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NUR 325 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Stress definition

A

response to challenges (it doesn’t have the resources for), different for everyone

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2
Q

Stress neutral

A

coping effective, ex. a paper cut

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3
Q

Challenge/manageable stress

A

coping effectively but may need new coping skills, ex. big cut on your leg and learn to apply pressure

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4
Q

Stress not manageable

A

ex. degloving skin (comes off hand), need outside help

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5
Q

Chart of stress response starts with a ____, triggering ______ to release _____

A

stressor
hypothalamus response
corticotropin releasing factor

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6
Q

Stress response goes down what three paths

A

Sympathetic nervous system
Anterior Pituitary gland
Posterior Pituitary gland

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7
Q

sympathetic nervous sys activation path of stress

A

norepinephrine, epinephrine, dopamine (flight or flight) –>

increasing: HR, BP, CO, blood glucose, blood perfusion to muscle; bronchial dilate, pupils dilate,

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8
Q

anterior pituitary path of stress

A

ACTH –> adrenal cortex –> aldosterone (increase Na and water) or cortisol (increase: protein synthesis, blood glucose, BP, CO, anti-inflammatory, immunosuppression)
prolonged response, at risk to be sick

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9
Q

posterior pituitary path of stress

A

ADH –> water retention

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10
Q

General Adaptation Syndrome stages and info

A

alarm, resistance, and exhaustion

several body systems respond immediately to the stressor
goal to return to homeostasis

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11
Q

alarm stage

A

CNS aroused, fight or flight

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12
Q

resistance stage

A

PNS, try to go back to normal, resist stress, repair damage,

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13
Q

exhaust stage

A

no resources left, high BP, depression (health issues)

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14
Q

positive stress called

A

eustress

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15
Q

negative stress called

A

distress

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16
Q

Transactional Theory of Stress and Coping

A

two stages of appraisal (primary and secondary) before responding

primary: does it pose a threat (stop if no)
secondary: can we cope? do we have resources?

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17
Q

Sources of stress

A

Physiological

Psychological

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18
Q

Physiological stress ex.

A

car accident, chronic illness

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19
Q

Psychological stress ex.

A

divorces, family problems

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20
Q

Types of Stress

A

Acute Stress
Episodic acute stress
Chronic Stress

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21
Q

Acute Stress

A

most common, brief, pos or neg, fight or flight

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22
Q

Episodic acute stress

A

frequent episodes of acute stress, affects relationships

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23
Q

Chronic Stress

A

constantly wears on pt, uses all the resources up

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24
Q

Cognitive appraisal meaning

A

what/how you view stress

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25
Q

Cognitive appraisal aspects

A 
Age
Developmental level 
Maturation 
Environment 
Life experiences 
General mental and physical health status
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26
Q

Consequences of Chronic Stress on CNS

A

continuous activation, headache, irritable, anxiety

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27
Q

Consequences of Chronic Stress on Cardiovasc

A

incre HR, BP

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28
Q

Consequences of Chronic Stress on Immune sys

A

lower WBC, asthma, arthritis

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29
Q

Consequences of Chronic Stress on Musculoskel

A

knots in neck/shoulders

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30
Q

Consequences of Chronic Stress on GI

A

IBS, ulcerative colitis

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31
Q

Consequences of Chronic Stress on Integumentary

A

hair loss, acne

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32
Q

Consequences of Chronic Stress on Reproductive

A

ED, decrease sperm

menstrual issues

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33
Q

Risk for psychological stress

A 
Problems w/relationships 
Strained family relationships 
Financial strain 
Job stress/insecurity
Food insecurity
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34
Q

Risk for physiologic stress

A

Significant injury or illness

Chronic pain

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35
Q

Acute stress s/s

A

headache, trouble focus, GI issue, irritable, increase HR, dilate pupils

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36
Q

Chronic stress s/s

A

infections, slow wound heal, unintentional weight loss, increase blood glucose, depression, high BP, change in sleep

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37
Q

Denial

A

Refusal to accept reality to avoid the emotional impact

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38
Q

Rationalization

A

Justify/explain bad behaviors to avoid emotional discomfort or save face

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39
Q

Projection

A

Attribute negative feeling onto someone else

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40
Q

Repression

A

Conceal bad thoughts or memories to try to forget about them

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41
Q

Regression

A

Movement back to a more comfortable developmental time in life

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42
Q

Compartmentalization

A

Categorize life experiences to avoid facing the anxieties while in that mindset

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43
Q

Clinical Management: Primary Prevention

A

try to prevent illness as a result of stress

promote effective coping, nutrition, exercise, social support, self-esteem

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44
Q

Problem- focused coping

A

try to eliminate stressor

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45
Q

Emotion- focused coping

A

control our emotional response to it

ex. journal, walk

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46
Q

Meaning- focused coping

A

find meaning behind stress

ex. religion

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47
Q

Common positive coping strategies

A 
Education 
Social support 
Exercise 
Therapeutic lifestyle change 
Music therapy 
Relaxation strategies 
Alternative therapies
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48
Q

Ineffective and maladaptive coping responses

A 
Appropriate but insufficient 
Use or abuse of alcohol or other substances 
Smoking 
Overeating 
Denial 
Avoidance
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49
Q

Pharmacologic Therapy used for stress do what

A

treat the s/s not the stress

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50
Q

Crisis

A

threatening situation trigger by an event causing a body response

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51
Q

Situational stressors

A

personal, family, work-related

ex. chronic illness, financial strain, motor vehicle accident, death of a loved one, change in marital status, unwanted pregnancy

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52
Q

Developmental stressors

A

occurs as the person moves through the stages of life

ex.
Kids (physical appearance, family, friends, school)
Adolescents (friendships, belong, identity formation, leaving home)
Adults (marriage, family, career, aging)
Older adults (health problems, mobility, cognition)

