adults exam 1: set 1

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kbryant86
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259069
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adults exam 1: set 1
Updated:
2014-01-29 15:52:59
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adults pain periop
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adults pain and periop
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  1. Acute pain
    1-5
    • sudden onset
    • ID'd cause
    • sharp, localized
    • <6 months
    • warning sign for other things
  2. Chronic pain
    1-4
    • prolonged
    • usually result of chronic disease
    • may have no ID'd cause
    • physiologic adaptation
    • deplete serotonin and endorphins (depression)
  3. breakthrough pain

    end of dose
    vs
    incident
    end of dose= pain will return before next dose time (not effective)

    incident= given before events such as physical therapy
  4. untreated chronic pain causes these 3 things
    • depression
    • dec. quality of life
    • affects family/work
  5. assessing pain
    P
    Q
    R
    S
    T
    • Precipitation= what started the pain?
    • Quality= pt.s own words
    • Region/Radiation
    • Severity
    • Timing
  6. assessing pain
    W
    I
    L
    D
    A
    • Words = quality
    • Intensity
    • Location
    • Duration
    • Alleviating/Aggravating factors
  7. addiction
    psychological need / overwhelming feeling of need to obtain substance
  8. pseudo-addiciton
    pt displays addiction behaviors, but is not actually addicted

    pt. who is ready for next pain med exactly when scheduled
  9. acetaminohen
    • good for analgesic and fevers
    • affects liver function though
  10. NSAIDS

    name 3 too
    • include anti-histamines
    • hard on GI

    • ASA
    • Ibuprofen
    • Torodol
  11. opiod meds bind to ________
    central and periph opiate receptors
  12. Narcan
    reverse CNS and resp. DEPRESSION (<12)
  13. SE of opiods
    • constipation --> never goes away
    • n/v
    • puritis = itchy
    • sedation
    • resp depression
  14. 3 things used as adjuvant analgesics
    these boost pain killers

    • local anesthetics
    • anticonvulsants= Gabapentin for nueropathic pain
    • antidepressants= Serotonin Reuptake inhibs
  15. on WHO's pain ladder, the pain levels are broken into mild, moderate, and severe...

    assign number levels and meds used to each level
    mild= 1-3, bottom (level 3), non-opioids

    moderate= 4-6, middle (level 2), oral opioids

    severe= 7-10, top (level 1), IV
  16. transdermal drug delivery
    can take up to 12 hours to kick in on 1st use

    give oral/IV during 1st use
  17. reassess times for:
    oral
    IM
    IV
    • oral= 60-90 min
    • IM= 30-45
    • IV= 15
  18. informed consent must be explained by ___
    the person performing the procedure***

    RN's can ONLY witness the signiture, NOT inform the patient
  19. Surgical care imporvement project (SCIP)
    1-4
    • thromboembolisms
    • hypothermia
    • surgical site infections (pre-surg antibios)
    • adverse cardiac events (given certian meds throughout procedure for CHF and the like)
  20. Joint Commission's "Universal Protocol"
    1-4
    b/c of sentinal events= HCP does something to cause pain/injury to pt.

    • pre-procedure verification process
    • markk surgical site
    • time out
  21. what is the goal of pre-op pre-admission testing?
    to decrease risk factors
  22. pre-op check list
    1-7
    • informed consent
    • Dx tests
    • H & P
    • removal of glasses, dentures, etc.
    • NPO status
    • ID bands
    • Pre-op meds and preps
  23. llist of med types given pre-op
    • anti-anxiety
    • anti-cholinergics
    • antibios
    • H2 blockers
  24. Benzodiazepines
    • anti-anxiety med
    • given 1 hr before surgery
    • Valium
  25. Atropine
    • anti-cholinergic
    • given to dry secretions and prevent aspiration
  26. Pepcid
    H2 blocker given to decrease aspirations as well
  27. 3 principles of positioning
    • avoid skin brkdown
    • avoid nueromusc damage
    • maintain correct body allignment
  28. 3 types of anesthesia
    • general
    • conscious sedation
    • regional
  29. general anesthesia

    3 phases
    • most common
    • complete CNS sedation (pt can't maintain own airway)

    • Induction= administering, air way is placed
    • Maintenance
    • Emergence= coming out of sedation
  30. conscious sedation
    • short acting
    • pt can maintain own airway
  31. narcan reverses what?>

    Romanazicon reverses what?
    opioids

    benzodiazepines
  32. Neruoendocrine response
    • surgical incision causes vascular and tissue damage
    • chem mediators released, altering vascular membrane permeability
    • Increase cell perm. to h20
  33. Immune responses
    • changes vascular permeability
    • bld collects at surgical site, increase capillary hydrostatic pressure
    • response causes cap leak in lungs and interstitial spaces
  34. nursing management of fluids
    • manage vascular volume deficit 1st
    • return interstitial fluid to venous system
    •  -exercise helps promote lymph drainage
  35. what is the most common cause of intravascular overload? (fluid volume excess)
    • over correction of hypovolemia
    •  --> see BP drop and HR rise
    • **important to look at pt trends
  36. hyper/hypovolemia refers to the fluid in the vascular system ONLY

    a pt. can have edema and still be hypovolemic
    hyper/hypovolemia refers to the fluid in the vascular system ONLY

    a pt. can have edema and still be hypovolemic
  37. Immediate post-op care
    • respers are 1st priority
    • cardiac
    • neuro (LOC)
    • dressings
    • pain
  38. 9 conditions that must be met in order to discharge to PACU
    • stable vitals
    • patent airway and adequate resp fnction
    • control of bleeding and wound drainage
    • normal thermal state
    • absence or control of any anesthetic or surgical complication
    • full or almost full recovery from anesthesia
    • orientation to environment
    • adequate fluid balance and urinary output
    • ability to request assistance if needed
  39. post-op assessment times
    • Q15 for 1st hour
    • Q30 for next 3 hours
    • Q1hr for next 4 hours
  40. cardiovascular complications post-op
    • shock
    • hemorrhage
    • DVT
    • PE
  41. nursing actions for cardiovasc complications
    monitor vitals to prevent shock and hemorrhage

    • give isotonic fluids for shock/hemorrhage
    • give anti-coags for clots
  42. resper post-op complications
    • pneumonia
    • atelectasis
    •  -hypoventilation
    •  -splinting
  43. nursing actions for resper complications
    • encourage deep breaths
    • pain management
    • supply O2
    • antibiotics
  44. wound post-op complications
    • infection
    • dehiscence=  some layers of wound edges no longer together
    • evisceration= ripped open, organs visible
  45. GU and GI post-op complications
    urinary retention

    • paralytic Ilius (obstruction)
    •  STD Tx= make pt NPO and insert NG tube
  46. Discharge criteria
    1-8
    • A&O x 3
    • positive gag reflex
    • o2 >92%
    • distal pulses palpable and equal
    • pain managed tolerably
    • vital signs stable
    • complications resolved
    • teaching done

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