Foundations Module 2 Week 5 - Chapters 40 + 31 + 36

1. Breathing

2. Inhale O2, exhale CO2

3. Air can't get in

4. Choking, asthma, COPD, neuromuscular issues, opiates

RESPIRATORY SYSTEM REVIEW: VENTILATION

1. Main purpose is what?

2. Inhale ___ and exhale ___

3. What could go wrong?

4. What conditions or things do we see ventilation going wrong?

1. Gas exchange

2. From alveoli into blood

3. From blood into alveoli

4. Gases cannot cross

RESPIRATORY SYSTEM REVIEW: RESPIRATION

1. Main purpose?

2. O2 moves from ____ into ____

3. CO2 moves from ____ into ____

4. What can go wrong?

Pneumonia, CHF, pulmonary edema, fibrosis, aspiration

RESPIRATORY SYSTEM REVIEW: RESPIRATION

Where can we see gases being unable to cross?

1. Blood flow

2. Blood can't flow

3. Pulmonary embolism, cardiac arrest, severe shock

RESPIRATORY SYSTEM REVIEW: PERFUSION

1. Main purpose?

2. What could go wrong?

3. What conditions can we see perfusion go wrong?

BODY --> inferior & superior vena cava --> right atrium --> right ventricle --> LUNGS --> left atrium --> left ventricle --> aorta --> BODY

BLOOD FLOW

Describe the way blood flows from out the body and back to the body.

1. Chambers and valves

2. Squeeze to pump blood throughout body & valves prevent backflow in heart

3. Heart failure (left, right, or both) and valve disorders

HEART SYSTEMS: PUMP

1. The pump system includes what 2 structures?

2. Main purpose?

3. What could go wrong?

1. SA and AV nodes

2. Left and Right bundles

3. Bundle of HIS

4. Purkinje fibers

HEART SYSTEMS: ELECTRICAL

The electrical system includes what 4 structures?