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53
Q

Adventitious stressors

A

disaster events, rare and unexpected

ex. natural disasters, physical/sexual assault, terrorism

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54
Q

Socioeconomic stressors

A

stressors that occur from poverty, SES, and homelessness

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55
Q

Cultural stressors

A

living in a society they do not fit in culturally or receiving care that ignores their cultural beliefs

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56
Q

Nursing process

A

Assess, Diagnosis/Analyze, Plan, Implement, Evaluate

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57
Q

A nurse is caring for a client who has migraine headaches and reports that they are “getting worse”. Which of the following questions should the nurse ask the client to determine if the headaches are stress-related disorders (select all that apply)

What is the intensity of your migraines
How often do the migraines occur
Are you eligible for workers compensation due to the migraines
What type of support is available to you when you have a migraine
What coping strategies do you use when you experience a migraine

A

What is the intensity of your migraines
How often do the migraines occur
What type of support is available to you when you have a migraine
What coping strategies do you use when you experience a migraine

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58
Q

A nurse is caring for a client who has delivered a healthy newborn. The client is tense, refuses to hold the baby, and tells the nurse, “I have no idea how to handle having a baby. I wish this pregnancy had never happened”. Which of the following statements should the nurse make

Becoming a parent is a new experience for you. Let’s talk about your concerns
You should be thrilled about having a newborn. I would be
Why don’t you hold the baby? I’m sure it will make you feel better
How can you think that way? This is a joyous occasion and should be celebrated

A

Becoming a parent is a new experience for you. Let’s talk about your concerns

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59
Q

A nurse is talking about implementing self-care strategies to cope with the stress of caregiving with the partner of a client who has dementia which of the following strategies reported by the partner should the nurse identify as an example of effective coping

Practicing deep breathing while sitting outside
Sitting by the clients bedside and drinking coffee
Going out onto the patio to smoke a cigarette when feeling stressed
Drinking a glass of wine every night before falling asleep

A

Practicing deep breathing while sitting outside

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60
Q

A nurse is planning care for a client who recently divorced with two young children. the client reports difficulty sleeping, feeling hopeless, and being estranged from the family. the nurse should plan to monitor the client for which of the following potential manifestations of chronic stress.

Systemic infection
Exaggerated startle response
Recurring nightmares
Suicide

A

Suicide

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61
Q

A nurse in a community clinic is interviewing a client who is in distress and reports being unable to sleep following a neighborhood fire several days ago. The client has hypertension, tachycardia, and is diaphoretic. The nurse should identify that the client is experiencing which of the following types of stress

Acute stress
PTSD
Episode acute stress
Chronic stress

A

Acute stress

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62
Q

A nurse is caring for a client who has been charged with partner violence against their spouse. The client is angry, pacing, and yells out, “I wouldn’t lose my temper If my spouse would just leave me alone. It’s their fault. “ the nurse would identify the client is displaying which of the following defense mechanisms

Projection
Compartmentalization
Repression
Regression

A

Projection

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63
Q

A nurse is conducting an educational session for client to report experiencing stress-related disorders. A client asks the nurse which part of the body activates the stress response. Which of the following responses should the nurse provide

Sympathetic nervous system
Adrenal glands
Hypothalamus
Adrenocorticotropic hormone

A

Hypothalamus

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64
Q

A nurse is interviewing a client who is in distress and tell the nurse, “my ex-partner is suing for full custody of my children. I am so worried and don’t know what to do.” which of the following questions should the nurse asked to evaluate the client coping skills

can you describe your relationship with your ex partner
what happens when you feel worried like this
what do you believe with your contribution to the relationship break up
what strategies have you used in the past to do with stress

A

what strategies have you used in the past to do with stress

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65
Q

A nurse is providing discharge teaching about health promotion to a client who has a new diagnosis of type 2 diabetes mellitus. which of the following instructions should the nurse include. (select all that apply)

Practice mindful breathing
Start each day with a to-do list
Include simple carbohydrates in the diet
Develop habits to mitigate stress
Preserve energy by reducing physical activity
A

Practice mindful breathing
Start each day with a to-do list
Develop habits to mitigate stress

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66
Q

A nurse is caring for a client who has delivered a healthy newborn. The client tells the nurse that while they are somewhat stressed about being a new parent, they are thrilled by the birth of their child. The nurse should identify that the client is experiencing which of the following types of stress

Allostatic load
Distress
Eustress
Fight or flight response

A

Eustress

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67
Q

A nurse is caring for a client who is in crisis following the Break-Up of a long-term relationship. The client tells the nurse, “I might as well just die. My life is over.” Which of the following actions should the nurse take first

explore past positive coping strategies
establish a follow-up plan of care
conduct a suicidal risk evaluation
display a neutral attitude

A

conduct a suicidal risk evaluation

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68
Q

A nurse is caring for an older adult client who reports being stressed about their health status due to problems with short-term memory oh, slow reaction times when driving, and urinary frequency. The nurse should recognize that the client is experiencing which of the following types of stressors

developmental stressors
situational stressors
adventitious stressors
socioeconomic stressors

A

developmental stressors

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69
Q

A nurse is assessing a client who is working at home due to covid-19 restrictions. The client reports abdominal cramping and bloating diarrhea and states, “I’m completely stressed out from working at home.” the nurse should identify that the client is experiencing manifestations of which of the following stress related conditions

irritable bowel syndrome
food poisoning
panic disorder
major depressive disorder

A

irritable bowel syndrome

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70
Q

A nurse is caring for a college student admitted for acute alcohol intoxication. The client reports feeling overwhelmed and expresses an inability to cope with stressors at school. Which of the following statements should the nurse make

