Med-Surge Exam 1 Flashcards
HIPAA
Health Insurance Portability and Accountability Act
- Federal legislation developed to protect the right of confidentiality.- efforts must be made to protect each patient’s private health information (PHI), whether it is transmitted by verbal, written, or electronic means of communication. Communication should be confined to the appropriate settings and with appropriate individuals and should occur for the appropriate purposes of facilitating patient care. Violations of protection of any patient’s privacy could result in criminal or civil litigation.
Pain Management
Effective pain management includes the use of pharmacological and
nonpharmacological pain management therapies.
- Clients have a right to adequate assessment and management of pain. Nurses are accountable
for the assessment of pain. Professional organizations and The Joint Commission have mandates
requiring pain assessment and management. The nurse’s role is that of an advocate, member of
the health care team, and educator for effective pain management.
Nonpharmacological pain strategies
help to improve coping by relieving stress associated with
pain. These strategies can assist clients in reducing the amount of pharmacological interventions
for pain and are particularly helpful when clients cannot take pain medication.
- Clients might choose nonpharmacological complementary and alternative measures to manage
pain.
- Mind-body practices (yoga, chiropractic manipulation)
- Cognitive approaches (meditation, distraction)
- Natural products (herbs, oils)
Non-opioid analgesics
-Treating mild to moderate pain,
-Often added
to opioids for treatment for more intense pain.
-have antipyretic and
anti-inflammatory properties.
- Acetaminophen often used alone or in combination with other mediations.
- Ensure total amount of acetaminophen does not exceed 4 g for
clients 50 kg (110 lb) or greater.
- It is safe to administer acetaminophen concurrently with NSAIDS (ibuprofen, aspirin, celecoxib,
naproxen, ketorolac), because the medications act in different ways.
-NSAIDs have considerably more adverse effects than acetaminophen, with gastric toxicity and ulceration being the most common
Opioid analgesics
-For treating moderate to severe pain.
- Opioid analgesics for moderate pain include hydrocodone, and codeine.
- Hydromorphone, fentanyl, morphine, oxycodone, or methadone are effects for more severe
pain.
-Morphine is the opioid most used and other opioid effects are compared to the effects of morphine.
- Opioids are available in oral, subcutaneous, intramuscular, intravenously, intrathecal,
transdermal, transmucosal, and buccal routes.
Opioid Adverse Effects
-Constipation:
- Orthostatic hypotension:
- Urinary retention:
- Nausea/vomiting:
- Sedation:
- Respiratory depression
PCA Pump Care and Management
-PCA is a medication delivery system that allows clients to self-administer safe doses of
opioids.
- Small, frequent dosing ensures consistent plasma levels.
- Clients have less lag time between identified need and delivery of medication, which increases their sense of control and can decrease the amount of medication they need.
- Morphine and hydromorphone are typical opioids for PCA delivery.
- To prevent inadvertent overdosing, the client is the only person who should push the PCA button.
- The primary benefit of PCA is that - Only the patient feels the pain and knows how much analgesic will relieve it.
Obesity
-BMI of 25-29.9 is considered overweight.
- Obesity is defined as a BMI greater than 30
-Class II obesity (BMI 35 to 39.9 kg/m2)
- Class III/severe/extreme obesity (i.e., BMI in excess of 40 kg/m2)
Medical Management of Obesity
-Lifestyle modification
-pharmacologic management,
-nonsurgical or surgical interventions.
Obesity Lifestyle MODS
The U.S. Preventive Services Task Force (USPSTF) recommends that all adults with BMIs in excess of 30 kg/m2 be advised to engage in multicomponent
behavioral interventions that include
- Setting weight loss goals,
- Improving lifestyle behaviors (e.g., diet habits, physical activity),
- Addressing barriers to change
- Obesity Pharmacological interventions
Antiobesity medications work by either inhibiting GI absorption of fats, or by altering central
brain receptors to enhance satiety or reduce cravings.
Obesity surgical and Minimally invasive therapies.
vagal blocking therapy, intragastric balloon therapy,
bariatric surgical interventions
PPE
-Chemical or biologic agents and radiation are silent killers and are generally colorless and odorless. The purpose of PPE is to shield health care workers from the chemical, physical, biologic, and radiologic hazards that may exist when caring for patients who have been contaminated or who can spread contagion.
PPE LEVEL A
Level A protection is worn when the highest level of respiratory, skin, eye, and mucous
membrane protection is required. This includes a self-contained breathing apparatus (SCBA) and
a fully encapsulating, vapor-tight, chemical-resistant suit with chemical-resistant gloves and
boots.
PPE Level B
Level B protection requires the highest level of respiratory protection but a lesser level of skin and eye protection than with level A situations. This level of protection includes the SCBA and a chemical-resistant suit, but the suit is not vapor tight.
PPE Level C
Level C protection requires an air-purified respirator, which uses filters or sorbent materials to remove harmful substances from the air. A chemical-resistant coverall with splash hood, chemical-resistant gloves, and boots are included in level C protection.
PPE Level D
Level D protection is the typical work uniform and is used for nuisance contamination only; it
does not provide adequate protection in cases in which respiratory or skin threats are present. Other PPE such as gloves or mask may be required based on the situation.
PPE
Levels C and D are most often used in hospitals. Order for Removal - Gloves - Gown - Hand Hygiene - face shield/ goggles - Face mask/respirator.
Pain Med Prescription Guidelines
Many factors are considered when determining the appropriate opioid analgesic agent for the
patient with pain.
-The unique characteristics of the various opioids and patient factors, such as pain intensity, age, coexisting disease, current medication regimen and potential
medication interactions, prior treatment outcomes, and patient preference.
-In all cases, a multimodal approach that may rely on the selection of appropriate analgesic agents from the
nonopioid, opioid, and co-analgesic agent groups is recommended to manage all types of pain.
Pain Med Dose
Titration of the opioid dose is usually required at the start and throughout the course of treatment when opioids are given. Whereas patients with cancer pain most often are titrated
upward over time for progressive pain, patients with acute pain, particularly postoperative pain, are eventually titrated downward and discontinued as pain resolves. The absolute dose given is based on a balance between pain relief and tolerability of adverse effects. The goal of titration is to use the smallest dose that provides satisfactory pain
relief with the fewest adverse effects. The time at which the dose can be increased is
determined by the onset and peak effects of the opioid and its formulation.
Physical Health Assessment
- The components of a physical examination include general observations and then a more focused assessment of the pertinent body systems.
- General inspection begins with the first contact with the patient.
-The recording of vital signs is a part of every physical examination. Blood pressure, pulse rate, respiratory rate, and body temperature measurements are obtained and recorded. Pain is also assessed.
-Skin -Head and neck -Thorax and lungs -Breasts -Cardiovascular system -Abdomen - Rectum -Genitalia
-Neurologic system -Musculoskeletal system
-The traditional sequence in the focused portion of the examination is inspection, palpation, percussion, and then auscultation, except in the case of an abdominal examination (in which auscultation precedes palpation and percussion).
