JohnO-1610-3

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Serotonin and endorphins are morphine-like substances activated by pain and stress
Sources of stress of older adults: * rapid environmental changes that require immediate reaction
* changes in lifestyle resulting from retirement or physical incapacity
* acute or chronic illness
* loss of significant others
* financial hardships
* relocation
Any cellular damage caused by _____, _____, _____, or _____ stimuli results in the realease of pain producing substances. Mechanical - stretching of soft body tissues (ex. passing a kidney stone) Chemical - perforated visceral organ: thermal,
mechanical,
chemical,
electrical
Hispanic Americans: * Fastest growing cohort in USA
* Expected to be largest minority
* High birth rates
* Major issue - lack of citizenship is a barrier to availability of services
* Family is most significant social organization
* Family needs prevail over individual needs
* Dishonor and shame reflect on whole family
* Tend not to seek help from outsiders
* Father is dominant
* Strong sense of MACHISMO
* Belief in external LOCUS
* Good health implies proper balance
* Folk medicine / healers are usually female
Culture aspects of dealing with death: 1 - People want to die with dignity (in all cultures)
2 - Cultural and religious traditions help people cope with death
3 - Nurses are often present at time of death
4 - knowledge of patent's religious and cultural background helps nurses provide individualized care to patient and family
5 - dying alone is usually unacceptable in all cultures
6 - Some cultures - dying at home is preferable
7 - Some cultures patient should know what's going on, others don't feel patient should know what's going on
8 - Nurses need to know who to call and when
9 - Organ donation, autopsies, cremation, preparation of the body
10 - Rituals
Four categories of old: * Young Old = 65-74
* Middle Old = 75-84
* Old Old = 85-99
* Elite Old = 100+
"Reception Substances" released by the body include - * Histamine * Bradykinin * Potassium These combine with receptor sites. Not all tissues contain receptors that transmit pain signals, ex. Brain and alveoli.: * Histamine
* Bradykinin
* Potassium
These combine with receptor sites.
Characteristics of Intimacy (Stage 6): - Need for marital intimacy
- Possessing capacity to love and express that love
- Involvement with other generations in family
- Maintaining a sense of self
KNOW - Even with acceptance hope is still present and needs to be supported realistically
Erikson's Stage 6 - Young Adulthood ? vs ? Main Issue?: Intimacy vs. Isolation
Primary issue is love.
Mechanical: stretching of soft body tissues (ex. passing a kidney stone)
Implementing the following nursing interventions for all patients regardless of risk -: * Monitor the patient's activities and behavior as often as possible, preferably every 30 to 60 minutes
* Remind the patient to call for help
* Help the patient to get out of bed or chair
* Provided, or remind the patient to use, walking devices
* Remind the patient to wear glasses
* Toilet the incontinent every 1 to 2 hours
* Clean up spills immediately
* Arrange furniture accordingly
* Provide adequate lighting
* Observe for side effects
* Orient the patient to the environment
* Keep the call light within reach
* Place the bed in lowest position with the brakes locked
* Place objects within reach
* Ensure adequate handrails
* Have physical therapies assess the patient for mobility and safety
Apnea =: not breathing
Age-related changes that can potentially affect drug absorption from an oral route include -: * an increasing gastric pH
* a decrease in gastric blood flow
* a decrease in gastrointestinal motility
If pain is severe, or deep, typically involving visceral organs, the _____ nervous system goes into action: parasympathetic
Erikson's Stage 7 (Adulthood) - ? vs. ? Primary Issue: Generativity vs. Self-absorption/Stagnation
Primary issue is CARE
Caring: The essence of nursing is caring.
The dominant distinctive and unifying feature of nursing is caring.
1 - supportive and assistive acts for another individual
2 - Serves to improve human conditions
3 - Essential to human development, growth, and survival
4 - Caring behaviors include -
* comfort
* compassion
* concern
* empathy
* involvement
* love
* nurturance
* sharing
* support
* tenderness
* touch
* trust
Erikson's Stage 8 (Old Age) ? vs. ? Primary Issue?: Integrity vs. Despair

Primary Issue = Wisdom
Pain is influenced by interaction between ...: emotional, behavioral, cotnitive and physiologic sensory factors
Age-related changes affecting metabolism include -: * a decrease in liver size
* a decrease in liver blood flow
* a decrease in liver enzyme activity
Kubler-Ross: 1 - Denial - may be partial or complete; may occur during first stages of illness and later on from time to time. (Used as a buffer zone - allowing time to deal with)
2 - Anger
- r/t giving up life
- may be projected at others
3 - Bargaining
4 - Depression
- Two kinds
- Preparatory (with impending loss)
- Reactive (reaction to the news just received)
5 - Acceptance
Three most common cognitive problems among older adults: 1 - depression
2 - dementia
3 - delirium
Chemical: perforated visceral organ (ex. burst appendix, duodenal ulcer). Chemical secretions touch sensitive nerve endings.
