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Final for Critical Care > Pain and Sedation > Flashcards

Pain and Sedation Flashcards

1
Q

What is the goal for procedural sedation? (4)

A
  • guide patient safety and welfare
  • minimize negative psychological responses to tx with analgesia and maximize amnesia
  • minimize physical discomfort
  • control behavior
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2
Q

What is the criteria for discharge after sedation? (4)

A
  • ability to drink water
  • alert and oriented
  • stable vital signs
  • able to pass gas and urinate
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3
Q

what is the level of sedation defined by? (5)

A
  • airway control
  • respiratory responsiveness
  • gross motor skills
  • level of awareness
  • responsiveness to stimuli
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4
Q

example of minimal or light sedation?

A

anxiolysis: ativan

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5
Q

what is the level of responsiveness with minimal or light sedation?

A

normal response to verbal stimuli

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6
Q

how is the patients airway affected by minimal/light sedation?

A

unaffected

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7
Q

how is spontaneous ventilation affected by minimal or light sedation?

A

unaffected

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8
Q

how is cardiovascular function affected by minimal/light sedation?

A

unaffected

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9
Q

what is the level of responsiveness with conscious sedation?

A

purposeful response to verbal or tactile stimuli

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10
Q

how is the airway affected by conscious sedation?

A

no intervention required

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11
Q

how is spontaneous ventilation with conscious sedation?

A

adequate

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12
Q

how is cardio function with conscious sedation?

A

usually maintained

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13
Q

what is the level of responsiveness with deep sedation?

A

purposeful response following repeated or painful stimuli

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14
Q

how is the patients airway affected by deep sedation?

A

intervention may be required

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15
Q

how is the patients spontaneous ventilation affected by deep sedation?

A

inadequate

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16
Q

how is cardio function with deep sedation?

A

usually maintained

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17
Q

how responsive is the patient with general anesthesia?

A

unarousable even with repeated or painful stimuli

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18
Q

how is the patients airway during general anesthesia?

A

intervention is required

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19
Q

how is spontaneous ventilation during general anesthesia?

A

frequently inadequate and is compromised

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20
Q

how is cardio function with general anesthesia?

A

maybe impaired

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21
Q

how to prep a patient for sedation? (5)

A
  • NPO
  • baseline assessments
  • IV starts
  • informed consents
  • equipment set up
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22
Q

documentation required before surgery?

A

-Informed consent
-instructions for after
surgery
-last food and fluid intake
-vital signs
-review of systems

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23
Q

Who may sign an informed consent?

A
  • patient may sign
  • if emergent can perform without signing
  • DPOA may sign
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24
Q

what systems are reviewed before surgery?

A
  • age and weight
  • allergies
  • current meds (did they take?)
  • are you to hold any meds?
  • relevant disease processes
  • previous hospitalizations
  • history of sedation
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25
Q

on site equipment for sedation?

A

fit all sizes

  • positive pressure oxygen delivery
  • suction
  • ambu bag
  • NIBP
  • pulse oximetry
  • capnography
  • emergency cart
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26
Q

What does DEMOS stand for?

A 
are you ready for sedation?
D-drugs
E-emergency
M-monitoring
O-oxygen
S-suction
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27
Q

discharge criteria after sedation?

A
  • CV function and airway patency are satisfactory
  • arousable and protective mechanisms are intact
  • appropriate verbalization
  • alert and oriented
  • state of hydration is adequate
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28
Q

what type of medication is midazolam?

A

a benzodiazepine

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29
Q

what is midazolam used for?

A
  • immobility
  • sedation
  • amnesia
  • antianxiolytic
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30
Q

what drug is midazolam used with?

A

fentanyl

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31
Q

why is midazolam used with fentanyl?

A

because it is unpredicatable as a primary agent

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32
Q

what monitoring is required for use of midazolam?

A

cardiac monitoring

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33
Q

what is the antidote for midazolam?

A

flumazenil

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34
Q

what is flumazenil?

A

benzodiazepine antidote

-reverses induced sedation and amnesia

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35
Q

what can flumazenil cause?

A

seizures

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36
Q

how fast does flumazenil work?

A

rapid onset

duration <1hr

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37
Q

how long do you give flumazenil over?

A

1/2-1 minute

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38
Q

what type of drug is morphine?

A

opiate analgesic

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39
Q

what does morphine do?

A

analgesic, sedation, immobility

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40
Q

how do you give morphine?

A

IV, always give slowly

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41
Q

what is the concern with morphine?

A

respiratory depression

peak for respiratory depression 20 minutes

42
Q

what does morphine cause?

A

causes histamine release

  • itching
  • flushing
  • rash and hives
43
Q

what is the antidote for morphine?

A

naloxone

44
Q

what type of drug is fentanyl?

A

opiate analgesic

45
Q

what does fentanyl do?

A

analgesic, sedation, immobility

46
Q

how strong is fentanyl?

A

over 100 times more potent than morphine

47
Q

how is fentanyl given?

A

oralet, IM, IV

48
Q

what is the dosage of fentanyl?

A

1-2mcg/kg to begin, and titrate to effect

49
Q

how fast does fentanyl work?

A

rapid IV onset: 1-5 minutes

50
Q

duration for fentanyl?

A

1/2-1 hour

51
Q

antidote of fentanyl?

