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Cystoscopy
Procedure used to see inside bladder, urethra, ureters
Hollow tube (cystoscope) equipped with a lens
Inserted into urethra and slowly advanced into bladder
Examines the lining of bladder & urethra
Investigate causes of bladder signs and symptoms such as
- Blood
- in the urine
- Frequent UTIs
- Incontinence
- dysuria
- Overactive bladder
- To Diagnosis Diseases Such As
- Bladder cancer, stones
- Bladder inflammation (cystitis)
- Looking for Enlarged Prostate
- (benign prostatic hyperplasia)
- Narrowing of the urethra where it passes through the prostate gland
Sometimes used to remove small bladder tumors
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Dysuria
- Painful urination
- Only a little comes out and it burns
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Enuresis
Continued incontinence of urine past the age of toilet training
Occasional daytime incontinence of urine in children is not concerning
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Nocturnal Enuresis
- Bed wetting at night
- Subsides by 6 years old
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Nocturia
Urination at night
Diminished ability of the kidneys to concentrate urine
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Hematuria
- Blood in urine
- aka Presence of red blood cells in urine
Pink, red or cola-colored but can be microscopic
Takes very little blood to produce the color
Usually isn't painful unless it is the passing of blood clots in urine
- Common Causes
- UTI
- Inherited disorder (sickle cell, Alport Sydrome)
- Kidney infection, disease, or injury
- Bladder or kidney stone
- Enlarged prostate
A sign of advanced kidney, bladder or prostate cancer
Medications (some chemo drugs, antibiotics, aspirin)
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(Urinary) Hesitancy
Difficulty starting or maintaining a urine stream
Most common in older men with an enlarged prostate gland
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Kegel Exercises
Exercises used to strengthen perineal muscle tone
Target inner muscles that lie under & support the bladder
Same muscles that contract to stop urination midstream / control defecation
Hold for 10 seconds / relax for 10 seconds
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Micturition
The process of emptying the bladder
Nerve centers for it are in brain & spinal cord
Involuntary reflex but control can be learned
Voluntary control develops as higher nerve centers develop in infancy
aka Urination, Voiding
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Oliguria
Oliguria
Low urine output
- Adult
- Output (less than 400ml per day)
- Infant
- Output (less than 1 mL/kg/h)
- Child
- Output (less than 0.5 mL/kg/h)
Clinical hallmark of renal failure
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Post Void Residual
Test that measures amount of urine left in the bladder after urination
Measured by draining the bladder with a catheter
Can sometimes be measured with ultrasound
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Polyuria
Excessive volume of urination for an adult
Greater than 2.5 Liters / day
- Common & Not so Common Causes
- Diabetes (mellitus, insipidus)
- Drinking lots of water, coffee, alcohol)
- Diuretics or lithium medication
- Sickle Cell Anemia
- Ph of blood too high or low
- Kidney failure
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Stress Incontinence
Physical movement or activity (coughing, sneezing, running, heavy lifting)
Puts pressure (stress) on bladder
NOT related to psychological stress
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Urinary Incontinence
Involuntary loss of urine
- Common in women
- (urethra shorter than men)
Coughing & sneezing Increases abdominal pressure causing involuntary escape of urine
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Urinary Retention aka Ischuria
- Inability to empty the bladder completely
- Can be acute or chronic
Acute is considered a medical emergency (cannot empty at all)
- Chronic
- retention means can urinate but not completely
Causes
Obstruction of the Urethra due to
Benign prostatic hyperplasia (BPH) aka Enlarged Prostate
Urethral stricture due to inflammation, scarring from surgery
Urinary tract stones
- Cystocele
- (bulging of the bladder into the vagina)
- Rectocele
- (bulging of the rectum into the vagina)
Constipation
Hard stools in the rectum push against the bladder & urethra
Nerve damage or problems from
Vaginal childbirth
MS, stroke, diabetes
Brain or spinal cord infections or injuries
Medications (antihistamines, anticholinergics, tricyclic antidepressants)
Tumors & cancers
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Bowel Training Program
Treatment for patients with history of chronic constipation
Manipulate factors within patient’s control to produce soft, formed stool regularly
Goal is to not need laxatives
- Factors
- include: fluid intake, food, exercise, timing
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Laxatives / Cathartic
Used interchangeably but Cathartics exert a stronger effect
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Colonoscopy
- Endoscopic examination of the large bowel and the distal part of the small bowel
- Uses CCD camera or a fiber optic camera on a flexible tube
Tube is passed through the anus
Provides visual diagnosis (e.g. ulceration, polyps)
Can be used for biopsy or removal of suspected colorectal cancer lesions
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Constipation
Dry, hard, stools that are difficult or incomplete to pass
Having less than 3 bowel movements in a week
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Diarrhea
The passage of three or more loose stools a day