Two forms of competence -: 1 - Legally competent
2 - Clinically competent
Serotonin and endorphins are found in the ...: brain, spinal cord, and GI tract
Depression is thought to result from a lack of what two neurotransmitters?: norepinephrine
serotonin
Thermal (hot or cold): causing inflammatin or loss of superficial layers of epidermis. Increased sensitivity of nerve endings.
Characteristics of Despair: Despair = sense of hopelessness and dread
- Overwhelming regret over past mistake
- Worry about the future and unknown
- Feelings of loneliness and possible abandonment
Sense of not being missed when dead
Influences -: * Personal Values/Beliefs
* Life Review
* Family and friends reactions/attitudes
* Personal coping skills
* Health care staff
Define Cultural Competence: ability to understand and respond effectively to the cultural and language needs of patients.
- Respect the culture
- Be careful of discrimination
- Resources/protocol to address cross cultural legal and ethical conflicts
Gate Control Theory of Pain -: Pain impulses can be regulated or blocked by the gating mechanism along CNS. Pain impulses pass through when the gate is open and not while the gate is closed.
Characteristics of Integrity: Integrity = sense of satisfaction and fulfillment
- Knowledge developed from life experiences
- Ability to use all resilience and toughness learned
- Willingness to learn new coping skills
- Sense of humor
Hospice: 1 - specialized care for the dying including emotional and spiritual support
2 - may alleviate a lot of stress for family
3 - hospice personnel are educated to treat pain aggressively
4 - Hospice philosophy is as pain-free as possible and as alert as possible
5 - Doctor says that patient is less than six months
Characteristics of Stagnation: Stagnation
- Little involvement in adulthood activities
- Regret over putting aside personal interests for family
- Difficulty expressing feelings of affection
Lack of concern for family, country and mankind
Threshold of pain =: minimum level of stimulus intensity required to evoke a nervous impulse
Without treatment, depression may result in ?: 1 - worsening medical condition
2 - risk of physical illness
3 - alcoholism
4 - increased pain and disability
5 - delayed recovery from illness
6 - suicide
Pain Pathways: 1 - Source of pain
2 - Stimulation of pain receptor (may be mechanical, chemical, thermal, electric, or ischemic)
3 - Sensation travels along the sensory pathways and ascends the spinal cord to the thalamus
4 - The autonomic nervous system is activated
5 - Sensations travel to the sensory area of the cerebral cortex
6 - Pain reception occurs in the thalamus
7 - Pain interpretation occurs in the cerebral cortex
8 - The person become aware and the response patterns are activated
Medical Indications of Elder Abuse: 1 - Possibly bruising - old and new bruises at the same time
2 - Skin Tears
3 - Malnutrition/Dehydration
-decrease in thirst, appetite, and sense of smell
4 - Bed sores
5 - Fractures
6 - Patient History
Factors influencing pain...: * age
* sex
* culture
* meaning of pain
* attention
* anxiety
* fatigue
* previous experience
* coping style
* family/social
Largest subculture in USA?: Disabled
Types of breakthrough pain: 1 - Incident pain - caused by movement or activity
2 - Spontaneous pain - does not seem to be linked to any specific source
Delirium may be casued by...: - infection
- medications
- fever
- nutritional
- grief/stress
- change of environment
Sensory discriminative: * nerve transmission occurs between the thalamus and sensory cortex
* person perceives the location, severity, and character of pain
Characteristics of Delirium (vs. Dementia): - Short term
- Reversible
- Acute stage of confusion
- Agitation
Techniques for Pain Control: 1 - PCA (Patient-controlled analgesia)
2 - Epidural pain control
3 - Direct IV pain control
4 - Breakthrough pain control
Characteristics of Dementia: - cognitive decline
- can be slow and progressive
- irreversible
Examples of two tissues that don't contain receptors that transmit pain signals: Brain and alveoli
Common errors in drug self-administration: * may forget
- writing the drug regimen on the top of the bottle with large letters and numbers is helpful
* errors in taking medication may result from poor communication with health care professional
* attitude and long-ingrained feelings about taking medicine
- when obtaining a medication history, it is very important that the nurse ask patients about all OTC drugs, including herbal and food supplements
Electrical: skin layers are burned invloving the muscle and subcutaneous tissue, causing
injury to nerve endings.