1. Controls rhythm & rate of heartbeat

2. Dysrhythmias like Atrial Fibrillation & Bradycardia

HEART SYSTEMS: ELECTRICAL

1. Main purpose?

2. What could go wrong?

1. Coronary arteries & veins

2. Supplies heart muscle with oxygen & nutrition & remove waste

3. Myocardial infarction, CAD

4. Angina

HEART SYSTEMS: PLUMBING

1. Includes what 2 structures?

2. Main purpose?

3. What could go wrong?

4. What sign/symptom is a sign that something's wrong?

1. Renal, cardiac, liver failure --> fluid overload --> pulm edema & impaired tissue perfusion

2. Decreased ability to perfuse tissues

3. Scoliosis, pulmonary fibrosis, neuromuscular disease

4. Stroke --> dysphagia & incr. risk aspiration

FACTORS AFFECTING CARDIOPULMONARY FUNCTIONING: COMORBIDITES

1. What co-morbidities can lead to FLUID OVERLOAD...which then lead to what?

2. Myocardial infarction leads to decreased ability of what?

3. What conditions may decrease ability to expand lungs?

4. Stroke can lead to ____ and an increased risk for ____.

1. Less elastic alveoli & muscle strength

2. Decreased airflow and expansion

3. Increased risk of pneumonia

FACTORS AFFECTING CARDIOPULMONARY FUNCTIONING: AGING

1. Does aging cause more or less elastic alveoli? Higher or lower muscle strength?

2. How does this affect airflow & expansion?

3. How does this affect the risk for pneumonia?

1. Reduced respiratory drive and shallow breaths

2. Some BB may cause bronchoconstriction

FACTORS AFFECTING CARDIOPULMONARY FUNCTIONING: MEDICATIONS

1. What do opiates & CNS depressants do to respiratory drive and the depth of your breaths?

2. How can beta blockers affect breathing?

1. Lung dz, lung cancer, heart dz

2. Vasoconstrictor (stresses heart)

3. Decreased lung expansion

FACTORS AFFECTING CARDIOPULMONARY FUNCTIONING: LIFESTYLE

1. What conditions does smoking cause?

2. What does nicotine do to the body?

3. How do sedentary habits affect lung expansion?

1. Worsening hypoxia esp with increasing oxygen = concerning

2. Central

3. Accessory muscle use and/or retractions

4. Tripod position

5. RR < 10

6. New confusion, restlessness, sense of doom

7. Chest pain

8. Stridor

ASSESSING CARDIOPULMONARY FUNCTIONING: 🚩SIGNS OF DISTRESS🚩

1. Worsening hypoxia, especially with increasing ____. Is this concerning?

2. What kind of cyanosis do we assess for?

3. What kind of muscle use?

4. What position may the patient be in that'd raise a red flag?

5. Respiratory rate under what number is concerning?

6. What new symptoms would raise a red flag?

7. Pain in what area is a red flag?

8. What kind of breathing noise is a red flag?

1. RR, HR, O2 saturation

2. Symmetry

3. S1/S2 (normal), murmurs, extra sounds, S3 could be early fluid overload

ASSESSING CARDIOPULMONARY FUNCTIONING

1. What vital signs are we especially looking at?

2. What are we looking for when assessing lung expansion?

3. When you auscultate, what sounds do you listen for?

1. Sputum or fluid

2. CHF, renal fail, liver fail, pneumonia, atelectasis

ASSESSING CARDIOPULMONARY FUNCTIONING: ADVENTITIOUS SOUNDS:

1. Crackles are caused by what?

2. Crackles are heard in what five conditions?

1. Narrowed airways/inflammation

2. COPD, asthma, pneumonia

ASSESSING CARDIOPULMONARY FUNCTIONING: ADVENTITIOUS SOUNDS:

1. Wheezes are caused by what?

2. Wheezes are heard in what three conditions?

1. Large airway obstruction or inflammation

2. Asthma, croup, anaphylaxis, foreign body

ASSESSING CARDIOPULMONARY FUNCTIONING: ADVENTITIOUS SOUNDS:

1. 🚩Stridor is caused by what?

2. 🚩Stridor is heard in what four conditions?

1. Lack/reduced airflow

2. COPD, partial or complete lung collapse AKA pneumothorax

ASSESSING CARDIOPULMONARY FUNCTIONING: ADVENTITIOUS SOUNDS:

1. Diminished sounds are caused by what?

2. Diminished sounds are heard in what two conditons?

1. Nonproductive vs productive

2. Possible infection

3. Blood (cancer, PE, HF)

ASSESSING CARDIOPULMONARY FUNCTIONING:

1. What should you be looking for when assessing a cough?

2. Green/yellow/gray sputum indicates what?

3. Red or pink sputum indicates what?

1. Increased risk for pneumonia

2. Dyspnea/SOB, cough & sputum, wheezing, low O2 sat, increased CO2 -> confusion, sedation

3. Promote airway opening, IS (incentive spirometer), give O2, raise HOB, pursed lip breathing

COPD

1. What do we have an increased risk for with COPD?

2. What might you see in a patient with COPD?

3. How does the RN support a COPD patient?

1. Dyspnea/SOB, low O2 sat, cough & sputum, crackles, wheezing

2. IS (incentive spirometer), cough & deep breath, give O2, monitor WBC, cultures

PNEUMONIA

1. What might you see in a pneumonia patient?

2. How does the RN support a pneumonia patient?

1. From DVT

2. Incr HR & RR, low O2 sat, inspiratory chest pain, dyspnea, pink sputum, sense of doom, sudden anxiety

3. Give O2, raise HOB, bleeding precautions

PULMONARY EMBOLISMS

1. Where do they come from?

2. What might you see in a patient with a pulmonary embolism?

3. How does a nurse support a patient with a pulmonary embolism?

1. S3 heart sound possibly

2. Edema, weight gain, JVD

3. Dyspnea, crackles, hypoxia, increased RR, lower BP

HEART FAILURE

1. What might you POSSIBLY hear with a patient with heart failure?

2. What might you see in a patient with RIGHT sided HF?

3. What might you see in a patient with LEFT side HF?

Strict I&O, daily weights, sodium restriction, fluid restriction, watch electrolytes & renal function

HEART FAILURE

How would the RN support a patient with HF?

1. Irregular heart sounds; often high HR, watch for signs of stroke

2. Educate s/s stroke, bleeding precautions, telemetry

ATRIAL FIBRILLATION

1. What might you see in a patient with Afib?

2. How would the RN support a patient with Afib?

1. Chest pain/pressure, SOB

2. Fatigue, back pain, nausea

3. Arm & jaw pain, sweating

4. Rest, low fat diet, EKG, give O2, watch troponin

MYOCARDIAL INFARCTION

1. What general S/S would you see for men AND women?

2. What S/S would you see in women?

3. What S/S would you see in men?

4. How would the RN support a pt with myocardial infarction?

O2, EKG/telemetry, labs, diet & fluid changes

REMINDER:

What interventions does the nurse need orders for?

