Exam 1: Study Guide

What is pain

a complex multifaceted experience that encompasses physical, emotional, and psychological elements

What is the IASP definition of pain

an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage

What are the four standards of practice in relation to patient pain management

1. all patients have the right to pain assessment and management

2. safe medication policies and procedures must be used

3. outcomes measuring effectiveness and the appropriateness of assessment are monitored

4. pain management is included in patient discharge instructions

What is acute pain

Identifiable precipitating event with sudden pain and a duration of hours to weeks

What is chronic pain

there may not be a precipitating even and the onset is gradual over time with a duration of 3 or more months

What is the goal of chronic pain

to enhance functionality and increase QOL

Physiological effects of pain

Increase in HR, BP, RR, hypoxia, atelectasis, impaired cognition, anxiety, impaired functionality, muscle spasms, fatigue, fall risk, DVT risk, increase in stress hormones, decreased immune response and decreased gut mobility

An increase in E/Ne leads to what

vital sign changes

An increase in ACTH leads to what

cortisol increase

An increase in ADH leads to what

fluid retention

Psychological effects of pain

depression, mood swing, impaired social interactions, altered intimacy, and suicide

in an educational session for new nurses, the pain specialist includes what information related to Chronic pain?

a. Sudden onset

b. More responsive to pain management

c. Long duration

d. Unpredictable intensity

e. Precipitating event may or may not be known

c: long duration

D: unpredictable intensity

E: precipitating event may or may not be known

Nociepective pain

normal CNS/PNS processing, nerves are triggered by noxious stimuli

Cutaneous pain

SubQ, skin, mucous membrane that is well defined and located, described as sharp, tender, or itchy and includes sunburns

Somatic pain

muscle, joint, and bone pain localized but often diffuses and radiates, described as dull, achy, sore, cramping, spasm, and stabbing and includes fractures, arthritis, and myalgia

viceral pain

arises from organs and described as pressure, achy, stabbing, cramping, and difficult to localize and includes appendicitis, colitis, and heart attack

Neuropathic pain

abnormal processing of sensory input by CNS/PNS caused by damage to nerves, brain lesions, or CNS structures

A patient is receiving morphine sulfate IV for right flank pain caused by a kidney stone in the right ureter. The patient also complains of right inner thigh pain and asks the nurse whether something is wrong with the leg. IN responding, the nurse knows that this patient

a. Has acute pain that may be progressing into chronic pain.

b. Has neuropathic pain from nerve damage caused by acute inflammation

c. Is experiences referred pain from the kidney stone

d. Is experiencing altered perception from the morphine

C. is experiences referred pain from the kidney stone

Assessing pain

Aggravating factors, alleviating factors, and associated clinical manifestations

IPPA

Inspection, palpation, percussion, and auscultation

What do you assess in patient with altered consciousness or mental impairments who you suspect may have pain

breathing, negative vocals, facial expression, body language, and conceivability

Equianalgesic dosing

defined as the dose at which two opioids provide approx the same pain relief

Titration

dose adjustment based on effectiveness, using the smallest amount possible for effective control

Adjuvant Medications

used to enhance the effects of pain medication, treat concurrent symptoms, and provide analgesia for other types of pain and this includes antidepressants, anticonvulsants, corticosteroids, neuroleptics, and weed

What do you assess in patients receiving pain management

arousal, RR under 10, O2 stats

How does Narcan work

works by blocking the effects of opioids on the brain and restores breathing within two to eight minutes to prevent death

Post-Op narcan dose

0.4-2 mg every 2-3 mins PRN

Opioid OD Narcan dose

2-4mg inhaled, repeat every 2-3 min PRN

Side effects of Narcan

BP changes, increased HR, arrhythmias, N/V, sweating

The nurse is caring for a patient who had major abdominal surgery yesterday requiring a colostomy and is receiving fentanyl. What is the nurse's priority

a. Assessing for nausea and pain

b. Auscultating for bowel sounds

c. Counting the RR

d. Checking for fever

e. Inspecting the incision for infection

C: counting the RR

How is BP calculated

BP=COxPRV

What is Cardiac Output

the total volume of blood pumped per minute, influenced by HR and SV

What is stroke volume

the amount of blood pumped out of the left ventricle per beat

What is PVR

the source opposing the movement of blood in the vessels, largely determined by arteriole diameter or how tight the smooth muscle tone is

Primary HTN

Has no single identifiable cause and is 90-95% of cases

Secondary HTN

has specific cause such as renal disease, endocrine disorder, and drug induced, only 5-10% of cases

What are the risk factors for HTN

age, gender, ethnicity, family history, alcohol abuse, tobacco use, diabetes, obesity, physical inactivity, increase serum lipids, high sodium diets, socioeconomic status, elevated stress

Who is at the highest risk for HTN

African Americans

what is a art line

a thin catheter inserted into an artery to provide continuous blood pressure monitoring and easy access for arterial blood sampling

What is the diagnosis criteria of HTN

2 or more measured readings on 2 or more office visits, over 130/80

first line treatment of HTN

lifestyle

second line treatment for HTN

medications; for those over 60 tx starts with BP over 150/90 and for those under 60 tx starts with BP over 140/90

What is hypertensive urgency

DBP over 120 mmHg with no evidence of TOD

what is hypertensive emergency

target organ damage

Orthostatic hypotension

changes more than 10 mmHg when supine, sitting, and than standing

Arteriosclerosis

Thickening or hardening of the arterial wall that causes stiffness and loss of elasticity

Atherosclerosis

particle build up on the arterial wall that can block blood and decrease flow and typically starts in childhood and progresses with age

Clinical manifestations of atherosclerosis

Pain which does not show until 60-75% blocks

Peripheral arterial disease

a chronic and progressive disease classified as obstruction through large peripheral arteries causing total or partial arterial occlusion which deprives the limbs of adequate oxygen and nutrients

what is PAD caused by

atherosclerosis, inflammation, embolus, thrombus, stenosis

What are S/SX of PAD

thin, shiny, dry, taunt skin, hair loss, thick nails, weak or absent pulses, prolonged capillary refill, cold skin, muscle atrophy, elevation pallor, reactive hyperemia, intermittent claudication, ischemic muscle pain

Non invasive diagnostic studies for PAD

ankle-brachial index, plethysmography, treadmill exercise test

Diagnostic studies for highly symptomatic patients with PAD

duplex ultrasound, CT and MRI angiography, direct arteriography

Treatment procedures for PAD

percutaneous transluminal angioplasty, laser assisted angioplasty, rotational atherectomy, surgical intervention

Medications for PAD

hemorheological agent, anti-platelet, vasodilator, anti-lipid

Critical limb ischemia

sustained, severe decrease in arterial blood flow to an extremity

acute limb ischemia

sudden decrease in arterial blood flow to an extremity

When developing a teaching plan for a patient newly diagnosed with PAD, which information should the nurse include?

a. "Try to keep your legs elevated when sitting"

b. "Exercise only if you do not experience leg pain"

c. "Avoid sitting with legs crosses"

d. "put support hose on early in the day before swelling occurs"

c. avoid sitting with legs crossed