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Assessment & Diagnosis > Acute Pain & Delirium > Flashcards

Acute Pain & Delirium Flashcards

1
Q

What is physical dependence defined as?

A

The development of withdrawal symptoms after discontinuation of therapy

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2
Q

What is the difference between physical dependence and addiction?

A

Physical dependence produces withdrawal sx and addiction is psychological

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3
Q

How to treat mild to moderate pain initially?

A

With a non-opioid

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4
Q

What do you do if you give a non-opioid for mild-mod pain and pt still has pain?

A

Give an opioid

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5
Q

What do you do if you give a non-opioid and an opioid for mild-mod pain and pt still has pain?

A

Titrate up on the opioid by 25-50% and see how they do

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6
Q

How do you start treating mod-severe pain?

A

With an opioid

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7
Q

What is nociceptive pain?

A

Pain caused by inflammation in a nerve ending - commonly caused by injury, surgery

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8
Q

Does nociceptive pain respond well to opioids?

A

Yes

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9
Q

What is somatic vs visceral nociceptive pain?

A

Somatic = Localized, from tissue injury; somatic=not well localized, associated with internal organs

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10
Q

What is acute pain?

A

Lasts less than 3 months, response to a known painful stimuli

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11
Q

What is chronic pain?

A

Long-term, difficult to treat

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12
Q

Allodynia and hyperalgesia are characteristic of what type of pain?

A

Chronic pain

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13
Q

What is allodynia?

A

Pain response to stimuli that is not normally painful

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14
Q

Is neuropathic pain responsive to opioids?

A

Not as much

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15
Q

What is neuropathic pain?

A

Caused by nerve damage

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16
Q

What is breakthrough pain?

A

Pain that is felt despite having pain medication given

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17
Q

What type of pain occurs in response to a sudden pain stimulus?

A

Breakthrough pain

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18
Q

A numeric pain rating scale of what or greater is considered significant?

A

4

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19
Q

A CPOT score of what or greater is significant?

A

3

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20
Q

What kind of pain is a PCA good for?

A

Mod-severe pain that is expected to be for a brief duration

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21
Q

How much should you dose reduce by when switching between different opioids?

A

25-50%, unless pt is in severe pain (than can be more aggressive)

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22
Q

How much Narcan to start with for a spontaneously breathing pt?

A

0.4mg

23
Q

How much Narcan to start with for an apneic pt?

A

0.4mg

24
Q

How much Narcan to give for a pt in cardiac arrest with suspected opioid overdose?

A

2mg

25
Q

What two opioids should you not use in acute care?

A

Meperidine and codeine

26
Q

What is the Tylenol limit per day?

A

3g

27
Q

What is Tylenol contraindicated in?

A

Liver failure

28
Q

In what pts should you avoid NSAIDs?

A

High risk ortho pts (may inhibit bone healing)

29
Q

What should gabapentin be started at?

A

300mg PO TID

30
Q

What’s the max dose of gabapentin?

A

1200mg TID

31
Q

What is a major side effect of gabapentin?

A

Sleepiness

32
Q

What happens if you d/c gabapentin?

A

Withdrawal

33
Q

INR above what is a contraindication to regional anesthesia?

A

Above 2

34
Q

Platelets should be above what for regional anesthesia?

A

50k

35
Q

Is increased ICP a contraindication for regional anesthesia?

A

Yes

36
Q

When is IV lidocaine used?

A

When pt has contraindication for regional anesthesia

37
Q

What is the therapeutic range for IV lidocaine?

A

1.5-5mcg/mL

38
Q

What are sx of lidocaine toxicity?

A

Seizures, cardiac collapse

39
Q

What are early signs of lidocaine toxicity?

A

Tinnitus, perioral numbness, metallic taste in mouth

40
Q

What to give for cardiac collapse in lidocaine toxicity?

A

Intralipids

41
Q

What is the primary side effect of ketamine?

A

Dissociation, hallucinations, tachycardia, hypertension

42
Q

In what three pt populations is ketamine contraindicated in?

A

PTSD, cardiac disease, head injury

43
Q

What is the most common cause of agitation in the ICU?

A

Untreated pain

44
Q

What is the most common sedation scale?

A

RASS

45
Q

What four classes of drugs are used for sedatives?

A

Benzos, propofol, opioids and alpha 2 agonists

46
Q

What is the closest to ideal sedative class?

A

Alpha 2 agonists

47
Q

Which sedative does not reduce respiratory drive?

A

Dexmedetomidine (Precedex)

48
Q

Are benzos good for sedation?

A

No

49
Q

What is the RASS goal?

A

0 to -2

50
Q

What is delirium caused by?

A

Underlying illness or substance intoxication

51
Q

Is hyper or hypoactive delirium more common?

A

Hypoactive

52
Q

What assessment is used to ID patients who have delirium?

A

CAM-ICU

53
Q

In what type of delirium would you use antipsychotics?

A

Hyperactive delirium

Assessment & Diagnosis (5 decks)

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