1. Typically included on admission order sets & do not delay administration if clear indication

2. Nasal canula....0.5L-6L O2

3. Patients w/ obstructed nares or if need a bit more O2......6L-10L O2

4. Good for pts needing high concentration O2 & prevents rebreathing CO2.....10L-15L O2 used

OXYGEN ADMINISTRATION:

1. As mentioned earlier, oxygen administration needs provider order BUT typically put on the admission order as what?

2. What's the most common oxygen delivery system and how much is used?

3. What is a simple mask good for and how much is used?

4. Nonrebreather good for what kind of patients? How much is used?

1. Yes for patient comfort

OXYGEN

1. Can you humidify oxygen at home for patient?

1. Encourage more fluid intake --> thins secretions (be careful with those in fluid overload)

2. Cough post thoracic & abdominal procedure to prevent atelectasis

3. Splinting helps reduce pain

4. Include it with deep breathing & encourage volunteer coughing

5. Improves oxygenation, sputum movement, expands lung volume

COUGHING/DEEP BREATHING/AND PURSED LIP BREATHING:

1. If productive cough, what should you encourage and why?

2. Coughing after what kind of procedures to prevent what?

3. Splinting helps to reduce what?

4. How should you encourage the patient to cough?

5. Why should you encourage the patient to cough?

1. Deep nasal breath & exhale slowly out the mouth

2. Mobilizes secretions, prevents & improves atelectasis

COUGHING/DEEP BREATHING/AND PURSED LIP BREATHING:

1. How to teach the patient deep breathing?

2. Why teach the patient deep breathing?

1. Inhale through nose & exhale through pursed lips = smaller opening = slows & prolongs expiration

2. Prevent collapse of smaller airways, improves air/gas exchange, relaxes

COUGHING/DEEP BREATHING/AND PURSED LIP BREATHING:

1. How to teach patient to do pursed lip breathing?

2. Why do pursed lip breathing?

1. EXPANDING

2. INHALE

INCENTIVE SPIROMETER

1. You're doing what to the lungs?

2. Therefore, how must the patient breathe?

1. Pushes diaphragm down to expand lungs

2. SOB when lying flat

3. Red flag for CHF

POSITIONING (RN intervention unless contraindication)

1. Raising the HOB does what to the diaphragm?

2. What is Orthopnea?

3. Orthopnea is a red flag for what condition?

1. Used for productive cough...thins secretions to get sputum up and out

2. Nonproductive cough, suppresses cough so patient can rest

ORAL AND INHALED MEDICATIONS: COUGH

1. Expectorants are used for what?

2. Suppressants are used for what?

1. COPD, asthma, pneumonia, etc

2. Bronchodilators...they open airways (SE = high HR, anxiety)

3. Decrease inflammation (SE = incr risk for infection, restlessness. If inhaled steroid, rinse mouth --> can cause oral candida)

ORAL AND INHALED MEDICATIONS: RESTRICTED AIRWAY

1. What conditions are restricted airway conditions?

2. What is gold for a restricted airway? (include its side effects too)

3. What do inhaled and oral steroids do?

1. Diuretics

2. Renal injury, hypokalemia, hypoTN

ORAL AND INHALED MEDICATIONS: PULMONARY EDEMA & CHF

1. What drug do we use?

2. What are some common SE?

1. Remove saliva, sputum, blood, vomit from airway to prevent aspiration...this is an RN intervention

2. Removing secretions from deep in the airways

3. Sterile technique and need order

ORAL SUCTIONING

1. What does oral suctioning do? Do you need an order or is it an RN intervention?

2. What does deep suctioning do?

3. What kind of technique needed for deep suctioning? Do you need an order or is it an RN intervention?

1. Do everything to revive patient

2. CPR not initiated (usually)...DNR does NOT mean do not treat

3. Pt no longer breathing or no longer has a pulse

4. Call code blue and start compressions....don't call code blue on someone w/ documented DNR

CPR/AED

1. Full code means what?

2. DNR means what?

3. CPR/AED is indicated if when?

4. What do you do when you need to initiate CPR/AED?

Care before, during, and after surgery

What is Perioperative Nursing?