Define restraint: any device or medication that prevents the patient from moving freely
Perception =: point at which a person is aware of pain
Examples of things cultures share...: * Food/nutrition * Dress
* Language * Morals
* Treatment of illness
* Laws * Art * Customs
* Rituals * Economics
* Family systems
Characteristics of Acute Pain: * rapid onset
* it is self-limiting; with an end in sight
* an episode that lasts for seconds to fewer than about six months
What is the single most important predictor of falls?: a history of falling
Motivational-affective: * interaction between the reticular formation and limbic system results in pain perception
* limbic system controls emotional response and coping with pain
What is goal of Healthy People 2010?: Goal is to eliminate disparities with healthcare delivery among racial and ethnic minorities.
Behavioral reactions to pain...: 1 - Anticipation
2 - Sensation
3 - Aftermath
Common causes of undernutrition include: - drugs
- chewing problems
- immobility
- infections
- alzheimer's disease
Superficial: * short duration
* sharp sensation
* localized
Characteristics of Generativity (Stage 7): Generativity
- Creative
- Giving of self to world
- Perpetuating
- Helping and giving to next generation
- Vital involvement in adulthood activities
- Participation in caring for what one truly believes in Nurturing and maintaining relationships
- Care for the present and concern for the future
Characteristics of Deep Visceral: * diffuse
* radiating
* sharp or dull or unique to organ involved
Older people tend to have more short term or more long term memory loss?: short term
Locations of Pain: 1 - Superficial or Cutaneous
2 - Deep Visceral
3 - Referred
4 - Radiating
Types of Elder Abuse (8): Physical Abuse
Emotional Abuse
Financial Abuse
Sexual Abuse
Active Neglect
Passive Neglect
Denial of Civil Rights
Self Abuse / Neglect
Characteristics of Chronic Pain: * an episode of pain htat lasts for six months or longer
* pain may be limited, intermittent, or persistent
* difficulty describing the pain because it is poorly localized
Characteristics of Isolation (Stage 6): Isolation
- Inability or unwillingness to express feelings
- Dissatisfaction with long term marriage
- Feelings of bitterness toward life events
- Refusing assistance from family, friends, neighbors
Characteristics of Referred: * pain felt in part of body separate from source of pain
Older patients with a pressure ulcer need additional ...: protein
vitamen C
zinc
Characteristics of A-beta neurons -: * mechanoreceptor
* thicker
* when released inhibit the other neurotransmitters (close the gate)
Define active neglect: the intentional failure to perform a care giving function in order to inflict pain or injury
Three Physiological Components of Pain: 1 - Reception
2 - Perception
3 - Reaction
Define passive neglect: the unintentional failure to perform a care giving function which results in pain or injury
Types of Pain: * acute
* chronic
- Intractable pain (malignant pain)
- Nonmalignant pain
Effects of drugs on older adults: Older adults are at a high risk for side effects and toxic effects from drug.

Elders have less reserve capacity in most organ systems
Signs of pain ...: * facial expression
* clenching teeth
* holding the painful part
* bent posture
* grimaces, cries, groans
* restlessness
* frequent rests
Age-related changes of the renal system include -: * decreased renal blood flow
* reduced glomerular filtration rate
Reaction is a physiological and behavioral response to pain.
Age-related changes that affect drug distribution include -: * smaller amounts of total body water
* an increased ratio of adipose tissue
* a decreased albumin level
* a decreased cardiac output
Cognitive-evaluative (intellect): * higher cortical centers in the brain influence perception
* helps the person to interpret the intensity and quality of pain so that action can be taken
Which is the most potent group of psychoactive drugs?: antipsychotics
Non malignant pain: * Pain such as low-back pain results from nonprogressive or healed tissue injury.
* Pain is still ongoing and often does not respond to treatment.
* Frequently the cause is unknown.
