CNA509
Storyboard Text
- Assessment of Elderly people and pain in Emergency Departments by Ashlee Smith
- I AM HAVING SUCH A GREAT DAY TODAY!
- -The Australian Institute of Health and Welfare (AIHW) stated in 2016, the aged population of over 65 years reached 3.7 million. -AIHW explains that life expectancy for men and women has increased more than 10 years since the 1960s, with the amount of over 65s tripling and the amount of over 85s increasing tenfold in this time
- HELP ME! i've had a fall and hurt my leg :(
- BANG!!
- It hurts so much, but i'm stubborn and won't admit i need help.
- IT'S BROKEN!!
- RISK FACTORS - Gender: Males more likely to suffer life altering injury -Co-Morbidities (i.e. respiratory or cardiac issues) are more likely to lead to secondary issues post fall -Polypharmacy: potentially leading to adverse reactions of the body leading to increased risk of falls
- Hi Mr Jones, on a scale of 0 to 10, how bad is your pain?
- He really looks uncomfortable, maybe i will try a different pain scoring technique
- It's not too bad, maybe a 3.
- Tailored to patient's cognition and individual needs
- Other ways to assess pain?
- Type and location of injury
- BARRIERS FOR PAIN ASSESSMENT IN THE ELDERLY PATIENT
- Cognition and congnitive awareness
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- Compliance for administration of analgesia
- Pre-existing contraindications for analgesia
- Individual Nurse skill level (i.e. understanding non-verbal cues)
- Experience (i.e. amount of time nursing)
- Staffing levels
- Input from the multidisciplinary team
-
- -Voicing a pain score -Crying -Yelling out (different to normal behaviours if cognitively compromised)
- Verbal Cues of Pain
- -Crying -Whincing -Abnormal vital signs (eg. tachycardic, hypertensive) -Agitation -Diaphoresis
- Non-Verbal Cues of Pain
- I have the Abbey Pain scale, Mr Jones is whincing in pain, groaning, yelping when he moves and is a bit diaphoretic. He scores 'severe pain'. I am going to talk to the doctor.
- -10% falls result in fractures - Fractured hip or femoral head most life altering, difficult to the control pain -Great difficulty in accurately assessing pain -Requires multi-faceted approach to assessing and managing acute pain
- Popular analgesia choice in EDs is a femoral nerve block via ultrasound guidance
- -reduced opiate requirements -improved comfort -decreased risk of delerium
- TWO WEEKS, intensive rehabilitation and physiotherapy LATER...
- "Thank you for all your help"
- "You look much better!"
- Take Home Points -Accurate and early pain assessment in elderly -Assessment using a variety of techniques may be necessary -Effective and quality pain management -Remain aware of individual circumstance (i.e. language, customs)
- Main Article: Ko, A, Harada, MY, Smith, ET, Scheipe, M, Alban, RF,Melo, N, Margulies, DR, & Ley, EJ 2016, 'Pain Assessment and Control in the Injured Elderly', The American Surgeon, vol. 82, no. 10, pp. 867-871. References Abraham, M & Cimino-Fiallos, N 2017, 'Falls in the Elderly: Causes, Injuries, and Management', Medscape, accessed September 10, 2017, from . Australian Institute of Health and Welfare (AIHW) 2017, 'Older People', Australian Institute of Health and Welfare, accessed September 10, 2017, Fitzgerald, S 2017, 'Assessment and management of acute pain in older people: barriers and facilitators to nursing practice', Australian Journal of Advanced Nursing, vol. 35, no. 1, pp. 48-57. Savvas, S, & Gibson, S, 2015, ‘Pain management in residential aged care facilities’, Australian Family Physician,vol. 44, no. 4, pp. 198-203
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