1. Decision on surgery—transfer to operation room (OR)

2. Prepare, assess for risk, post-op education, prevent complications

PERIOPERATIVE PHASES: PREOPERATIVE

1. What is the time frame for the preoperative phase of perioperative nursing?

2. What is the RN focused on?

1. Once patient in OR—transfer to post anesthesia care unit (PACU)

2. Safety, sterility, monitoring, prevent injury

PERIOPERATIVE PHASES: INTRAOPERATIVE

1. What is the time frame for the intraoperative phase of perioperative nursing?

2. What is the RN focused on?

1. Admission to PACU—last follow up provider visit

2. Assess, stabilize, prevent complications, recover

PERIOPERATIVE PHASES: POSTOPERATIVE

1. What is the time frame for the postoperative phase of perioperative nursing?

2. What is the RN focused on?

1. Airway and respirations

2. Cardiovascular function

3. Fluid balance

4. Pain

5. Mobility

6. Wound healing

7. Increased infection risk

The patient is vulnerable...surgery may affect what 7 things in the patient's body?

1. Patient stable pre-op

2. Remove or repair body part, improve self concept (cosmetic)

3. Tonsillectomy or facelift

ELECTIVE SURGERY

1. Is the patient stable or unstable pre-op?

2. What is the purpose of the surgery?

3. Give two examples of this kind of surgery?

1. Within 24-48 hrs to prevent further complication

2. Remove or repair body part, preserve or restore health

3. CABG, cholecystitis

URGENT SURGERY

1. Needs to be completed within what time frame to prevent what?

2. What's the purpose?

3. Two examples of this?

1. IMMEDIATELY, major risk for complication if not done now

2. Preserve life or body part

3. Control hemorrhage post trauma, tracheostomy

EMERGENCY SURGERY

1. Needs to be done when?

2. What's the purpose?

3. Two examples of this?

1. Confirm diagnosis

2. Biopsy of concerning mole

3. Remove diseased part

4. Amputation

SURGERY TYPES

1. Diagnostic surgery does what?

2. What's an example of a diagnostic surgery?

3. Ablative surgery does what?

4. What's an example of ablative surgery?

1. Palliative is to reduce intensity of illness NOT curative

2. Tumor debulking

3. Restore function

4. Skin grafts

SURGERY TYPES

1. What is a Palliative surgery?

2. What's an example of a Palliative surgery?

3. What is a Reconstructive surgery?

4. What's an example of reconstructive surgery?

1. Replace diseased organs with functioning one

2. Kidney transplant

3. Restore function in congential anomalies

4. Cleft palate repair

SURGERY TYPES

1. What's a Transplant?

2. What's an example of Transplant?

3. What's the purpose of Constructive surgery?

4. What's an example of Constructive surgery?

1. Think major surgery

2. CNS depression, loss of consciousness & airway, amnesia, analgesia

3. Aspiration, resp depression, hypoTN

4. Monitor airway & VS, post-op N/V

SYSTEMIC/GENERAL ANESTHESIA

1. What should you think of when you see systemic/general anesthesia?

2. What 4 things does it do?

3. What do you wanna watch out for?

4. What's the RN's priorities?

1. Think colonoscopy

2. Decreased LOC, airway maintained, responds to commands

3. Airway obstruct, resp depression

4. Monitor airway & VS, assess LOC

MODERATE SEDATION

1. What should you think of when you see moderate sedation?

2. What 3 things does it do?

4. What do you wanna watch out for?

4. What's the RN's priorities?

1. Epidural, nerve block

2. Remains alert, blocks sensation to large specific region

3. HypoTN, urine retention, headache (if epidural)

4. Monitor VS, assess return of sensation & motor function

