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Med Surge Exam 2
| Question | Answer |
|---|---|
| Examples of acute pain | Trauma, myalgia following exercise, and postoperative pain |
| Examples of chronic pain | Migraines, lower-back pain, peripheral neuropathy, arthritis, and fibromyalgia |
| Onset of pain | When did the pain start? Was the pain sudden, gradual, or on-going? |
| Provocation of pain | Did anything prompt this pain? Such as walking, turning in bed, etc... |
| Quality of pain | Can you describe your pain for me? (Ex: sharp, dull, stabbing, etc..) |
| Region and Radiation of pain | Where is the pain located and does it extend anywhere else? |
| Severity of pain | Numerical scale for pain. |
| Time and Duration of pain | How long have you had this pain? |
| Cutaneous pain | Superficial skin and tissues, easily localized, and short (hours to days) |
| Somatic pain | Deeper tissues, joints, and bones. Can be short to very long |
| Visceral pain | Mostly hollow organs in the abdominal or thoracic cavities, including heart, bladder, stomach, intestinal tract |
| Neuropathic pain | Peripheral and central nervous system structures. Numbness, tingling, shooting, burning, pins and needles, electric shock, stabbing |
| Risk factors for under treatment of pain | Cultural and social attitudes, lack of knowledge, fear of addiction, and exaggerated fear of respiratory depression |
| Causes of acute and chronic pain | Trauma, surgery, cancer, arthritis, fibromyalgia, neuropathy, and diagnostic or treatment procedures |
| Non-verbal queues of pain | Grimacing, wrinkled forehead, restlessness, pacing, guarding, moaning, crying, decreased attention span, and initial increase of blood pressure, pulse, and respiratory rate |
| Non-pharmacological pain management | Yoga, chiropractic manipulation, meditation, distraction, herbs, or oils |
| Non-opioid analgesics | Acetaminophen (shouldn't exceed 4 g a day for clients 110 lbs or greater). Okay to administer with NSAIDs |
| Opioid analgesics | Moderate pain: tramadol, hydrocodone, and codeine Severe pain: hydromorphone, fentanyl, morphine, oxycodone, or methadone |
| Adverse effects of opioid use | Constipation, orthostatic hypotension, urinary retention, nausea/vomiting, sedation, and respiratory depression |
| Adjuvant analgesics | Enhance the effects of non-opioids, help alleviate other manifestations that aggravate pain, and are useful for treating neuropathic pain |
| Patient-controlled analgesia (PCA) | Medication delivery system that allows clients to self-administer safe doses of opioids |
| Pain scale types | Simple descriptive pain intensity pain, numeric pain intensity scale, visual analog scale |
| Osteoarthritis (diff) | Morning stiffness: < 30 min Immune Mediated: No Typical Joint Involvement: Large weight-bearing joints such as hips and knees Symmetrical Joint Involvement: Not typical Systemic Joint Involvement: No |
| Rheumatoid arthritis (diff) | Morning stiffness: > 30 min Immune Mediated: Yes Typical Joint Involvement: MCPs, PIPs, MTPs, Wrists, Elbows, Ankles, Knees Symmetrical Joint Involvement: Very typical Systemic Joint Involvement: Yes |
| Characteristics of osteoarthritis | Cartilage destruction with bone spur growth at joint ends; degenerative, pain with activity that improves at rest, localized inflammatory response, usually overweight, no systemic involvement |
| Characteristics of rheumatoid arthritis | Synovial membrane inflammation resulting cartilage destruction and bone erosion; inflammatory, swelling, redness, warmth, pain at rest or after immobility, all joints, usually underweight, systemic involvement |
| Risk factors for Gout | Obesity, heredity, postmenopause, cardiovascular disease, trauma, alcohol ingestion, starvation dieting, diuretic use, some chemotherapy agents, chronic kidney failure |
| Expected findings for Gout | Severe joint pain, especially in the metatarsophalangeal joint of the great toe. Redness, swelling, and warmth of affected joint |
| Clinical Manifestations of Systemic Lupus Erythematosus | Fatigue, fever, difficulty concentrating, rash (malar), photosensitivity, alopecia, urticaria, ulcers, joint pain with or without synovitis, muscle pain or weakness, lupus nephritis, proteinuria, hematuria, stroke, seizures, psychosis, pericarditis, etc.. |
| Active immunity | An adaptive process that allows the body to make antibodies in response to the entry of antigens into the body |
| Passive immunity | Develops when antibodies that are created by another human or animal are transferred to the client |
| First line of defense | Physical barriers, biochemical barriers, and mechanical barriers |
| Second line of defense | Inflammatory response |
| Third line of defense | Acquired (adaptive) immunity |
| Cardinal signs of inflammation | Fever, malaise, chills, and elevated WBC count |
| Cellular-mediated response | T lymphocytes |
| Humoral-mediated response | B lymphocytes (antibodies) |
| Neutrophils | Phagocytes of early inflammation that destroy bacteria |
| Lymphocytes | Both humoral and cell-mediated responses |
| Monocytes | Differentiate into macrophages or dendritic cells |
| Eosinophils | Phagocytes that destroy allergens and combat parasitic infections |
| Basophils | Release heparin as an anticoagulant and histamine during the early inflammatory response |
| X-linked agammaglobulinemia | Result of a mutation of the BTK gene; essential to the development of the B lymphocyte |
| DiGeorge's Syndrome | Arises from a disturbance of the abnormal embryological development of the pharyngeal pouches occurring between the 6th and 10th weeks of gestation. Typically involves the dysfunction of the thymus gland and parathyroid |
| Type I Hypersensitivity: Immediate rapid allergic reaction | Reaction of IgE antibody with antigen-releasing mediators especially histamine |
| Type II Hypersensitivity: Cytotoxic reactions | Reaction of IgG with host cell membrane of antigen absorbed by host cell membrane |
| Type III Hypersensitivity: Immune complex reactions | Formation of innate complex of antigen and antibody that is deposited in walls of blood vessels, resulting in complement release and inflammation |
| HIV Stage I | CD4+ T lymphocyte count: 500 cells/mm3 or more CD4+ T lymphocyte percentage of total lymphocytes: 29% or more |
| HIV Stage II | CD4+ T lymphocyte count 200 to 499 cells/mm3 CD4+ T lymphocyte percentage of total lymphocytes: 14%-28% |
| HIV Stage III | CD4+ T lymphocyte count of 200 cells/mm3 or more CD4+ lymphocyte percentage of total lymphocytes of more than 14% |
| HIV Stage IV (AIDs) | CD4+ T lymphocyte count: < 200 cells/mm3 CD4+ T lymphocyte percentage of total lymphocytes: < 14% |
| Clinical manifestations of HIV | Weight loss, fever, night sweats, cough, dyspnea on exertion, unable to do usual activities, severe headache, pain when swallowing, mental status changes, fatigue |
| Risk factors for getting HIV | Unprotected sex, multiple sex partners, occupational exposure, perinatal exposure, blood transfusions, IV drug use with a contaminated needle, older adults are more likely to go undiagnosed |
| Lab tests for HIV | CBC and differential, platelet count < 150,000/mm3 |
| Diagnostic procedures for HIV | Positive result from ELISA, confirmed by a positive result from a Western blot or IFA |
| Medications for HIV | HAART, fusion inhibitors, entry inhibitors, nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors, anti-neoplastic medication |
Created by:
zolumi
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