comfort and hygiene TLO 2.3.7 nurs 212
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| def pain; what is the most common reason to seek health care; physical pain can cause __ pain and visa versa; | An unpleasant, _subjective_ sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such.; pain; psych
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| physiology of pain: what are the 4 physiological processes of pain; def transduction; def transmission; | transduction, transmission, perception, modulation; thermal, chemical or mechanical stimuli that causes pain; excitatory neurotransmittoers are released with cellular damage caused by the stimuli;
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| physiology of pain: when pain reaches the cerebral cortex what is interpreted; def perception; def modulation; | the quality of pain, process of information from past experiences knowledge, and cultural associations in the perception of pain; point at which pt is aware of pain; is the inhibition of pain impulse by inhibitory neurotransmitters;
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| gate control theory of pain: where are gating mechanisms located; the gating mech. can block what; pain impulse pass through when gate is open or closed | along the central nervous system; pain impulse; open
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| physiologic response: pain of low to mod intensity and superficial pain elecits what response; what type of pain initiates the [arasympathetic stimulation; not all pt in pain will have ____ signs; | sympathetic fight or flight- touching the hot stove; continuous pain that is severe, deep and typically involving the visceral organs (MI, GB colic, renal stones); physical
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| behavioral response to brain: a pts ability to tolerate pan influences the nurses ____ of pts pain level; teach pts that pain is easier to ___ then treat; | perception; prevent;
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| types of pain: acute- duration; does it have identifiable cause; has limited __; if acute is not treated it can delay __; acute can become __ pain | < 3 mo; yes- incisional; tissue damage and emotional response; rehab and pt can become immobile; chronic;
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| what pain is treated aggressively acute or chronic pain | acute
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| nursing goal for acute pain | provide pain relief that allows pt to participate in their recovery
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| types of pain: chronic- duration; does it always have identifiable cause; this pt becomes __; chronic pain is pt that physicicans are less likely to treat what type of chronic pain | >3 mo; no; frusterated; non cancer chronic pain
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| chronic episodic pain: def; how long does it last; ex of dx who get this | occurs sporadically over an extended duration of time;day hours, or weeks; cickle cell anemia, migraines
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| cancer pain: acute or chronic; usually due to what; is the pain usually severe | both; a tumor progression and related pathology; yes
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| pain by inferred pathological process: def; neuropathic pain arises from what; | nociceptive pain includes somatic and visceral pain; abnormal or damaged pain nerves;
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| def somatic pain; def of visceral pain | musculoskeletal; internal organ
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| idiopathic pain: def; | chronic pain in the absence ofan identifiable physical or psych cause;
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| complex regional pain symdrome: acute or chronic; what does it affect; develops after ___; this pain is out of proportion with the severity of the __ injury | chronic; the arm and the leg; injury, surgery, stroke or heart attack; initial
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| pain can be ___ or ___ or ___ | physical, mental or emotional
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| what is the single most reliable indicator of pain; no 2 ppl experience ___ the same way;if unable for pt to report pain- what do we assess for; | pts self report of pain; pain; restless, change in vital signs, diaphoresis;
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| sometimes pt in post op w/ incision the response to pain may be r/t what | other noxious stimuli (bladder distension)
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| what heightens the perception of pain; pain is less after ____ | fatigue; a restful sleep
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| what may determine pts pain threshhold | genes
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| how can neurological function effect pain; ex of neurological disorders; ___ agents influence pain perception and response; | it can interrupt or influence normal pain; spinal cord injury, peripheral neuropathy, neurological disease; analgesics, sedatives and anesthetics
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| the more we focus on pain the pain increases of decreases | increases
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| what nonpharm psychological thing can minimize pain; | distraction;
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| methods of pain assessment: what pain rating scales are unidimensional; def of multidimentional pain assessment tool; unidementional assesses what only; | verbal, numeric rating scale, visual analog scale, pictorial scale; they assess the onset duraction, location, intensity, quality,relief measures, contributing symptoms and effect of pain on mood and function; just pain itself
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| methods of pain assessment:multidimensional- are they more or less timely then unidimensional; | more;
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| what are the 3 types of analgesics | opioids, non opioids, adjuvant /coanalgesics
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| give ex of nonopioid meds; | acetaminophen and NSAIDS
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| non opioids: for what type of pain; what is the reversal agent if there is resp depression; what is the protocol for narcan; | moderate to severe pain; narcan; give until resp >8 /min
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| adjuvants/coanalgesics: what can treat neuropathic pain; ex of anticonvulsant; what can relieve pain associated with inflammation and bone metastisis | tricyclic, antidepressants and anticonvulsants; Neurontin; corticosteriods
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| in regards to pain nurses are legally and ethically responsible for what | to relieve pain and suffereing
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| effective pain management : it can improve what; this can shorten ___ stays; | quality of life; hospital stays;
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| pain is always objective or subjective | subjective
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| equialgesic dosing: def; permits substitution of analgesics in the event particular drug is ___ | refers to a dose of one analgesic that isequivalent in pain relieving effects compared with another analgesic; ineffective
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| 10 mg morphine =___ mg codeine = ___ mg oxycodone; =___ mg hydromorphone = ____ mg methadone all po | 100; 5-7.5; 2; 1
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| PCA pump: aka; def; why should fam not push button; when is it used; when basal rate per hour is used pt is at risk for what; | patient controlled analgesia; IV delivery system that is pt controlled or demand analgesia; bc if pt is not able to push button they really do not need another dose; acute and post op pain; resp depression;
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| what drug is used to reduce opiate induced respiratory depression | narcan
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| PCA pump: pt should push button when pain is greater then pt ___; assure pt that they cannot get too much ___ in one dose; how should it be tapered | goal- ex ask for dose when pain is at a 2 instead of a 5; med; with transition to oral medications
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| continuous epidural meds: where is cath placed; tip of cath is located where; thoracic cath is used for what surgery; high lumbar cath is used for what surgery; | in epidural space; close to the nerve supplying the painful dermatome; upper abdominal surgery; lower abdominal surgery
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| continuous epidural meds: with this are smaller or larger analgesic doses needed; what are common drugs used; what are common side effects; | smaller; morphine, fentanyl, hydromorphone; N, itching, urinary retention
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| continuous epidural meds: what can become displaced; what type of dressing is used; if there is wetness on the transparent dressing this is an indication of what; if there is wet dressing what is done 1st; s/s of dislodged dressing with bolus of med; | the catheter; transparent; leakage of CSF; call md; there will be little to no relief in pain
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| continuous epidural meds: what happens when the catheter migrates; s/s of catheter migration; what is bupivavaine complication | it can migrate from the epidural to the subarachnoid space; somnolence, confusion, increased anesthesia; the inability to move or feel the unaffected leg
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| continuous epidural meds: what to check for infection; s/s of intraspinal infection; in infection of this is fever always present | inflammation, drainage, pain; diffuse back pain, pain or paresthesia during bolus injections, unexplained sensory or motor deficits in legs; it may not be
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| monitored anesthesia care: aka; formerly called __; what is the med used; this is given under the direct supervision of a __; this relieves ___; provides ___; are pt responsive; can they breath independently; | mac; consciuous sedation; versed; physician; anxiety; analgesia and amnesia; yes; yes;
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| monitored anesthesia care: often used in what procedures; requires continuing monitoring of __; what are the meds commonly used; | minor surgical procedures and diagnostic procedures- ex colonoscopy; vs, LOC, cardiac rhythm, deep sedation, pulse ox; midazolam- versad, fentanyl-sublimaze
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