Cramps, nausea, vomiting, & blood in stools may occur
Protective response to irritation in intestinal tract
Fluids & electrolytes are lost quickly
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Endoscopy
To “look inside” the body for using an endoscope
Examines interior of a hollow organ or cavity of the body
Are inserted directly into the organ
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Fecal Impaction
Buildup of stool in the colon
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Flatulence / Flatus
Intenstinal gas
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Hemorrhoids
Abnormal distended rectal veins
Vertical folds in rectum (three transverse) each contain an artery & vein
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Occult Blood
Blood in stool that is hidden in the specimen and cannot be seen on gross examination
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Peristalsis
Contractions of the circular & longitudinal muscles of the intestine
Moves waste products along length of intestine continuously
Occurs every 3 to 12 minutes
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Sigmoidoscopy
Minimally invasive medical examination of the large intestine from the rectum through the last part of the colon
Two Types
- Flexible sigmoidoscopy, which uses a
- flexible endoscope (preferred procedure)
- Rigid sigmoidoscopy, which uses a rigid
- device
Similar to, but not the same as, a colonoscopy
Only examines up to the sigmoid (most distal part of the colon)
Verses a colonoscopy examines the whole large bowel
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Valsalva’s Maneuver
Moderately forceful attempted exhalation against a closed airway
Done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon
Find avideo on YouTube
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Sims Position
Used for rectal examination, treatments and enemas
Patient lie on left side
Left hip and lower extremity straight
Right hip and knee bent
- Also
- called lateral recumbent position
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Increased instance of voiding
Frequency
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Sugar in urine
Glycoseuria
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Protein in urine
Proteinuria
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Puss in urine or cloudy urine
Pyuria
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Stoppage of urine production
Suppression
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Adults produce urine at rate of _______ per hour
62-120 ml
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Strong desire to void
Urgency
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Involuntary loss of urine
Incontinence
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Turbidity
How clear urine is
Urine is clear when fresh but becomes cloudy as it stands and cools
Urine that is cloudy fresh is abnormal
Could be due to the urine containing the following contents
Vaginal discharge or sperm
White or red blood cells
Bacteria
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Normal pH of urine is
6.0
But can range from 4.6 – 8
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Urine becomes ______ on standing due to CO2 diffusion into air
alkaline
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High protein causes ___a___ urine
Citrus, juices, dairy, veggies make urine ___b___
a. Acidic
b. Alkaline
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What is the normal Specific Gravity of urine
High Specific Gravity means ______(a)
Low Specific Gravity means _____ (b)
Normal Specific Gravity of urine is 1.015-1.025
- a. dehydration
- b. hydration
Concentrated means higher than normal range
Diluted means lower than normal range
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Organic Constituents of urine are
Inorganic Constituents of urine are
Urea, uric acid, creatinine, urine pigments, nitrogen
Ammonium, electrolytes
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Abnormal Constituents of urine include
Blood, puss, albumin, ketones, glucose, bile, bacteria
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Cystoscopy
- Direct visual of bladder, urethra
- Pre-op consent, can
- have fluids in morning but no solid food
Sedated & ordinary painless
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Intravenous Pyelogram (IVP)
Examines kidneys with IV contrast dye
Rules out renal dysfunction or impairment
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Abrupt & strong desire to void
Seen in patients with UTIs
Urge Incontinence (Urgency)
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Urine loss from two or more types of incontinence
Mixed Incontinence
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Type of Incontinence Associated
with over-distended bladder
Overflow Incontinence
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Inability to reach toilet due to functional barriers, memory loss, cognitive deficiency
Functional Incontinence
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Incontinence that lasts for 6 months or less
Usually due to UTIs & being on medication
Transience Incontinence
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Emptying bladder without a feeling of need to void
Seen in spinal injuries
Reflex Incontinence
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Continuous & unpredictable loss of urine
Due to trauma, surgery, physical malformation
Urination cannot be controlled because of anatomical abnormalities
Total Incontinence
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External Condom Catheter (Texas Catheter)
- Soft pliable sheath of silicone applied externally to penis (self-adhesive) connected
- to bag
