M3 F/E Comfort Flashcards
Nociceptive vs Neuropathic
Nociceptive - pain response to noxious stimuli, “normal” pain
Neuropathic - abnormal processing of sensory input by nerves
NSAIDS that inhibit both COX 1 and 2
NSIAD that inhibits only COX 2
Ibuprofen, naproxen, diclofenac, ketorolac
Celecoxib
FACES pain scale can be used in children as young as
3
OPQRST
Onset
Provocation
Quality
Region/Radiation
Severity
Time
Hierarchy of pain measures
Attempt to obtain report
Consider pt condition
Observe - grimace, crying, restlessness
Observe vitals
Conduct analgesic trial
FLACC
For young children
Facial expression
Leg movement
Activity
Crying
Consolability
PAINAD
FLACC for patient sin AD
advanced dementia
CPOT
For patients in critical care who can not self report
Patterned after FLACC
Max acetaminophen
4000mg
Max ibuprofen
3200mg
NSAID toxicity effects
Gastric bleeding
Ulcerations
NSAIDS inhibit prostaglandins which can cause
Cardio Vascular problems
MI
pt with CAD
Coronary artery disease
can take NSAIDS?
NO
Opioid mu agonist
Opioid mu antagonist
Morphine
Hydromorphone
Fentanyl
Naloxone
Opioid induced hyperalgesia
Pain due to opioid meds
Drug used to wean people off opioids
Methadone
Basic adverse effects of opioids
NV
Pruritus
Hypotention
Constipation
Major opioid effects
Over sedation
Respiratory distress
Med to prevent nausea
GOOD FOR POST OP
Ondansetron
in pt with pruritus post op due to opioids, give
or
antihistamines - loratadine, cetirizine
just lower the opioid given
Recover pt from resp depression and over sedation using what drug
Naloxone
Pasero opioid scale
S-sleep easy to arouse
1 - awake/alert
2 - slightly drowsy, easy to arouse
3 - frequently drowsy, drifts off during conversation (UNACCEPTABLE)
4 - Somnolent not responsive (UNACCEPTABLE)
Neuropathic pain first line meds
Anticonvulsant
GABApentin and pregabalin
calcium channel blockers
NSAID or Acetaminophen for older adults
Acetaminophen
Greater risk for bleeds with nsaids
Acute kidney injury
Rapid loss of renal function
can result in metabolic acidosis and electrolyte imbalances like HYPERKALEMIA
Urine with AKI can be
Normal
Oliguria
Anuria
Oliguria numbers
Less than 400ml a day
Anuria
Less than 50ml a day
AKI can be caused by
hypovolemia
hypotension
reduced cardiac output
obstruction of kidney tubes by tumor, blood clot, kidney stone
AKI and RIFLE classification system
Risk
Injury
Failure
Loss
ESKD
GFM
ESKD
Glomerular filtration rate
End stage kidney disease
RIF
Risk - creatinine 1.5x baseline, GFR v 25%
Injury - creatinine 2x baseline, GFR v 50%
Failure - creatinine 3x baseline, GFR v 75%
LE
Loss - persistent acute kidney injury longer than 4 weeks
ESKD - injury longer than 3months
Phases of AKI
Initiation
Oliguria
Diuresis
Recovery
Initiation - start
Oliguria - serum concentration develops, THIS IS WHERE HYPERKALEMIA STARTS
Diuresis - glomerular filtration starts to recover, risk for dehydration which will re-raise creatinine and BUN
Recovery - 3-12 months for renal return, 1-3% reduction in GFR
AKI S/S
Oliguria
Anuria
Hypoperfusion
Shock
Low specific gravity
high BUN
HYPERKALEMIA
METABOLIC ACIDOSIS
Hyperkalemia leads to
Monitor
Cardiac arrhythmias
Ventricular tachycardia
Cardiac arrest
HEART
Metabolic acidosis occurs in AKI because
Kidney cant get rid of acid type metabolic waste
RRT
renal replacement therapy
AKI risk factors
Severity of injury
RRT requirement
Age
Comorbidities - kidney vascular respiratory diseases
Antibiotic med that impact kidneys
VamcoMYCIN
GentaMYCIN
TobraMYCIN
cyclosporine
Interstitial nephritis - inflammation in kidney can also be caused by what analgesic
NSAID’s
Managing AKI
Fluid balance based on daily weight
Monitor for fluid excess - give furosemide (diuretic)
Dialysis - hemodialysis HD or CRRT
Fluid excess indicators
Dyspnea
Tachycardia
Crackles
Distended neck veins
CRRT
Continuous renal replacement therapy
Most lifethreatening problems with AKI
Hyperkalemia
ECG to watch for in hyperkalemia
Tall, tented or peaked T waves
Hyperkalemia S/S
MURDER
Muscle weakness
Urine output increase
Respiratory failure
Decreased cardiac contractility -v in HR and pulse
Early on muscle twitches and cramps
Rhythm changes - Peak T waves, Prolonged PR interval
As potassium level rises cardiac and other muscle function
DECLINES
MED EMERGENCY
Med for hyperkalemia
take _h to work
Kayexalate
(sodium polystyrene sulfonate)
6
When ECG changes occur with hyperkalemia give this combination IV
it will
watch for
arrange for
Dex50%
Insulin
Calcium
shift potassium back to cells
hypoglycemia
emergency dialysis
AKI pt may go into metabolic acidosis, may need what med
Sodium bicarbonate
In AKI, phosphate may rise, control with
calcium
hyperphosphatemia S/S
same as hypocalcemia
Paresthesia
Tetany
cramps
spasms
Numbness around MOUTH (CIRCUMORAL)
If pt gains or does not lose weight with AKI suspect
hypertension
AKI diet
what not to eat
High CARB, will spare protein for recovery
NO sodium potassium or phosphorus
(bananas, citrus or dairy)
Nursing with AKI
Monitor Fluids and Electrolytes -know aforementioned S/S
Reduce metabolic rate -by preventing infections, do blood and urine cultures regularly and act promptly
Promote pulmonary function -turn cough and prevent atelectasis
Provide skin care -breakdown due to edema, excoriation due to deposits, bathe in cool water
Reduce metabolic rate AKI
-by preventing infections, do blood and urine cultures regularly and act promptly
Promote pulmonary function AKI
turn cough and prevent atelectasis
Provide skin care
-breakdown due to edema, excoriation due to deposits, bathe in cool water
Erythropoietin is produced by the kidneys so a chronic kidney disease will result in
ANEMIA
What electrolytes go up with Kidney diseases
Potassium Sodium Phosphorus
With kidney failure, an increase in urea causes blood uremia. This damages what organ and creates what injurys
Heart
Pericarditis - s/s friction rub
Pericardial effusion/tamponade - s/s paradoxical pulse, hypotension, JVD
1 complication of dialisis and CKD
Cardiovascular disease
other dialysis complications that are worsened by procedure
HF
CAD
Stroke
When pt is on dialysis give meds
AFTER
Propofol med type
Anesthetic
B2 agonists and K+
Decrease potassium levels
GABApentin and other anticonvulsant Calcium Chanel Blockers can be used for what pain
BURNS
First thing to give a pt suspected of MI
other MI meds
Low dose aspirin
beta blockers
ace inhibitors
HF
Heart failure 101
heart is unable to pump enough blood to meet body’s needs
Primary cause of HF
CAD
deprives heart of O2
Other causes of HF
MIs
Hypertension
Cardiomyopathy (disease of myocardium)
Valvular failure
Kidney failure