Comfort, Inflammation And Mobility (Exam 1) Flashcards
What is one of the first interventions should you take as a nurse when it comes to opioid tolerance clients?
Gradually increase the does of the medication
The body gets used to the medication more quickly
What is the other name for Acetaminophen
Tylenol
Define inflammation
Think of the body crying out for help
It’s a reaction to stressors
It is the tissue response to tissue injury
What are the chemical mediators of inflammation
Histamine
Kinins
Prostaglandin
What are infections
They are caused by microorganisms and are a result of inflammation
Are all inflammation caused by infections
No
What is the first mediator in inflammation
Histamine
What is the first mediator in the inflammatory process
Histamine
What does histamine do
In causes a dilation in the arteries and increase capillary permeability causing an increase in blood flow to the injured area
What is the side effect of activating histamine
Swelling
What do kinins do?
Increase capillary permeability and sensation of pain
What is the effect of prostaglandin
Vasodilation
Relaxation
Relaxation of smooth muscle
Increased capillary permeability
Makes cells get swollen and red
What are the 5 cardinal signs of inflammation
Redness
Swelling
Heat
Pain
Loss of function
What are signs of comfort for your patient
No pain
No signs of physical discomfort
Absence of emotional distress
What are signs that inflammation is being subsidized
Absence of edema
Normal WBC
No redness
No pain
Full functionality
Active vs passive range of motion
Active: patient does it by themselves
Passive: you help the patient
When it comes to making your patient comfortable and mobile what is the last resort and what is the first resort
Last resort is the medication
Go from invasive to noninvasive
For your patient to be free of pain and discomfort there should be?
Maintaining functionality
Effective communication
Well balance between psychological, spiritual activities and state
What can lead to the consequence of lack of comfort
Stress
Fear
Pain
Immobility
What is the most common reason patient seek healthcare
Pain
Acute pain
Minutes to hours
Less than 3 months
Chronic pain
Days to months
Persistent and reoccurring
Greater than 3 months
Somatic pain
Think skeletal
Skeletal muscles
Ligaments
Joints
Visceral pain
Think internal
Originates from organs and smooth muscle
Superficial pain
Originates from skin and mucous membrane
Vascular pain
Originates from vascular or peri vascular tissues
Migraines headache
Neuropathic pain
There is damage to the nerve
Unexplained or resulting from damage to peripheral or CNS nerve fibers by disease or injury
Phantom
Think amputation pain.
Patient feels pain where they had an amputation
Cancer pain
Occurs from pressure on nerves and organs
Blockage to blood supply
Metastasis to bone
Again what do prostaglandins do?
They increase swelling
Activate platelets
Protect kidney
Stomach lining
Prostaglandin
They can the inflammatory response= swelling and so forth
When are prostaglandin produced
When the cell is injured
Name some anti-prostaglandin
Aspirin
Acetaminophen
NSAIDS
Name the 2 pain scale
FLACC
Defense and veterans pain scale
What does NSAID stand for
Non steroidal anti inflammatory drugs
What do NSAIDS do
They inhibit prostaglandin. So they are anti inflammatory drugs
Name the first generation of NSAIDS that aspirin fall under
Salicylates
What is the most commonly used salicylates
Aspirin
Why would you administer aspirin
For mild to moderate pain
Aspirin is
Anti inflammatory
Anti platelet
Who is aspirin only given to
Adults only!!!!
What is the most important teaching about aspirin
Never ever ever give to children with a virus or flu symptoms
Causes Reye’s syndrome
Should you give aspirin to children?
No. Especially if they have a virus or flu like symptoms
Reye’s syndrome
What might be a risk of giving aspirin to children
Reye’s syndrome
How can aspirin be harmful in high doses
It can be nephrotoxic
This is when it causes damage to the kidney
Impaired renal function and aspirin administration
The purpose of the kidney is to filter out the blood and help filter out the medication. If the kidney is not working there is filter issues. Causing a buildup in the blood of aspirin.
This is why we increase the blood level
If the kidney is t functioning well what happens to the dose of aspirin
It decreases
what are some adverse effects that can occur while taking aspirin?
hemorrhage
GI bleeding
hearing loss
Ryes syndrome
low level of WBC
What do you do if your patient start tp show signs of Reyes syndrome?
stop administering medication
You have a patient who is about to have a surgery. The patient informs you that they are currently taking NSAIDS. What should you do?
tell the doctors so they cancel the surgery
what can be a nursing intervention when you have a patient about to go in surgery?
ask the patient if they are currently on any NSAIDs
they should stop taking it at least 28-48 hours before
Salicylism
toxicity is associated with the chronic use
toxic levels of aspirin
what are signs and symptoms of salicylism
dizziness
vertigo
tinnitus
difficulty hearing
mental confusion
bronchospasm
what should you check when giving aspirin
CBC
what is a contraindication of aspirin
(HINT: ASPIRIN IS A NSAID AND SALICYLATES)
hypersensitivity to NSAIDs or Salicylates
What are some precautions to watch out for when administering aspirin
renal or hepatic disorder= increase risk of toxicity
GI bleeding or history
Head trauma
who might be taking a high dose of salicylates
patients with arthritis
patients with chronic conditions
normal therapeutic range for aspirin
15-30 mg/dl
mild toxicity level
greater than 30 mg/dl
severe toxicity
above 50 mg/dl
name some nursing implications when administering ASPIRIN
observe signs for bleeding
asses therapeutic effect
severe overdose signs
what are some signs for bleeding with aspirin
dark tarry stool
bleeding gums
petechiae
how might you know that the patient has reached the therapeutic effect (ASPIRIN)
decrease pain, fever, inflammation
how long after administration should you ask the patient
30
what should you do if the patient is overdosing
gastric lavage
suction with ng
iv sodium bicarbonate
activated charcoal
if the patient is overdosing on oral medication what should you do?
