LA 2 Flashcards
What is the purpose of a “drug holiday” with clients who are taking narcotics on a long-term basis?
With narcotics, especially stronger agents, that are used long-term (e.g., ms contin, transdermyl fentanyl), a 3-day drug holiday (or as ordered by the physician) every month has shown evidence of increasing the sensitivity of the client to specific narcotics, as now the receptors have also become more sensitive.
true or false and explain your answer:
Cancer clients should never receive strong narcotics at the beginning of any pain experience because of the fear of addiction
False. With cancer pain, a client’s quality of life is far more important than the fear of addiction. Clients who are living with cancer need to experience comfort and maintain quality of life as much as possible. Addiction should not even be a concern for these clients because quality of life is so important for those afflicted with the illness.
You administer 100 mg meperidine (Demerol) intramuscularly to a client in severe post-operative pain, as ordered. What assessment data should be gathered before and after administering this drug? Explain your answer.
The nurse should always assess the client’s blood pressure, pulse, and respirations before administering any narcotic or, in this situation, meperidine. This allows comparison of baseline vital signs to those taken after the drug has been administered, as well as the assessment of the effect of the drug on the physiological response to pain.
Your client complains that the drugs he is receiving for severe pain are really not helping. What should be the most appropriate response to this client?
- First, it is important to assess the client and his or her previous reactions to pain medications and then assess the dose, action, route, and appropriateness of the agent.
- The client’s medical history, nursing assessment, and medication history should also be studied carefully because the client’s diagnosis may not match up with the type of analgesic ordered.
- Once it has been determined that the client is getting the right medication and dosage, then education about pain management
- The nurse should administer the medication at regular intervals, as ordered
- The nurse should also always include non-pharmacological methods of pain management
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of self-preparation:
Oral:
Very easy if alert; easy to teach others.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of self-preparation:
IM:
Not easy to carry out on own; would need assistance from healthcare personnel or other trained person
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of self-preparation:
Transdermal
Easy to learn to use and easy to teach to others.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of administration:
Oral:
Very easy if alert; easy to teach others.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of administration:
IM:
Easy to administer medication by this route if qualified healthcare provider is there to assist
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of administration:
Transdermal
Easy to administer and learn how to apply. Very easy to instruct on application and administration of patch.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Onset of therapeutic effects:
Oral:
Varies depending on specific drug properties and chemical composition of the oral drug; some very predictable and some very unpredictable. Generally speaking, 45 minutes to 1 hour for onset of effects. Remember that some drugs with longer half-lives may take weeks to have therapeutic effects
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting
Onset of therapeutic effects:
IM
Generally dependable; onset of therapeutic effects within at least 15 to 30 minutes
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Onset of therapeutic effects:
Transdermal
Dependable onset but is variable in some of the pharmacokinetics until serum steady states are achieved because of the nature of topical absorption into systemic circulation. However, once used for a few days, transdermal patches are very effective in their onset of therapeutic effects.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Serum concentrations:
Oral
Serum concentrations are dependent on the drug, its properties, chemical composition and dosage form (i.e., if enteric-coated. If the oral drug is taken at regular intervals, it may achieve adequate serum concentrations; however, many physiological factors provide barriers to predictable concentrations of the drug in the serum.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Serum concentrations:
IM
Very effective serum concentrations.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Serum concentrations:
Transdermal
Very effective serum concentrations that remain fairly predictable with routine usage and application.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Degree of sedation:
Oral:
Degree of sedation is dependent on dosage of drug and the potency of the drug. Medications such as morphine and other opioid derivatives are very sedating, but again, level of sedation depends on dose and other variables.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Degree of sedation:
IM
: Once again, the degree of sedation depends on drug and dosage, but because systemic absorption is more rapid, there are more CNS-depressing effects, and thus more CNS sedation
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Degree of sedation:
Transdermal
CNS sedation depends on drug patch and dosage. Often the client builds up some resistance to the sedation, but this is generally seen with lower dosage forms of the patch.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Side-effects:
Oral:
Narcotics usually have many side effects, and even more with oral dosage forms owing to gastric upset related to gastric irritation.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Side-effects:
IM
Side effects depend on drug and dosage but with IM route, the effects are generally more profound because of increased absorption. Therefore, the side effects related to CNS depression, such as sedation and decreased vital signs, are more often associated with these dosage forms.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Side-effects:
•Transdermal
Side effects are very likely to occur with transdermal patches once the steady state of the drug is achieved. Because of steady absorption with consistent dosing, the side effects will depend on the dosage and drug.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of home management:
Oral
Very easy.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of home management:
IM
Not easy without medical or nursing assistance.
