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Lpn > FON CH 11and CH 21 > Flashcards

FON CH 11and CH 21 Flashcards

1
Q

**Types of pain

A

MILD/SEVERE
CHRONIC/ACUTE. Chronic- usually the result of prior tissue damage. Pain lasting more than 6 months. Can be constant or intermittent increase/decrease
Acute-intense, usually of short duration therefore usually tx w/opioids and other analgesics
REFERRED PAIN-can radiate, felt at a site other than the injured or diseased part of the body

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2
Q

Acute pain response

A

Creates a response that starts in the sympathetic nervous system (SNS) flooding the body with epinephrine/fight or flight response. Associated w/ anxiety can be a warning of actual or potent tissue damage

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3
Q

**Chronic pain

A

Does not serve as warning of tissue damage in process. May be linked to arthritis, back injuries. Accidents, or neurological condition, cause may be unidentifiable **6months

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4
Q

**High risk of self injury, cause of depression, suicide

A

Chronic pain

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5
Q

**Gate control theory

A

Pain impulses can be regulated or even blocked by gating mechanisms along the central nervous center (CNS).
Location of the gate is in the dorsal horn of spinal cord. Pain and other sensations of the skin and muscles travel this route

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6
Q

**Endorphins

A

Morphine like substance produced by body(naturally occurring)
Activated by stress and pain
Attach to opioid receptors sites in brain
Prevent release of neurotransmitters
Inhibit transmission of pain impulses
Analgesia
People who feel less pain than others have a higher endorphin level
TENS , acupuncture and placebos may cause the relief of endorphins

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7
Q

Subjective data

A

Characteristics and descriptions of the pain where?, anywhere else?
Pain is what pt. says it is

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8
Q

**Objective data

A

Is measurable
Tachycardia
Increased rate and depth of respirations
Diaphorisi
Increased systolic / diastolic BP
Pallor
Facial expressions
Restlessness
Muscle tension

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9
Q

Pain assessment

A

Subjective and objective data (crucial)
Subjective:pain is what the pt. says it is
Objective data: is measurable

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10
Q

H I L D A

A

H- how does your pain feel?
Intensity
Location
Durations
Aggravating and alleviating factors

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11
Q

P Q R S T Pain assessment used by ATI

A
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12
Q

The Joint Commision Requiements for controlling pain

A

The management of pain is appropriate for all patients, not just dying patients
Routine and PRN analgesics are to be administered as ordered
Education of practitioners: assessment and management

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13
Q

Fifth vital sign

A

Pain is monitored on regular basis

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14
Q

Appropriate pain management brings about

A

Quicker recovery‘s
Shorter hospital stays
Fewer readmissions
Improved quality of life

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15
Q

Unrelieved pain

A

Harmful physical and psychological effects

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16
Q

**Noninvasive pain relief techniques

A

Removal of pain source
Distraction
Relaxation
Guided imagery
Hipnosis
Biofeedback

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17
Q

**Invasive approaches to pain

A

Higher risk than non-invasive strategies
Nerve blocks
Epidural analgesics
Acupuncture
Injections
Oral medications

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18
Q

Medication for pain management

A

ANALGESIC=Acting to relieve pain
Non opioids
Opioids
Compound analgesics

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19
Q

Non-opioid pain medication
NSAID= non steroidal anti inflammatory drugs used to relieve pain reduce inflammation

Antiprostaglandins= agains inflammation (?)

A

Ibuprofen= advil, Motrin, nupren (faster)
Naproxen= used for arthritis, swelling inflammation, stiffness joint pain
Aleve is Naproxen (longer lasting)
Rx versions= Celebrex, toradol, daypro
(?3200 mg -4equal doses daily?)

