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pathophysiology of pain

Discuss in-depth the pathophysiology of Gwendolyn’s
condition firstly, therefore pathophysiology of pain and wound healing. We are then to identify
objective and subjective data & formulate relevant actual or potential four (4) nursing issues
based on the data presented in the scenario. The four (4) nursing issues identified for Gwendolyn
1) Chronic wound healing
2) Chronic pain
3) Poor eyesight
4) Hearing loss.
For each of the nursing issues identified above, we are to provide a brief pathophysiology
for each one, provide excellent understanding of current evidence based practice and patient
centred care. We are also to discuss the inter-professional roles likely involved, discuss/link
pharmacology (Macuvision for her poor eyesight, antibiotics for her wounds and chronic pain
management medication like Metronidazole, Ciprofloxacin), discuss lifespan issues (how her age
can affect wound healing, Poor eyesight and hearing loss because of her age), discuss also briefly
her psychosocial issues (she is a 82 yr. old widow living independently) This should be included
for each of the nursing issues. We should demonstrate clear links between these concepts and the
case scenario and nursing practice.


Pain has a warning damage as well as a protective function in nature, which calls for
adequate medication and treatment of the affected areas as in the case of Mrs. Gwendolyn.
Wounds resulting to pain is identified to have failed to heal in an orderly reparative process. The
wounds lead to poor functional, and anatomy integrity due to pain that follows. Pain influences
poor perfusion and low oxygen tension reduces the rate of collagen deposition in the tissues.
Consequently, vasoconstriction follows due to severe pain which also impairs the healing of
wounds. Infection, ischemia, nerve damage or the severe injury on the skin are the major causes
of wound pain similar to the case of Mrs. Gwendolyn. The decrease of oxygen in the tissues
results to production of low leucocytes which causes infection as the bacteria is given a chance to
colonize the wound (Robb, 2016, pg. 56). In this case, the patient suffers severe pain and makes
the healing process of the wound cumbersome. However, pain is identified to be a personal thing
that is dependent on what the patient would express.
Etiology and pathology of pain dictate the sort of pain experienced by the patients. In this
case, Mrs. Gwendolyn suffers from severe pain since the deep venous disease is a peripheral
vascular problem which affects the healing process (Roberts et al, 2016, pg. 88). The deep
venous disease in the patient also causes the venous ulcers which need to be addressed carefully
through the right treatment and management strategies. Provision of a moist wound environment,
compression therapy necrotic tissues’ debriment is essential during the pain and wound healing
process of a patient (Bester & Van, 2015, pg. 79).
Patients with chronic wounds require quick management to prevent its progression to
fatal stages causing severe pain. The accurate assessment of the patient’s pain progression is vital
before the adoption of treatment strategies for chronic wounds. Venous insufficiency as

identified in Mrs. Gwendolyn is one of the major causes that leads to the progression of wounds
to be chronic. Other factors include arterial perfusion, unrelieved pressure, and
immunosuppression. The chronic wound healing issue as identified is affected by many
systematic and local factors (Robb, 2016, pg. 105). Age factor affects wound healing. The
altered inflammatory process is related to impaired healing of chronic wounds among the elderly.
Delayed infiltration of T-cell and chemokine production influence the delayed healing of chronic
wounds among the elderly. Exercise is proved to enhance faster wound healing among the
elderly. Elimination of the noxious stimuli and identifying the underlying cause is crucial while
managing the chronic wound issues. Chronic wounds healing is closely associated with the high
intensity of the acute postoperative pain.
It is essential to follow the patient centered care and evidence-based practices while
treating patients with chronic wounds. While addressing chronic wound healing complications,
there are various elements identified using TIME mnemonic device (Mehmood et al, 2015, pg.
112). The device is set to identify elements of chronic wound healing impairment. These
elements include tissue surrounding the wound, infection or inflammation, moisture balance and
edges blood supply. Preserving vital tissue is essential as there are many impediments that hinder
optimal healing. Sharp debridement as an effective evidence-based practice used in the treatment
of chronic wounds arising from venous related ulceration such as the patient in our case study.
Topical antibiotics such as Vitamin A& D ointments, antacids, regranex, and collagen are used
to enhance the faster and more efficient healing of chronic wounds (Mehmood et al, 2015, pg.
60). Silver-containing dressings are used in improving the healing rates for wounds. Nurses and
other medical practitioners are supposed to treat the patient through proper dressing of wounds,
enhancing adequate nutrition, ensuring proper tissue oxygenation as well as treating underlying

infections. It is the role of the nurse to follow-up even after debriment and treatment of infections
to ensure wound care is efficient to control chronic contamination of the wound (Rhee et al,
2015, pg. 109).
It is the professional role of nurses to provide wound management education and training
to patients and their family members. Such measures and practices have been seen to improve
the efficacy and quality of the treatment strategies used thus preventing the complication of
situations. Optimal care should be provided to the patients, especially the elderly who have
numerous cases of malnutrition which affects their wound healing process (Hosseini et al, 2016,
pg. 93). The collaboration between the physician and patient enhances the better management of
the chronic wounds.
The chronic pain is another nursing issue identified and requiring the quick address to
prevents further complications experienced by the patient. The initiating causes and the patient’s
threshold for pain is used in differentiating whether the pain is chronic or not. Multiple
neurobiological mechanisms are said to contribute to pain making its categorization cumbersome
(Lee et al, 2014, pg. 156). Nevertheless, some of the most common types of pain include
nociceptive pain, central pain augmentation, and inflammatory pain. Aberrant somatosensory
processing which occurs in the central nervous system is used to explain the chronic pain.
Inflammation or damage to the tissue sensitizes nociceptors which are the nerve ending
transmitting signals of pain in the nervous system (Scherer et al, 2016, pg. 112). Chronic pain is
identified to be a persistent maladaptive response where psychological comorbidities are
Better pain management is made possible through adherence to the right evidence-based
practices as well as the provision of patient-centered care to the patient. Such strategies would