Drinking too much alcohol is not the best choice. I suggest you stop
I can see why you’re using alcohol to cope; you’ve got a lot going on
Let’s talk about the coping methods that have worked for you in the past
I’ve been stressed before too but I tell myself that I can handle it

A

Let’s talk about the coping methods that have worked for you in the past

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71
Q

A nurse is interviewing a client who recently experienced in Act of workplace violence when an armed person how the workers at gunpoint before the police intervened. The client now reports being anxious and fears the gunman might return. The nurse should identify that the client is experiencing which of the following types of crisis

Situational
Cultural
Maturational
Adventitious

A

Adventitious

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72
Q

A nurse is caring for a client who reports experiencing stress over an upcoming surgical procedure. Which of the following statements describe the characteristics of stress

Stress is an easily defined phenomenon regardless of viewpoint and discipline
Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one state of equilibrium
Stress only affects the individual and does not affect the person’s family, friends, or other associates
The lack of definition regarding stress does not pose a problem for the client or the nurse

A

Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one state of equilibrium

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73
Q

A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment. The client is experiencing significant weight loss and fatigue, but when the nurse asked how they are feeling, they respond with, “great I’m going to beat this cancer.” which of the following defense mechanisms is the client using

Regression
Projection
Repression
Denial

A

Denial

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74
Q

A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment. The client is experiencing significant weight loss and fatigue, but when the nurse asked how they are feeling, they respond with, “great I’m going to beat this cancer.” which of the following defense mechanisms is the client using

Regression
Projection
Repression
Denial

A

Denial

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75
Q

A nurse in a health clinic Is interviewing a client who is upset and reports that their stress is “too much to handle.” The client is unemployed, a single guardian to young children, and has periodic asthma attacks. Which of the following stress related conditions is the client experiencing

PTSD
Allostatic load
Chronic illness
Alarm stage

A

Allostatic load

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76
Q

A nurse is caring for a client whose partner was recently hospitalized with covid-19. The client is experiencing manifestations related to the alarm stage of General Adaptation Syndrome. For which of the following manifestations should the nurse monitor (select all that apply)

 hypertension
 dilated pupils
 increase state of arousal
 bradycardia
 lethargy
A

hypertension
dilated pupils
increase state of arousal

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77
Q

A nurse is assessing a client who was sexually assaulted six months ago and has been diagnosed with PTSD. Which of the following manifestations should the nurse expect (select all that apply)

 intrusive memories of the event
 flashbacks of the event
 poor work relationships
 exaggerated startle response when reminded of the event
 frequent episodes of diarrhea
A

intrusive memories of the event
flashbacks of the event
exaggerated startle response when reminded of the event

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78
Q

What are some reasons it is important to understand the med that we are administering

A

Can question an order if you think it is wrong (pt safety)
Providers are humans and can make mistakes
Can answer pt questions

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79
Q

Drug categories

A

Similar: act, therapeutic effects, ADR, contraindications, precautions
Allergic to one, likely allergic to all

Sometimes have outliers though

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80
Q

Generic name

A

Given by company who created it

Not capitalized

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81
Q

Brand name

A

Drugs commercial name

Capitalized

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82
Q

Rates of absorption of oral med (quickest to slowest)

A 
liquid, 
suspension, 
powder, 
capsule, 
tablet, 
coated tablet, 
enteric-coated tablet
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83
Q

Enteric-coated (EC)

A

released in the intestine

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84
Q

Extended-release (ER) or Sustained-release (SR/XR)

A

doesn’t release right away, slow

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85
Q

Immediate-release (IR)

A

released right away

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86
Q

Scored tablet

A

line that goes across pill to cut it in half

has to have the line to cut it

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87
Q

Parenteral meaning

A

Injectable drugs

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88
Q

Parenteral routes

A

IV, IM, sub-Q

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89
Q

Intravenously (IV)

A

Absorption: immediate
Onset of action: immediate

used when they already have an IV in pt

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90
Q

Intramuscular (IM)

A

Absorption: varies (rapid if water-soluble, rapid if good circulatory flow)
Onset of action: varies

a little faster than sub-Q cause of increase blood flow

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91
Q

Subcutaneously (sub-Q)

A

Absorption: varies (rapid if water-soluble, rapid if good circulatory flow)
Onset of action: varies

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92
Q

Transdermal routes/places

A

skin, eyes, ears, nose, rectum, vagina, lungs

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93
Q

Transdermal info

A

fast
constant amount of drugs over an extended time
slow onset
long duration of action

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94
Q

Pharmacokinetics

A

describes the absorption, distribution, metabolism, excretion of the drug

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95
Q

Absorption

A

movement of administration site to various tissues

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96
Q

Distribution

A

movement of a drug by the circulatory system to the intended site of action
depends on blood flow

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97
Q

Metabolism

A

a change in the drug that may make it more or less potent, soluble, or inactive
usually occurs in the liver

if liver problems, build-up of toxins

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98
Q

Excretion

A

elimination
ex. feces, urine, sweat, exhaled air

if kidney problems, can’t rid of it and build-up of toxins

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99
Q

First pass effect

A

Before it is in the blood in circulation, some drug is lost

Oral drugs

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100
Q

Drug half-life

A

Takes time for a drug to decrease in amount by half
Med with a long half-life don’t give often since they last long
Half-life won’t be as fast if pt has liver/kidney problems

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101
Q

Drug half-life

A

Takes time for a drug to decrease in amount by half
Med with a long half-life don’t give often since they last long
Half-life won’t be as fast if pt has liver/kidney problems

