knowledge assessment I Flashcards
the nature of pain involves
physical, emotional, and cognitive components
pain is
subjective and individualized and can reduce quality of life
pain can lead to
serious physical, psychological, social, and financial consequences
nurses are ethically and legally responsible to
manage pain
transduction
activation of pain receptors
transmission
conduction along pathways
fast fibers and slow fibers
perception of pain
awareness of the characteristics of pain
modulation
inhibition or modification of pain
gate control theory
a mechanism, in the spinal cord, in which pain signals can be sent up to the brain to be processed to accentuate the possible perceived pain, or attenuate it at the spinal cord itself
the gate control theory describes the relationships between
pain and emotions (how you think/react to pain)
the more emotional you are…
the greater the pain (controls a person’s tolerance level for pain)
gate control theory is the basis for
non-pharm pain management
gate control theory is regulated in the
CNS
an open gate lets impulses to the brain in, closing the gate closes off the impulse
a massage or warm compress, acupuncture
ascending impulses going to the brain stimulate the
ANS
stress responses (SNS)
fight or flight - mild to moderate pain
fight or flight is associated with what physiological indiciations
increased respiratory rate
increased HR
increased blood glucose
increased muscle tesnsion
vasoconstriction
decreased GI motility
diaphoresis
pupil dilation
continuous, severe, or deep pain activates the
parasympathetic nervous system - things slow down
pallor (paleness)
N/V
decreased HR and BP
rapid irregular breathing
behavioral response of pain
clenching teeth, facial grimacing, holding or guarding the painful part, and bent posture
lack of pain expression does NOT
indicate that a patient isn’t experiencing pain
S/S of pain
- moaning/crying
- biting lips
- pacing
- change in VS
- tightly closed eyes
- wrinkled forehead
- muscle tension
- avoiding others
- rubbing
types of pain
somatic
visceral
somatic pain
pain in joints, bone, muscle, skin, connecting tissue
visceral pain
comes from major organs
tumors
obstructions
acute/transient pain
identifiable
short duration
limited emotional response
chronic/persistant noncancer apin
may or may not have an identifiable cause
chronic episode
occurs sporadically over an extended duration
cancer
can be acute or chronic
idiopathic pain
chronic pain without identifiable physical or psychological cause
common biases regarding pain
- substance abusers over react to pain
- minor illness = less pain
- taking pain meds on a continuing basis leads to addiction
- levels of tissue damage indicates pain level
- health care providers are the best to determine pain
- psychogenic pain is not real
- chronic pain is psychological
- patients who cannot speak, have no pain
physiologic factors influencing pain
age
fatigue
genes
neurological function
fatigue increases the
perception of pain and can cause problem with sleep and rest
social factors influencing pain
previous experiences, family and social support
spiritual factors influencing pain
why am i suffering?
psychological factors influencing pain
anxiety
coping style
pain tolerance
level of pain person is willing to accept
cultural factors influencing pain
meaning of pain (some cultures feel asking for pain meds is a sign of weakness)
some are expressive others are not
suffering and pain is a part of life
language barrier
pain assessment
PQRSTU
P (PQRSTU)
palliative or provocate
what makes it better or worse?
Q (PQRSTU)
quality
what does the pain feel like
R (PQRSTU)
relief/region
where is the pain? does it radiate? what relieves the pain?
S (PQRSTU)
severity
scale 1-10 how bad is the pain?
T (PQRSTU)
timing
when did it start?