REGIONAL ANESTHESIA

1. What should you think of when you see regional anesthesia?

2. What two things does it do?

3. What do you wanna watch out for?

4. What's the RN's priorities?

1. Think dental numbing

2. Remains alert, blocks sensation to small targeted area

3. Allergic reaction, tissue necrosis

4. Monitor injection site, assess return of sensation

LOCAL/TOPICAL ANESTHESIA

1. What should you think of when you see local/topical anesthesia?

2. What two things does it do?

3. What do you wanna watch out for?

4. What's the RN priorities?

1. Patient VOLUNTARY agreement to procedure

2. Risk and benefits, description of procedure, explanation of expected outcomes, recovery

3. YES

INFORMED CONSENT

1. What is informed consent?

2. What does the provider explain to the patient?

3. Is it a legal document?

1. Verify and witness consent is signed

2. Has understanding of procedure

3. Notify the provider

INFORMED CONSENT: RN'S ROLE

1. What should the RN verify and witness?

2. Confirm patient has what?

3. What does the nurse do if the patient has questions/confusion?

1. Communicate pt's wishes for healthcare if they become unable to make decisions

2. Discussed prior to surgery --> know what to do if something happens

3. Yes, LEGAL DOCUMENT

4. Can be suspended during surgery (ex: pt is DNR but wants to be full code during surgery)

ADVANCED DIRECTIVES

1. What does an advanced directive do?

2. When is the advanced directive discussed?

3. Is it a legal document?

4. With an advanced directive, what can happen to DNR orders?

1. Increased risk for respiratory depression

2. Less perfusion to vital organs

3. Renal and liver dz

4. Risk for hypoglycemia

5. Yes look for allergies

PRE-OPERATIVE NURSING: ASSESSING MEDICAL HX

1. 🚩Asthma or COPD in medical hx means risk for what?

2. 🚩HypoTN + anesthesia does what?

3. What kind of organ diseases to look out for?

4. DM + NPO for procedure = risk for what?

5. Should you look for allergies?

1. yes duh

2. NPO status

PRE-OPERATIVE NURSING: ASSESS

1. Should you check their current condition?

2. What other risk factors do you assess?

1. Risk of bleeding

2. Held 3-7 days prior to surgery unless emergency

3. Risk of bleeding

4. Increased CNS depression and resp failure

PRE-OPERATIVE NURSING: ASSESS MEDICATIONS

1. 🚩Anticoagulants increase risk of what?

2. Anticoagulants are held how long before surgery?

3. Antiplatelets increase risk of what?

4. CNS depressants + anesthesia = what?

1. 🚩High creatinine

2. Increased risk of bleeding

PRE-OPERATIVE NURSING: ASSESS LABS/DIAGNOSTICS

1. What levels of creatinine to look out for?

2. 🚩Thrombocytopenia means risk of what?

1. Expectations, pain management, coughing and deep breathing, incentive spirometry, DVT prevention, and post-op wound care

2. Can be up to 8 hrs prior to surgery

3. Antiseptic skin prep may be needed

PRE-OPERATIVE NURSING: IMPELMENTATION

1. What are the many things to teach your patient about?

2. Patient can be NPO how long before surgery?

3. What kind of hygiene may be needed?

1. Error prevention

2. Pre-op patient ID, mark operative site, and TIME OUT

3. Immediately prior to surgery in OR

4. All OR staff & providers STOP & verify patient name, DOB, allergies, procedure to be performed, and correct site.

INTRA-OPERATIVE NURSING:

1. What's the main goal in intra-operative nursing?

2. How do we prevent errors?

3. When is time out done?

4. What happens in time out?

prevent complications

RN's main role during post-operative nursing is what?