Compare and contrast the effectiveness of oral, intramuscular, and transdermal routes for narcotic administration, considering ease of self-preparation and administration, onset of therapeutic serum concentrations, degree of sedation, side effects, and ease of management in the home setting.
Ease of home management:
Transdermal
Very easy.
When is spinal anesthesia the method of choice?
There are many conditions besides labour and delivery for which spinal anaesthesia would be indicated.
Conditions for which one might have a “spinal” rather than general anaesthesia include any that would be exacerbated, causing possible harm to the client—such as a client with severe respiratory or cardiac disease who could not tolerate the effects of general anaesthesia.
It is important to remember that spinal anaesthesia is often used with specific types of surgeries or in clients in poor health or with conditions/diseases that would be exacerbated by general anaesthesia.
What is the purpose of adding epinephrine to a local anesthetic?
Epinephrine is added to topical and local anesthetics to enhance blood vessel constriction at the area and decrease the risk of possible systemic absorption.
What are potential complications of local anesthetics used in dental offices, such as lidocaine with epinephrine, in a client with a variety of cardiac or vessel diseases?
there is concern regarding the absorption of epinephrine, which could lead to blood vessel constriction and rapid elevation in blood pressure and pulse.
For the “at-risk” client who might have vessel disease and weakened vessels, there is concern regarding the subsequent rupture of a vessel and cerebrovascular accident or death.
Rapid acceleration of pulse rate could also be detrimental to at-risk clients because of the potential for ischemia from excessive oxygen demand oversupply
pain that originates from organs or smooth muscles
visceral pain
pain that originates from skeletal muscles, ligaments, or joints
somatic pain
pain that is psychological in nature but is truly pain in terms of actual pain impulses that travel through nerve cells
psychogenic pain
pain experienced in a body part that has been surgically or traumatically removed
phantom pain
pain that results from a disturbance of function or pathological change in a nerve
neuropathic pain
Enflurane is a(n) ______ anaesthetic.
inhalation general
Halothane is a(n) ____________ anaesthetic.
inhalation general
Nitrous oxide is primarily indicated for use in __________?
dental procedures (such as removal of “wisdom teeth”) or as a useful supplement to other, more potent anaesthetics.
Three major complications of general anaesthesia include _____________________
respiratory and/or cardiac depression, cardiac and/or respiratory arrest, irregular heart rhythms, malignant hyperthermia, aspiration pneumonia, and central nervous system depression
pain that results from any disorder that causes central nervous system damage
central pain
These contraindications are for???
i) known drug allergy
ii) severe asthma or other respiratory insufficiency, especially in the absence of resuscitative equipment,
iii) conditions involving elevated intracranial pressure, and
iv) pregnancy, especially in long-term or high doses
Narcotics
An antidote to an overdose of morphine is ____________________.
naloxone hydrochloride
Opioid analgesics bind to an opioid pain receptor in the brain and cause an analgesic response—the reduction of the pain sensation.
mechanism of action of the opiates
What are the neurotransmitters that are produced by the body to fight pain. They bind to opioid receptors and inhibit the transmission of pain by closing the “GATE” to the pain impulse
Endogenous enkephalins and endorphins
Any of a group of highly addictive analgesic drugs derived from opium or opium like compounds. Narcotics can cause drowsiness and significant alterations of mood and behavior.
