Exam 3 Flashcards
Transduction of the pain process
Activation of pain receptors, nocieptors- peripheral nerve fibers that transmit pain
The pain experience order
1) detect sensation
2) in spinal cord sends message to brain
3) in the brain forms response
Transmission of the pain process
Pain sensations travel along pathways to the spinal cord to higher centers, a delta fibers or c delta fibers
A delta fibers
Transmit acute, well-localized pain, sharp stabbing= quick response
C delta fibers
Conduct diffuse, visceral pain, general ache
Once pain stimulus reaches the brain it interprets _____ of pain and _____ with information from past pain experiences
Quality, processes
Perception of pain process
The point of which the person is aware of the pain, starts to hurt so person can react
Modulation of the pain process
Process by which the sensation of pain is inhibited or modified, neuromodulators (release once brain perceives pain), have analgesic activity and alter perception of pain
Acute pain
Sudden onset short duration
Chronic pain
Greater than 3 months
Cutaneous superficial pain
Skin cut
Somatic pain
Muscle pain
Visceral pain
Organ pain
Referred pain
Starts in one place felt somewhere else
Neuropathic pain
Nerve pain
Intractable pain
No cure nonstop
Phantom pain
Pain in missing limb
Pain assessment
Duration location quantity/intensity quality aggravating factors alleviating factors physiological responses behavioral factors effect on lifestyle expectations for pain relief
Interventions for pain
Opioid analgesic, nonopioid analgesic, adjuvant
Opioid analgesic
Moderate to severe pain, attach to opioid receptors in the brain, side effects respiratory depression sedation nausea constipation, examples: morphine diaudid
Nonopioid analgesics
Mild to moderate pain, many OTC, NSAIDS, Tylenol, aspirin
Adjuvant
Used for other purposes but can also enhance the effects of opioids, examples: corticosteroids antidepressants antiepileptic
Gate control theory of pain
- Actual existence and intensity of pain depends on transmission of pain
- Gate mechanisms along the nervous system control transmission of pain
- If the gate is open the pain impulses reach the conscious level
- If the gate is closed the pain impulses don’t reach the conscious level and the sensation of pain is not experienced
Pain travels along ____ nerve fibers. _____ nerve fibers close the gate.
Small, large
Cutaneous simulation
Many large fibers present, help close the gate
Interventions to close gate
TENS (low voltage electro therapy) accupressure massage hot and cold, distraction, imagery, PCA (patient controlled analgesic), epidural, Q pump (goes into site for 3-5 days to go home)
Hot intervention
Dilates vessels, decrease blood viscosity, relieves spasms, dry( pads), moist (compress, sitzbath)
Cold interventions
20 minutes on hour off, constricts blood vessels
Complementary pain relief measures
Distractions humor listen music relaxation cutaneous stimulation hypnosis biofeedback therap
Nurse practice act
Most important law affecting nurses, differ by state, protects public by defining scope of nursing practice, practice beyond scope is a violation of the nurse practice act
Accreditation
Educational program is evaluated and recognized as having met criteria, legally required to be state accredited KBN ( sets minimum standards), voluntary agencies accredit schools when they met criteria (NLNAC AACN)
Licensure
Legal document which permits person to practice nursing (NCLEX-RN exam), determines entry level competence
Certification
Validates specialty, examples: American association of critical care nurses and certified pediatric nurse
Torts
Wrong committed by person against another person or his belongings
Intentional legal issues
Assault battery fraud false imprisonment invasion of privacy
Assault/ battery
Restraining an alert oriented client in order to administer Meds
False imprisonment
Forcing someone to stay in the hospital (if they are of sound mind) AMA(against medical advice)
Negligence
Unintentional tort, preforming(or not) act that a reasonable prudent person would not(or would) have done, example: don’t give Meds or don’t report sore
Malpractice
Negligence by a professional
Liability (6 elements to prove malpractice or negligence)
Duty (obligation to do care), breach of duty( failure to meet standards of care), foreseeability (link between nurses act and injury), causation (failure to meet SOC caused injury), harm or injury (physical emotional financial), damages (awarded if malpractice caused injury)
Standards of care (SOC)
Differ for each patient or unit, skills and learning commonly possessed by members of a profession, legal guidelines for nursing practice
Disposition
Formal interview of an expert witness or anyone with relevant information
Nurse can be used as a
Defendant fact witness or expert witness
Student liability
Responsible for own actions, legal responsible to prep for clinical, instructors must provide supervision, notify instructor right away if changes in pt occur, only perform jobs in description
HIPPA
Health insurance portability and accountability act, passed in 1996 enacted in 2002, PHI, patient rights, public health activities, judicial and law proceedings, deceased individuals, permitted disclosure of PHI
PHI
Protected health information
Patient rights
See and copy health record, update health record, to get a list if disclosures, choose how to receive health information
Public health activities PHI
Tracking disease outbreaks, infection control
Law and judicial proceedings PHI
Information necessary for investigation or prosecution of a crime, example: abuse cases
Deceased individuals PHI