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102
Q

Onset

A

Amount of time it takes to demonstrate a therapeutic response
Starts to help

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103
Q

Peak

A

Amount of time to achieve a full therapeutic effect

Completely helps with the issue

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104
Q

Duration

A

Amount of time the drugs therapeutic effects last

The whole time the med last

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105
Q

Peak vs Trough

A

Peak- highest level

Trough- lowest level

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106
Q

Therapeutic level

A

Space between peak and trough

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107
Q

Drug levels needed in pt

A

Need to be in a therapeutic level so you can help with the issue
If too low can lead to resistance
If too high can injury body

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108
Q

When is peak lab drawn

A

1hr and a half after administration

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109
Q

When is trough lab drawn

A

30 mins before administration

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110
Q

Pharmacodynamics

A

biochemical changes that occur in the body as a result of taking a drug

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111
Q

Agonists

A

drugs that bind with a receptor and increase the typical response
works with what the body is doing and increases it

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112
Q

Antagonists

A

drug that binds with a receptor and either blocks or inhibits a typical response
like an umbrella, blocks most of the receptors but not all

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113
Q

Expected action

A

What we expect to happen in response to a specific drug

Ex. give acetaminophen which will reduce pain, fever, fatigue

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114
Q

Therapeutic uses

A

Why we are giving the pt the med

Ex. give to reduce headache (even though it helps with other s/s as well)

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115
Q

Adverse drug reactions (ADR)

A

nontherapeutic and unintended

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116
Q

Ex. of mild and severe ADR

A

mild- nausea, itchy, dizzy

severe- anaphylaxis, convulsions

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117
Q

Drug tolerance

A

decreased response to a drug over time or repeated use

may need to increase dose to get the same body response as before

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118
Q

Drug cumulative effect/drug sensitivity

A

body can’t excrete existing dose before another dose is given
can lead to toxicity
may be caused by a metabolic change in the body (liver/kidneys)

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119
Q

Liver lab test

A

AST- 0-35 ul

ALT- 4-36 ul

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120
Q

Liver lab test

A

AST- 0-35 ul

ALT- 4-36 ul

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121
Q

Kidney lab test

A

BUN- 10-20 mL/deciL

Creatine- male 0.6-1.2 mg/deciL or female 0.5-1.1 mg/deciL

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122
Q

Drug toxicity

A

excessive doses resulting in a negative physiologic effect
can be a result of impaired excretion
important to monitor drug serum levels

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123
Q

Drug toxicity

A

excessive doses resulting in a negative physiologic effect
can be a result of impaired excretion
important to monitor drug serum levels

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124
Q

What to do to avoid drug toxicity

A

Prescribe lowest dose that achieves therapeutic effect

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125
Q

Precautions

A

Use drug when benefits outweigh risk

Know why pt is taking it, precautions that go with it, diet restrictions, physical assessments that need to be done

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126
Q

Contraindications

A

potential to cause serious ADR in relation to a specific factor

ex. specific foods, combination of certain meds, certain populations

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127
Q

Interactions

A

can change the action of the drug in the body (absorption, metabolism)
can be drug-drug or drug-food

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128
Q

Types of drug interactions

A

additive
synergistic
antagonistic

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129
Q

Additive effect

A

Effects add together and cause the same action, do not influence each other

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130
Q

Synergistic effect

A

Effect of one drug are greater w/another, increase each other

131
Q

Antagonist effect

A

Effects of one drug are decreased or stopped w/another, counteract

132
Q

Grapefruit juice does what to certain drugs

A

slows down metabolism of some drugs

decreases enzymatic activity

133
Q

Dark greens (vit k) does what to certain drugs

A

counteracts anticoagulant effects of warfarin

134
Q

Considerations for breast feeding (with drugs)

A

baby weight, will it pass through milk, will it negatively affect baby

135
Q

Considerations for infants (with drugs)

A

weight, big head, large surface area, less acidic stomach

136
Q

Considerations for older (with drugs)

A

body doesn’t work as well, slow stomach

137
Q

Considerations for pregnancy (with drugs)

A

affects baby, teratogenic (harm to the fetus in utero)

138
Q

Client instructions for drugs

A

purpose, generic vs. brand name, need to know the route, administration schedule, potential ADR (to know what to expect), precautions (ex. don’t drive while using)

139
Q

Prescription drugs

A

drugs that are prescribed by a provider and can be harmful without supervision

140
Q

Nonprescription drugs/Over the counter (OTC)

A

drugs that are relatively safe to talk without supervision

141
Q

A patient talking SMZ/TMP asks the nurse what the name means. The nurse replies sulfamethoxazole is combined with trimethoprim in SMZ/TMP to help drug effectiveness. How does this work?

SMZ has a synergistic effect with TMP against gram pos and neg
SMZ acts along with TMP as an anesthetic
SMZ increases the excretion of TMP thereby increasing the response in the bladder
SMZ is highly protein bound and displaces TMP

A

SMZ has a synergistic effect with TMP against gram pos and neg

142
Q

When a drug binds to a receptor to produce a pharmacologic effect, the drug may be called

Agonist
Accelerator
Antagonist
Blocker

A

Agonist

143
Q

Which organ does drug metabolism usually occur in?

Heart
Stomach
Liver
Brain

A

Liver

144
Q

The peak is the amount of time the drug

Needs to produce an initial response
Needs to reach its highest effective concentration
Need to change into active metabolites
Is in the therapeutic range

A

Needs to reach its highest effective concentration

145
Q

A patient requires a high dose of a new antihypertensive medication because the new medication has a significant first-pass effect. What does this mean?

The med passes through the renal tubules and is excreted in large amounts
The med is extensively metabolized in the pt liver
The med must pass through the pt bloodstream several times to generate a therapeutic effect
The med is ineffective following the first dose and increasing effective with each subsequent dose

A

The med is extensively metabolized in the pt liver

146
Q

Which of the following circumstances will increase the rate of drug absorption for a subcutaneous injection

Large surface area
Large muscle mass
Low blood flow
Lipid solubility

A

Large muscle mass

147
Q

Which is safer to use when referring to a drug

generic or brand

A

generic (only one generic name vs multiple brand names)

148
Q

When performing an assessment to determine which med can be used, which of the following elements is most important?