Narcotic
Medications that relieve pain without causing
loss of consciousness (sometimes referred to as painkillers).
Analgesic
Any of various sedative narcotics containing opium or one or more of its natural or synthetic derivatives. or A drug, hormone, or other chemical substance having sedative or narcotic effects similar to those containing opium or its derivatives: a natural brain opiate. Also called opioid
Opiate
Is it a narcotic and non-narcotic analgesics?
-Acts centrally-
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Does not produce CNS depression
Non-Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Cause addiction
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Produce CNS depression
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Do not produce gastric irritation
Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Has anti-inflammatory effect
Non-Narcotic Analgesics
Is it a narcotic and non-narcotic analgesics?
Act peripherally
Non-Narcotic Analgesics
A synthetic analgesic drug that is used as a substitute to treat morphine and heroin addiction
Methadone
pain that continues or recurs over a prolonged period, caused by various diseases or abnormal conditions. Chronic pain may be less intense than acute pain. The person with chronic pain does not usually display increased pulse and rapid respiration because these autonomic reactions to pain cannot be sustained for long periods. Some factors that can complicate the treatment of persons with chronic pain are scarring, continuing psychologic stress, and medication
Chronic Pain
Acute pain is sudden and usually subsides when treated—for example, postoperative pain or the sudden onset of a headache.
Acute Pain
pain anywhere in the body of unknown cause
Idiopathic pain
What medications relieve pain without causing loss of consciousness?
“Painkillers”
Opioids
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Pain felt in a different are of the body
Referred Pian
Persistent or recurring
Lasting 6 weeks or longer
Often difficult to treat
Persistent pain/Chronic Pain
It uses the analogy of a gate to describe how impulses from damaged tissues are sensed in the brain
Many current pain management strategies are aimed at altering this system
Gate Theory
What are the four processes to the gate theory?
Transduction
Transmission
Perception
Modulation
What are the two types of nerves stimulated?
A fibres
C fibres
real pain of psychological orgin eg. Fibromyalgia, chest pain from anxiety
Psychogenic Pain
Pain felt from touching a hot stove
superficial pain
The amount of pain a patient can endure without its interfering with normal function
Pain tolerance
The level of stimulus needed to PRODUCE THE PERCEPTION OF PAIN
Pain Threshold
What are the two endogenous neurotransmitters the body produces in pain modulation?
Endorphins & Enkephalins
In pain modulation, rubbing or applying liniment to a painful area stimulates the?
large sensory fibres
Pain relievers that contain opium, derived from the opium poppy or chemically related to opium:
Opioid Analgesics
What are the three Chemical Classification of Opioids
Meperidine-like drugs
Methadone-like drugs
Morphine-Like drugs
What are the actions based on the three classifications?
Agonist- cause analgesic response
Partial agonist
Antagonist
Often given with adjuvant analgesic drugs to assist the primary drugs with pain relief
NSAIDS AND CORTISONES reduce
INFLAMMATION
Often given with adjuvant analgesic drugs to assist the primary drugs with pain relief
Antidepressants and Anticonvulsants
Are used for NERVE PAIN
What kind of drug can be used for Cough centre suppression,Treatment of diarrhea (causes constipation), & Procedural pain during surgery as an adjunct to anaesthesia
Opioids
What are some contraindications to opioid use?
Known drug allergy
Severe asthma or other respiratory insufficiency
Elevated intracranial pressure
Pregnancy
Hypotension, palpitations, flushing
Sedation, disorientation, euphoria, lightheadedness, dysphoria, lowered seizure threshold, tremors
Nausea, vomiting, constipation, biliary tract spasm
Urinary retention
Itching, rash, wheal formation
Respiratory depression and aggravation of asthma
ADVERSE
What is the most common Opiate Antagonists?
Naloxone (Narcan)
Used for complete or partial reversal of opioid-induced respiratory depression
What is a common physiological result of chronic opioid treatment?