1. Resp depression --> atelectasis --> pneumonia

2. RR, O2 sats, lung sounds, cough/sputum, 🚩stridor after extubation

POST-OP NURSING: RESPIRATORY SYSTEM

1. What could go wrong?

2. What am I watching for?

1. Hemorrhage --> shock OR DVT --> PE

2. HR, BP, signs of low perfusion, edema, 🚩sudden dyspnea (SOB)

POST-OP NURSING: CARDIOVASCULAR SYSTEM

1. What could go wrong?

2. What am I watching out for?

1. Decreased LOC (opioids, anesthesia)

2. LOC, orientation

POST-OP NURSING: NEURO SYSTEM

1. What could go wrong?

2. What am I watching out for?

1. Fluid overload due to increased IV fluid OR fluid deficit bc hemorrhage

2. I&O, BP

POST-OP NURSING: FLUID SYSTEM

1. What could go wrong?

2. What am I watching out for?

POST-OP NURSING: SKIN SYSTEM

1. Wound infection or bleeding

2. Dressing, drainage, incision, 🚩don't remove 1st surgical dressing

POST-OP NURSING: PAIN SYSTEM

3. Poor pain control

4. Pain score & nonverbal signs of pain

POST-OP NURSING: SKIN SYSTEM

1. What could go wrong?

2. What am I watching out for?

POST-OP NURSING: PAIN SYSTEM

3. What could go wrong?

4. What am I watching out for?

1. Subtle changes in trends may indicate complications prior to overt signs

2. 🚩Decreased BP, increased HR

POST-OP NURSING: VITAL SIGNS

1. What could go wrong?

2. What am I watching out for?

1. Low BP + High HR = 🚩🚩

2. Blood pooling, saturated dressings

3. Call provider

4. Pressure to bleeding site and PRBC infusion (packed RBC)

KEY: blue highlight = order needed

COMPLICATIONS: HEMORRHAGE 🚩

1. What might you see in internal bleeding?

2. What might you see in external bleeding?

3. Prevention & management for internal bleeding?

4. Prevention & management for external bleeding?

1. Restless, anxiety, cold clammy mottled skin, DECREASED urine output

2. Apply oxygen, IV fluids, lay flat, monitor urine output, rapid response PRN

KEY: blue highlight = order needed

COMPLICATIONS: SHOCK

1. What might you see?

2. How do we prevent & manage this?

1. DVT breaks off and goes to lung

2. Edema, erythema distal to clot

3. Sudden dyspnea, anxiety, hypoxia, increased RR, inspiratory chest pain

4. SCDs (no scd if dvt already present), ankle pumps in bed, ambulation, anticoagulants

KEY: blue highlight = order needed

COMPLICATIONS: DVT/PE

1. How does a DVT become PE?

2. What might you see in a DVT?

3. What might you see in PE?

4. How do we prevent and manage?

1. Crackles, wheezes, productive cough, hypoxia, dyspnea

2. Cough & deep breathing, incentive spirometer, oral hygiene, ambulation, antibx

KEY: blue highlight = order needed

COMPLICATIONS: PNEUMONIA

1. What might you see?

2. How do you prevent and manage?

1. Distended bladder, abdomen pain, urine in bladder w/ bladder scan, low urine output

2. Promote oral fluid once cleared, ambulation, urinary catheter

KEY: blue highlight = order needed

COMPLICATIONS: URINARY RETENTION

1. What might you see?

2. How do you prevent and manage?

1. Hypoactive bowel sounds, abdominal distention, no BM for a few days

2. Ambulation, stool softeners, laxatives, promote fluid & fiber once cleared

KEY: blue highlight = order needed

COMPLICATIONS: CONSTIPATION

1. What might you see?

2. How do you prevent and manage?

1. Patient report, grimacing, moaning, crying, guarding

2. Non-pharm strategies, analgesics

KEY: blue highlight = order needed

COMPLICATIONS: PAIN

1. What might you see?

2. How do you prevent and manage?

1. Patient reports, retching

2. Antiemetics, sips of fluid once cleared, aspiration precautions

KEY: blue highlight = order needed

COMPLICATIONS: NAUSEA/VOMITING

1. What might you see?

2. How do you prevent and manage?

1. Erythema, warmth, edema, tenderness, purulent drainage, dehiscing edges

2. Fever, increased WBC, malaise, fatigue

3. Hand hygiene, dressing/incision care, antibx, ambulation

KEY: blue highlight = order needed

COMPLICATIONS: INFECTION

1. What might you see locally?

2. What might you see systemically?

3. How do you prevent and manage?

Hyperglycemia, increased CV work, immune/GI/GU dysfunction, fatigue

What physiologic effects may pain cause?