Presence of illness
Allergies
Physical examination
Weight

A

Allergies

149
Q

When two drugs given together have an effect equal to the sum of their respective effects, the interaction is

Antagonized
Additive
Agonist
Potentiated

A

Additive

150
Q

An unintended effect of the drug is

Toxic reaction
Side effect
Allergic reaction
Adverse effect

A

Adverse effect

151
Q

Indications (drugs)

A

information on condition and diseases for which the drug is used for

152
Q

1

A
153
Q

2

A
154
Q

3

A
155
Q

4

A
156
Q

5

A
157
Q

6

A
158
Q

7

A
159
Q

8

A
160
Q

9

A
161
Q

10

A
162
Q

11

A
163
Q

12

A
164
Q

13

A
165
Q

14

A
166
Q

15

A
167
Q

16

A
168
Q

17

A
169
Q

18

A
170
Q

19

A
171
Q

20

A
172
Q

21

A
173
Q

22

A
174
Q

23

A
175
Q

24

A
176
Q

25

A
177
Q

Pain definition

A

whatever the experiencing person says it is
most reliable indicator of pain
issue when someone is unable to verbalize it

178
Q

Acute pain

A 
short term (less than 3 months)
usually know what caused it
try to minimize side effects
179
Q

Chronic pain

A

long term (more than 3 months or longer than it should be for the specific injury)
may not know what caused it (etiology)
want people to be lowest possible level

180
Q

Nociceptive

A

normal pain or response to injury (protective)
tissue injury
dull, aching, poorly localized

181
Q

Somatic pain

A

bone, joint, muscle, connective tissue

182
Q

Visceral pain

A

organ, (could also mean emotional)

183
Q

Cutaneous pain

A

skin

184
Q

Transduction

A

noxious stimuli cause cell damage which releases chemicals (prostaglandins, bradykinin, serotonin, substance P, histamine)

activates nociceptors causing action potential

185
Q

Transmission

A

Action potential goes from injury, spinal cord, brainstem, thalamus, cortex to processing

186
Q

Perception

A

the conscious experience of pain

187
Q

Modulation

A

neurons in brainstem go down spinal cord and release substances (ex. endorphins, enkephalins) to stop nociceptive impulses

188
Q

Neuropathic

A

pathology or disease of the somatosensory system, communication issue, not processing sensory input
shooting, tingling, burning, numbness

189
Q

Mixed pain

A

combination between nociceptive and neuropathic

190
Q

Psychosocial consequences of untreated pain

A

fear, anger, depression, anxiety, difficulty maintaining relationships

191
Q

Cardiovascular response and s/s to untreated pain

A

increase: HR, CO, peripheral vascular resistance, myocardial O2 consumption, coagulation

HTN, unstable angina, MI, DVT

192
Q

Endocrine and Metabolic response and s/s to untreated pain

A

increased: ACTH, cortisol, ADH, epinephrine, norepinephrine, renin, aldosterone
decreased: insulin
gluconeogenesis, glycogenolysis, muscle protein catabolism

weight loss, increases RR and HR, shock, glucose intolerance, hyperglycemia, fluid overload, HTN, urinary retention, decrease urine output (f/f s/s)

193
Q

GI response and s/s to untreated pain

A

decreased gastric and intestinal motility

constipation, anorexia, paralytic ileus

194
Q

Immunologic response and s/s to untreated pain

A

decreased immune response

infection

195
Q

Musculoskeletal response and s/s to untreated pain

A

muscle spasm, impaired muscle function

immobility, weakness, fatigue

196
Q

Neurologic response and s/s to untreated pain

A

impaired cognitive function

confusion, impaired ability to think, reason, and make decisions

197
Q

Renal and urologic response and s/s to untreated pain

A

decrease urine output, urinary retention

fluid imbalance, electrolyte disturbance

198
Q

Repiratory response and s/s to untreated pain

A

decreased: tidal volume, cough, sputum retention
hypoxemia

atelectasis, pneumonia

199
Q

Infants and kids at risk for pain because

A

cant communicate, immune system might not be fully developed, people don’t always listen to them

200
Q

Older adults at risk for pain because

A

cognitive decline, cant verbalize or choose not too, don’t want to lose independence, more health issues

201
Q

Gender info related to pain

A

women more likely to report pain, have a lower threshold

202
Q

SES info related to pain

A

might not have access/be able to afford care

203
Q

Cultural info related to pain

A

some may feel pain is necessary (suppose to feel a lot), some may feel it is not acceptable to admit they are in pain

204
Q

Substance abuse risk factors in related to pain

A

providers may not want to prescribe them meds, might have a tolerance to meds

205
Q

Individual risk factors that place pt at a higher risk for pain

A

chronic conditions, acute or traumatic injury, medical procedures

206
Q

fatigue affecting pain experience

A

more pain when tired

207
Q

cognitive function pain experience

A

not understanding what is going on, may experience more pain

208
Q

prior experiences affecting pain experience

A

if pt had bad pain w/ an issues before, next time they have that issue they may be very worried and in more pain

209
Q

anxiety and fear affecting pain experience

A

if a pt is already worried about the pain, may be experience more

210
Q

Elements of pain assessment

A

location,
intensity (scale),
quality,
onset and duration (and what were you doing),
relieving factors,
function goal (what number show the pain be at to function)

211
Q

Pain scale info to know

A

use the same pain scale every time (not always true in practice)
faces scale for 3yr and younger and cognitive impaired
number scale for 8yr and older