Opioid tolerance
Definition
The physiological adaptation of the body
to the presence of an opioid
Physical Dependence
Definition
A pattern of compulsive drug use
characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief
Psychological Dependence
What is expected with long-term opioid treatment and should not be confused with psychological dependence (addiction)?
Opioid tolerance and physical dependence
Misunderstanding of these terms leads to ineffective pain management and contributes to the problem of undertreatment
What occurs when opioid are abruptly discontinued or when an opioid antagonist is administered
Opioid withdrawal (opioid abstinence syndrome) because the body has a physical dependence on them
Anxiety, irritability, chills and hot flashes, joint pain, lacrimation (teary), rhinorrhea(runny nose), diaphoresis, nausea, vomiting, abdominal cramps, diarrhea are symptoms of?
Withdrawal
What drug Has analgesic and antipyretic effects
Has little to no anti-inflammatory effects
Is available over-the-counter (OTC)
Is a component of many combination products with opioids?
Acetaminophen
Overdose, whether intentional or due to chronic unintentional misuse, can cause?
hepatic necrosis (liver)
Long-term ingestion of large doses of acetaminophen can also cause?
nephropathy (kidneys damage)
What is the recommended antidote to acetaminophen?
Acetylcysteine regimen
What is the Maximum daily dose of acetaminophen for healthy adults?
4000 mg per day
What are some interactions to Acetaminophen?
Alcohol use
Liver dysfunction
Possible liver failure
Other hepatotoxic drugs
Opioid Analgesics:Nursing Implications
What is the most significant nursing implication to opioid use?
Withhold dose and contact physician if there is a decline in the patient’s condition or if vital signs are abnormal, ESPECIALLY IF THE RESPIRATORY RATE IS LESS THAN 12 BREATHS/MIN
What is the most common adverse effect and may be prevented with adequate fluid and fibre intake
CONSTIPATION
Should vital signs change, patient’s condition decline, or pain continue a nurse should
contact physician immediately
Manifested by respiratory rate of less than 12 breaths/min, dyspnea, diminished breath sounds, or shallow breathing
Respiratory Depression
Definition-
Drugs that depress the central nervous system (CNS)
Anaesthetics
What are the two types of anaesthesia?
Two types:
General anaesthesia
Local anaesthesia
What are the effects of anaesthesia?
Depression of consciousness
Loss of responsiveness to sensory stimulation (including pain)
Muscle relaxation
Definition: Drugs that induce a state in which the CNS is altered to produce varying degrees of Depression of consciousness Skeletal muscle relaxation Visceral smooth muscle relaxation
General Anaesthetics
How is general anaestheia administered?
Inhaled anaesthetics-Volatile liquids or gases that are vaporized in oxygen and inhaled
Injectable anaesthetics-Administered intravenously
Inhaled Anaesthetics
What is an example of Inhaled gas
nitrous oxide (“laughing gas”)
Inhaled Anaesthetics
What is an example of Inhaled volatile liquids
halothane (Halothane)
isoflurane (Forane)
When would an Injectable Anaesthetics be used?
To induce or maintain general anaesthesia
To induce amnesia
To reduce anxiety
As an adjunct to inhalation-type anaesthetics
Which theory explains the more fat soluble the better it works?
Overton-Meyer theory
During surgical procedures general anaesthetics is used to produce
Unconsciousness
Skeletal muscular relaxation
Visceral smooth muscle relaxation
What are some General Anaesthetics: Contraindications?
Known drug allergy
Pregnancy (depending on drug type)
Narrow-angle glaucoma (depending on drug type)
Known susceptibility to malignant hyperthermia- genetic condition from prior experience with anaesthetics (depending on drug type)
General Anaesthetics: What are some possible Adverse Effects?
Primarily affect:
Heart, peripheral circulation, liver, kidneys, respiratory tract
Commonly include myocardial depression
Sudden elevation in body temperature (greater than 40°C)
Tachypnea, tachycardia, muscular rigidity
Life-threatening emergency
Very dangerous when given anasthesia
General Anaesthetics: Interactions
General anaesthetics are associated with a wide array of drug interactions varying in severity
More common drug–drug interactions occur with:
ANTIHYPERTENSIVES
β-blockers
Tetracycline
Blood pressure drugs
What would a Local Anaesthetics be used for?
