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Math 215 > Pain Directives > Flashcards

Pain Directives Flashcards

1
Q

What two drugs can be administered for the adult pain standing order?

A

Morphine or fentanyl

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2
Q

What are the conditions for fentanyl in the adult pain medical directive?

A

The patient must be:

Equal to or greater than 18
Unaltered
Normotensive

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3
Q

What are the conditions for morphine in the adult pain medical directive?

A

The patient must be:

Equal to or greater than 18
Unaltered
Norm ostensible

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4
Q

What are the contraindications to fentanyl in the adult pain medical directive?

A

Allergy or sensitivity to fentanyl
Injury to the head, chest, abdomen or pelvis
SBP drops by 1/3 or more of its original value

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5
Q

What are the contraindications for Morphine in the adult pain medical directive?

A

Allergy or sensitivity to morphine
Injury to the head, chest, abdomen or pelvis
SBP that drops by 1/3 or more of its initial value

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6
Q

What is the dosing of Fentanyl in the adult pain medical directive?

A

25-50 mcg fentanyl IV q 5 minutes to a maximum of 4 doses.

Max single dose 50 mcg

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7
Q

What is the dosing for morphine in the adult pain medical directive?

A

2-5 mg morphine IV q 5 minutes to a max of 4 doses.

Max single dose of 5 mg

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8
Q

What is the adult pain medical directive?

A

The patient must be in severe pain AND have an isolated hip or extremity fracture or dislocation, major burns, current history of cancer related pain, or renal colic with prior history or acute musculoskeletal back strain or ongoing pacing.
Must be 18 or older, unaltered and normotensive

Must have no allergy or sensitivity to morphine or fentanyl. No injury to the head, chest, abdomen or pelvis. Bp can’t drop by 1/3 or more

Fentanyl 25-50 mcg q 5 min max 4 doses. Or
Morphine 2-5 q 5 min max 4 doses

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9
Q

What are the indications for the paediatric pain medical directive?

A

Severe pain AND isolated hip or extremity fracture or dislocation OR major burns OR current history of cancer related pain.

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10
Q

What are the conditions for the pedi attic pain medical directive?

A

Less than 18 years old
Unaltered
HR more than 60/min (61 and up)
Age related normotensive

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11
Q

What are the contraindications to morphine in the paediatric pain medical directive?

A

Allergy or sensitivity
Injury to the head, chest, abdomen or pelvis
SBP drops by 1/3 or more of initial value

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12
Q

What do you have to do before administering morphine in the paediatric pain medical directive?

A

Patch

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13
Q

What is the dosing of morphine in the paediatric pain medical directive?

A

0.05 mg/kg ( to a max of 3 mg)
IV or SC
Q 5 minutes
Max 2 doses

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14
Q

In what ways can you administer fentanyl or morphine in the adult pain standing order?

A

IV only

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15
Q

How can you administer morphine in the paediatric pain standing order?

A

IV or SC

But….. Since it is a patch consider asking for IN

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16
Q

What are the indications for the analgesia medical directive? (Auxiliary directive)

A

Isolated hip OR extremity trauma
AND
Pain

17
Q

What two drugs can be administered for the analgesia medical directive?

A

Tylenol and Advil

18
Q

What are the conditions of administering Tylenol for the analgesia medical directive?

A

18 and older

Unaltered

19
Q

What are the conditions of administering Advil for the analgesia medical directive?

A

18 to 49 years of age. (Equal to or greater than 18 and less than 50)
Unaltered

20
Q

What are the contraindications for Tylenol in the analgesia medical directive?

A 
Tylenol use within the past 4 hours
Allergy or sensitivity to Tylenol
Signs or symptoms of intoxication
Active vomiting
Major burns
HX of liver disease
21
Q

What are the contraindications for Advil in the analgesia medical directive?

A 
Advil or NSAID use within the previous 6 hrs
Allergy or sensitivity to ASA or NSAID's
Active vomiting
Current active bleeding
Major burns
HX of peptic ulcer disease or GI bleed
Pregnant
HX of cardiovascular disease
Asthmatic ( unless prior use of ASA or other NSAID)
CVA or TBILISI in the previous 24 hrs
22
Q

What is the dosing for Tylenol in the analgesia medical directive?

A

One dose of 960-1000 mg

Max dose 1000mg

23
Q

What is the dosing for Advil in the analgesia medical directive?

A

One dose of 400mg

Max dose 400

24
Q

What are the clinical considerations for Advil and Tylenol in the Analgesia medical directive?

A

Whenever possible administer Advil and Tylenol together
This does not replace the core pain medical directive and this directive can be used in conjunctive with the pain medical directive

25
Q

What is the analgesia medical directive?

A 
For isolated hip or extremity trauma and pain
Patient must be 18 or older for Tylenol and between 18 and 49 for Advil
Patient must be unaltered
Tylenol:
Must not have had Tylenol in past 4 hrs 
No allergy or sensitivity to drug 
No s/s intoxication
No active vomiting
No major burns
No HX liver disease

Advil:
No Advil or NSAID in past 6 hrs
No allergy or sensitivity to ASA or NSAID’s
No active vomiting
No current active bleeding
No major burns
No HX of peptic ulcer disease or GI bleed
Not pregnant
No HX cardiovascular disease
Not asthmatic (unless prior use of ASA or NSAID)
No CVA or TBI in past 24 hrs

Dosing
Tylenol 960-1000mg X11
Advil 400 mg X1

Give both together if poss
Can also use with morphine/ fentanyl

26
Q

What are the indications for the moderate to severe pain medical directive (auxiliary)?

A

Moderate to severe pain
AND
Isolated hip or extremity trauma OR major burns OR current history of cancer related pain OR renal colic with prior history OR patients with acute musculoskeletal back pain

27
Q

What are the conditions for ketorolac for the moderate to severe pain medical directive (auxiliary)?

A

Between 18 and 49 years old
Unaltered
Normotensive
Patient must remain NPO or is unable to take oral medications

28
Q

What are the contraindications for ketorolac?

A 
NSAID or Advil use in past 6 hrs
Allergy or sensitivity to ASA or NSAIDs
Pt is on anticoagulant therapy
Current active bleeding
CVA or TBI in the past 24 hrs
Asthmatic (unless prior use of ASA or other NSAID)
Pregnant
Known renal impairment
29
Q

What is the dosing of ketorolac?

A

30 mg IM/IV

MAX 1 dose

30
Q

What are the clinical considerations for ketorolac?

A

This directive may be used in conjunction with the core directive for pain (morphine/fentanyl)

31
Q

What are the indications for the adult pain medical directive?

A

Severe pain

AND

Isolated hip or extremity fractures or dislocations OR major burns OR current history of cancer related pain OR renal colic with prior history OR patients with acute musculoskeletal back strain OR ongoing transcutaneous pacing

Math 215 (2 decks)

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