Pain, pharmacology, PACU, Administrarion of medication

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Pain, pharmacology, PACU, Administrarion of medication
2011-12-03 23:18:09
Nursing Fundamentals

Nursing Fundamentals
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  1. Nature
    sharp, dull, aching, squeezing, deep, pressing, gnawing
  2. Intensity
    mild, moderate, severe
  3. location
    can you point to it?
  4. onset
    suddent, slowly, gradual, build-up
  5. tolerance
    it takes a larger dose to provide the same level of pain relief
  6. physical dependence
    a physiological phenomenom that some people experience after taking the medication for a few weeks. They exhibit symptoms such as sweating, tearing, runny nose, restlessness, irritability, tremors, dilated pupils, nausea, vomiting and diarrhea.
  7. Physiological dependence
    addiction, compulsive drug use with craving for opoid for the effects other than pain relief
  8. Gate Control Theory
    Pain viewed as being controlled by a gate mechanism in the CNS. Opening the gate allows transmission of pain. Closing the gate blocks the transmission of pain. The gate may be opened by activity in small diameter nerves, such as tissue damage. Large diameter nerve activity seems to close the gate (massage, vibration). Lack of input allows the gate to open.
  9. Endorphins
    Endogenous, naturally occuring opiate-like peptides that modify the perception of pain. They attach to opoid receptors and block pain (they degrade quickly and are not effective analgesics). Physiologic and psychological stressors can cause the release of endorphins.
  10. Pain descriptions 6
    Types of pain, severity of pain based on pain scale, quality of pain, location of pain, duration of pain, degree of pain.
  11. Type: acute
    short term, associated with injury. Short duration lasting a few hours to a few days, expected to be over soon, described as aching or throbbing, pt may be restless or aggitated, controlled by analgesics. Moaning, crying, irritable, grimacing, guarding/splinting.
  12. Type: Chronic
    long term, may continue for months or years. may be dull, constant, shooting, tingling or burning. May be treated with both pharmacologi interventions. Flat affect, fatigue, withdrawal from others, decreased physical movements.
  13. Type: Nocieceptive
    Body's normal reaction to noxious stimuli, such as tissue injury. Involves injury to tissue in which receptors called nociceptors are located. Found in skin, joints, or organ viscera. 4 phases: transduction tissue damage, pain sensation; transmission-transmitted to spinal cord, conscious of it; perception-brain recognition recognizes impulse as pain; modulation-brain sends signals back. NSAIDs, Opoids, distraction and guided imagery block perception.
  14. Type: Neuropathic
    sensitivity to stimuli (injury affects the peripheral or CNS). Associated with dysfunction/damage of the nervous system. Pain receptors become more sensitive to stimuli. Associated with Guillan Barre Syndrome, cancer, DM, shingles and HIV. Treated with NSAIDs, tricyclic antidepressants, anticonvulsants or corticosteroids.
  15. Type: phantom
    after loss of body part. Not controlled bny conventional methods.Treated with TENs implanted in the thalamus.
  16. Type: psychogenic pain
    Most people with chronic pain have some degree of psychological disturbance. Causes a psychologic problem and contributes to the pain.
  17. Analgesics: Nonopiods
    Tried first, acute and chronic pain, has ceiling effect, no tolerance or physical dependence, NSAIDs (block prostaglandins), anti-pyretic effect
  18. Analgesics: Cyclooxygenase-1 inhibitors
    Block COX2 enzyme, present with pain like arthritis
  19. Analgesics: Opiods
    For moderate to severe pain, no ceiling effect, morphine-drug of choice, need to monitor level of sedation and respiratory status, Naloxone opiod antagonist.
  20. Analgesics: Adjuvants
    May potentiate effect of opiod or nonopiod, have analgesic activity, ex: steroids, antidepressants, anticonvulsants.
  21. To assess thoroughly: OLD CART
    onset, location, duration, characteristics, alleviating/aggravating, radiation, timing.
  22. To assess thoroughly: WHATS UP
    Where is it, how does it feel, aggravating/alleviating factors, timing, severity, usefule data (other sx), perception (what do they think).
  23. Stages of sleep: REM
    rapid eye movement, time in which you dream, a period of a high level of activity, heart rate, bp, and respirations are similar to that when awake, spend 25% of sleep here, Normal: leg kicks, arms, swinging, moaning, nose scratching, laughing.
  24. Stages of sleep: NREM
    non-rapid eye movement. believed to be the time when the body receives the most rest. heart rate, blood pressure and respirations decline, 4 stages: light sleep to very deep sleep/difficult to arouse. In one night, go thru 2 states (REM, NREM) in 90 minutes cycles, 5-6 times/night
  25. Schedule I
    Drugs with no accepted medical use and a high potential for abuse. (ex. heroin, LSD, crack cocaine}
  26. Schedule II
    Drugs with a medical use and high potential for abuse and/or dependence (certain narcotics-morphine, stimulants, Ritalin, depressants)
  27. Schedule III
    Drugs that are medically useful but with less potential for abuse (Tylenol #3, Vicodan, Valium)
  28. Schedule IV
    Drugs that are medically useful but with less potential for abuse than schedule III drugs.
  29. Schedule V
    Drugs with medical use and low potential for abuse and that produce less physical dependence than do schedule IV drugs.
  30. Pharmokinetics
    how drugs enter the body, are metabolized, reach their site of action, and are excreted.
  31. Distribution
    distribution to tissues and site of action depends on chemical and physical properties of drug and physical status of patient.
  32. Metabolism
    chemical transformation
  33. Absorption
    rate determine by weight, age, sex, disease conditions, genetic factors and immune mechanisms.
  34. Excretion
    elimnation from body.
  35. Absorption rate: skin
    slow absorption
  36. Absorption rate: mucous membranes
    quick absorption
  37. Absorption rate: respiratory tract
    quick absorption
  38. Absorption rate; Oral
    slow absorption
  39. Absorption rate: Intramuscular
    Depends on the form of the drug
  40. Absorption rate: Subcutaneous
    slow absorption
  41. Absorption rate: Intravenous
    Most rapid absorption
  42. Onset
    Begins with the drug reaches a minimum effective concentration level.
  43. Peak
    Occurs when the highest blood or plasma concentration of the drug is achieved.
  44. Duration
    Length of time the drug exerts a pharmacologic effect.
  45. Agonists
    Drugs that produce a response.
  46. Antagonists
    Drugs that block a response.
  47. Standing order
    carried out until it it canceled by physician or prescribed number of doses has been given.
  48. PRN order
    an order written for when the pt requires it.
  49. One time order
    Written for a drug to be just given the one time.
  50. Stat order
    a single dose of a medication to be given without delay.
  51. What are the 5 Rights?
    • 1. The right drug
    • 2. The right dose
    • 3. The right route
    • 4. The right time
    • 5. The right Pt
  52. What are the 5 Rules?
    • 1. Teach the pt about the drugs
    • 2. Take a complete drug hx
    • 3. Assess the pt for drug allergies.
    • 4 . Be aware of potential drug interactions from other drugs or foods.
    • 5. Document each drug you administer after giving it.
  53. Renewal orders: opiate analgesics
    48-72 hour limit
  54. Renewal orders: Sedatives and antibiotics
    5 or 7 day limit
  55. Renewal order: all medications
    30 day limit on all medications.
  56. How many times should you monitor a post-op surgical pt?
    Every 15 minutes for first hour. Every 30 minutes for next 2 hours. Every hour for 4 hours or until pt is totally recovered and VS have returned to normal.