NURS 255 Exam 4 Flashcards
Origin of pain (6 types)
- Cutaneous
- Deep somatic
- Visceral
- Radiating/Referred (moves)
- Phantom
- Psychogenic (Arises from the mind)
Causes of pain (2 types)
- Nociceptive
- Neuropathic
Durations of pain (3 Types)
- Acute
- Neuropathic
- Intractable
Descriptions of pain (3 types)
- Quality
- Periodicity
- Intensity
Factors that influence pain (6 factors)
- Emotions
- Past experience with pain
- Developmental stage
- Sociocultural factors
- Communication skills
- Cognitive impairments
Non-pharmalogical measures of pain management (What are 11 ways pain can be managed)
- Transcutaneous electrical nerve stimulation (TENS)
- Percutaneous electrical nerve stimulation (PENS)
- Spinal cord stimulator (SCS)
- Acupuncture
- Acupressure
- Message
- Use of heat and cold
- Contralateral stimulation
- Immobilization and traction
- Guided imagery
- Animal assisted therapy
- Expressive writing
Pharmacological measures of pain management (3 Types of medications)
- Non-opioid analgesics
- NSAIDs
- Acetaminophen - Adjuvant analgesics
- Opioid analgesics
- IV’s, transdermal patches, and epidural forms
What should you do if a patient is suspected of drug seeking?
- It is not your job to determine whether the person should or should not have the medication
What factors influence Oxygenation (11 factors)
- Lifespan and development
- Environment
- Lifestyle
- Smoking
- Medications
- URI’s
- LRi’s
- Pulmonary system abnormalities
- Pulmonary circulation abnormalities
- Neuromuscular abnormalities
Assessing oxygen status (11 ways to assess)
- Type of cough
- Allergies
- URI
- Airway obstruction/constriction
- Sputum
- Sputum samples (Organisms present)
- Pulse oximetry (Measures SPO2)
- Capnography (Measures CO2)
- Spirometry (lung capacity)
- Arterial blood gasses (CO2 and O2 in blood)
- Peak flow monitoring
What are some Bronchodilators (3)
- Beta-2 adrenergic agonists
- Anticholinergics
- Methylxathine
(Ventolin, Albuterol)
What are some Respiratory Anti-inflammatory agents (3)
- Corticosteroids
- Cromolyn
- Leukotriene modifiers
(Pulmicort, Flovent)
What are some Nasal Decongestants (3)
- Ephedrine
- Pseudoephedrine
- Phenylephrine
What are some Antihistamines (6)
- Diphenhydramine
- Chlorpheniramine
- Brompheniramine
- Loratadine
- Fexofenadine
- Cetirizine
(Benadryl, Zyrtec, Claritin)
Expectorants (What are they)
- They are used to help thin mucous.
What type of cough can cough suppressants be used on?
A dry cough only
Factors that influence Cardiac Function (7 Factors)
- Developmental stage
- Environment
- Lifestyle
- Medications
- Cardiovascular abnormalities
- Peripheral vascular abnormalities
- Oxygen Transport Abnormalities
Cardiac Nursing Diagnosis (5 possible diagnosis)
- Decreased cardiac output
- Risk for Impaired cardiac tissue perfusion
- Risk for impaired cerebral, gastrointestinal or renal tissue perfusion
- Impaired peripheral tissue perfusion
- Risk for shock
What are some Vasodilators (3)
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin ll receptor blockers
- Nitrates
What are some Beta-andrenergic blockers. (2)
- Beta selective (Atenolol, Metoprolol)
- Nonselective (Carvedilol, Metoprolol, Propranolol)
What are some Calcium channel-blockers (1)
- Nifedipine
What are some diuretics (5)
- Thiazide (hydrochlorothiazide)
- Loop Diuretics (Furosemide)
- Potassium-Sparing (spironolactone)
- Bemetanide
- Metolazone
- Triamterene
What are some Anticoagulants? (5)
- Heparin
- Warfarin
- Lovenox
- Xarelto
- Eliquis
What is the order air travels into the lungs?