The minimal nutritional requirements of the human body remain consistent from youth through old age, with a few exceptions.
Three interactional systems of pain...: 1 - sensory-discriminateive
2 - motivational-affective
3 - cognitive-evaluative
The most common accident among older patients in a hospital or LTC is?: falling
Methods for Intractable Pain: * restorative care - nurses continue to use nonpharmacological measures that are effective for individual patients.
* hospice
* pain clinics
Older adults need an increased dietary intake of calcium, vitamin D, vitamin C, and vitamin A because alteration with age disrupt the ability to store, use and absorb these substances.
The central processing of pain occurs at three different levels of the brain: 1 - thalamus
2 - midbrain
3 - cortex
Oversedation, isolation, an unsafe environment are all types of what?: Neglect
To manage delirium, the nurse should ...: use a calm voice in reorienting the patient and try to divert attention away from devise or tubes
Lack of privacy and involuntary servitude are types of ?: Abuse
Characteristics of Radiating: * sensation of pain extending from initial site of injury to another body part
Define Culture: body of learned beliefs, traditions, and guides for behavior that are shared among members of a particular group
The sympathetic nervous system response is usually stimulated by superficial pain.
What are the six target areas of Healthy People 2010?: Infant Mortality
Cancer Screening
Cardiovascular Disease
Diabetes
HIV
Immunizations
Non-pharmalogic relief measures: * distraction
* imagery (therapeutic touch)
* relaxation
* cutaneous stimulation
* TENS (transcutaneous electrical nerve stimulation)
* acupuncture
* hypnosis
Older adults experience a greater decline in the ability to taste sweet and salt than in the discrimination of bitter and sour
Physical dependent =: a physiologic adaptation of the body tissues so that continued administration of the drug is required for normal tissue function
Native American Indians: * 10 Tribes
* 1.9 million
* Cherokee and Navajo have largest populations
* Each tribe has own language
* Equal number of Native Americans live on reservations as in cities
* Bureau of Indian Affairs (1954) now called Indian Health Services
* Family oriented
* Some tribes are MATRIARCHAL
* Same household with wife's relatives
* Religion and healing are blended together
* Values and basic beliefs to culture and religion are day to day
* Value harmony with earth
* Native American healers are respected
Larger peptide (ENDORPHINS) exert more prolonged analgesic (pain-relieving) effects than do the enkephalins (smaller peptides)
Approximately 80-85% of older adults are relatively healthy and live in the community at home, in assisted-living facilities, or in retirement complexes. Five percent reside in longterm care facilities. Ten to fifteen percent are il
For patients with cancer the aim of drug therapy is to _____ pain rather than cure it.: ANTICIPATE and MINIMIZE
African Americans: * Many health problems closely associated with economic status
* Poverty, discrimination
* Social and psychological barriers to health care
* Morbidity and mortality rates are higher than general population and other minorities
* Morbidity = illness
* Mortality = death
* Higher infant mortality rates
* Families are MATRIFOCAL (no male in household)
* Even when a male is present families are oriented around women
* Families tend to be very supportive during times of crises and illness
* Some fold medicine is used by some raised in South
Dyspnea: is a subjective experience in which the patient experiences an uncomfortable awareness of breathing, breathlessness, or severe shortness of breath
Diminished senses of taste and smell often result in a loss of appeal of food.
Essential Data for a complete Pain History: 1 - Precipitating factors
2 - Aggravating factors
3 - Localization of pain
4 - Character and quality of pain
5 - Duration of pain
Asian Americans: * Family is basic institution
* Well-defined family roles
* Close-knit; tend to be in same community
* Mistrust is a barrier
* Eldest son has responsibilities
* Women often secure jobs
* Consider seek illness cures in herbs, therapeutic diets, and hygienic measures
* Information is usually transmitted orally and with secrecy
* Beliefs in BALANCE
Elders with depression may experience: * early morning insomnia
* excessive daytime sleeping
* poor appetite
* a lack of energy
* an unwillingness to participate in social and recreational activities
Common health issues and problems that may affect older adults in any setting include ...: Health promotion
Self-management
Nutritional awareness
Physical fitness and mobility
Stress management
Accidents
Drug use and misuse
Mental health
Elder neglect and abuse
Delirium: * An acute confusional state
* Fast onset
* Duration of hours to less than one month
* Cause is multiple, such as surgery, infection, drugs
* Usually reversible
* Remove or treat the cause as management
* Nursing intervention -reorient the patient to reality; provide a safe environment
What are the two most common nutritional problems in both hospital and LTC settings?: Anorexia
Wight loss
Dementia: * Chronic, progressive cognitive decline
* Slow onset
* Duration of months to years
* Cause is unknown
* Non-reversible
* Management includes treat signs and symptoms
* Use validation therapy (acknowledge the patient's feelings and do not argue)
- provide a safe environment
- observe for associated behaviors (delusions and hallucinations)
Identify nursing interventions for common health and economic issues common to the older adult.: Religious assistance
Community assistance
Government assistance
The ethics of nursing includes -: * ensuring patient confidentiality
* getting informed consent for certain procedures and surgery
* respecting the right of patients to make autonomous decisions about their care
Most common abuse of elders is: Financial abuse is most common
Epidural space =: the space between the dura mater and the vertebral column
Pain is subjective
When respirations fall below 10, the nurse should rouse the patient (p 75, ig).
