exam #3 Flashcards
1
Q
iatrogenic addiction
A
- addiction inadvertently caused from valid medical use of opioids
- actual incidence is 1%
2
Q
addiction
A
- primary, chornic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestation
- behaviors include: impaired control over drug use, compulsive use, continued use despite harm, and craving
3
Q
physical dependence
A
- state of adaptation that is manifested by a drug class specific withfrawal syndrome following: abrupt cessation, rapid dose reduction, decreasing blood levels, and/or administration of an antagonist
4
Q
tolerance
A
- state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug’s effects over time
- use of words: drug seeker, clock watcher, addicted to their pain meds
5
Q
pain transmission
A
1) tansduction
2) transmission
3) perception
4) modulation
6
Q
categories of pain
A
- acute: traumatic injury, surgical procedure, medical disorder
- chornic: lasting more than 6 months
- nociceptive pain: complex interaction between peripheral nerves and central nervous system
- somatic: soft tissue, musculoskeletal
- visceral: abnormal stretching, distention of smooth muscles
- neuropathic pain: disruption to nerves
7
Q
non-opioid, adjuvant, co-analgesic agents
A
- NSAIDs
- cox-2s
- tricyclic antidepressants
- anticonvulsants
- alpha 2 adrenergic agonists
8
Q
opioids
A
- endogenous opioids
- opioid receptors
- agonist-antagonist
- antagonist
- parenteral: continuous IV, intermittent doses, combination
9
Q
nursing points of care opioid medications
A
- kept under double lock
- record use
- lost or contaminated doses must be signed for
- counted by 2 nurses and signed
10
Q
PCAs
A
- patient controlled analgesics
- anticipating pain that is severe but intermittent
- constant pain that gets worse with activity
- not already sedated from other medications
- SQ administration
- provides serum analgesia levels for comfort with minimal sedation
- good candidates: kidney stones, constant pain that worsens with activity, capable of manipulating the dose button, motivated to use PCA, home care pts with long term pain control needs
11
Q
advantages and disadvantages of PCAs
A
- advantages: acute pain relief, good for post op pts, safe and effective, constant therapeutic serum level, abdominal surgery pts end up ambulating sooner, better able to cough and deep breath when pain is controlled
- disadvantages: risk for respiration supression, LOC must be in tact to manage pain, constipation, nausea, vomiting, pruritis
12
Q
points of care with PCAs
A
- must determine pt baselines first
- must determine first bolus, lock out interval between each dose, and the 1 hours and 4 hours lock out dose limits
- always validate with another caregiver
- current guidlines: 6-8 minute dose interval and 1 hour lockout
- ONLY pt can touch it
13
Q
SQ infusions
A
- provides hydration into SQ tissues
- candidates for continuous SQ: unable to take PO, moderaltely dehydrated and confused, pts with limited venous access
- advantages: ease of initiation and maintenance, reduction in transfers to acute care from long term care for IV therapy, fewer complications, decreased cost
- disadvantages: local irritation at infusion site, inappropriate for large volumes, edema, risk of infection, risk of abscess formation
14
Q
points of care: SQ infusions
A
- rotate site q 3-5 days, monitor access site
15
Q
pain mngmt epidural and intrathecal medication
A
- spinal cord and brain
- decreases risk for thrombophlebitis and paralytic ileus
- common epideral meds: preservative-free morphine, sublimaze (fentanyl), sufentanil, bupivacaine, lidocaine, tetracaine
16
Q
JCAHO guidelines for pain assessment
A
- pt right to appropriate assessment and mngmt of care
- assess pain in all pts
- record the results in a way that facilitates regular assessment and follow up
- educate relevant providers in pain assessment and mngmt
17
Q
neonate
A
- extra uterine life up to the first 28 days
- low birth weight and premature infants have decreased energy stores and increased metabolic needs compared with those of full term and average weight newborns
18
Q
water
A
- premi: 90% water
- newborn infant: 70-80% water
- adult: 60%
- infants have more water in the extracellular compartmant than adults do
19
Q
ped IV therapy
A
- illness, increased muscular activity, thermal stress, congenital abnormalities and resp distress syndrome influence metabolic demands
- metabolic demand of an infant is 2Xhigher per unit of weight than that of an adult
- for high-risk infants, calorie requirement is up to 100% higher than normal newborn
- renal fxn, acid base balance, body surface area, and electrolyte concentrations must be taken into consideration when planning fluid needs
- renal fxn is not completely developed, kidneys have limited concentrating ability and require more water to excrete a given amount of solutes
20
Q
candidates for neonatal and infant IV fluids
A
- neonatal: congenital cardiac disorders, GI defects, neurologic defects
- infant: dehydration, diarrhea, abx therapy, nutritional support, antineoplastic therapy
21
Q
pediatric physical assessment
A
- measurement of the head circumference (up to 1 year)
- height or length
- weight
- vital signs
- skin turgor
- presence of tears
- mucous membranes
- urinary output
- fontanelles
- level of activity
22
Q
peds assessment of fluid needs
A
- meter square method (body surface area): nomogram used
- weight method: 100-150ml/kg to estimate fluid requirements
- caloric method: calculates the usual metabolic expenditue of fluid
23
Q
IV site selection in peds
A
- age, size, condition of vein, reason for therapy, general pt condition, mobility, level of activity, gross and fine motor skills, sense of body image, fear of mutilation, cognitive ability of the child
- sites: subclavian, cephalic, brachial, temporal, posterior auricular, jugular, basilic
24
Q
geriatric iv therapy
A
- loss of cells and loss of physiologic reserve make up the dominant processes of aging
- major changes: homeostatic changes, immune system, cardio changes, skin and connective tissue changes
- less fluid
- less ability to adapt readily to rapid changes
- renal changes: decreased GFR
- total body water reduced by 6%
- cardio and resp changes combine to contribute to a slower response time to blood loss, fluid depletion, shock, acid base imbalances