- Nasal cavity
- Nasopharynx
- Larynx
- Trachea
- Primary brochus
- Bronchioles
- Alveoli
What are type 1 and type 2 alveoli
- Type 1 are gas exchange cells
- Type 2 are surfactant producing
What does hyperventilation cause
- A decrease in oxygen in the lungs
Kussmaul’s respirations (What are they)
- Regular respirations but increased in rate and abnormally deep. May be to compensate for metabolic disorders that lower blood pH as well as a form of hyperventilation caused by fear anxiety or panic.
Biot’s Respirations (What are they)
- Irregular respirations but increased in rate and abnormally deep. These may be alternating with periods of apnea (usually this is caused by damage to the medullary respirations centre or high intracranial pressures.
Cheyne-Stokes Respirations What are they?
- Gradual increase in depth of respirations, followed by a gradual decrease in depth, then a period of apnea. Damage to medulla or high intracranial pressure.
What is the normal SPO2%?
95-100% (values below 94% are abnormal in most people)
What is the normal P02 range
- 80-100 in arteries
- 40 in veins
What are the 5 A’s for treating Tobacco dependence?
- Ask about Tobacco use
- Advise to quit
- Assess willingness to quit
- Assist in a quit attempt
- Arrange a follow up
What are endogenous opioids?
- Opioids that are naturally occurring in the body
What can unrelieved pain do to the EN, CV, and MSK systems of the body?
- Endocrine: can trigger the release of endless hormones. Reduces testosterone and insulin levels
- Cardiovascular: Hyper-coagulation and high heart rate, blood pressure, cardiac workload and oxygen demand.
- Musculoskeletal: Fatigue, immobility and impairment of ADL’s
What can unrelieved pain do to the RS, GU, and GI systems of the body?
- Respiratory: Shallow breathing (Splinting), Reduces tidal volume. Increased inspiratory and expiratory pressures. Acidosis
- Genitourinary: High catecholamines, aldosterone, ADH, Cortisol, Angiotensin ll, Prostoplanigans. Urine retention, hypertension.
- Gastrointestinal: Intestinal secretions, smooth muscle tone increase, gastric emptying increases.
Steps to Create a pain management plan 3
- Diagnosis: Specify the location of pain and any etiological or precipitating factors that you are aware of.
- Planning: for acute pain (pain control, pain level, and comfort status: Physical) for chronic pain (Previous ones, depression level, adverse psychological response, disruptive effects)
- Implementation: each situation is unique, most effective and least invasive method, include non pharmacological interventions, use interventions that address pain.
Addiction (definition)
- a state of psychological dependence In which a person uses a drug compulsively and will engage in self destructive behaviour to obtain a drug even when they cause themselves or others harm.
What should be screened for when assessing potential drug misuse (5 things to watch for)
- Illegal drug use/ prescription drug use for non medical reasons
- History of substance abuse
- Mental health conditions
- Sleep disordered breathing
- Concurrent benzodiazepine use
What screening Tools exist for Drug misuse (3 systems)
- ORT: yes/no risk report designed to predict a patients tendency for aberrant behaviours when prescribed opioids
- SOAPP: more detailed than above and meant for patients with long term opioid use
- COMM: Meant to assess opioid misuse among patients currently taking long term opioids
What are 4 misuse behaviours?
- Repeated requests or high dosage
- Refusal to try oral doses
- “Doctor shopping” asking multiple for drugs
- “Pharmacy shopping” Asking multiple to dispense for them
What 3 things should be EVALUATED in a pain management plan
- Are the patients scores consistently at or below the desired level
- Is the patients behaviour, mobility, range of motion, mood, sleep and or affect consistent with pain relief
- What is the quality of the patients life according to the patients standards.
Using a PCA machine (Step 1-5)
- Don protective gloves (and insert iv if not already)
- Obtain medication
- Double check dose
- Prime tubing then clamp
- Insert the cartridge or vial
Using a PCA machine (Step 6-10)
- Turn pump on and set parameters
- Scrub the port on the IV (and connect tubing)
- Open the clamp and administer first dose
- Close pump door and lock machine
- Check for flashing lights
Using a PCA machine (Step 11-13)
- Release tubing clamps
- Ensure battery life is sufficient
- Place control button on bed
What should the patient be taught about a PCA Machine before use?