212
Q

Behavioral signs of pain

A

facial expressions (grimace), restlessness (cant sleep, changes spots a lot), change in activity (usually decrease), crying, assessment tool

213
Q

Nonpharm strategies to help treat pain

A

massage, repositioning and body alignment, splinting (hold pillow against incision), thermal interventions, mind-body therapies, exercise, TENS, acupuncture

214
Q

Can non pharm strategies replace pharmacology strategies

A

usually they don’t

215
Q

Nursing care to treat pain

A

schedule pain interventions PRN,
review orders for analgesia,
give pain meds before pain levels get very high,
have pt report pain,
create plan w/ more pharm and non pharm interventions

216
Q

Meds do target what to deal with pain

A

Target opioid receptors

217
Q

Types of opioid receptors

A

mu, kappa, delta

218
Q

Mu receptors

A

stimulated by opioid drugs

pos effects: analgesia
neg effects: euphoria, sedation, decrease RR, physical dependence

219
Q

Kappa receptors

A

stimulated by a lesser extent to opioid drugs

pos effects: some analgesia
neg effects: sedation, hallucination, delusion

220
Q

Types of analgesics

A

NSAIDs (1st and 2nd gen), acetaminophen, opioids, centrally acting nonopioids

221
Q

COX (Cyclooxygenase)

A

produces inflammatory response

enzymes convert arachidonic acid into prostaglandins and other compounds

222
Q

COX-1

A

homeostasis

protects gastric mucosa, enhance platelet aggregation, renal perfusion

223
Q

COX-2

A

response to injury

inflammation, pain, fever

224
Q

Types of 1st gen NSAIDs

A

aspirin (ASA), ibuprofen (Advil, Motrin), naproxen, aleve, indomethacin, ketorolac

225
Q

1st gen NSAID Pharm Action

A

COX-1 and COX-2 inhibitor
decrease: pain, inflammation, temp
anticoagulant, impairs renal perfusion, gastric mucosa not protected

226
Q

1st gen NSAIDs ADR

A

gastric upset, heartburn, nauseas, gastic ulcers, bleeding tendencies, renal dysfunction, Reye’s syndrome (swelling in liver and brain in kids after viral infection

227
Q

1st gen NSAIDs Interventions

A

monitor s/s of bleeding and easy bruising petechiae,
may need to use proton pump inhibitor,
monitor I&O,
do labs: BUN and creatine,
monitor tinnitus, dizzy, headache
abd pain, hematemesis, coffee-ground emesis
red, black or tar stool

228
Q

1st gen NSAIDs Admin

A 
swallow whole (enteric-coated or SR)
stop 1 week before surgery
229
Q

1st gen NSAIDs Client Instructions

A 
take w/ food or milk
avoid alcohol
report s/s bleeding
changes in urination
sudden weight gain, edema
stop taking if: ringing in ears, dizzy, unwarranted sweat
230
Q

1st gen NSAIDs Contraindication/Precaut

A

pregnancy, peptic ulcer disease, bleeding disorder, pre-op, older adults, ETOH abuse, H. pylori, HTN, kids w/viral infection, heart fail, renal dysfunc

231
Q

1st gen NSAIDs Interactions

A

aspirin and anticoagulants (both incre bleed), aspirin and NSAID, ACE inhibitors (both incre renal dysfunc)

232
Q

2nd Gen NSAIDs name

A

celecoxib (Celebrex)

233
Q

2nd Gen NSAIDs Pharm Action

A

COX-2 inhibitor, suppress pain inflammation and fever, decrease gastric effects, increase risk for CV issues (vasoconstrictor and platelet aggregation)

234
Q

2nd Gen NSAIDs Intervention

A 
monitor s/s of GI bleed
may need proton pump inhibitor 
monitor I&O
monitor lab: BUN, creatine
monitor s/s for MI (left arm hurt, impending doom, jaw pain) and CVA (slur speech, face droop)
235
Q

2nd Gen NSAIDs Client Instructions

A

take a w/low dose of ASA, and food or milk
avoid alcohol
report s/s GI bleed
changes in urination
sudden weight gain
report: chest pain, short of breath, severe headache, s/s stroke
give 2 hours away from Mg or Al antacids

236
Q

2nd Gen NSAIDs Contraindication/Precaut

A

pregnancy, kidney or liver impairment, GI bleeds, anemia, ETOH abuse, asthma

237
Q

2nd Gen NSAIDs Interactions

A

Lasix (decre the diuretic effect of Lasix), fluconazole (can incre its levels), anticoagulants (both)

238
Q

Acetaminophen Pharm Action

A

nonopioid analgesic (mild to moderate pain), COX inhibitor, fever reducer,

239
Q

Acetaminophen ADR

A 
liver damage (if take too much)
HTN (mainly in women or those taking it daily)
240
Q

Acetaminophen Admin

A

can be given oral, rectal, IV

max 4g per day

241
Q

Acetaminophen Interventions/Client Instructions

A

avoid more than 4g a day
report/monitor: abd discomfort, N/V/D, sweating
take BP

242
Q

Acetaminophen Contraindication/Precau

A

ETOH abuse

use w/ caution: anemia, hepatic or renal disease, immune suppression (may mask infection)

243
Q

Acetaminophen Interactions

A

alcohol

warfarin (incre risk of bleed)

244
Q

Centrally Acting Nonopioid name and pharm action

A

tramadol (Ultram), for moderate to moderately severe pain

binds to select opioid receptors, blocks reuptake of norepinephrine and serotonin

245
Q

Centrally Acting Nonopioid ADR

A

sedation, dizzy, headache, nausea, constipation, seizure, urine retention

246
Q

Centrally Acting Nonopioid Interventions

A

monitor ambulation (dizzy)
give w/food and antiemetic (nausea)
measure VS and give opioid antagonist when RR falls
Monitor s/s seizures, have suction equipment ready
monitor for urinary retention
fluid, fiber, movement (constipation)