Used to render a specific portion of the body insensitive to pain
Do not cause loss of consciousness
What are ways to administer Local Anaesthetics?
Topical-(Applied directly to skin or mucous membranes)
Parenteral- outside the GI tract-(Injected intravenously or into the CNS)
What are the two types of Local Anaesthetics?
- Central
- Spinal or intraspinal
- Intrathecal
- Epidural
- Peripheral
- Infiltration
- Nerve block
- Topical
What is a common form of a Parenteral Anaesthetic Drug?
lidocaine (Xylocaine)-freezing, used in combination with ephinephrine to keep it local
In what order would Local Anaesthetic Drugs Effect Paralysis?
First, autonomic activity is lost, then sensory, and motor last
As local drugs wear off, recovery occurs in reverse order (motor, sensory, and then autonomic activity)
What are Local anaesthetics are used for:
Surgical, dental, and diagnostic procedures
Treatment of certain types of chronic pain
What are some Local Anaesthetics: Contraindications
Contraindications include known drug allergy
Ophthalmic use requires specially designed dosage forms
What is a Local Anaesthetics: Adverse Effects
May include “spinal headache,” which is treated by an “epidural blood patch”
What does NMBAs stand for?
Neuromuscular Blocking Drugs
A neuromuscular blocking drug is used to?
Prevent nerve transmission in certain muscles, resulting in paralysis of the muscle
True or False
NMBAs cause sedation or relief of pain
FALSE
TRUE OR FALSE
When NMBAS are used during surgery, artificial mechanical ventilation is required
TRUE
TRUE or FALSE
Patient may be paralyzed yet conscious when NMBAs are used
TRUE
Drugs ending in AM such as diazepam,
lorazepam are what types of drugs
anti anxiety
Drugs ending in IUM such as
atracurium
nondepolarizing
Nondepolarizing NMBAs prevent ______ from acting at the neuromuscular junctions
ACh
A Short-acting NMBAs is mainly used for ?
endotracheal intubation
What are some contraindications to NMBAs?
Known drug allergy
Previous history of malignant hyperthermia
Penetrating eye injuries
Narrow-angle glaucoma
Overdose of a NMBA can cause?
prolonged paralysis
What are the main things to know about NMBAs?
- Lots of drugs interact with neuromuscular drugs
- Causes Paralysis
- Can feel pain
- Doesn’t treat pain
Moderate Sedation is also known as?
conscious sedation
During moderate/conscious sedation a combination of ______________and an _______ is often used.
intravenous (IV) Benzodiazepine and Opiate analgesic
Used for diagnostic procedures and minor surgical procedures that do not require deep anaesthesia
Moderate sedation
What are some adverse effects to NMBAs
Hypotension (blockade of autonomic ganglia)
Tachycardia (blockade of muscarinic receptors)
Hypotension (release of histamine)
Assessment is vital during pre-, intra-, and postoperative phases of sedation. What would you assess for?
Vital signs Baseline laboratory tests, electrocardiogram Pulse oximetry ABCs (airway, breathing, circulation) All body systems
Nursing considerations during the perioperative phase include what three phases?
Preoperative phase
Intraoperative phase
Postoperative phase
What do we monitor during recovery?
During recovery, monitor for cardiovascular depression, respiratory depression, and complications of anaesthesia
During conscious sedation it preserves the patient’s ability to maintain____________________.
own airway and to respond to verbal commands
-First sensation felt is muscle weakness
-This is followed by total flaccid paralysis
Small, rapidly moving muscles (fingers, eyes) are affected first, and then limbs, neck, trunk
-Finally, intercostal muscles and the diaphragm are affected, resulting in cessation of respirations
-Recovery of muscular activity usually occurs in reverse order
-Transient muscle fasciculations may result in later muscle soreness
NMBAs
