ATI Med-Surge Book (Ch 94) Flashcards
List some Non-Opioid Meds and NSAIDS:
Acetaminophen
Ketorolac
Aspirin (Acetylsalicylic Acid)
Ibuprofen
Celecoxib
List some Opioids:
Morphine
Meperidone
Hydromorphone
Oxycodone
Fentanyl
List some Antidepressants:
Tricyclic Antidepressants (TCA’s):
Amitriptyline
Desipramine
Imipramine
Nortriptyline
Selective Norepinephrine Reuptake Inhibitors (SNRI’s):
Venlafaxine
Duloxetine
Nortriptyline
List some Anticonvulsants:
Gabapentin
Phenytoin
Pregabalin
Carbamazepine
List some Corticosteroids:
Prednisolone (syrup)
Dexamethasone
List the different types of Adjunctive Agents:
Sympatholytic Agents
Skeletal Muscle Relaxants
What is Clonidine?
A Sympathetic Agent
What is Baclofen?
A Skeletal Muscle Relaxant
What is a Lidocaine (Patch)?
A Tropical Local Anesthetic
What is the Therapeutic intent for Non-Opioid Meds and NSAIDS?
For mild to moderate pain.
What is the Therapeutic intent for Opioids?
For moderate to severe pain.
For Breakout Pain.
What is the Therapeutic intent for Antidepressants?
Reduce Depression.
Promote Sleep.
Increase Serotonin and Norepinephrine levels to improve feelings of well-being.
Decrease Neuropathic Pain.
What is the Therapeutic intent for Anticonvulsants?
Neuralgia and Neuropathic Pain
What is the Therapeutic intent for Corticosteroids?
Reduce pain by reducing Edema
What is the Therapeutic intent for Sympatholytic Agents?
Neuropathic Pain.
Administer with Bupivacaine in epidural or other local infusions.
What is the Therapeutic intent for Skeletal Muscle Relaxants?
Used with other pain meds for muscle spasms accompanying cancer pain
What is the Therapeutic intent for Tropical Local Anesthetics?
Block generation and conduction of impulses that transmit pain
List some Systemic Local Anesthetics:
Lidocaine
Bupivacaine
Ropivacaine
What is the Therapeutic Intent for Systemic Local Anesthetics?
Administered via an infusion pump directly into the area of pain to provide pain relief
What are the things that you need to teach to a pt before giving them Non-Opioid Meds and NSAIDS?
Take them with food to avoid GI upset.
Be alert to GI or other bleeding and bruising.
Don’t chew or crush enteric-coated products.
Drink adequate fluids when taking NSAIDS to prevent acute renal failure.
What are the things that you need to teach to a pt before giving them Opioids?
Avoid driving and using hazardous equipment until the effects of the opioid are known.
Don’t take with alcohol.
Prevent constipation with diet changes and stool softeners.
Nausea can subside within a few days.
Lower the risk of orthostatic hypotension by rising slowly from a sitting/lying position.
What are the things that you need to teach to a pt before giving them Antidepressants?
Notify the provider if depression increases or if any thoughts of suicide occur.
Therapeutic effects take 2-3 weeks to start any effect.
Take TCA’s in the evening.
What are the things that you need to teach to a pt before giving them Anticonvulsants?
Can cause Sleepiness and Dizziness.
Avoid Alcohol.
Don’t drive at the start of therapy.
Notify the provider if rash or tremors occur.
What are the things that you need to teach to a pt before giving them Corticosteroids?
Don’t discontinue the med suddenly.
Take the med with food.
This med weakens the immune system.
Report any indications of infection.
What are the things that you need to teach to a pt before giving them Sympatholytic Agents?
Change positions slowly, these meds can cause orthostatic hypotension
What are the things that you need to teach to a pt before giving them Skeletal Muscle Relaxants?
Take med with food.
Use caution when driving or operating machinery.
These meds can cause drowsiness and dizziness.
What are the things that you need to teach to a pt before giving them Systemic Local Anesthetics?
Observe the infusion site for any indications of infection like redness or edema.
Watch for fever.
Notify the provider if increased pain occurs or if decreased movement that can indicate a motor block occurs.
Care for and protect the external part of the catheter.
What are the things that you need to teach to a pt before giving them Tropical Local Anesthetics?
Use the med only on intact skin
What are the Nursing Actions for Non-Opioid Meds and NSAIDS?