Used when voluntary control of urination not possible for males
An alternative to indwelling catheter
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Occult Blood
Blood that is hidden in the stool and cannot be seen on gross examination
- May be performed by nurse at bedside
- or by patient at home
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Endoscopy
- The direct visual examination of body organs
- Uses a fiber-optic endoscope that transmits light
- Esophagogastroduodenoscopy
- (visualizes esophagus, stomach, & duodenum)
- Colonoscopy
- (Visualizes large intestine from anus to ileocecal valve)
- Sigmoidoscopy
- (Visualizes sigmoid colon, rectum, & anal canal)
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Application of mechanical law to the human body
Regarding structure, function, & position
Body Mechanics
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Atelectasis
Incomplete expansion / collapse of lung tissue due to areas of lung tissue not used
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Atrophy
Decrease in muscle size
Happens rapidly in patients confined to a bed
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Ankylosis
Consolidation & immobilization of a joint
Increasesprocess of osteoporosis (bone de-mineralization)
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REM Rebound
Phenomenon where one amount of REM sleep remain constant over time
(If missing REM sleep for a few nights, will spent more time in REM sleep on successive nights)
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Dyssomnias
Sleep disorders characterized by insomnia or excessive sleepiness
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Insomnia
Type of Dyssomnia
Difficulty of falling asleep, intermittent sleep, or early awakening
More common of all sleep disorders
More in women (pre & post menopause), 60+, depression
Can be acute or chronic
Sleep hygiene (non-pharmacologic treatments) may help
- Causes
- Stress,
- psychiatric disorders
- obesity
- caffeine use
- diabetes
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Hypersomnia
Type of Dyssomnia
- Excessive sleep (particularly during the day)
- Fall asleep during work, eating, etc.
- Napping does not relieve symptoms
- Feel disoriented, irritated when awake
- Causes
- Sleep apnea
- alcohol & substance abuse
- head trauma,
- Depression
- Obesity
- CNS disorders
- Medication side-effects
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Narcolepsy
Type of Dyssomnia
Neurological disorder causing uncontrolled desire to sleep
Patients fall asleep standing up, driving, mid-conversion, swimming,
Fall asleep quickly & hard to wake up
Treated with medication
Driving restrictions are placed due safety of patient
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Sleep Apnea
Absence of breathing (apnea) or diminished breathing efforts (hypopnea) during sleep between snoring intervals
Breathing ceases for 10 seconds to 2 minutes
- Causes
- irregular pulse, increase BP, irregular pulse
Oxygen levels in blood drop
Excessive sleepiness commonly reported
- More common in
- older, heavier,
- possessing thick short necks
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Obstructive Sleep Apnea (OSA)
airway blocked
Collapsed hypo-pharynx, enlarged tonsils, deviated septum
- Treatments
- CPAP machine
- Surgery (removing tonsils, & tissues)
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Restless Leg Syndrome (RLS)
Inability to lie still without unpleasant creeping, crawling, tingling sensation in legs
Associated with iron deficiency (correlation cannot be explained)
OCT meds like antihistamines exacerbate symptoms
- URGE acronym used
- Urge to move legs
- Rest induced
- Gets better with activity
- Evening symptoms more severe
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Sleep Deprivation
Decrease in amount, consistency, or quality of sleep
Decreased NREM & REM sleep
Damaging mental & physically
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Patterns of waking behavior that during sleep
Parasomnias
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What are examples of Parasomnias?
- Somnambulism
- (Sleepwalking)
Sleep Talking
Night terrors (screaming due to perceived threat)
Bruxism (grinding teeth during sleep)
Enuresis (urinating during sleep), usually outgrown by adulthood
Sleep Eating Disorder (Eating during sleep and not remembering)
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Medical Term for Sleepwalking
Somnambulism
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Nocturnal Myoclonus
Observed in 10%-20% of chronic insomniacs
Muscle contractions resulting in jerking of legs during sleep
Contractions may arouse sleeper, contributing to insomnia
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Condition in which a muscle has lost its strength
Atony
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Footdrop
Inability to lift the front part of the foot
This causes the toes to drag along the ground while walking
Stems from weakness or paralysis of the muscles that lift the foot
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The constant low-level activity of a body tissue, especially muscle tone
The continuous and passive partial contraction of the muscles
Tonus
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Cancer Pain
- Could come from the cancer (tumor infiltrations) or the treatments
- Hormone changes, skin, nerve changes
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Administering sedatives to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardio respiratory function
Conscious Sedation
aka Procedural sedation & analgesia
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the point along a curve of increasing perception of a stimulus at which pain
begins to be felt.
