Pain, headaches, fever Flashcards
acute vs chronic pain
less than 6 months
morethan 6 months
3 step model for pain control
1- asa, tylenol, nsaid,
adjuvant (gabapentin, antidepressants, pregabulin) may help some people but cause no harm. maintain initial nsaid of choice
2. apap or asa + but codeine, hydrocodone, oxycodone, codeine, tramadol
3. morphine, hydromorphone, methadone, levoprhanol, fentanyl, oxycodone, +/- nonopiod analgesics, +/- adjuvants
may also give break through like sustained release patch**
c/o cp 4/10 x 3 hrs. no cardiac hx. has pallor and not answering questions. what would cause acnp to admit pt to chest pain unit for observation
a. age, b. gender, c. pain d. level, ethnicity.
reluctant to answer questions is stoic asian male script so ethnicity is main reason to admit the patient
what is normal body temperature?
what is fever?
37
38.3 (101.5)
what is ACNP’s priority with a patient on anti psychotics with neuroleptic malignant syndrome
a. analgesics
b. antibiotics
c. FLUIDS **
d. RBC replacement
need to flush out of patient.
also true with seratonin syndrome and malignant hyperthermia
noninfectious postop fever.
two best questions to ask
what do lungs sound like?
I&Os.
two main causes are atelectasis and dehydration
causes of non-infectious post-op fever
postop atelectasis
- increased basal metabolic rate
- dehydration
- drug reactions
what are common drugs to cause post postop fever?
amphotericin B
bactrim
beta-lactam abx (pcn derivitives, cephalosporins, carbapenems- pcn, amoxicilllin, carbapenem, ampicillin
sign of infectiouse cause of postop fever
- subjective complaints and a wbc elevation with left shift (bandemia-immature wbc)
- wbc elevation over 30,000 usually not d/t infection. think leukemia
Initial treatment of post-op fever
-hydration and measures to expand lung inflation
treatment of infectious post-op fever
- supportive fluid therapy and tylenol
- tx apparent underlying source
- gram stain and C&S all invasive lines or catheters as indicated
components of HA evaluation
- chronology most impt hx item
- location, duration, quality
- assc activity
- timing of menstrual cycle
- presence of associated sxs
- presence of triggers
Tension HA
- vise-like or tight in quality
- usually generalized
- intense around neck or back of head
- no associated focal neurological sxs
- usually lasts several hours
tx: analgesics
relaxation
Migraine headaches
two types:
- classic: with aura
- common: w/o aura
r/t dilation and excessive pulsation of branches of external carotid artery; typically lasts 2-72 hours following trigeminal nerve pathway
Migrain HA causes/Incidence
- onset early adult years
- fam hx
- females > males
- triggers (menstruation, alc, foods, stress, oral contraceptives etc)
- nitrate containing foods
- changes in weather
