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CHA Exam 1

Pain & Hematology

visceral pain inside pain, not localized, comes from c fibers, dull achy descriptors
chronic pain lasts longer than 6 months, vital signs are stable, depression, pain can be constant or intermittent
acute pain vital sign changes in first 30 minutes, increased BP, P, RR, anxiety, diaphoresis,dilated pupils
pain threshold universal, when do you feel the sense of pain
pain tolerance what is the patient willing to put up with, ability to tolerate will depend on fatigue, stress, anger or scared
adverse effects of opioid constipation, n/v,decreased RR, urinary retention, itching and hypotension
categories of co-analgesics/adjutant meds antiemetic, anticonvulsant, corticosteroids and antidepressants
when doing a pain assessment, what do you ask? PQRST
Client teaching when on Vicodin? constipation, limit driving, no alcohol, only take recommeneded dose,
different types of pain scales NIPS - newborn to 6 weeks FLACC newborn to 2 years Faces - two to five years Numeric 5 and older
four factors that affect pain perception age, gender, culture and emotional status
client teaching with ibuprofen? watch for bruising/bleeding, no NSAIDS, take on full stomach, check stools for color
Interventions to calm a child about to get IV? distractions, role play, EMLA/Lidocaine, explain on their level and give choices
Nursing interventions when caring for a client with an epidural? maintain safety, catheter placement, urinary/bowel function, prevent respiratory depression, vitals every hour, respiratory status, have NARCAN at bedside
Client teaching about pain patch? rotate sites every three days, it may take up to 24 hours to become therapeutic, additional meds may be needed for breakthrough pain, overdose can occur, absorption is enhanced by fever, inflammation, stress, exercise and heating pad
referred pain pain in arm or jaw with heart attack, pain in back and shoulder with gallbladder
when should you do a pain assessment always with vitals
what is the priority pain assessment pain scale, what is the patients pain level, if a drug is ordered you may give it if necessary
PQRST what do you ask in pain assessment
opioids are used for which kind of pain moderate to severe
examples of opioids morphine/codine/fentanyl
there is no ceiling limit with opioids, means what? even if you increase the dose, it won't make a difference
NARCAN must be available when using which type of drug opioids
side effects of opioids sedation, drowsiness and dizziness
adverse effects of opioids n/v
avoid or use caution with opioids with which patients COPD
increase the intake of fiber and fluids with which meds opioids
non-opioids are used with which pain moderate to mild
examples of non-opioids tylenol, NSAIDs, torodol, ibuprofen
adjuvant pain meds are used why? to treat anxiety and fear
what drugs are used to treat neuropathtic pain anticonvulsants and antidepressants
types of non-pharmaceutical pain managements TENS units, heat/cold therapy, therapeutic touch, massage, vibration, guided imagery, hypnosis, biofeedback and nutrition
PCA patients over 5 years can have one, only patient can control it, no overdose, discontinued when patient can eat/drink after surgery
epidural nursing care fast absorption, may cause respiratory depression after first 24 hours, NARCAN at bedside, RN to monitor infusion and site as well as dose, assess patient and notify MD if no pain relief
two most common epidural meds morphine and fentanly
acute pain less than 6 months
chronic pain over 6 months, depression, no vital changes, not always constant
visceral pain inside pain, dull, achy, not localized
somatic pain incisional pain, located at the site
phantom pain located at site of no limb, it is real
referred pain pain that isn't felt where it is located
radiating pain pain that moves from injury site
neuropathic cannot find the source of the pain
incident pain something happens to cause the pain, patient moved to quickly, RN should know to pre medicate these patients
breakthrough pain pain that occurs between scheduled doses
central/intractable pain caused by a lesion in the brain
sickle cell anemia fatigue, jaundice, pallor and irritably
