Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NRSG 302 > Week 3 - PCA & Epidurals > Flashcards

Week 3 - PCA & Epidurals Flashcards

1
Q

define opioid naive

A

Pt who has not used opioids for more than seven continuous days during the previous 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define dermatome

A

Area of the skin supplied by nerves from a single spinal root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

define pruritus

A

Severe itching of the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define paresthesia

A

Abnormal touch sensation that occurs without an outside stimulus

Ex. burning or prickling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define tinnitus

A

Experience ringing or other noises in one or both of your ears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define dysgeusia

A

Bad taste in the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

define glabella/ glabellar

A

Smooth part of the forehead above and between the eyebrows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

define neuraxial

A

Administration of medication into the subarachnoid or epidural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is a PCA pump?

A

Computerized systems programmed for individual patient use for pain medication administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a dose interval for a PCA pump?

A
  • Set at 6 or 8 minutes for post-op pt
  • Pt can give themselves 1 dose of medication every 6-8 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is a lock out time for a PCA pump?

A
  • Set at 1-4hrs
  • Controls how much medication a pt can receive in the 1 or 4 hour period
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the benefits of having a 1 hour lockout vs. a 4 hour lockout for a PCA pump?

A

Lets nurse monitor PCA use more closely and adjust dosing as needed to control pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should a nurse do if a patient attempts to activate his PCA more than twice the number of doses actually delivered?

A

Increase the dose according to standing orders or request an order for a dose increase or a shorter dose interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are clinician boluses for PCA pumps?

A

Extra doses of medication that you can administer to manage increased pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

According to the article: Why are basal infusions not recommended for opioid-naïve patients? (this is up to the ordering physician, but thought may be changing around narcotic dosing).

A

Add little to pain control while increasing the risk of over sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is PCA considered to be superior to the intermittent administration of IV analgesics?

A
  • Pt experiences better pain relief
  • Pt maintains control over pain relief
  • Pt has pain under control can breathe deeply/ ambulate early > aids in recovery and reduces risk of complications
  • May shorten length of hospital stay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common type of PCA-related adverse event?

A

Programming errors causing overmedication or undermedication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can you reduce the likelihood of having a med error with a PCA?

A

get independent double check

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What types of patients are NOT appropriate for PCA? Why?

A
  • Confused pt
  • Pt not able to push the button independently
  • Infants/ young children
  • Obese
  • Have asthma
  • Sleep apnea
  • Pts taking other drugs that potentiate opioids (muscle relaxants, antiemetics, sleeping medications)
  • Must be able to understand the concept and willing to follow instructions and be physically able
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

can CPA be used safely with children?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is PCA by proxy and why is it dangerous?

A
  • PCA pump is activated by someone other than the pt commonly relatives or friends
  • Cause significant over sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can the design of a PCA pump lead to adverse events?

A
  • If button looks like call bell > pt may push by accident
  • Doesn’t have an alert to let pt know that dose was delivered > pt may keep pushing button b/c they may think they didn’t get the dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the most common types of PCA pump programming errors?

A
  • Confusing mL and mg
  • Confusing PCA bolus doses and basal rate
  • Loading dose programmed where basal rate should be entered
  • Wrong lockout settings selected
  • Wrong concentration selected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can you prevent med errors with PCA?

A
  • Learn to use PCA pumps in facility
  • Accept only PCA orders written on preprinted order sets
  • Develop list of pts who are good PCA candidates
  • Get an independent double check
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the more effective method of monitoring for respiratory depression: oxygen saturation or capnography?

A

capnography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why is it important to monitor for over sedation with a PCA?

A

To assess for respiratory depression, overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which drug is the reversal agent for opioids such as morphine, hydromorphone, or fentanyl?

A

naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If you are able to rouse a sleeping patient who had a PCA, and he is able to answer some questions, does this mean that he is not experiencing over sedation or respiratory depression?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What patient factors place a patient at higher risk for adverse reactions to PCA?

A
  • obesity
  • low body weight
  • sleep apnea
  • asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the 3 types of pain?

A
  • nociceptive
  • visceral
  • neuropathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

describe nociceptive pain

A
  • somatic
  • injury to body tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

describe visceral pain

A
  • pain that comes from the visceral organs
    ex. GI, heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

describe neuropathic pain

A

central and/ or peripheral nerve pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are the 2 classifications of pain?

A
  • acute
  • chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

describe the pain pathway

A
  • transduction
  • transmission
  • perception
  • modulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

describe the transduction portion of the pain pathway

A
  • noxious stimuli
  • causes cell damage with release of sensitizing chemicals
  • substances activate nociceptors/ lead to action potential
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the sensitizing chemicals that can be released during the transduction portion of the pain pathway?