Monitor for GI Bleeding (Blood in stool, coffee-ground emesis), Bruising, Bleeding, Tinnitus, Hearing Loss.
These meds can cause cardiovascular adverse effects (Heart Failure, Dysrhythmias).
What are the Nursing Actions for Opioids?
Use with caution for elderly pt’s.
Monitor for Respiratory Depression.
Have Naloxone available to reverse effects.
Administer stimulant laxatives with Opioids to prevent opioid-induced constipation.
Monitor and intervene for any adverse effects from the Opioids.
What are the Nursing Actions for Antidepressants?
Use with caution for older pt’s and young adult pt’s.
Use with caution for people who’re at risk for suicide because it can cause an increased suicide risk.
What are the Nursing Actions for Anticonvulsants?
Monitor Electrolytes + Liver Function + Blood Cell Counts + Medication Levels + Tremors + Rash (Life Threatening)
What are the Nursing Actions for Corticosteroids?
Reduce dosage gradually.
Monitor for Muscle Weakness, Joint Pain, or Fever.
Monitor Glucose Levels.
Monitor for any Behavioral Changes or Confusion.
What are the Nursing Actions for Sympatholytic Agents?
Monitor for Hypotension
What are the Nursing Actions for Skeletal Muscle Relaxants?
Monitor for Seizure Activity
What are the Nursing Actions for Systemic Local Anesthetics?
Monitor for Hypotension, Toxicity, Seizures, Respiratory Depression, and Bradycardia.
Monitor for infection at the catheter insertion site.
Monitor for Motor Impairment and level of Sedation.
Evaluate Pain Status.
Administer with Opioids or another medication or another medication (like Clonadine).
What are the Nursing Actions for Tropical Local Anesthetics?
Monitor for effective Pain Relief and if there’s any Local Skin Reactions
TCA’s are contraindicated for what kind’s of pt’s?
Pt’s with seizure disorders or a history of cardiac problems
What are the Adverse Effects of TCA’s?
Dry Mouth + Dizziness + Mental Clouding + Weight Gain + Constipation + Orthostatic Hypotension
What are the Adverse Effects of SNRI’s?
Nausea + Headache + Sedation + Insomnia + Weight Gain + Impaired Memory + Sweating + Tremors
What is Breakout Pain?
A sudden increase in pain that can occur in pt’s who already have chronic pain from cancer, arthritis, fibromyalgia, or other conditions. Usually only lasts for a short period of time
What are the routes that you can use for Fentanyl?
Transdermal, Lozenge/Sucker, Buccal Film and Tablets, Nasal Spray, Sublingual Spray
When might you need to take combinations of Opioids like taking Hydrocodone and Acetaminophen at the same time?
For Breakthrough Pain
What is the Epidural Space?
The area outside the Dura Mater of the spinal cord
What is the subarachnoid area within the spinal cord sheath that contains the cerebrospinal fluid called?
The Intrathecal Space
What are some things to keep in mind about Acetaminophen?
Contraindicated for pt’s with Liver Disease.
Pt’s with a healthy liver should take no more than 4 grams per day.
For long-term treatment, they should take no more than 3 grams per day.
What are the Adverse Effects of Opioids?
Constipation, Orthostatic Hypotension, Urinary Retention, Nausea, Vomiting, Sedation
You’re about to give a pt Opioids, what route is best for immediate, short-term relief of acute pain?
The Parenteral Route
You’re about to give a pt Opioids, what route is best for chronic, non-fluctuating pain?
The Oral Route
You should treat severe, acute pain by administering Opioids PRN rather than on a set schedule.
True or false?
False
How should you treat severe, acute pain with Opioids?
Solve the pain with a short-term (24-48 Hr) around-the-clock administration of Opioids
You can give Fentanyl via the Transdermal route.
True or false?
True
Tell me about what Fentanyl is like if you give it Transdermally?
It’s easy to administer.
Give it with a slow onset, consistent dosing.
This drug has a long duration (24-48 hrs).
Low WBC and Platelet Counts are a contraindication for which route?
Rectal
Morphine or Hydromorphine can be given via what route?
Subcutaneous Injection
Tell me about what Morphine or Hydromorphine is like if you give it via Subcutaneous Injection?
It’ll have a slow infusion rate (2-4 mL/hr).
Requires Nursing Support.
Risk of infiltration.
Has a Rapid Onset.