U (PQRSTU)
how does the pain affect you
ABCDE of pain management
A: ask about pain regularly, assess systematically
B: believe pt and family in their report of pain and what relieves it
C: choose pain control options appropriate for pt, family, and setting
D: deliver interventions in a timely, logical and coordinated fashion
E: empower pt and families, enable them to control course of care to greatest extent possible
wong-baker faces
used for children
has faces to associate feeling with number
oucher scale
picture scale with real life faces
planning
analyze information from multiple sources
apply critical thinking
adhere to EBP standards
setting priorities
goals and outcomes
teamwork and collaboration
pain ladder
step 1: nonopioid analgesics, NSAIDS
step 2: weak opioids
step 3: strong opioids, methadone, oral administration, transdermal patch
step 4: nerve block, epidural, PCA pump, neurolytic block therapy, spinal stimulations
nonpharmacological pain management
- relaxation
- guided imagery
- biofeedback
- distraction
- music
- cutaneous stimulation (massage, TENS, heat, cold, accupressure)
- herbals
- reducing pain perception
- control stimuli (loosen clothing, lower temp, hygeine, repositioning, etc)
pharmacological pain management
analgesics: dliever ATC or on a schedule
non opioids eg tylenol, NSAIDS eg asprin
SE: GI bleed, renal insufficiency, liver failure
not recommended for elderly
opioids
morphine, codeine, fentanyl, oxycodone, hydrocodone
SE: N/V, RR depression!, sedation, constipation, itching, urinary retention, withdrawal, hypotension, bradycardia, euphoria, pupil constriction
adjuvants/co-analgesics
antidepressants
anticonvulsants
PCA
patient controlled analgesia
pt must be ____ to use a PCA
physically able
goal of PCA is to
maintain a therapuetic level through self-administration
common meds through PCA
morphine, fentanyl, dilaudid
PCA implications
VS monitoring
IV site monitoring
pt teaching needed
local and regional analgesia
labor/delivery, chronic cancer pain, post-op pain
local analgesia
produces loss of sensation
lidocaine
regional analgesia
epidural or nerve block
perineural
infusion into painful site
on a pump or disposable unit (usually no more than 48 hrs)
topical analgesia
EMLA, lidocaine, lidoderm patch
epidural catheter care
- prevent displacement
- maintain function
- prevent infection
- monitor VS and R depression
- prevent complications (adequate hydration, assess for side effects: itching, N/V, assess sensation and motor function)
- maintain urinary and bowel functions
breakthrough cancer pain
worsening of pain either spontaneously or by a trigger despite adequate pain control
types of breakthrough apin
end of dose breakthrough
specific triggers
unpredictable
treatment to breakthrough cancer pain
- lifestyle changes
- non-pharm
- support
- rescue doses
- modification of disease
- manage the causes
pain clinics
chronic pain mngmt
multidiscipline approach to pain
palliative care/hospice
assist pts to manage pain when life is limited
hospice
inpatient or at home
support and care for pts in last stages of life usually less than 6 months
pain control is priority
ANA supports aggressive pain meds even if it shortens the life (moderate increases have not been shown to shorten life)
palliative vs hospice care
Palliative care focuses on easing pain and discomfort, reducing stress, and helping people have the highest quality of life possible.
Hospice care focuses on quality of life when a cure is no longer possible, or the burdens of treatment outweigh the benefits.
physical dependence
experiencing withdrawal s/s if taken off drug quickly, rapid dose reduction, decreased level of drug, or addition of an adjuvant
s/s of physical dependence
shaking
fever
chills
abdominal cramps
joint pain
yawning
addiction
neurobiologic disease with genetic psychosocial and environment factors influencing the development
behaviors of addiction
impaired control over use
compulsive use
use even though dangerous
craving durg
drug tolerance
adaptation to drug that decreases the effects over time
placebo use
drug with no active ingredients and no therapuetic effect
psuedoaddiction
chronic pain pt who seeks out mutiple HCP to find relief from pain- drug seeker
pt barriers to pain management
- fear of addiction
- side effects and injections
- suffering in silence is noble
- part of aging
- fear of others
HCP barriers to pain management
- malingerer or complainer
- assumptions about pt in pain
- biases based on culture, education, experiences
- limit ability to help pt
pt at risk for adverse effects
- sleep apnea/snoring
- obesity
- older adults
- co-morbidities
- no prior use
- polypharmacy
- recent surgery
- prolonged anesthesia
- smoker
evaluation of pain
what is pain rating now?