A
  • prostaglandins
  • bradykinin
  • serotonin
  • substance P
  • histamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

describe the transmission portion of the pain pathway

A

action potential continues from:
- site of injury to spinal cord
- spinal cord to brain stem/ thalamus
- thalamus to cortex for processing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

describe the perception portion of the pain pathway

A

conscious experience of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

describe the modulation portion of the pain pathway

A
  • neurons originating in brain stem descend to spinal cord/ release substance that inhibit nociceptive impulses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what are some pain therapies that are used in the transduction portion of pain

A
  • NSAIDs
  • local anaesthetics
  • antiseizure drugs
  • corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is the mechanism of action for pain therapy in the transduction portion of pain?

A
  • all block action potential initiation
  • NSAIDs block prostaglandin production
43
Q

what are some pain therapies that are used in the transmission portion of pain

A
  • opioids
  • cannabinoids
44
Q

what is the mechanism of action for opioid pain therapy in the transmission portion of pain?

A

block release of substance P

45
Q

what is the mechanism of action for cannabinoids pain therapy in the transmission portion of pain?

A

inhibit mast cell degranulation and response of nociceptive neurons

46
Q

what are some pain therapies that are used in the perception portion of pain

A
  • opioids
  • NSAIDs
  • adjuvants
47
Q

what is the mechanism of action for opioid pain therapy in the perception portion of pain?

A

decrease conscious experience of pain

48
Q

what is the mechanism of action for NSAIDs pain therapy in the perception portion of pain?

A

inhibit cyclo-oxgenase action

49
Q

what is the mechanism of action for adjuvants pain therapy in the perception portion of pain?

A

dependent on specific adjuvant

50
Q

what are some pain therapies that are used in the modulation portion of pain

A

tricyclic antidepressants

51
Q

what is the mechanism of action for tricyclic antidepressants pain therapy in the modulation portion of pain?

A

interfere with reuptake of serotonin and norepinephrine

52
Q

what is a significant issue for postoperative patients?

A

pain

53
Q

pain can lead to physiological changes such as what?

A
  • heart rate
  • respirations
  • blood pressure
  • immune function
  • healing
54
Q

What routes can a PCA be administered?

A
  • IV
  • subcutaneous
  • patient controlled epidural anesthesia (PCEA)
55
Q

what are prerequisites for PCA use?

A
  • pt must be cognitively capable of understanding concept
  • able to physically press button
  • willing to control own pain this method
  • not sedated from other meds
56
Q

what are some safety risks for PCA use?

A
  • med error
  • use of narcotic drugs
  • close nurse monitoring of side effects
  • system locked/ accessed by staff only
  • pt understanding
57
Q

what are 3 common types of opioids used?

A
  • morphine
  • HYDROmorphone
  • fentanyl
58
Q

what is the onset of action for morphine?

A
  • 17 minutes
  • delay across blood-brain barrier
59
Q

what is the duration of morphine? what is the half life?

A

duration - 4 to 5 hours
half-life - 2 hours

60
Q

what is considered the gold standard for pain relief?

A

morphine

61
Q

what is the onset of action for HYDROmorphone?

A

15mins

62
Q

what is the duration and half life for HYDROmorphone?

A

duration - 4 to 5 hours
half-life 2-3 hours

63
Q

how much more potent is HYDROmorphone compared to morphine ?

A

5-7 times more potent

64
Q

what is the onset of action for fentanyl?

A

effective in 4-5 minutes

65
Q

what is the duration for fentanyl?

A

can last longer than elimination of half-life if linger infusion times/ obese pt

66
Q

what is the half-life of fentanyl?

A
  • initial redistribution in 13 mins
  • elimination half-life 3-4 hours
67
Q

how much more potent is fentanyl compared to morphine?

A

80-100 times more potnent

68
Q

what are side effects of a PCA?

A
  • increase risk of respiratory depression
  • sedation
  • N&V
  • urinary retention
  • reduced gastric motility/ constipation
69
Q

in regards to PCA side effects, who is at a greater risk of experiencing N&V?

A
  • females
  • non-smokers
  • intra-operative opioids used
  • history of post-op N&V
  • long surgery (increases by 60% for q30mins)
70
Q

in regards to PCA side effects, what causes reduced gastric motility/ complications?

A
  • CNS and intestinal binding of opioids
71
Q

when do you use narcan?

A
  • RR <8/ min
  • sedation scale of 4
72
Q

where do you find the dose of narcan to administer?

