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2.0 Adult Nursing Final > Pain > Flashcards

Pain Flashcards

1
Q

Guide patient safety & welfare

A

Explain the procedure & what to expect

Monitor vitals

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2
Q

Minimize negative psychological responses to treatment with analgesia and maximize amnesia

A

Minimize fear having to do with the procedure.

And discuss medication they’ll be receiving

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3
Q

Minimize physical discomfort…

A

Before and after the procedure

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4
Q

Control behavior

A

Make sure procedure goes smoothly essenitally

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5
Q

Criteria for discharge

A

Swallow eval to see if they can drink water
AO
Stable vitals
Able to pass gas & urinate (listen to bowel sounds and check voiding)

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6
Q

Five things we use to choose the Level of Sedation for patients?

A

Airway control
- the type of surgery may need more airway control by intubation

Respiratory responsiveness

Gross motor skill

Level of awareness

Responsiveness to stimuli

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7
Q

Minimal light sedation

Responsiveness
Airway
Spontaneous vent
Cardiovascular

A

Normal response
Unaffected airway
Unaffected spontaneous vent
Unaffected cardiovascular

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8
Q

Moderate sedation

Responsiveness
Airway
Spontaneous vent
Cardiovascular

A

Purposeful response to verbal or tactile stimuli
No intervention need for airway
Adequate spontaneous vent
Usually maintained cardiovascular

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9
Q

Deep Sedation

Responsiveness
Airway
Spontaneous vent
Cardiovascular

A

Purpose response to repeated or painful stimuli
Intervention needed for airway
Compromised Spontaneous vent
Usually maintained cardiovascular

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10
Q

General Anesthesia

Responsiveness
Airway
Spontaneous vent
Cardiovascular

A

Unarousable response
Intervention needed for airway
Compromised spontaneous vent often
Impaired cardiovascular

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11
Q

What size of IV do you need to start for patient beforehand to prepare

A

Large iv that is patent

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12
Q

What equipment can you get ready before the proceudre

A

Gloves
Art line
Bronch

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13
Q

What dietary status do you need to make sure to keep patient on to prepare for procedure

A

NPO unless the physicians says otherwise. Document the last intake.
And document any meds you take & document the meds you didn’t give.
- we do this bc it can cause aspiration

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14
Q

What nature of an assessment are we supposed to do before a procedure?

A

Baseline assessments so we have a comparison

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15
Q

What types of consent do we need before the procedure?

And what do you need to consider

A

Informed consent in chart

Condier if the patient can sign? or is DPOA needed?
Emergency basis signing is allowed.

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16
Q

What types of instructions need to be given? And when?

A

Verbal & written instructions given post sedation

- for side effects and expectations

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17
Q

How far back do you need to document for food intake?

A

Just do the last known intake

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18
Q

What do you need to document?

A 
Informed consent
Instructions done
Food intake
Vital signs
Review of systems
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19
Q

What is review of systems?

A

Age & weight
Allergies
Meds & if they took them. Any NPO exceptions?
Holding any meds? So they know what to give after.
Disease & expected outcomes
Previous hospitalizations
Hx of sedation or anesthesia issues

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20
Q

On site equipment

A 
Standard sizes for general stuff
Positive pressure 
Suctions
Ambu
NIBP 5-15 min
O2 sat
Capnography for co2 of 35-45
Emergency kit
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21
Q

Are you ready pneumonic

A 
D-drugs
E - emergency
M - monitoring
O - oxygen
S - suction
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22
Q

Drugs you want in the room

A

Versed
Fent
Flumazemil
Narcan

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23
Q

Discharge criteria

A

Cardiovascular & airway function has to be good enough

  • what are their o2 levels
  • can they sustain respirations?

Are they AO?

Can they talk and verbalize?

Can they sit un-aided like they were before sedation? - can they hold their head up

Are they hydrated enough to where the meds are flushed out of their system.

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24
Q

What is Midazolam other name and the drug class?

A

Versed

Which is a benzodiazepine drug.