which pain rating is acceptable to patient?
how do you recommend that the pt treatment be changed to reduce pain rating?
pathogenicity
capacity to cause disease
what factors influence pathogenicity
- virulence
- survive in the host
- number of organisms
- ability of the host to prevent infection
kinds of pathogens
bacteria, virsues, and fungi (yeasts and molds) and helminths
transient microorganisms
attach to the skin during contact with another person or object
resident flora
permanent inhabitants of the skin and cannot usually be removed with routine handwashing
asymptomatic or convalescent carriers
infected without signs or symptoms of the disease
bacteria examples
staph
strep
tb
gonorrhea
viruses examples
hep A, B, C
herpes
HIV
chicken pox
COVID
fungi
yeast infections
candida
helminths
tapeworms
round worms
typhoid mary
1800s
asymptomatic carrier of salmonella
she was a cook for several families - transmission by food preparation
who is most likely a carrier of MRSA
nurses
nation safety patient safety goals
- identify patients correctly
- improve staff communication
- use medications safely
- prevent infection
- identify patient safety risks
- prevent mistakes in surgery
modes of transmission
- contact
- indirect
- droplet
- airborne
- vehicles
- vectors
contact transmission
direct person to person contact
ex. touching, kissing, sexual contact
indirect transmission
contaminate inanimate object
ex. thermometer, blood pressure machine, pens
droplet transmission
pathogen travels in water droplets
ex. sneezing and coughing
airborne transmission
travels through air or dust particles
ex. heating, air, conditioning, sweeping a floor, shaking out bed linens
vehicles of transmission
contaminated items
water, blood, food, air
vectors of disease
external mechanical transfer of a pathogen
mosquitos, ticks, fleas, bats
resovoirs
a place where microorganisms survive, multiple, and await transfer to a susceptible host
what conditions allow for replication and survival of pathogens
- nutrients
- moisture
- temperature
- oxygen
- pH and electrolytes
- lighting
living resovoirs
- humans
- animals
- insects
nonliving resovoirs
- food
- floors
- equipment
- contaminated water
portal or exit
any route that the pathogen can leave the resovoir
portal of entry
the route a pathogen can take to enter a susceptible host
host
a person with inadequate defenses against an invading pathogen
temperature of resovoirs
68-109
anerobic
no oxygen for growth
aerobic
oxygen for growth
pH for resovoirs
5.0-7.0
portals of entry
broken skin, mucous membranes, respiratory tract, urinary tract, reproductive track, wounds, catheters, tubes
chain of infection
- pathogenic organism
- resovoir
- portal of exit
- means of transmission
- portal of entry
- susceptible host
common cold (organisms, resovoir, portal or exit, transmission, portal of entry, susceptible hsot)
- rhinovirus
- can live in nose and upper respiratory tract
- way for infectious agent to escape the reservoir, nasal and mouth secretions
- airborne droplets, coughing, sneezing
- respiratory tract, nose mouth
- young children, older adults
stages of infection
- incubation period
- prodromal stage
- illness stage
- decline
- convalescence
incubation period
successful invasion of pathogen
first appearance of symptoms
stage can last a day or month
- chicken pox 2-3 wks
- common cold 1-2 days
- rabies days-years
prodromal stage
interval from onset of nonspecific signs and symptoms to more specific signs and symptoms
ex. scratchy throat, colds
not all infections have prodromal stage
illness
patient becomes ill when the first signs and symptoms of the disease occur
first signs and symptoms of disease occur
decline