Funeral arrangements, organ donations, coroner cases
Nursing documentation
Record of all patient interactions, promotes communication between members, shows quality of client care
Purpose of client records
Communication between disciplines, diagnostic orders, care plan, quality review(SOC are met), research, education, legal documentation, reimbursements, provide medical history
Telephone orders
Must verify, includes: date time, T.O. With physicians name and title, signed with nurses name and title, later cosigned by dr
Verbal orders
Used during emergency, must be verified, recorded with date and time with STAT physicians name VO and nurses name
Kardex
Written documentation of allergies diet activity IV and test
ISBARR
I=identify self and pt
S=situation (why calling)
B=background ( are they familiar?, VS, diagnosis, date admitted, IV labs and metal status
A=assessment(what you think is going on)
R=recommendation (what you need from the physician)
R=read back any orders
Consultations
With a specialist
Referral
PT OT hospice home health or social services(doesn’t need order)
Ventilation
Process of moving gas in and out of lung
Inspiration expiration
Active process stimulated by chemical receptors in aorta and a passive process for expiration
Pulmonary circulation
Moves blood to and from the alveolar capillary membranes for has exchange
Diffusion
Exchange of respiratory gases in the alveoli and capillaries
Oxygen transport is done by
Lungs and cadiovascular system
Carbon dioxide transport
Diffuses into red blood cells and is hydrated into carbonic acid
Physiological factors affecting oxygenation
Decreased oxygen carrying capacity and inspired oxygen, hypovolemia, increased metabolic rate
Conditions affecting chest wall movement
Pregnancy obesity musculoskeletal abnormalities trauma neuromuscular disease CNS alterations
Hyperventilation
Ventilation in excess of that required to eliminate carbon dioxide produce by cellular metabolism, trachypnea
Hypoxia
Inadequate tissue o2 at cellular level
Hypoventilation
Alveolar ventilation inadequate to meet the body’s o2 demand or to eliminate sufficient carbon dioxide, bradypnea
Cyanosis
Blue discoloration of skin and mucous membrane
hypoxia
insufficient o2 anywhere in the body,early signs: increased pulse rapid shallow breathing, later signs: decrease pulse and BP cough
hypoxemia
reduced o2 in blood
chronic hypoxia
fatigue lethargy clubbing of fingers
orthopnea
when laying flat, difficulty breathing
APNEA
no breathing
healthy people do NOT produce
sputum (mucous secretion from lungs or bronchi)
small intestine
from stomach to large intestine, for digestion and absorption, 3 divisions: duodenum jejunum ileum, interior highly folded with villi
large intestine
last 5 ft of GI not coiled, chime from the small intestine moves through the ileocecal valve (prevents from entering large intestine too soon) into the cecum (first part of the large)
resident bacteria in the large intestine act on food as it passes through which produces
vitamin A and some B-complex
sigmoid colon empties into the
rectum
feces from the rectum go through the _____ via the ____ and then the waste is called _____
anal canal, anus, stool
internal sphincter control in the anal canal
involuntary control
external sphincter control at the anus
voluntary control
factors that affect bowel elimination
development, daily patterns, food and fluid intake, activity, lifestyle, psychological variables (stress), pathologic conditions, medications, diagnostic studies, surgery
stool color for adults, infants, barium or bile obstruction, iron or upper GI bleed, lower GI bleed, and colitis or fat malabsorption
brown, yellow, clay or white, black, red, pale or frothy
infant frequency of stool
1-6 per day
bulk forming laxatives
Metamucil, increase h2o absorption, safer, onset 24 hours
stool softeners
Colace, safer, lowers surface tension of feces to allow water and fat to penetrate stool, prevent straining
lubricant laxatives
mineral oil, safe, absorbed from the intestinal tract and soften stool, onset w/in 8 hrs
stimulant laxative
Dulcolax, not safe, direct irritant effect on mucosa, faster onset and longer duration, most abused laxative
saline and osmotic agents
quick acting, draws H2O into intestines and stimulates peristalsis, can produce dehydration, ex: MOM fleet magnesium phosphate, miralax
cleansing enemas Hypotonic
tap water, large volume enema, water moves from bowel to interstitial tissues, can cause imbalance if used frequently
cleansing enemas Hypertonic
fleets, water moves from interstitial tissue into bowel, can cause Na retention
isotonic enema
equal balance of particles, large volume, no fluid shift, best type for infants
soap suds enema
large volume enema, may cause mucosal irritation or injury
retention enemas
oil retention (lubricates stool and mucosa to ease) carminative enema (relieve gaseous distention) medicated enema (absorption of medications through intestinal mucosa)
anti diarrheal medications
immodium paregoric lomotil (increase smooth muscle tone decrease GI motility and secretion can be addictive or cause drowsiness) kaopectate (absorbs and soothes) Pepto-Bismol (contains aspirin cant give to children, decreases secretions)
biological sex
denotes chromosomal sexual development XX/ XY, internal and external genitalia, secondary sex characteristics, and hormones
gender identity
inner sense of being male or female, can be different from biological sex
factors influencing sexuality
developmental cultural religious and ethics, lifestyle, childbearing, STD
counseling for altered sexual function
P-permission giving LI- limited information SS- specific suggestions IT- intensive therapy