sickle cell anemia crisis severe pain, low pulse ox, cyanosis, SOB, fever and obstructed capillary blood flow
sickle cell treatment pain control and fluids, prevent stressors, hydroxyurea
sickle cell RN interventions administer meds, oxygen, high calorie and high protein diet
Acute lymphocyte leukemia onset younger than 15 years old, fever, infection, bone pain and weight loss
acute myeloid leukemia onset between 15-39 years old, fatigue, fever, bleeding, low WBC count and platelets and bruising/petechaie
chronic myeloid leukemia onset in 40's, weakness, fatigue, weight loss, bleeding
chronic leukocyte leukemia onset after 50's, may not treat, fatigue, pallor and infections
leukemia affects bone marrow, causing anemia from low erythrocytes, infection from neutropenia and bleeding from thrombocytopenia
leukemia risk factors genetic, viral, immune system, exposure to chemicals
treatment involves what for myeloid leukemia chemo and stem cell transplant
treatment for leukocyte leukemia bone marrow transplant, chemo and stem cell transplant
monitor for signs of infection with which patients leukemia, they are immunocompromised
hodgkins disease possibly caused by viral infection or exposure to chemicals, good prognosis, monitor for signs of infection, enlarged lymphnodes, fever, night sweats, fatigue and weight loss
non hodgkins disease more common in older adults, environmental factors, genetic factors, enlarged lymph nodes, fever, night sweats, LOC, headaches
thrombocytopenia low platelets, risk for bleeding and medication, prednisone, pheresis and stop heparin and splenectomy
neutropenia genetic or caused by chemotherapy, infections, fever and fatigue, protective isolation
hemophilia bleeding disorder, abnormal bleeding, nose bleeds, joint bleeding, platelets are normal, clotting factor not normal, wear medic alert bracelet
hemolytic anemia caused by autoimmune disorder or infections, jaundice, pallor, spleen enlarged, bone marrow expansion causing fractures
hemolytic anemia assessment findings fatigue, SOB, dizziness, chronic bleeding, diet, color of stools, meds, surgeries, chemical exposures pain and cap refill time
normal RBC count men 4.7-6.1 women 4.2-5.4
normal WBC count 4,500-11,000
normal platelets 150,000-400,000
normal male hemoglobin 14-18
normal female hemoglobin 12-16
normal hematocrits male 42-52% females 35-47%
low red blood cells associated with what anemia
low white blood cells associated with what leukocytosis
decreased platelets are seen with which disorder leukemia
hematocrit is decreased in which disorder leukemia
staging of cancer 1 localized 4 spread
a stage cancer not systemic
b stage cancer systemic
bone marrow aspiration used to diagnose aplastic anemia
shows an abnormal number of immature cells bone marrow aspiration
bone marrow transplant used to replace damaged cells caused by radiation or chemo
treatment for leukemia and lymphoma bone marrow transplant
new stem cells delivered through central line bone marrow transplant, stem cell transplant
WBC and erythrocyte count begin to rise as well as platelet count BMT and stem cell transplant
engraftment takes place 2-5 weeks
watch for bleeding, infection, neutropenia and thrombocytopenia bone marrow transplant and stem cell transplant
radiation therapy used to kill cancer cells directed at one location
effective on tissues directly in patient beam radiation therapy
watch and treat side effects, watch for skin changes, alopecia, fatigue and altered taste sensation radiation therapy
kills or inhibits reproduction of neoplastic cells and normal cells chemotherapy
drugs are given IV if at all possible chemotherapy
alopecia, fatigue, n/v, mucositis, skin changes, neutropenia, anemia and thrombocytopenia chemotherapy
granulocyte colony stimulating factor used to rescue bone marrow following chemotherapy
bone pain is common with this drug granulocyte colony stimulating factor
fever, chills, anorexia, muscle aches and lethargy granulocyte colony stimulating factor
epogen is used to treat this anemia
headache, n/v, weight loss, joint pain, sores in mouth, difficulty sleeping, depression, site complications epogen complications/side effects
MS contin oral morphine
gabapentin anticonvulsant used in pain treatment
Created by: bkgrota