patients immune defenses along with medical therapies, successfully reduce number of pathogenic microbes
convalescence
interval when the acute symptoms of infection disappear
primary defenses against infection
anatomical features that prevent organisms from entering body
ex. normal body flora
body system defenses, intact skin, respiratory tree, tearing, blinking, voiding, sneezing
secondary defenses against infection
biochemical processes that are activated by chemicals released by pathogens
- phagocytosis
- inflammation
- fever
tertiary defenses against infection
humoral immunity is the production of antibodies in response to pathogens (immunoglobins)
IgG and IgM
factors increasing host susceptiblity
developmental stage
immunizations
breaks in skin/surgeries
illness/injury
chronic diseases (diabetes)
tobacco use/substance abuse
multiple sex partners
medications that increase or decrease immune response
nursing/medical procedures
enironment/lifestyle
exposure
socioeconomic functional status
factors that support host defenses
nutrition (to manufacture cells of immune system)
hygiene (sufficient to decrease skin bacterial count)
rest and sleep
exercise
stress reduction
immunizations
phagocytosis
process by which phagocytes (specialized WBC) engulf and destroy pathogens
inflammation
process that begins when histamine and other chemicals are released from damaged cells
s/s of inflammation
localized warmth and erythema (redness)
what occurs physiologically during inflammation
blood vessels dilate and become more permeable which increases the flow of phagocytes, antimicorbial chemicals, oxygen, and nutrients to affected area
fever
rise in core body temperature that increases metabolism, inhibits multiplication of pathogens, and triggers specific immune responses
IgG
most common antibody
in blood and other body fluids and protect against bacterial and viral infections
IgM
found mainly in blood and lymph
first antibody the body makes when fighting a new infection
noticing infection
patient appearance
vital signs
diagnostic testing
vital signs include
temperature
pulse
respiration
blood pressure
o2 saturation
diagnostic testing
WBC
ESR
iron levels
CRP
serum complement
lactate levels
cultures
iron levels
disease titers
health history
exposure, outside the country, unusual foods, past/present disease, medications, OTC meds, herbal, stress level, immunization/vaccine history, symptoms of illness
physical assessment
general apperance, facial expressions, posture, body build and type, signs of distress such as dyspnea, level of consciousness, speech, speech pattern
5 s/s of infection
- fever
- diarrhea
- fatigue
- coughing
- muscle aches
WBC infection
> than 10,000 mm3
erythrocyte sedimentation rate
elevated presence of inflammatory process/infection
iron levels
low levels imply chronic infection
C-reactive protein
measures protein in blood, high levels can indicate severe infection
serum complement
proteins that protect against infection decrease when an infection is present
lactate levels
biproduct of normal metabolism, high levels indicate spesis, shock, decreased oxygenation
cultures
blood, urine, throat, wound, spinal fluid
disease titers
exposure to disease and immunity
what happens to blood pressure in the presence of infection
BP can temporarily increase because of the inflammatory response and as the immune system fights the infection increasing BF
if left untreated, pathogens can create holes in vessels and with leaking of blood, decrease BP
preventing infection at home
- teaching infection prevention
- promote wellness to support host defenses
- hand hygeine
- disinfectants
- prepare and store food safely
- cook food appropriately
- do not share with personal care items
- washing dishware, clothing, etc.