suction
another name for acetaminophen is
tylenol
what is acetaminophen used for
mild to moderate pain
reduce fever
which medication is the drug of choice for children. why is that?
acetaminophen
they are less susceptible to liver toxicity
when administering acetaminophen what’s important to note? (ROTATING
why?
its better to rotate with ibuprofen
because its better to control fever than monotherapy
with a PRN pain medication what is important to note
that you must know how often the medication is being administered
adverse reaction (ACETAMINOPHEN)
oliguria
hearing loss
elevated hepatic enzyme= affected kidney and liver
what is oliguria
eliminating less than 30ml per hour urine
hepatoxicity and renal failure (ACETAMIN)
take as directed as it can cause liver necrosis and overdose
what lab work should you monitor with acetaminophen
CBC
CMP
precaution of ACETAMIN
alcohol use disorder
renal/hepatic disease
what is the maximum daily dose of acetaminophen for adults
4000mg’
4g
ACETAMIN therapeutic serum level
10-20 mcg/mg
ACETAMIN toxicity serum level
greater than 200 mcg/mg
what are the late signs of acetaminophen toxicity
jaundice
vomiting
cns stimulation
what do anti inflammatory agents do (MOA)
inhibit the synthesis of prostaglandin
affect the inflammation process
Antipyretic
reduce fever
Analgesic
reduce pain
Anticoagulant
inhibit platelet aggregation
make the blood thinner
What is ibuprofen MOA
they inhibit the synthesis of prostaglandin
what is ibuprofen used for
decrease pain
decrease inflammation related to rheumatoid and osteoarthritis
why is ibuprofen so commonly used with patients with arthritis
because they have alot of inflammation
what ways are ibuprofen given
po
iv
adverse effects of ibuprofen
hearing loss
gi bleeding
tinnitus
seizure
anaphylaxis
anemia
renal failure
thrombocytopenia
angioedema
what might Ibuprofen cause
renal impairment which increases BUN and Creatinine
what should you check before administering ibuprofen
BUN
CREATINE
what do you do if the BUN AND CREATNINE is high
do not administer
Nursing implications for IBUPROFEN
decreased pain, inflammation and fever
assess for bleeding and dyspepsia
assess for rash and bronchospasm
administer at mealtime with food
monitor vitals
why do you administer ibuprofen with food
to prevent GI upset
what does the rash and bronchospasm tells us with ibuprofen
that they cannot breathe
can you give patient ibuprofen who has had recent asthma attack? Why?
no
Because it may cause bronchospasms
what is dyspepsia
discomfort in upper abdomen
which route is ketorolac mostly used
IV
why would you administer ketorolac
short term pain management
5 days or less
What is ketorolac mostly used for?
Short term pain
5 days or less
What is the other name for ketorolac
Toradol
What should you monitor with ketorolac?
How do you monitor it?
Monitor renal function
By assessing urine output and serum creatinine levels
Who would you not administer ketorolac to
A patient with renal problems
What might ketorolac cause
Dizziness
Headache
Dyspepsia
Nausea
Why is NAPROXEN usually given ?
Mild pain
Mild fever
Osteoarthritis
What is the most common risk when taking naproxen
Gi bleeding
Gi upset
What should you instruct a patient to look for who is taking NAPROXEN
Black tarry stool ( gi bleed)
Abdominal pain (gi upset)
What are some things that NAPROXEN cause
Dizziness
vomiting
Nausea
Elevated hepatic enzyme
Tinnitus
Gi bleeding
Ulcer
Perforation
Most medications for severe pain is given what route?
Intravenous (IV)
Give an example of an opioid agonist
Morphine
What is the main reason opioid agonist are taken
Moderate to severe pain
What routes are morphine given
PO
IV
IM
Which route is faster when giving morphine
IV
What are the main uses of morphine
Acute pain
Chronic pain
Severe pain
What are some other effects of morphine
It relaxes your body so it promotes sedation, decrease anxiety, decreases the amount of anesthesia required
Who should you be cautious with using MORPHINE
Older adults
How should you give MORPHINE
Start low and go slow
What are some adverse effects of MORPHINE
Orthostatic hypotension
Bradycardia
Tachycardia
Respiratory depression
Side effects of MORPHINE
Myosin’s
Out of it
Respiratory depression
Pneumonia
Hypotension
Infrequency
Nausea
Emission: vomiting
How can morphine affect the CNS effects
Depresses the CNS
Respiratory depression
Decreased physical and mental activity
Who should be cautious with when giving morphine
Older adults
How can morphine affect the gi system
Nausea
Vomiting
Constipation
What does morphine do to the GI system motility
It slows the motility causing constipation
Those who are not ambulatory are more likely to cause constipation
What are the contraindications when taking morphine
Respiratory depression
BPH
What is the precaution when taking morphine
If you have respiratory insufficiency
How do you assess the therapeutic effect of morphine
Decreased in pain without the adverse effects
What are some withdrawal symptoms of morphine
Restless
Sweating
Dilated pupil and watery eyes
Diarrhea
Nausea
Vomiting
Muscle pain
Anxiety
What do you give to a patient who is having overdose for morphine?
Naloxone
Why do you give NALOXONE for morphine overdose
Because it reverses the severe respiratory depression
Name a opioid antagonist
Naloxone
What is another name for Naloxone
Narcan
How does Naloxone work
It reverses analgesia and the CNS and respiratory depression
It decreases the substance use disorder
Used for overdoses
How do opioid antagonists work
It prevents opioid from binding to receptor sites and displace opioids that are already bound
What are the adverse effects of opioid antagonist
Tremors
Drowsiness
Sweating
Nausea
Vomiting
Hypertension
