NUR 318 EXAM 3 REVIEW

Before we give opioid medications what do we monitor first?

Respiratory rate

If respiratory is less than _____ we hold off on giving opioids

12

What do we give to reverse the effects of opioid ?

Naloxone

What’s the best medication to give someone who has had addiction in the past but is experiencing pain.

Buprenorphime

A-Delta fiber

Myelinated fiber

C-Fiber

Unmyelinated Fiber

What are the two primary types of nociceptors.

1. A-Delta fibers

2. C fibers

If there is an unmyelinated fiber transmitting a pain impulse, what kind of pain will it transmit?

Slow aching pain or burning sensation

If there is an myelinated fiber transmitting a pain impulse, what kind of pain will it transmit?

Fast sharp pain such as intense Heat or pinprick to the skin.

What pathways travels to the brain for interpretation?

Afferent pathway

Is pain easy to define?

No, it usually has emotion behind it maybe past experience, so it’s not a very easy thing to define. It’s what we say multi sensory experience.

It is protective we know that we will stop doing something that hurts us, it’s always what the client tells us.

We make it more measurable by asking them what level on a scale.

What is it called when you recognize the pain? Or when it’s perceived as pain?

Pain threshold

When you define that you can’t bear the pain anymore?

Pain tolerance

Which one has more variance between people ? Pain threshold or pain tolerance

Pain tolerance

Type of pain that does have a cause and effect and is a result from tissue damage “we see the pain, we know that we see the damage, and we have pain”

What kind of pain?

Nociceptive pain

When you’re Experiencing pain but we can’t identify what the cause of that pain is?

Nonnociceptive pain

We can override a pain stimuli by doing what?

We stimuli the nonnociceptive pain receptors which tend to be larger

Acute vs chronic which is easier to treat?

Acute pain

Because it has more of a cause and effect

Physiological responds to pain when the patient came speak

1. Facial expressions

2. Verbal sounds

3. Increase in blood glucose

4. Pallor

5. Sweating

6. Body language

7. GI upset

If a patient has mild pain, for example, a 3 out of 10 what will we start with?

NSAIDs or Tylenol

What do we check for prior to deciding what type of NSAIDs we give?

GI and bleeding history

• HX of bleeding

• On blood thinners

• HX of ulcers

If the patient has a history of GI problems and bleeding what type of NSAIDs do we give and why?

2nd generation because it inhibits COX-2

What do NSAIDs cause

Bleeding

NSAIDs didn’t work what do we give now?

Opioids

For Chronic pain it is sometimes recommended to give opioids along with _________.

Adjuvant medications

What are some adjuvant medications that can be given with opioids?

• Anticonvulsants

• CNS stimulants

• Tricyclic antidepressants

If an adjuvant medication is given with an opioid the dose is _____________.

Lower

What kind of pain is migraine and where ?

Throbbing unilateral pain

Other symptoms with a migraine

• Nausea

• Vomiting

• Photophobia

What is the mechanism that causes migraines

Overdialation

Sumatriptan

Reconstricts blood vessels

Watch for: Hypertension Cardiac artery disease

Mechanism of sumatriptan

It is a serotonin receptor agonist and a vasoconstrictor

Before we give Sumatriptan what do we ask the patient, history of?

• CAD -Cardiac artery disease

• HTN -hypertension

Migraine Preventative medications

• SSRA

• Sumatriptan

• Beta blockers

• Ergot alkaloids

• Anticonvulsant

• Tricyclic antidepressant

• Estrogens

• Analgesics

Another name for Nonnociceptive pain

Neuropsychologic pain

Neurogenic pain

Nerve pain

Somatic pain

Pain that comes from inside, muscles, bones.

Medications for TB

• Rifampin

• Isoniazid

Rifampin side effects

• Orange everything! Urine, saliva, sweat and tears. We let patients that wear contacts know that it will turn Orange

Isoniazid side effect and what do we recommend to take with it to help

• Peripheral neuropathy

Recommend to take vitamin B6 to help

Patient is on Vancomycin IV and you notice redness all over the patient’s face what May it be and what do you do?

• It may be Red man syndrome

• We slow it down

Why do we give up to 4 medications for TB

To avoid resistance we don’t want to give TB a living chance!

Do we need an order to slow the vancomycin due to red man syndrome?

Yes it is recommended to let the provider know but with antibiotics we don’t have a set speed of administering the medication so we have some freedom to change it.

What do we collect before giving antibiotic to patient?

Culture

Which antibiotic would we expect to give before we get culture results ?

Broad-spectrum

Antibiotics are hard on what two organs ? And how do we monitor ?

Kidney and liver

Get LFT, BUN, and Creatinine, all the blood panels.

Patient is taking antibiotics for example cephalexin and they call doctor office because they have white spots and pain on their tongue, what would be our concern?

-thrush

What is the mechanism of thrush

Fungal infection or mycosis

What can we do to treat thrush ?

Antifungal medication and probiotics

Antibiotics cause GI problems, what do we recommend for their diet.

• Avoid alcohol

• Avoid spicy food

• Avoid caffeine

• Avoid citrus

• Avoid black tea

If taking an antacid when should it be taken ?

2 hours before or after

Patient is taking antibiotic they call the doctor because they’re having a lot of loose stools. What are we concerned about?

C DIFF 💩

What part of our body controls our temp when having an infection?

• Hypothalamus

• Pyrogens both exogenous and endogenous pyrogens

What has been done around the world to prevent infection?

Vaccination

Epidemic

The number of new infections in a particular population greatly exceeds the number already observed

Pandemic

Spread over large areas or worldwide

pathogenicity

Ability to produce disease

Bugs that live all over us

Microbiome

Second line of defense

Inflammation

State of illness

Morbidity

state of Death

Mortality

The proportion of population affected by the disease at a specific point

Prevalence

Number of cases divided by population

Incidence

What kind of medication is erythromycin and azithromycin?

Macrolides

What two medications have beta-lactam structures?

• Cephalosporins

• Penicillin

What two antibiotics have a cross allergy ?

Penicillin and cephalosporins

What category is Tobramycin and Gentamycin

Aminoglycosides

What category is Vancomycin

Glycopeptide

What category is Aztreonam ?

Monobactam

What population do we not give tetracycline to ?

Kids under 8 or pregnant women