Common Problems Flashcards
Pain < 6 mo
Acute pain
Pain > 6 mo.
Chronic main
6th vital sign
Walking/gait speed
Cutaneous pain
Localized to skin or surface of body
Visceral pain
Internal organ pain (PUD, Gallbladder)
Somatic pain
Not localized- pain in muscle, bone, nerves, blood vessels and supporting tissue
Step 1 of WHO ladder meds
ASA
ACETAMINOPHEN
NSAIDs
ADJUVANTS
Step 2 of WHO Ladder meds
Step 1 +
Codeine
Hydrocodone
Oxycodone
Dihydricodeine
Tramadol
+ adjuvant
Step 3 of WHO Ladder
Morphine
Hydromorphone
Methadone
Levorphanol
Fentanyl
Oxycodone
+ non opioid analgesic
+ adjuvant
What should be used for break though cancer pain
Fentanyl patches for sustained release
Metastatic bone pain management includes
Biphosphonates ( inhibit bone transcription by reducing osteoclast apoptosis and therefore prevents development of cancer induced bone lesions)
Skin intact with erythema that does not blanch
Stage 1 pressure injury
Partial thickness loss with exposed dermis
Stage 2 pressure ulcer
Full thickness skin loss with adipose tissue visible.
Stage 3 pressure injury
Full thickness skin and tissue loss. Exposed fascia, muscle, tendon, ligaments or bone
Stage 4 pressure injury
What type of dressing for pressure injuries
Hydrocolloid dressing
What 3 labs have values of 3.5-5
Albumin
Potassium
Phosphorus
Worst possible outcome of pressure ulcer
Death
Worst complication of pressure ulcer
Osteomyelitis
Fever definition
Body temp > 37 C
Causes of fever
- Bacterial, viral, rickettsia, fungal or parasitic infections
- Autoimmune dx
- CNS disease
- Malignant neoplasticism dx
- Hematologic dx
- CV disease
- GI dx ( IBD, alcohol hepatitis)
- Endocrine dx
- Neuroleptic malignant syndrome
Increase in antipsychotic meds or decrease in dopaminergic meds can lead to
Neuroleptic malignant syndrome
Succylcholine - relaxes laryngeal muscles for intubation can cause
- high fevers
- contraindicated in Hyperkalemia
Treatment for fever
Fluids
Antipyretics
Treat underlying cause
Non infectious post op fever causes
Atelectasis
Dehydration
Drug reaction- *Beta lactam antibiotics
Infectious causes of post op fever
Usually a subjective complaint
WBC elevation with left shift (bandemia)
Surgical incision
IV sites
Catheters
Utinary tract
Sinusitis
Abscess
With no known infection, first treatment to post op fever
Hydration
Incentive spirometer
Mylanta is high in
Magnesium
Citrical is high
High in calcium
Enteral vs parental
Can use Gut vs contraindication for gut use
Enteral
Enterostomal vs nasoenteric
Supplemental for < 6 wks vs > 6 wks
Risk for aspiration…. A duodenal tube vs
Nasogastric tube
Tpn has
Glucose
Electrolytes
> d 10 glucose for TPN requires a
Central line
Complications of enteral nutrition support
Aspiration
Diarrhea
Hypernatremia
Dehydration
Feeding syndrome: hypophosphatemia, hypokalemia, hypomagnesemia, hypocalcemia, thymine deficiency
What usually helps with diarrhea with Enteral support
Switching from bolus to continuous feeds
Examining concentration of feeds
Slowing down feeding rate
Complications of parenteral nutritional support
Pneumothorax
Hemothorax
Air embolus
Hyperglycemia
HHS
Catheter thrombus
Catheter sepsis
What position should you place your patient if they have an air embolus
Left lateral decubitus position
Cachexia
Muscle wasting