Tylenol= APAP. (metabolized in liver) is NOT a NSAID. is anti-pyrectic. It is acetaminophen treats pain and fever headaches
No more than 4000mg per day

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20
Q

Aspirin=ASA

A

Risk of bleeding
Do not give to children

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21
Q

Mechanism of action (meds)
Different analgesics relieve pain in different ways

A

NON OPIOIDS
TYLENOL= seems to inhibit prostaglandins (inflammation)
that may serve as mediators of pain and fever primarily in the central nervous system but they may also block pain impulses peripherally
ASPIRIN= blocks pain impulses in the central nervous system and reduces inflammation in
NSAIDS= TRAMADOL, IBUPROFEN=MOTRIN,ALEVE, TORADOL work in the CNS but their better characterized actions are peripheral ( at site of injury)

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22
Q

Mechanism of action
Opioids

A

Hopefully to leave pain mainly by action in the CNS Binding to the opioid receptor sites in the brain and spinal cords. When a drug attaches to these sites pain relief occurs

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23
Q

Narccan ( opioid antagonist)

A

Blocks/reverses the action of all opioids

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24
Q

Adjuvant analgesic=Diverse mechanisms of actions
Drugs meant to relieve one condition but also work on other conditions

A

Some antidepressants appear to relieve pain by blocking the way up take a serotonin some local anesthetics such as Mexitil in certain anticonvulsants such as Tegretol a sodium channel blocking agents and this part of the mechanism contributes to their ability to relieve certain pain. Neuropathic pain is difficult to treat and some antidepressants and anti-convulsant such as duloxetine which is Cymbalta are used
Antidepressants - Cymbalta
Anticonvulsants- tegretol, Neurontin, Lyrica

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25
Q

Opioids they REMOVE pain sensation (it does not exist)

A

Open voice being binds to receptors sites in the brain and spinal cord they decrease perception of pain they do not fix the cause of the pain

NAMES of some opioid medications
Morphine Dilaudid, Fentanyl, Percocet= Oxycodone, codeine,


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26
Q

Medication patches

A

Never apply any form of heat to a patch

27
Q

Dangers of opioid medication

A

Respiratory depression rate and depth
Dangers of vary based on the route of administration
Abuse versus used
Addiction versus tolerance versus dependence
increase in rem sleep

28
Q

PCA=Patient controlled analgesia

A

Patient has a button to administer bolus dolls
May also have a continuous rate
Timer to prevent overdose
Records number of button presses

29
Q

Short acting IV push

A

Best for rapidly increasing Also known as breakthrough pain. last 3 to 6 hours

30
Q

Extended release (Coated pills and capsules patches and pumps)

A

Last 24 to 72 hours or longer DO NOT crush extended release pills

31
Q

IM (muscle) route

A

Good for quick administration

32
Q

Nursing interventions forPrevention and management of constipation

A

Diet high fiber veggies and fruit
Fluid intake
Stool softeners/ stimulants

33
Q

Causes of opioid induced constipation

A

Delayed emptying
Decreased peristalsis
Ileus impaction=peristalsis stops, no movement

34
Q

Nursing principles: analgesics

A

No the patient
No the medication which is the best right now
No the dose
No the timing
Which route


35
Q

Nursing principles: epidurals= Anesthetized at certain level of spine

A

Another method of delivery of analgesia is the insertion of an epidural catheter and infusion of opiates into the epidural space. The medication diffusers slowly epidural administration brings the drug close to the action site. Therefore relatively small doses are affective

36
Q

Patients who receive epidurals may have or need

A

Dressings
Catheter
I&O
Vitals and O2 sat
 Bowel and bladder Elimination issues
Side effects
Patient may be unsteady on the feet after an epidural patients

37
Q

Responsibility of nurse and pain control

A

Advocate for the patient. clarify concerns. answer questions. supply information the patient needs to make decisions about care. support patients decisions

38
Q

Individualizing pain therapy

A
39
Q

More interventions

A
40
Q

Promoting patients rest and sleep

A
41
Q

A patient feels at rest when

A

Mentally relaxed. free from worry physically calm. free from physical or mental exertion Sleep is a sustained period of rest
Reduced consciousness provides time for repair and recovery of body systems
Restores energy and feeling of well-being