self-care for preventing infection
hand hygiene
rest and sleeo
exercise and activity
stress reduction
immunizations
tier one, standard precautions
protects healthcare workers from exposure
decreases transmission of pathogens
protects clients from pathogens carried by healthcare workers
*applies to blood, all body fluids, non-intact skin, and mucous membranes
tier two
airborne
droplet
contact
airborne infection prevention
private room, mask, negative pressure room
ex. tuberculosis
droplet infection prevention
private room, room with someone with same disease, mask
ex. pneumonia, sepsis
contact infection prevention
private room, gloves, gowns, dispose of dressing in single bag
ex. HSV, varicella, RSV, scabies
how does rest affect infection prevention
6-9 hrs per night is considered fully restorative for most people
sleep is neccessary for energy needed for healing
how does exercise affect infection prevention
too little activity causes circulation to slow and lungs to supply less oxygen
too much leads to fatigue and joint injury
stress reduction and infection prevention
laughing increases immune responses, improves oxygenation, and promotes body movement
physical or mental stress decreases the body’s immune defenses
immunizations and infection prevention
encourage clients to follow recommendations for immunzations (vaccinations)
for most diseases at least ___ of the population must be immunized in order to protect the entire population from disease
85%
medication legislation and standards
- pure food and drug act
- food and drug administration
- harris-kefauver amendment to the federal food, drug, and cosmetic act
- controlled substance act
- medwatch program
the pure food and drug act
1906
prohibited the sale of misbranded or adulterate food and drugs in interstate commerce and laid a foundation for the nations first consumer protection agency, the FDA
federal food drug, and cosmetic act
new drugs must be tested with results reviewed by the FDA
the FDA approves the drug for marketing based on test results showing that drugs are safe
harris-kefauver amendment to the FDA
1962
drugs must be proven to be effective before they can be put on the market
controlled substance act
1970
aka comprehensive drug abuse prevention control act
the manufacture and distribution of drugs that have the potential for abuse must be regulated
grouped drugs into 5 distinct schedules depending on drug’s acceptable medical use and the drug’s potential for abuse or dependency
medwatch program
the FDA medical product safety reporting program for health professionals, patients and consumers
medication regulations and nursing practice
state nursing practice act define required skill levels of all state-licensed nurses
states have the power to enforce additional regulations beyond federal mandates
health care facilities must develop
policies and procedures for managing medication inventory and distribution in compliance with federal, state, and local regulations
facilities address the management of controlled substances at both
the organization and unit levels by means of careful tracking policies for disposal of unused controlled substances
state NPAs
define required educaiton and skill levels of all state-liscenced nurses
NPAs are mandated on what level
state level
medication names
chemical
generic
offical name
trade
chemical medication name
provides the exact description of medications composition
ex. 2-(4-isobutylphenyl) proponic acid
generic name
manufacturer who first develops the drug assigns the name and it is then listed in the US pHarmacopeia
meds in same family have same stem in end of generic names
ex. lidoCAINE, oxycoDONE, peniCILLIN
offical name
designated by FDA and is usually the generic name
ex. ibuprofen
trade name
also known as brand or proprietary name
name under which a manufacturer markets the medication
ex. motrin, advil
classification of medication
- effect on body system
- symptoms the medication relieves
- medication’s desired effects
ex. ASA/NSAID: antipyretic, non-opioid analgesic, antiplatelet, anti-inflammatory
drug absorption
the transportation of the unmetabolized drug from the site of administration to the body circulation system
factors that influence absorption of drugs
- route of administration
- ability of a medication to dissolve
- blood flow to the site of administration
- body surface area
- lipid solubility
pharmacokinetics
study of how a medication moves into through and out of the body
what kinds of administration absorb least quick to quickest
PO
SC
IM
IV
IV push
distribution of meds
circulation
membrane permeability
protein pinding
metabolism and medications
medications aer metabolized into a less-potent or an inactive form
- biotransformation occurs under the influence of enzymes that detoxify, break down, and remove active chemicals
where does most metabolism of drugs happen
within the liver
harmful chemicals, and disease can affect
liver and aging can cause medications to leave the body more slowly
excretion of medication
meds exit through the kidney (main organ), liver, bowel, lungs, exocrine glands
chemical makeup of medication determines
the organ of excretion
therapuetic effect of medication
