Comprehensive Study Notes on Pain, Sleep, Medications, Diagnostic Tests, and Admission Procedures

Quality of Pain

• Quality of pain refers to what the discomfort feels like.
• Radiation of pain means whether the pain travels from one spot to another (e.g., chest pain radiating to the heart, sciatic nerve pain radiating down the leg).

Severity and Timing of Pain

• Severity of pain refers to how bad the pain is.
• Timing of pain refers to how often the pain occurs.

Pain Scales and Assessment

• Numeric pain scale: a tool used to quantify a person's pain level.
• Pain assessment includes observing vitals to gauge pain.

TENS and PENS for Pain Relief

• TENS (Transcutaneous Electrical Nerve Stimulation): A method that stimulates muscles to relieve pain.
• PENS (Percutaneous Electrical Nerve Stimulation): Uses probes and small needles.

Non-Pharmacological Pain Relief Methods

• Hydrotherapy: Using water for pain relief.
• Acupuncture: Traditional Chinese medicine technique.
• Biofeedback: A mind-body technique.
• Distraction: Diverting attention from the pain.
• Heat and cold application.
• Guided imagery.

Side Effects of Pain Medications

• Constipation: A common side effect, especially with narcotics.

Interventions for Constipation

• Increase fluid intake.
• Stool softeners (e.g., Colace).
• Suppositories or enemas (as a last resort).

Safe Disposal of Pain Patches

• Wrap used pain patches (e.g., fentanyl) in a bio bag.
• Dispose of them in a secure trash can to prevent accidental exposure to pets or children.

Stages of Sleep

• REM (Rapid Eye Movement) sleep.
• Non-REM sleep.

Vital Signs During Sleep

• REM sleep: Vital signs are similar to when awake.
• Non-REM sleep: Vital signs are lower due to relaxation.

Sleep Cycles and Duration

• Individuals cycle through REM and non-REM sleep approximately five to six times per night.
• Newborns need the most sleep.
• School-age children need 10-11 hours of sleep.
• Adults need slightly less sleep than school-age children.

Creating a Safe Sleep Environment in Hospitals

• Avoid turning off all lights to prevent falls.

Sleep Aids and Disorders

• Sleep apps can be helpful.
• Snoring is not necessarily sleep apnea but can affect airways.
• Narcolepsy: Uncontrollable and recurrent episodes of falling asleep.

Comfort Items for Hospital Sleep

• Patients can bring comforting items from home, such as blankets and pillows.
• CPAP machines or white noise machines can be brought if regularly used.

Drug Names and Classifications

• Drugs have generic and brand (trade) names.
• Drugs are classified into schedules.

Nurse's Role in Medication Safety

• The nurse is the last check for medications.
• Report any discrepancies in medication administration, even if it involves a friend, to the charge nurse.
• Failure to report can result in being an accessory to the issue.

Pharmacokinetics

• ADME: Absorption, Distribution, Metabolism, Excretion.
• Absorption: How the medicine enters the body.
• Distribution: How the medicine spreads through the body.
• Metabolism: How the medicine is processed.
• Excretion: How the medicine exits the body (primarily through the kidneys and bladder).

Factors Affecting Drug Excretion

• Kidney function: Poor kidney function affects medication excretion.

Routes of Drug Absorption

• Fastest: Inhalation (respiratory tract).
• Followed by: Mucus membranes.
• IV (intravenous) is also very fast.

Pharmacodynamics

• Primary Effect: The desired effect of the drug (e.g., Benadryl to decrease allergic reaction).
• Secondary Effect: Side effects (e.g., drowsiness from Benadryl).
• Onset: When the drug starts to take effect.
• Peak: How long it takes for the drug to reach maximum concentration in the body.
• Duration: How long the drug lasts in the body.

Medication Scheduling

• Medications are scheduled based on their peak and duration (e.g., Tylenol every four hours, Aleve every eight hours).

Black Box Warning

• Indicates significant side effects, but the medication can still be used if the benefits outweigh the risks.

Routes of Administration

• Oral Routes:
  • Swallowing (PO).
  • Sublingual (under the tongue).
  • Buccal (between the cheek and gum).
• Parenteral: Injections
  • Intradermal (ID): Injected into the dermis.
  • Subcutaneous (Sub-Q): Injected into the fatty tissue.
  • Intravenous (IV): Injected into a vein.
  • Epidural: Injected into the spinal column.
• Topical and Transdermal: Applied to the skin.
• Mucous Membranes: Vaginal, rectal, inhalation.

Six Rights of Medication Administration

• If a patient says they've never taken a medication before, double-check the order before administering.

