Comprehensive Medical-Surgical Nursing Review: Pain, Infections, Oncology, Cardio, Neuro, GI, Endocrine, Musculoskeletal, Reproductive, Sensory, and Lab Values

Acute Pain

Sudden onset, <3 months, identifiable cause (surgery, trauma, labor).

Sympathetic response to Acute Pain

↑HR, ↑RR, ↑BP, diaphoresis, pallor.

Goal of Acute Pain Management

Pain control to allow participation in recovery.

Chronic Pain

Gradual/sudden, >3 months, may persist after injury healing.

Behavioral symptoms of Chronic Pain

Fatigue, withdrawal, depression, ↓physical activity.

Goal of Chronic Pain Management

Improve function and quality of life, not complete elimination.

Neuropathic Pain

From nerve/CNS damage.

Descriptions of Neuropathic Pain

Burning, stabbing, shooting, electric shock, numbing.

Causes of Neuropathic Pain

Trauma, inflammation, diabetes, metabolic diseases.

Nociceptive Pain

From tissue damage.

Descriptions of Nociceptive Pain

Aching, throbbing, dull, cramping.

Subjective Pain Assessment

Patient report = gold standard.

Non-verbal cues in Pain Assessment

Grimacing, guarding, restlessness.

Associated symptoms of Pain

Anxiety, fatigue, depression, poor sleep.

Pain Assessment Tools

Numeric Rating Scale (0-10), Wong-Baker FACES, FLACC (non-verbal).

Non-opioids in Pain Management

Acetaminophen: analgesic + antipyretic (NO anti-inflammatory). Risk = hepatotoxicity.

NSAIDs in Pain Management

(ibuprofen, aspirin, naproxen): analgesic + anti-inflammatory. Risks = GI bleed, renal impairment, HTN.

Opioids in Pain Management

Moderate-severe pain (morphine, hydrocodone, oxycodone).

Side effects of Opioids

Constipation (most common), N/V, sedation, respiratory depression.

Teaching for Opioid Use

Take with stool softeners/laxatives, report difficulty breathing.

Adjuvants in Pain Management

Antidepressants (TCAs, SNRIs) - neuropathic pain. Antiseizure drugs (gabapentin). Corticosteroids, local anesthetics, cannabinoids.

Non-Pharmacologic Pain Management

Heat/cold therapy, massage, exercise, TENS, acupuncture.

Nursing & Patient Teaching for Pain Management

Believe patient's report - not 'drug-seeking.' Encourage early reporting and routine dosing.

Gerontologic Considerations in Pain Management

50-80% of older adults experience chronic pain.

Barriers to Pain Management in Older Adults

Think pain is normal with aging, fear addiction, don't use word 'pain' (instead 'soreness,' 'aching').

Risks in Older Adults for Pain Management

Polypharmacy, slower metabolism, ↑NSAID bleeding risk, ↑sedation/falls.

Substance Use Disorder (SUD)

Chronic, relapsing disease involving impaired control, social impairment, risky use, and physical dependence.

Common substances in Substance Use Disorder

Alcohol, opioids, nicotine, stimulants, cannabis, sedative-hypnotics.

Nursing Role in Substance Use Disorder

Screening, safe withdrawal management, patient/family teaching, advocacy for treatment.

Alcohol Use Disorder Effects

CNS depressant → affects impulse control, motor coordination, mood, respiratory/cardiac function.

Withdrawal in Alcohol Use Disorder

Onset: within a few hours after last drink; peaks at 24-48 hrs.

Symptoms of Alcohol Withdrawal Syndrome

Agitation, anxiety, tremors, sweating, insomnia, nausea/vomiting, tachycardia, hypertension.

Complication of Alcohol Withdrawal

Alcohol Withdrawal Delirium (delirium tremens, 2-3 days after cessation).

Symptoms of Alcohol Withdrawal Delirium

Disorientation, hallucinations (visual, tactile, auditory), seizures, severe autonomic instability.

Nursing Interventions for Alcohol Withdrawal

Monitor ABCs, VS, neuro status.

Medications for Alcohol Withdrawal

Benzodiazepines (diazepam, lorazepam) - prevent seizures, reduce agitation.

Preventive Medications for Wernicke-Korsakoff syndrome

Thiamine, multivitamins, magnesium, glucose.

Thiamine, multivitamins, magnesium, glucose

Prevent Wernicke-Korsakoff syndrome.

β-blockers/α-blockers

Control autonomic symptoms.

Opioid Use Disorder

A disorder characterized by the compulsive use of opioids.

CNS depression

Effects include euphoria, sedation, pain relief, drowsiness, and respiratory depression.

Overdose signs and symptoms

Pinpoint pupils, respiratory depression (shallow, slow RR), unconsciousness.

Naloxone (Narcan)

Opioid antagonist; may need repeated doses until drug is metabolized.

Withdrawal onset for short-acting opioids

6-12 hours after last dose.

Withdrawal onset for long-acting opioids

24-48 hours after last dose.

Withdrawal peak

2-3 days after last dose.

Withdrawal subsides

5-7 days after last dose.

Early signs and symptoms of withdrawal

Cravings, anxiety, sweating, ↑HR, ↑BP, tremors, irritability.

Later signs and symptoms of withdrawal

Abdominal cramps, vomiting, diarrhea, insomnia, muscle spasms.