expected or predicted physiological response
side effect of medication
unavoidable secondary effect
adverse effect of medication
unintended undersiteable often unpredictable
toxic effect of medication
accumulation of medication in the bloodstream
idiosyncratic reactoin
over reaction or under reaction or different reaction from normal
allergic reaction
unpredictable response to medication
oxycodone hydrochloride-acetominophen (percocet)
TE - relieve moderate/severe pain
SE- potential for addiction, constipation, dizziness, drowsiness, headache, dry mouth, nausea-vomiting, sweating, respiratory depression
AE- severe hypotension, hepatoxicity, serious skin rxns
ALE- skin redness or rash, itching, swelling, anaphylaxis
OoA- 15-30 minutes, peaks in 1 hr and lasts up to 2-6 hrs
medication interactions
one medication modifies the action of another
medication tolerance
more medication is required to achieve the same therapeutic effect
medication dependence
physical
psychological
all medications have a maximum drug effect which means that
there is a point at which increasing the dose of a medication will not increase the effect of the drug
therapeutic effect is influenced by factors such as
- medication dose
- route of administration
- frequency of administration
- function of metabolizing organs
onset of action
time it takes for a medication to produce a response
peak
time at which a medication reaches its highest effective concentration
trough
minimum blood serum concentration before next scheduled dose
duration
time medication takes to produce greatest result
plateau
point at which blood serum concentration is reached and maintained
biological half-life
time for serum medication concentration to be halved
half-life of medication
100mg med at 1pm
1:00pm - 100mg
3:00pm - 50mg
5:00pm - 25mg
7:00pm - 12.5mg
what factors influence therapuetic effect on medication
age
gender and body build
chronic disease
concurrent medication use
nutritional status
pregnancy
genetic factors
health illness beliefs
previous experience with meds
knowledge base
culture
developmental stage
social support and finances
med dependence and misue
gender and body build
difference in hormones, distribution of fat and water, weight, height, and lean body mass can affect medication absorption metabolism distribution and excreation
presence or absence of food in the stomach can
alter medication absorption
decreased nutritional status impairs the clients ability to produce specific medication-metabolizing enzymes leading to impaired medication metabolism
preganancy on meds
circulatory changes, hormonal changes, can affect how meds are absorbed distributed metabolized and excreted
genetic factors influencing therapuetic effect
inherited traits may have a specific influence on metabolism of certain medication
routes of administration
oral (sublingual, buccal)
topical (direct, body cavity)
inhalation
parenteral (ID, Sub-Q, IM, IV) - epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, intrarterial
intraocular
metric system
most logically organized
meter, L, gram
never use a trailing zero
household system
most familiar
innacurate at imes
solutions
when a solid is dissolved in a fluid, concentration is expressed as
- unites of mass per units of volume
- percentage
- proportions
orders
written
verbal
telephone
when recieving TO or VOs..
clearly ID pt name, room number, and diagnoses
use clarifying questions to avoid misunderstandings
a nurse recieving a TO or VO enters the
complete order into computer by computerized provider order entry (CPOE) or writes it out on a physicians order sheet
TJC requires VO or TO to be
recorded and read back to provider
standing orders
administered routinely
single orders
one time use
prn orders
as needed by the patient
NOW orders
given within 60-90 minutes
STAT orders
must be given immediately
most likely during a code
prescriptions
at-home meds
nurses role in medication administration
determines medications ordered are correct
assesses pt ability to self administer
determines medication timing
administer meds correctly
closely monitors for effects
provides pt teaching
10 rights of medication
right medicine
right dose
right patient
right time
right route
right documentation
right assessment/indication
right evaluation
right to refuse
right pt education
check points when pulling meds
- check 1 when pulling it out of machine
- check 2 when preparing medication to be administerred
- check 3 just before giving meds
pt rights
be informed about meds
to refuse meds
to have med hx
to be advised of experimental meds
receive labeled meds safely
receive appropriate support
not receive unneccassary meds
be informed if meds are part of research study
med reconciliation
comparing past and present med list
- admission
- discharge
- transfer to new hcp
- post op
process of med reconciliation
verify the list
compare the list
reconcile the list if needed
communicate updates
medication error
any preventable event that may cause inappropriate medication use or jeopardize pt safety
when an error occurs
- assess pt condition, notify hcp
- when pt is stable, report incident
- prepare and ile occurence or incidence report
- report near misses and incidents that cause no harm