247
Q

Centrally Acting Nonopioid Admin

A

onset is 1 hr (give before pain is high level)

ER so swallow whole

248
Q

Centrally Acting Nonopioid Client Instructions

A

Avoid before driving
Sit if lightheaded/change positions slowly
fluid, fiber, movement when constipated
Only take PRN

249
Q

Centrally Acting Nonopioid Contraindication/Precau

A

acute ETOH, opioids, psychotics drugs (both depress)
seizure disorder
respiration depression

250
Q

Centrally Acting Nonopioid Interactions

A

MAOIs risk for hypertensive crisis
SSRI
Tricyclic antidepressants
CNS depressants

251
Q

Opioid Agonist vs Opioid Agonist-Antagonist

A

increase response, mimic action of natural opioids

decrease mu and increase kappa

252
Q

Opioid Agonist types

A

morphine, fentanyl, demerol, methadone

253
Q

Opioid Agonist Pharm action

A

analgesia

binds with mu receptor

254
Q

Opioid Agonist ADR

A

respiration depression, sedation, dizzy, lighthead, drowsy, constipation, N/V, euphoria, risk for abuse

255
Q

Opioid Agonist Interventions

A 
monitor VS/RR (give opioid antagonist if RR too low)
monitor during ambulation
monitor bowel function
hydration, encourage urination 
lowest dose, short term
256
Q

Opioid Agonist Admin

A

get VS before
oral, IM, IV, subcut, rectal, epidural
swallow whole SR
IV slow push 4-5 min

257
Q

Opioid Agonist Client Instructions

A

only take PRN
do not drive
get up slow/slow position change
incre fluid, fiber, activity

258
Q

Opioid Agonist Contraindication/Precau

A

pregnancy, renal failure, careful admin to old and young

259
Q

Opioid Agonist Interactions

A

CNS depressants
anticholinergics (both urine retention)
anti-hypertensives (both incre BP)

260
Q

Opioid Agonists-Antagonists names

A

butorphanol and pentazocine (Talwin)

261
Q

Opioid Agonist-Antagonist Pharm Action

A

analgesic

mu antagonist, kappa agonist

262
Q

Opioid Agonists-Antagonists ADR

A

respiration depression, sedation, dizzy, ligthead, headache, nausea, inre cardiac workload, abstinence syndrome

263
Q

Opioid Agonists-Antagonists Interventions

A

ask about opioid use
monitor VS
monitor ambulation
do not give to MI or cardiac insufficiency

264
Q

Opioid Agonists-Antagonists Admin

A

IM, IV, intranasal, oral
measure VS
don’t discontinue abruptly

265
Q

Opioid Agonists-Antagonists Client Instructions

A 
take PRN, short term
don't drive
caution when changing positions 
don't take with w/opioid 
don't use for heart pain
266
Q

Opioid Agonists-Antagonists Contraindication/Precau

A

acute MI, cardiac sufficient
opioid dependency
history of drug abuse

267
Q

Opioid Agonists-Antagonists Interactions

A

CNS depressants

opioids (decre effects)

268
Q

Opioid Antagonists name and Pharm Action

A

naloxone (Narcan)
block opioid receptors
reverse effects of opioids

269
Q

Opioid Antagonists ADR

A 
ventricular arrhythmias
abstinence syndrome 
HTN
vomit
tremor
270
Q

Opioid Antagonists Intervention

A

monitor BP, VS, heart rhythm

271
Q

Opioid Antagonists Admin

A 
IM, IV, subcut
IV: monitor VS every 5 min
effects last 60-90 mins
respiratory depression and pain can occur
prepare to give every 2-3 mins
272
Q

Opioid Antagonists Client Instructions

A

warn them of ADR and pain

273
Q

Opioid Antagonists Contraindication/Precaut

A

opioid dependent
respiratory depression not from opioid
caution w/cardiac irritability and seizure

274
Q

Opioid Antagonists Interactions

A

decrease opioid effect

275
Q

Cognition definition

A

mental action or process of acquiring knowledge and understanding through thought, experience, and the senses

276
Q

Six domains of cognition

A

perceptual motor function, language, learning/memory, social cognition, complex attention, executive function

277
Q

Perceptual motor function

A

take in outside environment and recognize it, then react

278
Q

Social cognition

A

processes, stores, and acts in a social situation

279
Q

Executive function

A

self-regulation, being adaptive, higher thinking, flexible

280
Q

Perception

A

how you interpret info around you

281
Q

Memory

A

ability to retain and recall what you know

282
Q

Scope of cognition

A

ranges from intact to impaired

impairment can range from mild, moderate, or severe

283
Q

Main places in the brain where cognition takes place

A

cerebrum, diencephalon, brain stem, cerebellum

284
Q

Optimal brain function depends on

A

continuous perfusion of oxygenated and nutrient-rich blood

285
Q

Delirium

A

sudden, acute, caused by an underlying condition, usually if you can treat the cause it goes away

286
Q

Cognitive Impairment Not Dementia

A

will not see a decrease in ADLs/functional ability

287
Q

Focal cognitive disorders

A

an example amnesia, can still understand the environment

288
Q

Intellectual disability

A

below-average intelligence (IQ score “70),

limitations in conceptual skills, social skills, and ADL

289
Q

Learning disability

A

Have average to above average intelligence

Issue with taking in new info

290
Q

Consequences of cognitive impairment

A

Increased risk for injury (don’t understand danger) Complicates disease management (may not help w/care)
Decreased ability to care for self and act in social interactions
Financial hardship
Caregiver burden

291
Q

Risk factors for cognitive impairment

A

Personal behavior (substance abuse, high-risk activities, injuries)
Environmental exposure
Congenital factors: maternal (substance abuse), birth injuries
Genetic conditions
Health-related conditions: acute/chronic treatments

