Study Guide Unit 1

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Study Guide Unit 1
2014-02-16 22:01:28
114 Final
Study Guide final 114
114 Study guide unit 1 chap 1,5,16,17,18
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  1. examples of acute pain
    • kidney stones
    • any pain that is acute in nature, the pain will go away after patient heals
  2. examples of chronic pain
    anything that lasts longer than 3 months

  3. chronic cancer pain
    • critical to perform complete pain assessment
    • causes: bone metastasis, nerve compression, invasion of tissue by tumor, or treatment related pain (pain after chemo, radiation, or surgery)
    • Give pain meds around the clock instead of PRN
  4. Non-Cancer Chronic Pain
    • a major health problem that serves no purpose (pain should be a warning signal)
    • Neurological pain is one of the hardest to treat

    Arthritis, Osteoporosis, Neuropathy related to DM or herniated disc, phantom limb pain
  5. Gate control theory
    • gate in spinal cord that allows nerve impulses to travel.  If gate is open the pain impulse travels to the brain and pt perceives pain.
    • Endorphins can cause the gate to close, breathing control and cognitive therapies work by closing the gate
  6. Somatic Pain
    pain of the skeletal muscle, ligaments, and joints

    describes as dull aching or cramping
  7. visceral pain
    pain of the smooth muscles and organs

    pain is poorly localized, diffuse deep cramping or stabbing
  8. localized
    describe each pain
    • referred-pain perceived in an area distant from the painful stimuli
    • radiating-diffuse pain around the site of origin that is not well localized
    • projected- pain along a specific nerve or nerves
    • localized- confined to the site of origin
  9. neuropathic pain
    pain from nerve fibers, spinal cord and CNS

    Pain is poorly localized shooting, burning, shock like or numbness
  10. PQRST
    • Pain
    • Quality
    • Region
    • Severity
    • Time

    A way to help assess pain
  11. What are some Full Agonists
    • Morphine
    • Fentanyl
    • Demerol
    • Methadone
    • Dilaudid
    • Codeine
    • opioid/acetaminophen combos
  12. what is a full agonist?
    meds that fully bind to opioid pain receptors in the brain and cause analgesic reaction from release of endorphins
  13. partial agonist
    binds to the opioid pain receptor and causes limited pain reduction

    Less risk of addiction
  14. Antagonist
    • reverse the agonist on pain receptors
    • pulls the opioid off he pain receptor and covers it so they cannot reattach

    used during overdose
  15. what are side effects of opiates
    • Hypotension, flushing, palpitations
    • Sedation, Euphoria, disorientation, lightheadedness, lowered seizure threshold
    • N/V, constipation
    • Urinary Retention
    • Itching, Rash
    • Respiratory Depression
    • Addiction, craving for drug
    • physical dependence, withdrawal
  16. the most serious side effect/ complication of using opiates
    • psychological dependence-addiction and cravings for drug
    • physical dependence- withdrawal
  17. what is addiction
    • primary chronic neurobiologic disease with genentic, psychosocial, and environmental factors. behaviors include impaired control over drug use, compulsive use and continued use despite harm and cravings
    • Addiction occurs of long time-not one hospital stay
  18. pseudoaddiction
    • created by undertreatment of pain
    • patient behaviors such as anger and escalating demands for more or different medications

    Pseudoaddiction can be distinguished from addiction by- when pain is treated the behaviors stop
  19. tolerance
    state of adaption in which patient becomes tolerant to a drug after taking it for a while the body gets used to it and it takes more to work
  20. physical dependence
    patient will have withdrawal when medication is stopped
  21. the best way to prevent addiction from occurring in a pt who is physically dependant
    slowly decrease the med so the patient does not feel it
  22. what are the S/S of withdrawal?
    • rebound pain
    • tachycardia
    • hypertension
    • mental agitation
  23. how do antagonists work?
    • they remove the opioid from the receptor and cover so the opioids cannot reattach.
    • completely reveres the effect of the opioid
  24. Acetaminophen
    Nursing implications
    best used for....
    teach to only take rec dose. it has ceiling effect and taking more will only cause liver damage

