Charting and Notes

Question 1

• required by all hospitals prior to procedure
• typically done by surgeon performing procedure
• statement detailing that they have seen the patient and confirmed that they are perfoming the correct surgery on the correct patient

Answer 1

preoperative note

Question 2

• short note typically completed by PA/NP assisting
• details procedure performed, finding, pertinent information regarding the case
• acts as a place holder until final operative not is dictated by the surgeon

Answer 2

Operative note

Question 3

• Detailed report summarizing the duration of the patients admission
• typically completed by MDs, but PAs can do it

Answer 3

discharge note

Question 4

type of fluid and rate

Answer 4

• maintenance fluids: replaces insensible fluid loss
• replacement fluids: corrects the body’s fluid deficit (surgery, gastric/bowel drainage, vomiting, diarrhea, infection, trauma, burns, third spacing)
• special fluids: hypoglycemia (D5) hypokalemia (KCl) metabolic acidosis (sodium bicarb)

Question 5

• caused by stimulation of peripheral nerve fibers (nociceptors) that respond to stimuli, approaching or exceeding harmful intensity
• thermal, mechanical (cut), chemical injuries
• Visceral: highly sensitive to stretch, ischemia and inflammation (ache, dull, crampy, diffuse, spastic gnawing, constant)
• deep somatic: stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fascia and muscled (broken bone, sprains)
• superficial somatic: well-defined and easily located activation of nociceptors in skin or other superficial structures

Answer 5

nociceptive

Question 6

• caused by damage to somatosensory system
• sx: burning, tingling, shooting, electrical, pins and needles

Answer 6

neuropathic

Question 7

what are preoperative analgesia?

Answer 7

• administration of analgesics prior to procedure or just prior to incision
• modifies the PNS and CNS processing of noxious stimuli, thereby reducing required postoperative analgesia
• Local anesthetic: lidocaine, marcaine
• systemic: IV APAP, ibuprofen, ketorolac, gabapentin, fentanyl, epidural

Question 8

• preferred mode of administering opioids for moderate/severe postop pain
• patients receive desired medication thorugh PIV via a patient controlled button
• infusion programmable by the provider
• benefits include: ease of use, easy to titrate, patient administered, minimizes risks of OD

Answer 8

Patient controlled analgesia

Question 9

what medication can be given PCA?

Answer 9

Hydromorphone (dilaudid)

• most common
• easiest dose and titrate
• most patients get adequate relief

Morphine

• typically used if hydromorphone is unsuccessful in controlloing pain or pt has allergy
• useful in pts with narcotic tolerance

Fentanyl:
* harder to dose and titrate because of short half life
* used in liver pts because it does not have first pass effect

Question 10

• Local anesthetic injected directly into the epidural space
• usually inserted prior to surgery or during childbirth
• pts receive slow basal rate of opioid (fentanyl most commonly)
• analgesia achieved from level of catheter down
• ability to allow for additional doses thorugh pt controlled buttun (PCEA)
• pain control monitored and changed by anesthesiologist

Answer 10

Epidural anesthesia

Question 11

• Technique where anesthetic is injected into CSF
• bupicacaine most commonly used
• only useful in procedures involving structures below the upper abdomen (risk for affecting respiratory muscles, diaphragm and heart
• most common side effect is puncture headache (positional quallity without visual sx, treated with rest, IVF, blood patch

Answer 11

Spinal Anesthesia

Question 12

• local anesthetic administered in a selective area to achiece a regional block of pain control
• brachial plexus- upper extremities
• femoral/popliteal- lower extremities

Answer 12

peripheral blocks

Question 13

what pain medications are often given IV?

Answer 13

• Hydromorphone (most commonly used)
• morphine
• fentanyl (synthetic derivative of fentanyl)
• acetaminophen (reduces narcotic demand, used 48hrs postop)
• ketorolac- potent NSAID

Question 14

• most commonly used oral medication
• bind to Mu receptors to cause euphoria
• easily abused by patients
• easy to withdrawl

Answer 14

opioids

Question 15

• long lasting pain control
• patch stays on for up to 3 days
• transmits opioid transdermally
• new adjunct to modern pain control

Answer 15

Fentanyl/Lidocaine patch

Question 16

• Gabapentin most commonly used
• SE profile low
• helpful with neuropathic pain by binding to Ca+ channels to decrease impusle conduction which increases GABA synthesis (inhibitory pathway to pain transmission)
• titrate dose to control pain
• no ceiling drug- if pain not controlled, increase the dose

Answer 16

anticonvulsants