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25
What does Midazolam provide
Immobility Sedation Amnesia Antianxiety
26
Is Midazolam primary or secondary agent
Secondary - used with Fentanyl
27
procedures that use Midazolam
Bedside procedure TEE Colonoscopy
28
Type of monitoring for Midazolam
Cardiac monitoring
29
Side effect of midazolom intranasal route
Burns for 10-15 min
30
If you give a patient Midazolam, what is a pre-requirement?
Ability to support their airway
31
Midazlom antidote And its contraindication?
Flumazenil | - contraindicated in those with epilepsy/seizures
32
Patient is desatting while on Midazolam. You give Flumazenil. Why or why not would this be beneficial?
Flumazenil is the antidote for benzos like Midazolam but it won't stop hypoventilation or breathing problems. - it just reverses the sedation. need to give them extra respiratory support
33
Onset & duration of Flumaezenil?
Rapid onset | Lasts 1 hour duration
34
How fast should you push Flumazenil?
Push slow bc it burns. 30 sec to 1 min
35
Morphine pros
Analgesic Sedation Some immobility
36
How fast should you give morphine IV? How should you titrate?
Push it slow so the patient doesn't end up slumped over | Titrate to effect at the lowest rate.
37
You give a patient morphine. How long does it take for them to expereince repsiratory depression?
Peak is at 20 minutes - so monitor them closely.
38
Rxn to morphine?
Histamine release but its not an allergy. | - itching, flushing, rash, hives.
39
Bad side effects of morphine
Respiratory depression & hypotension
40
Morphine antidote
Nalaxone or Narcan
41
Which is more potent : morphine or fent?
Fent by 100x
42
Routes available for Fentanyl?
Oral IM IV
43
How do we titrate Fentanyl?
Titrate to effect | Start at 1-2 mcg to begin with. Lowest dose.
44
Fentanyl onset & duration
Onset it rapid 1-5 minutes | Duration of 30 min to 1 hour
45
Fentanyl antidote
Naloxone or narcan
46
What speed do we push Fentanyl and why?
Give slow - can cause chest or skeletal muscle rigidity and affect breathing.
47
How does Narcan work? And how does that implicate the patient & us?
Displaces opioids at the receptor site - which means they will feel the pain that the opiate was covering up. - protect yourself
48
How fast do we give Narcan
slowly
49
Narcan onset and duration
Onset is 2 min. | Duration is 15-60 minutes
50
How often can you repeat narcan
Repeat every 2-3 minutes
51
What is Ketamine (Ketolar)
Dissociative Anesthetic general anesthetic that doesn't make someone unconscious but has catalepsy, catatonia, and amnesia. They will look awake but they really aren't. Educate family catalepsy = fixed posture
52
Can you use Ketamine for pain?
Probably not. it has those properties but don't rely on it for analegesia
53
Vital signs for Ketamine
Increase HR, BP, CO, & ICP | - monitor these
54
What medication will we use in combination with Ketamine & why?
``` Use glycopyrrolate (robinul) or atropine Due to increase of secretions from ketamine & to avoid aspiration ```
55
Precedex or Dexmedetomindine
Light sedation anxiolytic and can be aroused from it.
56
How long should a a Precedex drip go for
24 hours | - but not a significant issue if its longer
57
Precedex onset for PO & IV Half life Duration
PO 30 minutes IV 10 minutes Half life 6 minutes Duration 4 hours
58
Side effects of precedex
n/v hypotension bradycardia
59
Precedex side effects treatment if we decide to continue tx
(hypotension & brady) fluids, pressors, atropine
60
What is Propfol
Hypnotic agent w little analgesic | Can be helpful in decreasing oxygen consumption
61
Propofol route What other med do we give if we push?
IV only which can be painful if pushed | - use lidocaine
62
Propofol onset
Onset if 30-60 seconds | - which is helpful for when patients start bucking the vent bc we can titrate it quickly
63
IV needed for Propofol
Large, secure IV
64
You see your bottle of propofol is almost empty. What do you need to do
Go pull it. Do not wait for it to empty because it doesn't take very long for the patient to stop feeling the effects and bucking the vent
65
Propofol is a lipid emulsion. Why is this important for you to consider?
You will have to change tubing every 12 hours. | Monitor triglycerides since it is lipid based & if they are too high, we have to get a new med.
66
What age group is Propofol not approved for
Not approved for those under 12. | - up to doctor discretion
67
Propofol side effect
Hypotension so be diligient about checking q15 vitals | - and if it drops, you will have to titrate it
68
What does the Nurse practice act say about pushing propofol
``` We have to take a sedation class before pushing it. If we don't, we cannot push propofol. Doctor has to be there in the room & has to be certified too. ```
69
What is PRIS or propofol related infusion syndrome? What labs?
Propofol impairs ability to use fatty acids and so it leads to catabolism and muscle necrosis which elevated creatinine kinase and myoglobin
70
What happens if PRIS occurs in critical conditions
Cardiac failure Rhabdomyolosis Metabolic acidosis Renal failure
71
What to watch for for PRIS clues?
Elevated CK Lactic acidosis Hypotension ST segment elevation early intervention is very important.
72
Etomidate is used for __
RSI and allows for quick intubation
73
Etomidate effects on the cardiorespiratory and hemodynamics of a patient include?
Trick question. Etomidate doesn't usually harm anything. It does lower cerebral blood flow by 20-30% and reduces ICP. - not too big of a concern tho bc it works fast
74
Can Etomidate help with pain?
No analgeisc properties
75
With any type of sedation, what titration trend do we want to follow?
Start with low dose and titrate up.
76
Does everyone respond the same to these medications?
No! Respect that.
77
Make sure you have a plan..
Know plan A, B, C.. etc.
78
Mark all your ..
Synringes. And know all your drugs.
79
What is the purpose of using a continuous sedation regiment in adults in icu?
Help deliver oxygen to them in general through vent maybe | Decrease the amount of O2 they are using as well.
80
Which meds are used for continuous sedation
``` Barbiturates or pentobarbital Propofol Benzos - Ativan/Lorazepam onset of 15-20 minutes but can last 6-8 hrs Morphine Fentanyl ```
81
Why is level of sedation controversial
bc we want them to be sedated all the way
82
sedation vs analgesia
they are not the same & we shouldn't act like they are.
83
Sedation holidays/vacation
For sponteanous breathing & weaning them off the sedation when taking them off vent. - do not titrate down ; you turn it off!!!
84
Neuromusuclar blockades are sedation T/F
false.
85
What do we measure for those neuromuscular blockades
Train of four
86
why do we limit for neuromuscular blockades duration
muscle weakness
87
Nurse practice act
Physician needs to be available with sedative. meds RN competency from sedation class Accept assignments that you know how to take
88
Why do we consider the appropriate drug needed with the appropriate dose?
We have a goal of the level of sedation we want to accomplish , so we need to consider the med and dosage.
89
Are neuromuscular blocks analgesics? | Are they sedatives?
NOOO
90
Are sedatives analegisics?
NOO
91
What do you check when switching drugs
Equianalgesic chart
92
Why do we do around the clock pain management
To avoid breakthrough pain
93
Tolerance
A given dose of the drug that produces less analgesia or requires a larger dose for the same relief - 10 mg of one med works , they may need more.
94
Ceiling effect
No matter how much med you give, the med is at a point where the effects won't increase.
95
Physical dependance
altered physiological state due to opiates. | Withdrawals, tearing, rhinorrhea, yawns, insomnia, pupil dilation, N&V, diarrhea and muscle spasms
96
Addiction
Behavior response that has overwhelming preoccupation with securing & using a drug
97
Coanalgesics use?
PRNS to help out with breakthrough pain
98
Coanalgesic drugs
Gabapentin for neuropathic & herpetic pain Glucocorticoids for reduction of edema in tumor and nerve tissue; good for bone metsz. 5% lidocaine patches - postherpetic neuralgia - on 12 hours, off 12 hours. - initial & date and time
99
PCA pumps pros
Creates less anxiety bc patient con control it a little more and it makes relief quicker.
100
PCA modes
Basal Bolus or do both Loading dose as well
101
What to document for PCA pumps?
Monitor pattern of use. Do it at beginning of shift and at end.
102
What effects basal rate for pca pumps? What labs do we need to be monitoring?
Size & weight - larger patient, the harder it is to control pain - watch labs for kidney function
103
Controversial PCA pump issue related to age
How old is old enough for a pca pump | - not all kids are smart lmao
104
Gerontologic expectations of pain
They think pain is apart of getting old & that they have to deal with it. They are also scared that they'll be addicted to opioids They'll use less severe words like aches or sore instead of telling you they are in actual pain. - We need to educate them about how using it as prescribed is safe
105
Most common painful conditions of elderly
Osteoarthritis Low back pain Previous fractures
106
Chronic pain in geriatric populations are associated with ________ _____ & _______ ______ .
Physical disability | Psychosocial problems
107
What can untreated chronic pain lead to in geriatric patients?
``` Depression Sleep issues Decreased Mobility Decreased health care utilization Physical and social role dysfunctions ```
108
Facial expressions to look for in elderly to assess for pain
Sad/frightened facial expressions
109
Vocalizations to assess for pain in elderly
Vocalizations - chanting, calling out/praying, profanity
110
Body movements to assess for pain in eldery
Body movements - fidgeting, restless, withdrawal, and resisting care - so educate them about their care as well
111
Behavioral changes or patterns to assess for pain in elderly
Change in patterns - eating, sleeping (to avoid pain), immobility Confusion & irritability

2.0 Adult Nursing Final (1 decks)

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