Neurotransmitters are the chemicals that exert inhibitory (slowing down) or excitatory (speeding up) activity at postsynaptic nerve cell membranes.
Chapter 9 Palliative Care =: relieving or alleviating without curing
The best questions for cultural interviews are "semi-structured" and open-ended questions. Examples of such questions -: * I am interested in where you were born. Could you describe the community (or country)?
* I would like to know where your parents were born. If they are living, where are they now?
* Tell me about your household. Who lives in it? Are they related to you?
* Describe how you usually spend your days. What do you like to do most?
* Please describe your education for me.
* I am also interested in the church and religion. What do they mean to you?
* Tell me about what you believe about health. What does it mean to "be healthy"? To whom do you look for health care?
* Is there anything else you would like to tell me?
Characteristics of Pain: * Highly Individualized experience
* Invisible phenomenon
* Body's defense mechanism that indicates the person is experiencing a problem
Elder Neglect and Abuse: - Neglect
- Physical
- Financial
- Emotional
McCaffery definition of pain: Pain is whatever the person experiencing it says it is, existing whenver he or she says it does.
Physical: use of physical force that results in bodily injury, especially in the bathing suit zone
Withdrawal symptoms include -: - nausea and vomiting
- abdominal cramping
- muscle twitching
- profuse perspiration
- delirium
- convulsions
Factors that tend to decrease the threshold for and tolerance of pain include -: * discomfort * insomnia
* fatigue * anxiety
* fear * anger
* sadness * depression
* mental isolation
* introversion
* past experience
Four categories of location related pain: 1 - Localized pain is pain confined to the site of origin.
2 - Projected pain is pain along a specific nerve or nerves.
3 - Radiating pain is diffuse pain around the site of origin that is not well localized.
4 - Referred pain is pain perceived in an area distant from the site of painful stimuli.
Cordotomy =: a cut in the pain pathway at the midline portion of the spinal cord
Spirituality =: the connections to self, others, the environment and God
Neuromodulators are protein hormones in the brain.
Physiologic and behavioral responses to acute and chronic pain -: Acute Pain
* Increased blood pressure initially
* Increased pulse rate
* Increased respiratory rate
* Dilated pupils
* Perspiration
* Restlessness
* Inability to concentrate
* Apprehension
* Distress
QI for pain should be based on the following tenets (p. 91, ig): * pain should attract clinician's attention
* Information about analgesics should be accessible where orders are written
* Patients should be assured of responsive analgesic care and urged to communicate pain
* polices and safeguards should be implemented for the use of technology-supported pain care
* Implementation of these measures should be assessed and coordinated
The most important type of opioid receptor is the _____ receptor.: MU
Giving the right drug and the required dose at the proper interval: * alleviates the fear of pain
* protects the pateint from drug seeking behavior
* reduces dependence
Rhizotomy =: sensory nerve roots are destroyed where they enter the spinal cord
Financial: occurs when the patient's property or resources are mismanaged or misused
Side effects of NSAIDs: * Gastric irritation and upset
* Renal toxicity
* Decreased clotting
Reminiscence =: the process of randomly reflecting on memories of events in one's life
Nociceptors =: free nerve endings (receptors capable of responding to painful stimuli).

Nociceptors are located in various body tissues and are activated by thermal, mechanical, and chemical stimuli.