High-Alert Medications

• Insulin and narcotics require double-checking.
• Heparin requires double check if given IV

Terminology

• Use "non-adherent" instead of "non-compliant."

Medication Reconciliation

• A list of all current medications.
• Compare the list to what the patient says they're taking to prevent errors.

Preventing Medication Errors

• Ensure accurate medication lists to prevent errors from dosage increases or changes.

Order Types

• STAT: Give immediately.
• Routine: Regular order.
• Renewal: Requires doctor's approval to continue.
• Protocols: Order sets for specific conditions (e.g., chest pain).

Unit Dose System

• Prepackaged, pre-labeled, and pre-shipped from the pharmacy.
• Hospitals use systems like Pixis or Omnicell, requiring login and password for access.

Controlled Substances

• Must be locked up and secured behind two locks.

Measuring Liquid Medications

• Check the meniscus at eye level to ensure the correct dose.

Administering Eye Drops

• Do not touch the eye with the dropper.
• Place drops in the corner of the eye.
• Pull down the lower eyelid.

Administering Eye Ointment

• Apply inside the lower eyelid.

Administering Ear Drops

• Adults: Pull the ear up and back.
• Children: Pull the ear down and back.

Inhaler Use

• Use a spacer to improve medication delivery.

Rectal Suppositories

• Lubricate the suppository and the finger (index finger).
• Insert the pointed end first.
• Insert to the side of the rectum.

Administering Medications via Feeding Tube

• Administer one medication at a time.
• Flush with 30 mL of water between each medication.
• Flush again after all medications are given.
• If on continuous suction, turn suction off for 30 minutes after administration.
• Elevate the head of the bed to 30 degrees during and 30-60 minutes after to prevent aspiration.

Reporting Medication Errors

• Report immediately, even if witnessed.

Preparing Injections

• Label the syringe with the medication name, dose, and patient name.

Injection Site Selection

• Avoid hairy areas, lesions, and areas with blood vessels or nerves.
• Rotate injection sites.

Intradermal Injections

• Syringe size: 0.5 to 1 mL.
• Gauge: 25 to 29 (or even 31).
• Angle: 5 to 15 degrees.

Subcutaneous Injections

• Volume: Maximum 1 mL.
• Needle size: 25 to 27 gauge.
• Angle: 45 to 90 degrees.

Intramuscular Injections

• Volume: 1 to 3 mL (deltoid max of 1 mL)
• Angle: 90 degrees.

Intramuscular Injection Sites

• Muscles: Deltoid, ventrogluteal, vastus lateralis, rectus femoris.
• Avoid the rectus femoris, especially on skinny patients.

Preventing Needle Sticks

• Do not recap needles.
• Drop the needle into a sharps container.

Drawing Medication from an Ampule

• Use a filter needle to prevent drawing up glass particles.

Mixing Medications

• Only mix drugs if they are compatible.

Z-Track Injections

• Use the Z-track method for IM injections.

Diagnostic Tests

• Know the purpose, patient instructions (NPO, prep), and any specific considerations.

Complete Blood Count (CBC)

• Includes all parts of the blood.
• Leukopenia: Low white blood cell count.

Comprehensive Metabolic Panel (CMP)

• Includes electrolytes.

Blood Glucose Testing

• Wipe away the first drop of blood.
• Squeeze out the second drop.

Blood Coagulation Tests

• Heparin: PTT (Partial Thromboplastin Time).
• Warfarin: PT/INR (Prothrombin Time/International Normalized Ratio).

Stool Tests

• Ova and Parasites: Collect a sample and submit.
• Occult Blood (Guaiac) Test: Smear stool on the card, add developer, and check for blood.

CT Scans

• Involve radiation.
• Require patients to lie still (up to 45 minutes).

MRI Scans

• No metal.
• Require patients to lie still (up to 45 minutes).

Contrast Allergies

• Shellfish allergy may indicate a contrast allergy due to iodine content.

Cardiac Catheterization

• Involves inserting a catheter through an artery (femoral or radial) to the heart.
• Used to look for blockages and place stents.

Post-Cardiac Cath Care

• Ensure patient lies still.
• Apply pressure to the insertion site.
• Monitor for bleeding and check distal pulses.

Obtaining Culture Specimens

• Avoid touching other areas while collecting the specimen (e.g., throat or wound).

Patient Admission

• Chart planning for discharge
• Assess the patient.
• Prepare the room.
• Orient the patient to the space.

Types of Admissions

• Routine.
• Emergency.

LPN Role During Admission

• Assist the RN with various tasks during the admission process.