A
  • PPO
  • MAR
73
Q

how may times can you repeat administering narcan?

A

q2min x 4 until pt is awake

74
Q

if Benadryl is ineffective for pruritus, what can you give?

A

small doses of narcan either IM or subcut q1h

75
Q

what is the preferred route for narcan administration?

A

IV

76
Q

is complete pain relief a realistic goal for a pt post surgery?

A

no pain goal is around 3-4/10

77
Q

what is an epidural?

A

intermittent/ continuous infusion of analgesic agents into epidural space for purpose of providing pain contorl

78
Q

what are the 3 components of the spinal cord?

A
  • dura mater
  • arachnoid mater
  • pia mater
79
Q

describe the dura mater

A

outermost/ toughest layer

80
Q

describe the arachnoid mater

A

thin membrane covering the brain and spinal cord

81
Q

describe the Pia mater

A

most inner layer that clings tightly to the brain and spinal cord

82
Q

how many different categories are there of dermatomes? what are they? how many are in each?

A

4 different ones
Cervical (C) - 8
thoracic (T) - 12
lumbar (L) - 5
Sacral (S) - 5

83
Q

local anaesthetics block what?

A

initiation and transmission of electrical impulses along nerve fibres

84
Q

intraspinal administered analgesics are what?

A

highly potent b/c delivered close to opioid receptors in dorsal horn of spinal cord

85
Q

epidural opioid therapy involves what?

A
  • inserting catheter into epidural space
  • injecting analgesic either by intermittent bolus or continuous infusion
86
Q

what does epidural anesthesia produce?

A

produces:
- autonomic nervous system blockade
- anaesthesia
- skeletal muscle paralysis in area of affected nerve

87
Q

in regards to epidural anesthesia what order is the sensory system affected?

A
  • transmission of autonomic
  • somatic sensory
  • somatic motor impulses
88
Q

what medications are involved in epidurals?

A
  • opioids
  • local anesthetics
89
Q

what types of opioids are involved in epidurals?

A
  • morphine
  • HYDROmorphone
  • fentanyl
90
Q

what types of local anesthetics are involved in epidurals?

A
  • bupivacaine
  • ropivacaine
  • lidocaine
91
Q

for epidural analgesia autonomic blockade usually extends to what?

A

about 2 dermatomes above sensation

92
Q

what does the recovery from epidural blockade look like?

A
  • motor function comes back first
  • sensation is next
  • autonomic nerves come last (vasodilation, temperature)
93
Q

what are the pros to using epidural medications?

A
  • pt report high levels of satisfaction/ high levels of pain control
  • reduce incidence of pulmonary complications post surgery
  • reduce cardiac complications
  • lower doses of analgesics needed
94
Q

what are the risks/ cons to using epidural medications?

A
  • requires higher level of care from HCP
  • potential life threatening complications
  • higher cost than oral/ IV analgesia
95
Q

what does a higher level of care from a health care provider include in regards to risks/ cons to using epidural medications?

A
  • anesthesiologist inserts epidural
  • anesthesia department monitor pt with 24hr availability
  • frequent monitoring/ care by RN
96
Q

epidural analgesia/ anesthetics are particularly effective at managing pain following surgery to what?

A
  • chest
  • abdomen
  • pelvis
  • lower limbs
97
Q

what do you need to assess with an epidural?

A
  • epidural catheter length
  • insertion site/ dressing
  • use ice > assess sensation/ dermatome levels
    -motor function of lower extremities
  • pain level
  • sedation score
  • S&S of complications
  • vital signs
  • urinary output
98
Q

complications of PCEA and epidurals can arise from what?

A
  • the route/ technique
  • medications
  • secondary complications
99
Q

in regards to complications of PCEA and epidurals what are some examples of problems that can arise from the route/ technique?

A
  • epidural hematoma
  • postural puncture headache
  • local anesthetic toxicity
100
Q

in regards to complications of PCEA and epidurals what are some examples of problems that can arise from medications?

A
  • opioid or sedative-induced respiratory depression
  • nausea/ vomiting
101
Q

in regards to complications of PCEA and epidurals what are some examples of problems that can arise from secondary complications?

A
  • opioid or anesthetics may cause urinary retention
  • catheterization increases risk of UTI
102
Q

describe how SPINAL medication is different than epidural

A
  • sub-arachnoid space into CSF
  • affects motor function below level of injeciton
  • assessed using touch to pt skin
  • anaesthetic option for lower body surgery
103
Q

describe how EPIDURAL medication is different than epidural

A
  • epidural space
  • sensory block/ sometimes motor block
  • assessed by using ice to pts skin

NRSG 302 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions