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2.0 Adult Nursing Final > Pain > Flashcards

Pain Flashcards

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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
Q

What does Midazolam provide

A

Immobility
Sedation
Amnesia
Antianxiety

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26
Q

Is Midazolam primary or secondary agent

A

Secondary - used with Fentanyl

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27
Q

procedures that use Midazolam

A

Bedside procedure
TEE
Colonoscopy

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28
Q

Type of monitoring for Midazolam

A

Cardiac monitoring

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29
Q

Side effect of midazolom intranasal route

A

Burns for 10-15 min

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30
Q

If you give a patient Midazolam, what is a pre-requirement?

A

Ability to support their airway

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31
Q

Midazlom antidote

And its contraindication?

A

Flumazenil

- contraindicated in those with epilepsy/seizures

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32
Q

Patient is desatting while on Midazolam. You give Flumazenil.
Why or why not would this be beneficial?

A

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

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33
Q

Onset & duration of Flumaezenil?

A

Rapid onset

Lasts 1 hour duration

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34
Q

How fast should you push Flumazenil?

A

Push slow bc it burns. 30 sec to 1 min

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35
Q

Morphine pros

A

Analgesic
Sedation
Some immobility

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36
Q

How fast should you give morphine IV?

How should you titrate?

A

Push it slow so the patient doesn’t end up slumped over

Titrate to effect at the lowest rate.

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37
Q

You give a patient morphine. How long does it take for them to expereince repsiratory depression?

A

Peak is at 20 minutes - so monitor them closely.

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38
Q

Rxn to morphine?

A

Histamine release but its not an allergy.

- itching, flushing, rash, hives.

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39
Q

Bad side effects of morphine

A

Respiratory depression & hypotension

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40
Q

Morphine antidote

A

Nalaxone or Narcan

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41
Q

Which is more potent : morphine or fent?

A

Fent by 100x

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42
Q

Routes available for Fentanyl?

A

Oral
IM
IV

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43
Q

How do we titrate Fentanyl?

A

Titrate to effect

Start at 1-2 mcg to begin with. Lowest dose.

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44
Q

Fentanyl onset & duration

A

Onset it rapid 1-5 minutes

Duration of 30 min to 1 hour

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45
Q

Fentanyl antidote

A

Naloxone or narcan

46
Q

What speed do we push Fentanyl and why?

A

Give slow - can cause chest or skeletal muscle rigidity and affect breathing.

47
Q

How does Narcan work? And how does that implicate the patient & us?

A

Displaces opioids at the receptor site - which means they will feel the pain that the opiate was covering up.
- protect yourself

48
Q

How fast do we give Narcan

A

slowly

49
Q

Narcan onset and duration

A

Onset is 2 min.

Duration is 15-60 minutes

50
Q

How often can you repeat narcan

A

Repeat every 2-3 minutes

51
Q

What is Ketamine (Ketolar)

A

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
Q

Can you use Ketamine for pain?

A

Probably not. it has those properties but don’t rely on it for analegesia

53
Q

Vital signs for Ketamine

A

Increase HR, BP, CO, & ICP

- monitor these

54
Q

What medication will we use in combination with Ketamine & why?

A 
Use glycopyrrolate (robinul) or atropine
Due to increase of secretions from ketamine & to avoid aspiration
55
Q

Precedex or Dexmedetomindine

A

Light sedation anxiolytic and can be aroused from it.

56
Q

How long should a a Precedex drip go for

A

24 hours

- but not a significant issue if its longer

57
Q

Precedex onset for PO & IV
Half life
Duration

A

PO 30 minutes
IV 10 minutes

Half life 6 minutes

Duration 4 hours

58
Q

Side effects of precedex

A

n/v
hypotension
bradycardia

59
Q

Precedex side effects treatment if we decide to continue tx

A

(hypotension & brady)

fluids, pressors, atropine

60
Q

What is Propfol

A

Hypnotic agent w little analgesic

Can be helpful in decreasing oxygen consumption

61
Q

Propofol route

What other med do we give if we push?

A

IV only which can be painful if pushed

- use lidocaine

62
Q

Propofol onset

A

Onset if 30-60 seconds

- which is helpful for when patients start bucking the vent bc we can titrate it quickly

63
Q

IV needed for Propofol

A

Large, secure IV

64
Q

You see your bottle of propofol is almost empty. What do you need to do

A

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
Q

Propofol is a lipid emulsion. Why is this important for you to consider?

A

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
Q

What age group is Propofol not approved for

A

Not approved for those under 12.

- up to doctor discretion

67
Q

Propofol side effect

A

Hypotension so be diligient about checking q15 vitals

- and if it drops, you will have to titrate it

68
Q

What does the Nurse practice act say about pushing propofol

A 
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
Q

What is PRIS or propofol related infusion syndrome?

What labs?

