebos affect pain |
trigger release of endogenous opioids and reduce pain |
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Social Communication model of pain |
caregiver and patient bring different attitudes, skills and qualities when dealing with pain and they interact with each other continuously to influence experience of pain |
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communal coping model of pain catastophizing |
dweliing on pain increases it, catastrophizing to gain social support often back fires for people with chronic pain |
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overt vs covert behavioural pain coping |
overt: rest, medication covert: distraction, prayer, positive thinking |
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MMPI neurotic triad |
hypochonrdias, depression hysteria |
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pain acceptance |
when people don't dwell on pain and engage in activity despite the pain, has good outcome usually |
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Mcgill Pain Questionaire |
takes into account sensory, evaluative and emotional components -has big words so no good for kids and esl |
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what physiological measures are used to asses pain? |
EEg: measures evoked potential sin brain EMG: measures muscle tension, must measure repeatedly over extended period of time Atuonomic respose: HR, blood pressure all should be used in addition to self report |