1. Cut, poke, sore throat

2. Rapid

3. Short...minutes to

ACUTE PAIN

1. Three examples of acute pain?

2. What's the onset of acute pain?

3. Duration of acute pain?

4. Other S/S? (think what vital signs)

1. Fibromyalgia, sickle cell, back pain

2. Sudden or gradual

3. Over 3 months, maladaptive pain, may have periods of exacerbation and remission

4. Depression, anger, sleep & appetite disturbances

CHRONIC PAIN

1. Three examples of chronic pain?

2. What's the onset of chronic pain?

3. Duration of chronic pain?

4. Other S/S related to chronic pain?

1. Burn, fracture, laceration

2. Noxious stimuli -> pain receptors triggered -> pain

NOCICEPTIVE PAIN

1. Three examples of this pain?

2. What's the etiology?

1. Diabetic neuropathy, carpal tunnel syndrome, sciatica

2. Injury or disease of a nerve --> pain

NEUROPATHIC PAIN

1. Three examples of this kind of pain?

2. Etiology of this kind of pain?

1. Migraines, fibromyalgia, IBS

2. Altered nociception & amplified pain processing in CNS

NOCIPLASTIC PAIN

1. Three examples of this kind of pain?

2. Etiology of this kind of pain?

1. May vary culture to culture; best to ASK patient

2. No they do not

3. Less likely to receive recommended treatment for pain

4. Pain is NOT a normal sign of aging

FACTORS AFFECTING COMFORT/PAIN: CULTURE & ETHNICITY

1. Does response vary culture to culture? If so, what do you do?

2. Do cultural norms define every individual in that group?

3. How are minority populations affected in getting treated for pain?

FACTORS AFFECTING COMFORT/PAIN: AGE

4. Is pain a normal sign of aging?

1. Involuntary

2. Automatic changes to body by nervous system via SNS or PNS activation

3. VS changes, N/V, muscle tension

PHYSIOLOGIC RESPONSE TO PAIN

1. Is the response mechanism voluntary or involuntary?

2. Describe this voluntary/involuntary response.

3. What might you see in the patient?

1. Voluntary

2. Observable actions used to cope with pain

3. Grimacing, crying, protecting painful area, moving away from stimuli

BEHAVIORAL RESPONSE TO PAIN

1. Is it voluntary or involuntary?

2. What exactly is a behavioral response to pain?

3. What might you see in the patient?

1. Psychological—emotional toll of pain

2. Anger, fear, depression, stoicism, hopelessness

AFFECTIVE RESPONSE TO PAIN

1. What kind of response mechanism is this?

2. What might you see in the patient?

1. Believe them

2. Assess further via COLDSPA

3. Possible causes

4. Appropriate interventions

5. Reassess

YOUR JOB AS AN RN WHEN ASSESSING PAIN:

1. Do you believe the patient's report of pain or be suspicious?

2. How do you assess pain further?

3. Identify possible what?

4. What should you implement?

5. What do you do after implementation?

1. The 0-10 numeric scale for those that are verbal and can answer questions appropriately

2. For those who cannot communicate

3. For children and adults that cannot communicate

PAIN ASSESSMENT SCALES

1. What's the most common pain scale and who is it used for?

2. When do you use Nonverbal Indicators?

3. When do you use Wong-Baker FACES?

1. Pain & inflammation

2. GI bleed and renal impairment

3. Give with food + watch for black stools

NSAIDs

1. Why would you use it?

2. What do you wanna watch out for?

3. What considerations do you have to make as an RN?

1. Pain and fever (also given with opioids)

2. Liver impairment

3. 24 hr total doses + caution in liver dz & ETOH use

ACETAMINOPHEN

1. Why would you use it?

2. What do you wanna watch out for?

3. What considerations do you have to make as an RN?

1. Moderate to severe pain

2. 🚩Respiratory depression, sedation, constipation, urinary retention

3. Monitor RR, LOC, fall precautions, avoid other CNS depressants, Naloxone = antidote

OPIOIDS

1. Why would you use it?

2. What do you wanna watch out for?

3. What considerations do you have to make as an RN?

1. Severe pain...patient can self administer opioid when needed

2. Same as opioids

3. Same as opioids AND: check lockout rates...ONLY the patient pushes button

PCAs (opioids) "Patient controlled analgesia"

1. Why would you use it?

2. What do you wanna watch out for?

3. What considerations do you have to make as an RN?

1. Reverses opioid effects

2. Acute withdrawal, pain may return fast

3. Short half life = may wear off before opioid, monitor RR + LOC + pain, may need additional dose

NALOXONE

1. Why would you use it?

2. What do you wanna watch out for?

3. What considerations do you have to make as an RN?

1. 🚩BIG YIKES 🚩

2. Give Naloxone & support breathing

3. ONLY PATIENT.... not the nurse, spouse, or family

OPIOID SAFETY

1. Opioid + decr RR + decr LOC = what?

2. What do you do for the the patient in the event of question 1?

3. Who pushes the PCA button?

1. Together

2. Positioning, distracting, music, imagery, pet therapy, heat/cold therapy

1. Do non-pharm and pharm pain management methods work together or independently?

2. What are the 6 methods of non-pharm pain management?