Tell me about things that I need to keep in mind about the Intravenous Route:
Requires Nursing Support.
Risk of infiltration.
Has a Rapid Onset.
What are things to keep in mind about analgesia given via the Epidural or Intrathecal route?
There can be a risk of Infection, Pruritus, and Urinary Retention.
It requires nursing care to monitor, especially with increasing dosage.
It’s more effective than IV analegesia during the immediate post-operative period
Involves injecting an anesthetic agent (Bupivacaine) and/or a corticosteroid directly into a nerve route to provide pain relief =
This is called a Regional Nerve Block
What are Regional Nerve Blocks used for?
Used for identifying or treating an isolated area of pain
(For example, an intercostal nerve block treats chest or abdominal wall pain)
How long can a Regional Nerve Block take to do?
Anywhere form 15 min to 1 hr (Varies based on area receiving the nerve block
What are things that you’d want to teach a pt about Regional Nerve Blocks?
Keep an eye on the injection site for any redness, edema, or drainage.
Protect the area of injury.
Notify the provider if any increased pain or manifestations of Systemic Infusion occur.
What are the Nursing Actions for a Regional Nerve Block?
Measure baseline vitals. Monitor BP and other vitals during the procedure and for at least 1 hr following the procedure.
Monitor for any symptoms of Systemic Infusion.
Assess the level of nerve block and pain levels.
Establish IV access before the procedure.
Assess the site for redness and edema.
Protect the area of numbness from injury.
What are the manifestations of Systemic Infusion?
Metallic Taste, Tinnitus, Perioral Numbness, Seizures
Involves injecting a local anesthetic or analgesic into the epidural space or Intrathecal space before surgically placing an external catheter under the skin with an external port for Long-Term use =
Epidural or Intrathecal Catheter
What are things that you would educate a pt who has to have an epidural or Intrathecal catheter?
Notify the provider of any manifestations of infection (Fever, Swelling, Redness, Sudden Weakness of the Lower Extremities, Decreases in Bladder or Bowel Control, Increase in Pain or Headache)
Notify the provider of any manifestations of Systemic Infusion
What are the nursing actions for a pt who’s having a Epidural or Intrathecal Catheter?
Monitor during and for at least 1 hr following insertion or injection for Hypotension, Anaphylaxis, Muscle Weakness, Seizures, and Dura Puncture.
Monitor for Respiratory Depression and Sedation.
Monitor the insertion site for Hematoma, Infection, and Leakage of Cerebrospinal Fluid.
Assess the level of sensory block.
Evaluate leg strength prior to ambulating.
Local anesthetics block the sympathetic nervous system, causing Peripheral Vasodilation and Hypotension. This can cause-
Reduced SV, Less CO, and Less Peripheral Resistance
What should you do to compensate for the sympathetic blocking effects of regional or local anesthetics?
Increase the rate of IV fluid infusion
Involves interrupting the nerve pathway or destroying the nerve roots that are causing pain, usually involves a CT-guided probe and injection of chemicals (like Phenol or Ethanol) =
Neurolytic Ablation
Tell me important things to know about a Neurolytic Ablation:
It’s irreversible.
It can provide relief for several months until nerve fibers regenerate.
Nerve ablation can cause loss of Sensory, Motor, and Autonomic Function.
When should you use a Neurolytic Ablation?
Only when non-invasive methods don’t work
Electrical current that creates heat on a probe that the provider guides to the tumor or nerves to destroy cancer cells or ablate nerve endings (for lung and bone tumors) =
Radiofrequency Ablation
This is an invasive technique reserved for those who’re unresponsive to other methods. Requires a surgical procedure to place electrodes in the Epidural Space, the electrodes connect to an implanted or external programmed generator =
Spinal Cord Stimulation
Is Spinal Cord Stimulation considered to be an Alternative Approach?
Yes
What are the nursing actions for Spinal Cord Stimulation?
They’re the same as the ones for receiving epidural anesthesia:
Monitor during and for at least 1 hr following insertion or injection for Hypotension, Anaphylaxis, Muscle Weakness, Seizures, and Dura Puncture.
Monitor for Respiratory Depression and Sedation.
Monitor the insertion site for Hematoma, Infection, and Leakage of Cerebrospinal Fluid.
Assess the level of sensory block.
Evaluate leg strength prior to ambulating.
What would you teach a pt who’s about to undergo Spinal Cord Stimulation?
Program the device for maximal comfort