include understanding the pathophysiology of chronic pain appropriately before the
administration of management strategies. Interventional and behavioral therapy should be
combined as practices by the nurses while offering professional assistance to patients
experiencing chronic pain (Fox et al, 2016, pg. 145). Full involvement of the family members
and the patient would ensure they also contribute to making of clinical decisions towards their
treatment making management of situations such as chronic pain more efficient in nature.
Rehabilitation practices such as occupational, physical and cognitive therapy are used in the
management of chronic pain reducing medication needs (Lukewich et al, 2015, pg. 92). Various
drugs such as simple analgesics, opioid, and tricyclic antidepressants are used as the medication
for treating patients with chronic pain (Scherer et al, 2016, pg. 156). It is the role of the nurse to
offer proper clinical guidance to the patient as well as the prescriptions of drugs. Anti-
inflammatory drugs are used in the management of pain among patients. Other medication drugs
include ciprofloxacin and metronidazole (Patel et al, 2016, pg. 135).
The inter-professional role of the nurse ensures that approach of pain management is
organized in nature. The approach entails, routine chronic pain evaluation, encouraging patients
to share their chronic pain experiences, adopting evidence-based practices during treatment as
well as selective modification of opioid regulatory policies and practices. Adherence to
Consistent pain management strategies and minimizing pain is the major role performed by those
caring for the patient. The psychosocial issues should be handled effectively; it is most likely that
the woman feels lonely which might also affect her recovery process (Rommem et al, 2015, pg.
137). It is essential to administer therapies and advice that a person is attached to the patient to
offer her necessary support. Nurse Follow-up of her medication and treatment, while she is at
home, would help alleviate the psychosocial issues that could affect her recovery.

Poor eyesight is another nursing issue identified and requires proper management. Poor
eyesight causes people to have a blurry vision which makes various objects appear hazy or seems
to be out of focus. Some of the poor eyesight problems include astigmatism, refractory errors and
also presbyopia (Waldron, 2012, pg. 43). A comprehensive eye assessments such as Snellen eye
chart and the spatial contrast sensitivity test would be helpful in identifying the particular
eyesight problem. Age has been consistently identified as a factor influencing poor eyesight
among patients (Wadlron, 2012, pg. 64). There is macular degeneration which is age-related and
leads to blurry vision and gradual loss of vision. The elderly also experience distortions which
can lead to blindness at the end. The patient in our cases study has a family history of macular
degeneration which can be a cause of her poor eyesight problems due to genetic factors. Through
macular degeneration, the central vision would become blurred due to damage of macula. Age is
a major contributing factor since most people suffering from poor eyesight problems are above
the age of 65years while the risk rises with the increase in age (Dutta et al, 2015, pg. 117). Other
than macular degeneration vision impairment in the elderly patient would result due to cataract
and glaucoma.
Treatment and management of poor eyesight problems to prevent the progression to
severe stages is essential when caring for the patients. The diagnosis of poor eyesight problem
should be done correctly before undertaking any treatment strategies. Treatment is dependent on
specific causes. Psychosocial reasons such as stress and loneliness might hinder the patient from
taking care of herself well even to follow the diet that helps improve eyesight (Willis et al, 2016,
pg. 138). In this case, it is vital to have a caregiver who is there almost all times. Alterations in
vision, especially among the old, is detected using Amsler grid (Simsek et al, 2015, pg. 143). To
reduce the risks of suffering from the age-related macular degeneration (AMD), intake of foods

with high levels of carotenoids is useful. Foods rich in zeaxanthin and lutein are also required to
solve the problem. Mineral supplements and antioxidant vitamin are offered to the patient to
manage the situation (Sismek et al, 2015, pg. 73). Complete blindness is not related to AMD,
thus the management of poor eyesight is easier. Radiation therapy and provision antiangiogenic
drugs are recommended among the evidence-based practices to manage poor eyesight.
Hearing loss results from poor or lack of sound transmission to the cochlea. Hearing loss
is usually categorized into various levels such as slight, mild, moderate, severe and profound
hearing losses. Presbycusis is one of an age-related hearing loss problem which is experienced
among the elderly people like Mrs. Gwendolyn (Werfel et al, 2016, pg. 75). The hearing loss
gradually progresses as one gets old with time. Equal effects are experienced in both ears when
one is affected by the problem. Past medications toxic to ensory cells, past medical conditions
such as hypertension or chemotherapy drugs influence hearing loss among elderly people.
Hearing loss affect the functioning of the tympanic membrane (Schlauch et al, 2015, pg. 83).
It is the professional role to involve the patient and the family actively in training and
educating about hearing loss. Referral of patients to special programs or audiologist to assist in
improving auditory reception is important. Social workers can also be assigned to those who
already suffer from hearing loss to assist them in their daily activities since elderly people have
psychosocial problems which call for the caregiver to be present (Rudner et al, 2016, p.g 70).
The management and provision of patient-centered care are essential for the elderly patient
during prevention or treatment of the problem (Van et al, 2016, p.g 112).

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