    watch for hepatic necrosis, and hepatic toxicity

    • best used as antipyretic
    • mild pain
    • Does not treat inflammation
  25. examples of NSAIDS
    • Ibuprofen
    • Naproxen sodium
    • Troadol
    • Relafen
  26. Side Effects of NSAIDS
    • Bleeding
    • Gastric Upset
    • Nausea
  27. Nursing Implications for NSAIDS
    • watch for S/S bleeding, gastris upset and nausea
    • Give with food
    • Should be DC several days prior to surgical procedure
    • Troadol is only IV NSAID
  28. ASA is a ______ but it is technical considered a _______
    • salicylate
    • NSAID
  29. Guide for treatment of pain
    • 1-4 mild use nonnarcotic meds
    • 5-7 moderate use narcotic and nonnarcotic, PO Meds
    • 8-10 severe use narcotics parenteral (IM,IV)

    • Always Reassess  PO Meds 1 hour after
    •                     IM or IV 30mins after
  30. What is a TENS Unit
    • Transcutaneous Electrical Nerve Stimulator
    • provides skin stimulation to produce pain relief
    • works for acute and chronic pain
  31. What is a Spinal or Epidural
    Epidural catheter is placed in epidural space near not spinal cord and left in as long as needed

    • Spinal is an injection into the cerebrospinal fluid that produces loss of autonomic, sensory and motor nerve conduction, it lasts about 2 hours
    • good for lower abdominal and pelvic surgery
  32. PCA
    • patient controlled analgesia pump
    • preset amount of med, patient can push the button and med is delivered at preset intervals
  33. Adjuvant Agents
    meds that are given along with a narcotic to enhance the effect
  34. Informed consent
    what is it and how is it obtained?
    • consent implies that the patient has sufficient info and understands reason for surgery, who will preform, all options and risks, risks associated with anesthesia
    • Obtained by nurse but is surgeons responsibility
  35. who can sigh consent
    • must be over 18
    • parent an sing for minor
    • medical power of attorney
    • if pt cannot write they can put an X but it must be witnessed by 2 nurses
  36. what is importance of baseline assessment
    • to document everything about a patient it will be used after surgery
    • example patient has weak pulses prior to surgery and not documented, after surgery nurse checks and finds weak pulse and they will think it is new onset and complication
  37. what is involved in Baseline pre-op assessment?
    • use of alcohol, drugs and Rx drugs
    • Medical History
    • Prior Surgical History
    • Did Pt Donate their own blood
    • General Health & Family History
    • Support System
    • Complete Physical Exam
  38. what is the purpose of pre-op meds?
    • to decrease anxiety
    • promote relaxation
    • inhibit gastric secretions
    • decrease the amount of anesthesia required for induction
  39. If any abnormals are found before surgery who needs to be notified?
    Surgeon and Anesthesia
  40. What is the purpose of having a patient NPO?
    How Long should they be NPO?
    To prevent Aspiration

    8 hours, includes smoking
  41. What are the roles of a circulator nurse?
    • RN who coordinates, oversees and is involved in the clients nursing care performed in the OR
    • performs counts ad time out
    • Monitors Traffic in the room
    • Assesses the amount of urine and blood loss
    • records what procedure was done
    • ensures sterility by surgical team
    • anticipates needs and provides supplies
    • CN is not sterile
  42. What is the role of scrub nurse
    • sets up sterile field
    • assists team with gowning and gloving
    • passes instruments
    • maintains accurate count of sharps, sponges and instruments
    • Sterile
  43. count procedure
    • 1st count procedure
    • 2nd start to come out
    • 3rd half way out
    • 4th right before close
  44. What are the dangerous items in the OR
    • flammable gas
    • Electrocautery knife
    • Sharps, scalpel, suture instruments
  45. What causes malignant hypothermia
    inhalable gas
  46. what is the importance of surgical positioning?
    • prevent skin breakdown
    • prevent joint pain, stiffness after
  47. What are the 4 stages of anesthesia
    • 1:Analgesia and sedation, relaxation
    • 2:Excitement, Delirium
    • 3:Operative Anesthesia, Surgical Anesthesia
    • 4:Danger
  48. what is balanced anesthesia
    combination of agents to keep from using as much gas
  49. Stage 1 of general anesthesia
    • begins with induction and ends with loss of consciousness
    • feels drowsy and dizzy reduced sensation to pain