pain threshold
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Referred Pain aka Reflective Pain
Pain that is felt in location other than the site of the stimulus
- Example: Ischemia brought on by MI
- Pain is felt in neck, shoulders, and back
- Location of stimulus is in the chest
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Maximum level of pain that a person is able to tolerate
Pain Tolerance
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Endorphins
aka "endogenous morphine"
Endogenous opioid inhibitory neuropeptides
Produced by the central nervous system and pituitary gland.
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Acute vs Chronic Pain
- Acute Pain
- Rapid in onset varying in intensity from mild to severe
Protective in nature to alert of damage or disease
Ends when healing is complete
Cut finger, sore throat, surgical wounds
- Chronic Pain
- Lasts beyond the normal healing period
Can be limited, intermittent, or persistent
Difficult for patient to describe and for nurse to assess
Often perceived as meaningless causing emotional issues for patient
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Remission vs Exacerbation
- Remission
- Disease is present but individual does not have symptoms
- Exacerbation
- When symptoms reappear
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Cutaneous Pain (Superficial Pain)
Involves skin or subcutaneous tissue
Example: Paper cut, skinning of knee
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(Deep) Somatic Pain
Originates in tendons, ligaments, bones, vessels, & nerves
Diffuses and scatters from origin
Example: Ankle sprain (pressure on bone & damage to tissue)
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Visceral Pain
Originates in body organs in thorax, cranium, and abdomen
Poorly localized
Organs become distended, ischemic, or inflamed
Occurs due to organs stretching abnormally
Example:Appendicitis
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Neuropathic Pain –
- Pain resulting in PNS & CNS system damage
- Can be short duration or lingering Described as burning or stabbing
Diabetic Neuropathy, carpel tunnel
Examples listed on table 35-1 on pg. 1114
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Pain that is resistant to therapy and persists after variety of interventions
Intractable (Pain)
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Phantom Pain
Feel pain in amputated limb where receptors and nerves are gone
Location & presence of pain is clear to patient
Also called Phantom Limb Pain
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Physical cause for pain cannot be identified
Caused by mental event
Psychogenic Pain
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Western cousin of acupuncture
Use fingertips to give firm pressure to acupuncture sites
Acupressure
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A Pharmaceutical agent that relieves pain
Analgesic
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Name some examples of Non-Opioids
What are they used for?
- acetaminophen, NSAIDs, COX-2 Inhibitors
- Celecoxib (Celebrex)
for mild to moderate pain
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What are Opioids (formally narcotics)?
What are the side effects?
Analgesic that attaches to opioid receptors in the brain
Nausea, constipation, & sedation (drowsy)
Feared respiratory depression (keep eye on patients who are on it)
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Opioid Polymorphism
- Enzymes that promote binding at site may
- be missing in some individuals
May explain why responses to opioid meds vary in some patients
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Physical Dependence vs Tolerance vs Addiction
- Tolerance
- Body becomes accustomed to opioid & require higher dose for pain relief
- Physical Dependence
- Body is physiologically accustomed to opiod
- Suffers withdrawal symptoms if suddenly removed or dose decreases
- Addiction
- Pattern of compulsive opioid
- No longer using it for pain
- Craving, compulsive use, lack of control over use
- Continuing use despite harm
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Adjuvant Drugs (regarding analgesics)
Used for other purposes than pain
Used to enhance effects if opioids or reduce side effects
- Lessen anxiety about pain experience
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- Examples
- anti-depressants,
- anti-convulsion, corticosteroids
- Atropine
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Temporary flare-up of moderate to severe pain
that occurs even when patient is taking ATC meds
Breakthrough Pain (BTP)
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Patient-Controlled Analgesia (PCA)
Computerized portable infusion pump with bag or syringe prefilled with opioid
Lock-out-interval prevents over medication
Candidates for PCA must be alert & capable with no risk of over-sedation
- Gives patients a sense of control
- Studies find that patients use less
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Epidural Analgesia
Catheter inserted into mid-lumbar region, b/t walls of vertebral canal & dura matter
- Provide relief during / during
- Immediate post-op
- (thoracic, abdominal, & vascular, ortho surgery)
- Children with terminal cancer
- Chronic pain situations
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