A

naloxone

52
Q

how do we give fentanyl?

A

we give slowly through the IV

53
Q

why do we give fentanyl slowly?

A

may cause skeletal muscle or chest wall rigidity

54
Q

what does naloxone?

A

displaces opioid drugs at the opioid receptor site

55
Q

how do we give narcan?

A

give IV slowly until desired response

56
Q

how fast is the onset of naloxone?

A

2 minutes, may repeat every 2-3 minutes

57
Q

what is the duration of naloxone?

A

15-60minutes

58
Q

what type of drug is ketamine?

A

dissociative anesthetic: a form of general anesthesia, but not a complete unconsciousness

59
Q

what are dissociative anesthetics characterized by?

A

catalepsy
catatonia
amnesia

60
Q

what is the onset of ketamine?

A

1 minute, duration of 20 minutes

61
Q

what routes can ketamine be given through?

A

IV, IM, oral, rectal, IN

62
Q

what vitals are effected by ketamine?

A

increases pulse, BP, CO/CI, and ICP

63
Q

what other affect does ketamine have?

A

increases secretions

64
Q

what do we treat the increased secretions from ketamine with?

A

pre treat with glycopyrrolate or atropine

65
Q

what is dexmedetomidine?

A

sedative to provide light sedation, anxiolysis, arousable sedation and analgesia

66
Q

how long should a precedex drip last?

A

no longer than 24 hours

67
Q

what is the onset of precedex?

A

PO-30min IV-10min

68
Q

what is the half life of precedex?

A

6 minutes

69
Q

what is the duration of precedex?

A

4 hours

70
Q

what are the side effects of precedex?

A

N/V, HoTN, bradycardia

71
Q

what do we treat side effects of precedex with?

A

fluids, pressors, atropine

72
Q

what is propofol?

A

hypnotic agent, little analgesic effect, causing immobility

73
Q

how is propofol given?

A

IV only: is painful- can use lidocaine to ease pain

74
Q

how fast is the half life of propofol?

A

very fast! patient will be awake within minutes of cessation of med.

75
Q

when and why are sedation vacations done?

A

generally done in the morning to check neuro status

76
Q

what is the medication propofol given through?

A

med is in lipid emulsion, with strict asepsis (monitor pts triglycerides)

77
Q

what age can propofol be given to ?

A

over 12 years of age

78
Q

what is the primary concern for patients on propofol?

A

hypotension, monitor blood pressure every 3-5 minutes throughout

79
Q

What does PRIS stand for?

A

propofol related infusion syndrome

80
Q

what is PRIS?

A

propofol impairs utilization of fatty acids (necessary for cardiac and skeletal muscle activity) resulting in catabolism- muscle necrosis- elevated creatine kinase and myoglobin

81
Q

what can PRIS result in when combined with critical condition?

A

cardiac failure, rhabdomyolysis, metabolic acidosis, renal failure

82
Q

what do we need to watch for in relation to PRIS?

A

elevated CK, unexplained lactic acidosis, hypotension, ST segment elevation

83
Q

what is vital with PRIS?

A

early intervention

84
Q

what is etomidate?

A

ultra short acting non-barbituate hypnotic used for anesthesia

85
Q

what does etomidate produce?

A

rapid induction

86
Q

what effects does etomidate have on the body?

A
  • minimal cardio, respiratory, and hemodynamic effects

- lowers cerebral blood flow by 20-30% and slightly reduces ICP

87
Q

what is Etomidate used for?

A

RSI

88
Q

how do we give sedation?

A

start with low dose and titrate to effect

89
Q

what is the purpose of continuous sedation?

A

facilitate oxygenation, decrease tissues oxygenation needs and promote normal ICP

90
Q

T/F

neuromuscular blockades are not the same as sedation?

A

true

paralytics are not sedation!

91
Q

three aspects of the nurse practice act in relation to sedation?

A

-physician must be available
-RN has competency
accepts only those
-assignments for which she is competent

92
Q

what are the 5 key concepts for pharm pain management?

A
  • appropriate drugs in appropriate doses
  • sedation is not analgesia
  • neuromuscular blockers are not analgesics or sedatives
  • when switching drugs - check equianalgesic chart
  • around the clock to avoid break through pain
93
Q

definition of tolerance?

A

a given dose of the drug produces less analgesia or requires a larger dose for the same relief

94
Q

definition of ceiling effect?

A

the point beyond which no additional analgesia is

obtained

95
Q

definition of physical dependence?

A

altered physiological state produced by repeated administration of an opiate. Withdrawal produces tearing, rhinorrhea, yawning, insomnia, dilated pupils, N& V, diarrhea, muscle
spasms

96
Q

definition of addiction?

A

behavioral response characterized by overwhelming preoccupation with securing & using a drug.

97
Q

what are the 3 coanalgesics?

A
  • gabapentin
  • glucocorticoids
  • lidocaine patches
98
Q

what type of drug is gabapentin?

A

anticonvulsant - used for neuropathic pain and herpetic pain

99
Q

what type of drug is glucocorticoids?

A

reduce edema in tumor and nerve tissue, good for patients with bone mets

100
Q

what are lidocaine patches used for?

A

postherpetic neuralgia : on 12 hours, off 12 hours

Final for Critical Care (3 decks)

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