292
Q

Assessment for cognitive impairment (history)

A

can ask pt if you can speak to family/friends

patterns/behaviors
history of substance abuse/meds
family history
how independent pt is 
brain injuries
293
Q

Assessment for cognitive impairment (examination)

A

main points: general appearance, behavior, assess cognitive function

clothes and hygiene, do they pay attention, how they move, bruises from falling, facial expressions and responses, alert and orientated

294
Q

Mini-Mental State Exam (MMSE)

A

use to check for cognitive impairment

higher numbers mean they are fine

295
Q

Aphasia/Dysphasia

A

language impairment, may have difficulty w/production or comprehension of language

296
Q

Agraphia/Dysgraphia

A

inability to write

297
Q

Agnosia

A

impaired ability to recognize objects or persons through the five senses

298
Q

Alexia

A

impaired reading ability

299
Q

Apraxia

A

inability to perform purposeful movements or manipulate objects (even though sensory/motor ability is intact)

300
Q

Confabulation

A

making up answers w/o regard to fact

301
Q

Diagnostic tests for cognitive impairment

A 
Lab tests (ex. WBC, blood glucose, electrolytes)
Brain imaging (can ID brain abnormalities) 
Neuropsychometric testing
302
Q

Clinical management primary prevention

A

Promote healthy life
Education on substance abuse, risky activities, healthy pregnancy and aging
Genetic counseling (risk for abnormalities)
Practices to reduce risk for delirium (ex. lose dose/time for meds, have family visit, manage pain and infections)

303
Q

Collaborative interventions for cognitive impairment (main points)

A

Treatment depends on cause
Safety measures
Interdisciplinary treatment (work w/medicine, nutritious, speech and language, home health, etc.)

304
Q

Collaborative interventions for cognitive impairment (general management strategies)

A 
promote general health and comfort
reorientation (items from home)
pain management
regulation of stimulation (ex. lighting, clutter, noise)
behavioral management (give activities)
sensory aids
caregiver support
305
Q

Pharm for cognitive impairment

A

treat s/s, diseases, or control behavior

cholinesterase inhibitors and glutamate receptor antagonist

306
Q

Is dementia a normal part of aging?

A

No!

307
Q

Dementia is characterized by

and general adverse effects and risk

A

decline in one or more of the six domains of cognition
adverse effects on work, ability to perform ADLs
risk for injury, impaired nutrition, social isolation

308
Q

Dementia etiology

A

Caused by treatable and untreatable issues (need to treat early)
Most common causes: neurodegenerative or vascular disorders

309
Q

Dementia onset

A

Neurologic degeneration is gradual
Vascular dementia may appear abruptly or in a
stepwise progression

310
Q

Dementia diagnosis

A 
Focused on determining the cause
First step: medical, neurologic, and psychosocial history (cognitive/behavior changes, include family, rule out other conditions)
Then neuroimaging (rule out other conditions)
311
Q

Nursing and interprofessional management of dementia

A

treat risk factors to try to prevent it:
HTN (BV constrict), diabetes (BV damage), smoking (BV constrict), hypercholesterolemia (plaque build up), dysrhythmias (need blood flow & O2)

312
Q

Alzheimer’s disease (AD) background info

A

Chronic, progressive, neurodegenerative brain disease
Most common type of Dementia
Cannot be prevented/cured, cannot slow progression
Use only live 4-8 years after diagnosis (but can live longer)

313
Q

Alzheimer’s disease health disparities

A

women more likely (live longer)

blacks and hispanics more likely (SES risk, education, lifestyle, CV disease, diabetes)

314
Q

Alzheimer’s disease etiology

A

age 65 yr+ (biggest risk factor)
family history
diabetes mellitus (high levels insulin & glucose, insulin resistance, risk to not be able to break down protein)
head trauma

315
Q

Retrogenesis

A

Process where degenerative changes occur in
the reverse order in which development
occurred

316
Q

Behavioral problems w/Alzheimer’s

A 
Repetitiveness; asking same questions 
Delusions, Hallucinations
Agitation, Aggression
Altered sleep patterns
Wandering
Hoarding
Resisting care
317
Q

Neuropsychologic testing tool for Alzheimer’s

A

Mini-Cog

Mini-mental state examination (MMSE)

318
Q

Nursing Interventions for Alzheimer’s

A

Maintain function for as long as possible
Maintain safe environment
Educating/supporting the caregiver(s)
Awareness that hospitalization can worsen disease
Behavioral problems (Redirect, distract and reassure, validate)
Infection prevention
Skin Care
Elimination problems

319
Q

Sundowning and interventions

A

Patient becomes more confused and agitated in late
afternoon or evening
Stay calm, maximize daylight, limits naps and caffeine, evaluate meds

320
Q

Alzheimer’s Disease Safety

A

Injury: fall, Ingesting dangerous substance, Wandering, Inability to respond to crisis

Minimize risks in home environment
Supervision
GPS

321
Q

Alzheimer’s Disease Safety

A

Injury: fall, Ingesting dangerous substance, Wandering, Inability to respond to crisis

Minimize risks in home environment
Supervision
GPS

322
Q

Alzheimer’s Disease Eating and Swallowing Difficulties

A

Remind patients to chew/swallow; offer liquids frequently
Provide quiet and unhurried environment
Easy-grip utensils and finger food for self-feeding
Offer liquids frequently

323
Q

When chewing and swallowing become difficult, use:

A

Pureed food
Thickening liquids
Nutritional supplements

324
Q

Orthostatic hypertension

A

patient moves from a supine to standing position, and there is a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in the HR of 20 beats/min

dizzy, lightheaded

NUR 325 (2 decks)

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