  50. Stage 2 of general anesthesia
    • begins with loss of consciousness and ends with relaxation, regular breathing loss of eyelid reflex
    • Vomiting may occur

    Patient susceptible to external stimuli DO NOT MOVE OR TOUCH
  51. Stage 3 general anesthesia
    begins with generalized muscle relaxation and ends with loss of reflexes depressed vital functions

    • patient cannot hear all sensations are lost
    • Nurse should PREP and position
  52. Stage 4 general anesthesia
    Danger Zone

    may have respiratory or cardiac arrest
  53. early S/S of Malignant Hyperthermia
    • sinus tachycardia, tachypnea
    • Muscle Rigidity esp jaw and upper chest
    • Hypotension
    • cyanosis
  54. late S/S malignant hyperthermia
    extremely elevated body temp
  55. treatment of malignant hyperthermia
    • Dantrolene sodium
    • cooling blankets
    • rectal foley
    • NG Tube irrigation with ice water
    • treat other s/s
    • if caught before late S/S (Temp Change) pt has better chance
  56. what is local infiltration
    when is appropriate
    how to give
    • injection of a anesthetic agent directly into the tissue surrounding an incision, wound or lesion
    • it blocks the nerve impulses to specific site

    make sure to aspirate
  57. what is the purpose of anesthesia
    • to block nerve impulse transmission
    • suppress reflexes
    • promote muscle relaxation
    • and achieve a controlled level of unconsiousness
  58. what is significant assessment for a pt who is intubated?
    • check for equal breath sounds and bilateral chest expansion
    • this is to make sure the tube did not move or become displaced
  59. Restlessness and Agitation are most often early signs of.....
  60. always care for patient with____ in mind especially in the PACU
    • ABC's
    • Airway Breathing
    • Consciousness (mental Status)
  61. Patient with gastric surgery should never have ....
    their NG tubes moved or irrigated without a specific order
  62. After surgery it is important to compare......
    compare all findings with baseline pre-op findings
  63. you should report any change in VS that is __ change from baseline VS
    if patient has 25% change in VS notify physician
  64. Evisceration: what is it?
    what to do when it happens?
    what causes it?
    • Surgical Emergency!
    • 1st have pt lie flat with knees flexed, stay with patient, cover wound with sterile NS soaked gauze, call for help
    • Call Dr to notify
    • Find out pts NPO status
    • Notify Anesthesia
    • Call family
  65. what is wound dehiscence?
    how is it treated and what is the cause
    • splitting or partial opening of an incision
    • usually from infection
    • Should be left open to drain, treat with Abx and wet to dry dressing
  66. S/S of a post op infection?
    • Redness
    • Swelling around the incision
    • Excessive tenderness
    • Purulent or Odorous drainage

  67. Who is at risk for DVT postoperatively?
    • Obese
    • immobility
    • lower extremity trauma
    • H/O DVT
    • use of oral contraceptives
    • pts on chemotherapy
    • presence of PE (current or past)
    • smoking
    • pts with PVD
  68. what are complications of immobility that we worry about postop?
    • DVT
    • Pneumonia
    • Atelectasis
    • UTI
    • Skin Breakdown
    • Constipation
  69. Bowel Sounds should be auscultated postop, but until the pt is 24 hours postop ______ is a normal finding
    no bowel sounds is a normal finding for 1st 24 hours after surgery, Document the findings
  70. what is paralytic ileus?
    decreased or absent peristalsis

    S/S: few or absent bowel sounds, N/V, abdominal pain, abdominal distention

    • Tx: NGT to low suction for GI rest, NPO for GI rest, IV Fluids, wait for bowel sounds to return
    • Dx by abdominal x-ray
  71. Types of Post Operative Hemorrhage
    Concealed - bleeding inside the body. Pain and swelling around incision

    Evident- Bleeding outside the body via incision
  72. Signs of hypovolemia from blood loss
    • Hypotension
    • tachycardia, tachypnea
    • paleness
    • weakness
    • Later signs: decreasing HGB, decreasing O2 sats, paleness and pallor
  73. treatment for hypovolemia
    trendelenburg or modified trendelenburg

    • IV Fluids: Lactated Ringers (volume expanders)
    • Oxygen
    • continuous pulse Ox
    • labs
    • check HGB and HCT
    • Notify doctor
    • If evident bleeding put pressure over bleeding area