Question

A 91-year-old woman with a small bowel obstruction is admitted to the hospital from a long-term care facility. She has a history of dementia and is incoherent. Discuss how you would revise your assessment and evaluation techniques in managing her pain. List interventions you would implement. List goal for interventions. List a nursing diagnosis relevant to case.

Answer 1

Present Illness:small bowel obstruction She has a history of dementia and now her menta status is incoherent

Past History :dementia

Review of system: Need Questionere GI system along Genitourinary and constituonal

Physical Examination: Need to Examine the Patient excatly where the pain is located how the pain severity As pain SCale score 0-10

Assessment:

on pain assessment and treatment in elderly people with dementia, but also very worrisome because this assumption could lead to inadequate attention and undertreatment.

Pain assessment tools and the WHO Pain Ladder are decision support tools to assist in recognizing, assessing and managing pain in patients with dementia

to idenify pain severity by facial expressions

the Pain Assessment Checklist for Seniors With Limited Ability to Communicate [PACSLAC]) in this case this tool is very use ful to assess pain in seniors with severe dementia. In Phase 1, professional caregivers of seniors with severe dementia were interviewed in order to generate a list of pain-related behaviors that are characteristic of care recipients living in long-term-care facilities.

interventions:

PURPOSE:

Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain.

DESIGN AND METHODS:

Twelve nursing homes participated in this intervention study: six treatment homes and six control homes, divided evenly between urban and rural locations. Three hundred licensed and unlicensed nursing home staff members completed written knowledge and attitude surveys at baseline, and 378 staff members completed the surveys after intervention implementation.

RESULTS:

Baseline results revealed notable knowledge deficits in the areas of pharmacology, drug addiction and dependence, side effect management, and nonpharmacologic management-strategy effectiveness. Significant differences were noted by job title (registered nurse/licensed practical nurse/certified nursing assistant). Case studies displayed a knowledge application problem, with nurses often filtering resident pain reports through observed resident behaviors. The intervention led to significant improvement in knowledge scores in some, but not all, the treatment homes. Perceived barriers to effective pain management showed a significant decline across all study nursing homes.

IMPLICATIONS:

Knowledge deficits related to pain management persist in nursing homes. An interactive multifaceted educational program was only partially successful in improving knowledge across settings and job categories. Attitudes and beliefs appear more difficult to change, whereas environmental and contextual factors appeared to be reducing perceived barriers to effective pain management across all participating nursing homes.