The ethics regarding cultural care of patients considers -: * the values of each individual patient and his or her cultural beliefs and practices
The most common symptoms of distress are -: * dysphagia (impaired swallowing)
* pain
* dyspnea
* nausea and vomiting
* agitation
Neuralgias =: pain along the distribution of nerves
Withdrawal symptoms may result when a patient who is physically dependent abruptly ceases using the drug.
Nonpharmacologic Interventions: * Altering the environment to facilitate the circulation of cool air
* Cooling the body
* Position the patient to facilitate chest expansion
* Encouraging imagery and deep breathing
* Intervening to conserve patient energy
* Facilitating the patient's rest
The activity of endorphins and enkephalins may be enhanced by prolonged strenuous activity , transcutaneous electrical nerve stimulators (TENS), and antidepressant therapy.
Two specific fibers can transmit stimuli: 1 - A Delta Fibers found primarily in the skin and muscle
* myelinated
* carry rapid, sharp, pricking, or piercing sensations.
2 - C Fibers which are distributed in muscle, periosteum, and viscera.
* unmediated or poorly myelinated
* conduct thermal, chemical, and strong mechanical impulses
* usually produce constant pain
Various Meds and Routes for Chrnic Pain: 1 - Epidural analgesia
2 - Long acting/controlled release MS (morphine sulfate)
Rectal analgesia
3 - Transdermal
4 - PCA pump
5 - Continuous drip MS
6 - Surgery
Emotional: intentional use of threats, humiliation, intimidation, and isolation toward older adult
Chronic Pain: * Normal blood pressure
* Normal pulse rate
* Normal respiratory rate
* Normal pupils
* Dry skin
* Immobility or physical inactivity
* Withdrawal
* Despair
Common Nursing Dx related to pain: * Acute Pain
* Chronic Pain
* Anxiety related to loss of control
* Fear related to pain
* Powerlessness related to the illness-related regimen
* Ineffective role performance related to a change in health status and impaired coping
* Altered sexuality patterns related to illness and pain
* Impaired physical mobility related to pain and discomfort
* Activity intolerance related to pain and/or depression
* Sleep pattern disturbance related to pain
* Self-care deficit (total or partial) related to pain
* Altered health maintenance related to a feeling of hopelessness
Neglect: occurs when a caregiver fails to provide for a patient's basic needs
Religiosity =: the acts that are practiced alone or with others to preserve spiritual understanding
Stages of Grieving Process: 1 - Shock and disbelief
2 - Developing awareness
3 - Restitution
4 - Resolution
5 - Idealization
Factors that tend to increase the threshold for and tolerance of pain include -: * symptom relief
* sleep * rest
* sympathy * understanding
* diversion * elevation of mood * analgesics
* anxiolytic agents
* antidepressants
Theories of Pain: 1 - Specificity Theory = certain pain receptors are stimulated by specific type of sensory stimuli that sends impulses to the brain.
2 - Pattern Theory = pain originates in the dorsal horn of the spinal cord. A certain pattern of nerve impulses is produced and results in intense receptor stimulating that is coded in the CNS and signifies pain.
3 - Gate Control Theory =
* existence and intensity of pain experience depends on the particular transmission of neurologic impulses
In addition to endorphin "keys" and receptor "locks", researchers have found antilocks, called antagonists, that keep endorphins from working
Stages of the Dying Process: 1 - Denial
2 - Anger
3 - Bargaining
4 - Depression
5 - Acceptance
Endorphin receptors and antilocks have been found throughout the body
The parasympathetic nervous system response is usually stimulated by deeper pain and results in slowing down of all systems to conserve energy.
Common Emotional Signals: * Withdrawal
- person is preparing to "let go"
* Vision-like experiences
* Letting go
- may perform repetitive task
* Saying goodbye
A beta-endorphin is 50 times stronger than morphine. A dynorphin is 190 times stronger than morphine.
Addiction =: used to describe the persistent craving for and abuse of a drug for recreational purposes. IT IS PSYCHOLOGIC PHENOMENON, NOT A PHYSICAL ONE.
The goals of care for a patient near death are -: * To control symptoms
* To promote meaningful interactions between the patient and significant others
* To facilitate a peaceful death
The patient's interpretation of the physical sensation is influenced by the patient's -: * culture
* previous experiences with and without pain
* beliefs about self
* interpretation of the future
* present environment
* persons in the environment

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Number of cards 164