42
Q

Factors that influence sleep

A
43
Q

Sleep deprivation

A

Decreases the amount quality or consistency of sleep
Sleep can be interrupted or fragmented
Sleep deprivation in the hospital can be caused by water pills long naps, or an invironment with too much stimuli

44
Q

Effects of sleep deprivation

A

slowed response time
Cardiac dysrhythmias. Mood swings. Decreased mental acuity. Decreased reflexes. Tremors. Reduced word memory. Decressed reasoning. hypertension, heart disease, stroke

45
Q

Patient self-determination act of 1991

A

HIPAA addresses privacy of all information received from or about the patient

46
Q

When patient wishes to leave

A

Answer questions Directly
Offer information about care
Utilize therapeutic communication to offer support
Be kind caring and show empathy

47
Q

**Common patient reactions

A

Fear of the unknown*
Helplessness
Loss of identity
Separation anxiety
Loneliness
Fear of never going home again
Disorientation from loss of appetite/disrupted sleep cycle*

48
Q

Nursing interventions: ALWAYS PROVIDE PATIENT CENTERED CARE

A

Have a warm caring attitude,and be courteous.
show empathy
treat patients with respect
learn their names pronouns and preferences
Maintain their dignity
Involve them in the plan of care
Whenever possible, adjust hospital l routine to meet their preferences

49
Q

What should be done in patient room

A

Room should be welcoming make an open bed
Place special equipment before patient arrives
Greet the patient
Give orientation to unit/room
Explain hospital routine

50
Q

Non English speaking patient

A

Secure interpreter or translation services
Respect the patient as an individual
Practice cultural humility
Allow them to wear clothing of their choice

51
Q

Assessment: patient problems. (Admission/transfer/discharge)

A

Potential for injury
Fearlessness R/T admission to faculty

52
Q

Assessment (Admission /transfer/discharge)
Expected outcomes and planning

A

Patient will verbalize understanding of care Planned while in facility
Patient will not Suffer accidental injury while in facility

53
Q

Admitting procedure

A

Check ID band and verify info
Assess immediate needs- pain, SOB, or severe anxiety
Introduce roommate
Ask family to take valuables home
Send home meds to pharmacy

54
Q

Discharging a patient

A

Discharge patient with a written instructions and teaching(guide to use at home)
 Patient signs acknowledgment of understanding
Always send patient home with a discharge instructions



55
Q

Discharge : against medical advice AMA

A

When patient leaves without an order for discharge notify the provider immediately
An AMA form must be signed by the patient
It is illegal to detain the patient

56
Q

Nursing task(admission /transfer/discharge)

A

Take hx
RN performs initial assessment
The provider notified when patient has been admitted 

57
Q

Transferring pt

A

Note condition of the pt.
Improved/critical
Transfer to another unit in hospital
Transfer to another facility

Preparation and careful documentation
Many injuries and errors occur during transfer process

58
Q

Pain is the fifth vital sign

A

Unrelieved pain ha s harmful physical and psychological effects

59
Q

Synergistic Impact

A

2 or more factors together(medications)
Achieve a greater effect
Cannot be achieved by one factor alone
Can become a vicious cycle: making pain difficult to treat

60
Q

Pharmacology terminology

A

Desired effect- therapeutic effect
Side effect-problem occurs in addition to the therapeutic effect
Indication-what the drug is used(indicated) for
Adverse reaction-undesirable effects
*must be able to educate pts.about meds

61
Q

2 Phases of sleep

A
  1. Non rapid eye movement NREM
    Stage 1 light sleep few mins
    Stage 2 sound sleep 10-20 mins
    Stage 3 deep sleep 15-30 mins
    Stage 4 deepest sleep 15-30 mins
  2. Rapid eye movementREM
    Dreaming full, color
    90 mins(full sleep cycle) after sleep begins
    After stage 4 of NREM
    Duration increases with each cycle
62
Q

Admission

A
63
Q

*Assistive interventions

A

Lpn (18 decks)

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