- Safe use
- Benefits
- Only the prescribed amount is delivered
- Patient cant roll over button
- If pain is not alleviated tell the nurse
- Pump will alarm when empty
- Button is to relieve pain not help sleep
- Signs of allergic reaction should be reported
- How to rate pain with a scale
- Patient is the only one allowed to use button
TEACH ALL OF THIS BEFORE SURGERY NOT AFTER!!!!!!!
Steps to Administering oxygen (Step 1-5)
- Attach the flow meter
- Assemble hose and equipment
- Attach humidifier (if using)
- Turn on the oxygen
- Attach nasal cannula tubing (NASAL)
Steps to administering oxygen (Step 6-9)
- Place nasal prongs in the nose (NASAL)
- Use slide adjustment device (NASAL
- Gently place mask (FACE MASK)
- Secure elastic band (FACE MASK)
Steps to administering oxygen (Step 10-13)
- Gently place face tent (TENT MASK)
- Secure elastic band (TENT MASK)
- Double check oxygen setup
- Assess respiratory status before leaving the room
What should a patient be evaluate before leaving patient with oxygen? (6 things)
- Take vitals before leaving
- Check breath sounds before leaving then every 2-4 hours
- Monitor pulse oximetry until respiratory status improves
- Monitor ABG if prescribed
- Evaluate for skin breakdown especially behind ears cheekbones and under chin
- Notify provider of respiratory status, oxygen, and response and any additional prescriptions needed
Angiogram (What is it?)
- A contrast dye that is injected into a vein and serial films are taken to assess patency of the vessels
Arterial Blood Gasses (ABG) (What is it?)
- An analysis of arterial blood evaluates the effectiveness of gas exchange and perfusion
Cardiac Catheterization (What is it?)
- A catheter is threaded through the blood vessels into the heart to assess pressures, blood flow, and size and patency of chambers
Chest X-Ray (What is it?)
- Provides an anterior, posterior or lateral view of the heart and lungs, shows tissue density.
Cholesterol, lipid profile (What is it?)
- Indicates risk for cardiovascular disease long term
Creatine Kinase MB (What is it?)
- The MB isoenzyme is only in the heart muscle. A serum measurement of the MB band is used to detect a myocardial infarction. Levels rise with acute MI
Echocardiogram (What is it?)
- An ultrasound evaluation of the heart that examines heart function and blood flow
Electrocardiogram (What is it?)
- Electrodes placed on the extremities and chest wall conduct electrical activity from the heart. ECG illustrates heart rate, rhythm, and size and helps evaluate heart damage
Hemoglobin (What is it?)
- A serum measurement that affects the oxygen carrying capacity of the blood, may be measured separately or as part of of a complete blood count.
Holter monitor (What is it?)
- A continuous ECG tracing used to correlate symptoms and cardiac activity. typically the tracing lasts 48 to 7 days
Magnetic resonance angiography (MRA)
- Powerful magnetic field and radio frequency waves are used to evaluate blood vessels and help identify abnormalities. This examination is noninvasive and does not use radiation
Technetium scan (What is it?)
- Techtinium-99m sestamibi is injected intravenously. Approximately 90 to 120 minutes later, the heart is scanned. Areas of myocardial damage appear as “hot spots” on the scan.
Treadmill test (What is it?)
- Evaluates the effectiveness of exercise on the heart and circulation via continuous ECG and vital sign monitoring during exercise.
Troponin (What is it?)
- A serum evaluation of a complex of proteins is used to detect MI. levels of these contractile proteins remain elevated for up to 7 days after MI
Ultrasound (Doppler) What is it?
- A transducer, which directs high frequency sound waves to the artery of vein, is used to examine blood flow. A normal result shows no areas of narrowing or closure in the blood vessels
Venography (What is it?)
- Using dye and X-ray technology, a narrow tube (Catheter) is inserted into a large vein to identify any blood clots or unusual narrowing or blockage of venous blood flow.
VQ scan (What is it?)
- Used to detect a blood clot in the lungs