A

Propofol impairs ability to use fatty acids and so it leads to catabolism and muscle necrosis which

elevated creatinine kinase and myoglobin

70
Q

What happens if PRIS occurs in critical conditions

A

Cardiac failure
Rhabdomyolosis
Metabolic acidosis
Renal failure

71
Q

What to watch for for PRIS clues?

A

Elevated CK
Lactic acidosis
Hypotension
ST segment elevation

early intervention is very important.

72
Q

Etomidate is used for __

A

RSI and allows for quick intubation

73
Q

Etomidate effects on the cardiorespiratory and hemodynamics of a patient include?

A

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
Q

Can Etomidate help with pain?

A

No analgeisc properties

75
Q

With any type of sedation, what titration trend do we want to follow?

A

Start with low dose and titrate up.

76
Q

Does everyone respond the same to these medications?

A

No! Respect that.

77
Q

Make sure you have a plan..

A

Know plan A, B, C.. etc.

78
Q

Mark all your ..

A

Synringes.

And know all your drugs.

79
Q

What is the purpose of using a continuous sedation regiment in adults in icu?

A

Help deliver oxygen to them in general through vent maybe

Decrease the amount of O2 they are using as well.

80
Q

Which meds are used for continuous sedation

A 
Barbiturates or pentobarbital
Propofol
Benzos - Ativan/Lorazepam onset of 15-20 minutes but can last 6-8 hrs
Morphine
Fentanyl
81
Q

Why is level of sedation controversial

A

bc we want them to be sedated all the way

82
Q

sedation vs analgesia

A

they are not the same & we shouldn’t act like they are.

83
Q

Sedation holidays/vacation

A

For sponteanous breathing & weaning them off the sedation when taking them off vent.
- do not titrate down ; you turn it off!!!

84
Q

Neuromusuclar blockades are sedation T/F

A

false.

85
Q

What do we measure for those neuromuscular blockades

A

Train of four

86
Q

why do we limit for neuromuscular blockades duration

A

muscle weakness

87
Q

Nurse practice act

A

Physician needs to be available with sedative. meds
RN competency from sedation class
Accept assignments that you know how to take

88
Q

Why do we consider the appropriate drug needed with the appropriate dose?

A

We have a goal of the level of sedation we want to accomplish , so we need to consider the med and dosage.

89
Q

Are neuromuscular blocks analgesics?

Are they sedatives?

A

NOOO

90
Q

Are sedatives analegisics?

A

NOO

91
Q

What do you check when switching drugs

A

Equianalgesic chart

92
Q

Why do we do around the clock pain management

A

To avoid breakthrough pain

93
Q

Tolerance

A

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
Q

Ceiling effect

A

No matter how much med you give, the med is at a point where the effects won’t increase.

95
Q

Physical dependance

A

altered physiological state due to opiates.

Withdrawals, tearing, rhinorrhea, yawns, insomnia, pupil dilation, N&V, diarrhea and muscle spasms

96
Q

Addiction

A

Behavior response that has overwhelming preoccupation with securing & using a drug

97
Q

Coanalgesics use?

A

PRNS to help out with breakthrough pain

98
Q

Coanalgesic drugs

A

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
Q

PCA pumps pros

A

Creates less anxiety bc patient con control it a little more and it makes relief quicker.

100
Q

PCA modes

A

Basal
Bolus
or do both
Loading dose as well

101
Q

What to document for PCA pumps?

A

Monitor pattern of use.
Do it at beginning of shift
and at end.

102
Q

What effects basal rate for pca pumps?

What labs do we need to be monitoring?

A

Size & weight

  • larger patient, the harder it is to control pain
  • watch labs for kidney function
103
Q

Controversial PCA pump issue related to age

A

How old is old enough for a pca pump

- not all kids are smart lmao

104
Q

Gerontologic expectations of pain

A

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
Q

Most common painful conditions of elderly

A

Osteoarthritis
Low back pain
Previous fractures

106
Q

Chronic pain in geriatric populations are associated with ________ _____ & _______ ______ .

A

Physical disability

Psychosocial problems

107
Q

What can untreated chronic pain lead to in geriatric patients?

A 
Depression
Sleep issues
Decreased Mobility
Decreased health care utilization
Physical and social role dysfunctions
108
Q

Facial expressions to look for in elderly to assess for pain

A

Sad/frightened facial expressions

109
Q

Vocalizations to assess for pain in elderly

A

Vocalizations - chanting, calling out/praying, profanity

110
Q

Body movements to assess for pain in eldery

A

Body movements - fidgeting, restless, withdrawal, and resisting care
- so educate them about their care as well

111
Q

Behavioral changes or patterns to assess for pain in elderly

A

Change in patterns - eating, sleeping (to avoid pain), immobility
Confusion & irritability

2.0 Adult Nursing Final (1 decks)

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