Nicotine Use Disorder

The most common substance use disorder in healthcare settings.

CNS stimulant effects of nicotine

↑HR, ↑BP, ↑adrenaline release.

Nicotine withdrawal symptoms

Irritability, anxiety, cravings, fatigue, poor concentration.

Health risks of cigarettes

Lung cancer, COPD, CV disease.

Health risks of smokeless tobacco

Oral cancers, periodontal disease.

Health risks of vaping

EVALI (e-cigarette/vaping-associated lung injury), cardiovascular strain, negative effects on adolescent brain.

Nicotine replacement therapy (NRT)

Includes patches, lozenges, gum, inhalers, nasal spray.

Non-nicotine medications for cessation

Varenicline (Chantix), bupropion (Zyban).

Stimulant Use (Cocaine, Methamphetamines)

Characterized by agitation, paranoia, impaired judgment, and sympathetic overdrive.

Withdrawal symptoms of stimulants

Depression, fatigue, vivid dreams, irritability, ↑appetite.

Cannabis effects

Euphoria, relaxation, altered perception.

Adverse effects of cannabis

Impaired judgment, coordination, paranoia, psychosis; long-term effects include mental health issues and respiratory effects.

Cannabis withdrawal symptoms

Irritability, anxiety, insomnia, restlessness, loss of appetite.

Sedative-Hypnotics (Benzodiazepines, Barbiturates) overdose

Respiratory depression, hypotension, coma.

Flumazenil

Treatment for benzodiazepine overdose only.

Sedative-Hypnotics withdrawal symptoms

Anxiety, tremors, insomnia; risk of seizures and cardiac arrest.

Nursing priorities across SUDs

Include screening/assessment, safety monitoring, education, and support.

Ethical/Legal Considerations

Nurses must report unsafe practice and substance use in colleagues.

Inflammation

Protective response of vascularized tissue to injury, infection, or irritation.

Infection vs Inflammation

All infections cause inflammation, but not all inflammation is due to infection.

Signs & Symptoms of Inflammation - Local

Classic 5: redness, heat, pain, swelling, loss of function.

Signs & Symptoms of Inflammation - Systemic

Fever, leukocytosis (↑WBC, 'shift to the left'), malaise, ↑HR, ↑RR, nausea/anorexia.

Fever Pathophysiology

Triggered by cytokines and prostaglandins → hypothalamus raises set point → chills/shivering until new set point met.

Moderate Fever

<103°F/39.4°C: usually beneficial.

High Fever

>104°F/40°C: risk of seizures, delirium.

Extreme Fever

>105.8°F/41°C: impaired hypothalamic regulation, life-threatening.

Nursing Interventions for Mild Fever

Rest, fluids, monitor cause.

Nursing Interventions for High Fever

Administer antipyretics (acetaminophen, NSAIDs), cooling blankets, sponge baths, seizure precautions.

Inflammation Care

RICE: Rest, Ice (24 hrs), Compression, Elevation to reduce swelling.

Inflammation Care - Medications

Administer anti-inflammatories (NSAIDs, corticosteroids).

Inflammation Care - Nutrition

Encourage adequate nutrition (protein, vitamins A & C, zinc).

Wound Healing - Primary Intention

Edges approximated (surgical incision).

Wound Healing - Secondary Intention

Wide, irregular wounds heal with granulation.

Wound Healing - Tertiary Intention

Delayed closure, contaminated wound.

Complications of Wound Healing

Dehiscence, evisceration, adhesions, fistulas, hypertrophic/keloid scars.

Pressure Injuries - Risk Factors

Immobility, diabetes, anemia, poor perfusion, incontinence, advanced age.

Pressure Injuries - Stages

Stage 1: non-blanchable redness; Stage 2: partial-thickness skin loss; Stage 3: full-thickness with fat exposed; Stage 4: full-thickness with muscle/bone exposed; Unstageable: necrotic tissue covering wound bed.

Nursing Interventions for Pressure Injuries

Reposition q1-3 hrs, pressure-relieving devices, moist wound care, debridement, infection monitoring, nutritional support.

Types of Immunity - Innate

Present at birth, first-line defense (skin, mucous membranes, inflammatory response).

Types of Immunity - Acquired

Develops after exposure.

Types of Immunity - Active

Infection (natural) or vaccine (artificial).

Types of Immunity - Passive

Maternal antibodies (natural) or injection of immunoglobulin (artificial).

Normal Immune Response - Humoral

B-cell: produces antibodies (IgG, IgA, IgM, IgD, IgE).

Normal Immune Response - Cell-mediated

T-cell: defends against fungi, intracellular viruses, tumor cells, transplant rejection.

Immunoglobulins - IgG

Most abundant, crosses placenta.

Immunoglobulins - IgA

Protects mucous membranes (respiratory, GI).

Immunoglobulins - IgM

First antibody in primary response.

Immunoglobulins - IgD

Assists B-cell activation.

Immunoglobulins - IgE

Allergic reactions, parasitic infections.

Hypersensitivity Reactions - Type I

IgE mediated: anaphylaxis, asthma, allergic rhinitis.

Hypersensitivity Reactions - Type II

Cytotoxic: hemolytic transfusion reaction, Goodpasture syndrome.