Pharmacology in Pain Management Week 1

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Questions and Answers

What is the most appropriate method of administering IV morphine to ensure patient safety?

Administer rapidly until the client shows response

Administer over 4 to 5 minutes (correct)

Administer over 1 minute

Administer in a dose of 10mg

What is the minimum hourly urinary output expected for patients receiving opioid analgesics?

50ml/hr

30ml/hr (correct)

10ml/hr

20ml/hr

Why is buprenorphine considered unsuitable for patients with breakthrough pain?

It has a high potential for abuse

It must be administered by injection only

It is an agonist-antagonist that may interfere with other opioids (correct)

It can cause excessive sedation

What is the primary nursing action indicated when a patient's respiratory rate is below 12/min before opioid administration?

Withhold the medication and notify the doctor Signup and view all the answers

What is the primary goal of administering flumazenil in cases of benzodiazepine toxicity?

To reverse the effects of benzodiazepines Signup and view all the answers

After administering hydromorphone, when is the most suitable time to assess a patient's pain level for effective management?

30 minutes to 1 hour after administration Signup and view all the answers

What potential outcome should a nurse be cautious of when a patient experiences severe pain in a vaso-occlusive crisis with flexed knees and hips?

Diminished perfusion leading to increased pain Signup and view all the answers

What is the primary goal of administering diazepam during alcohol detoxification?

To relieve withdrawal symptoms and reduce anxiety Signup and view all the answers

When monitoring a client receiving opioid medications, which assessment is most crucial?

Respiratory rate changes Signup and view all the answers

Which symptom should clients taking oxycodone be most vigilant about monitoring?

Respiratory depression and orthostatic hypotension Signup and view all the answers

What should be the nurse's primary focus when initiating treatment with propranolol for migraine prophylaxis?

Closely monitoring heart rate and blood pressure Signup and view all the answers

In the context of administering acetaminophen to a client on warfarin, what should be closely monitored?

The International Normalized Ratio (INR) Signup and view all the answers

What is a significant risk when prescribing amitriptyline to a client with a history of seizures?

Increased risk of seizures Signup and view all the answers

Which nursing action is most crucial for a client using a transdermal fentanyl patch?

Assess pain level regularly Signup and view all the answers

What intervention should be prioritized for a client who continues to experience breakthrough pain?

Contacting the healthcare provider for further instructions Signup and view all the answers

Which medication is deemed the best option for treating neuropathic pain due to nerve damage?

Adjuvant analgesics like gabapentin Signup and view all the answers

What is the standard recommended duration for sleep in adults for optimal health?

12 to 14 hours Signup and view all the answers

Which cardiac condition is characterized by inadequate tissue perfusion resulting from insufficient output from the left ventricle?

Diastolic heart failure Signup and view all the answers

In the classification of heart failure by the American College of Cardiology, which stage represents structural heart abnormalities without symptoms?

Stage B Signup and view all the answers

What is the primary action a nurse should take immediately after a patient undergoes an exercise stress test?

Monitor the patient’s vital signs and blood pressure closely. Signup and view all the answers

Which laboratory testing is critical for patients on loop diuretics to avoid potential complications?

Electrolyte Levels Signup and view all the answers

What age range is considered most appropriate for introducing solid foods to toddlers?

1 to 3 years old Signup and view all the answers

Which type of food poses the greatest choking hazard for toddlers?

Nuts Signup and view all the answers

What is a significant nutritional risk for preschoolers resulting from meal timing?

Higher absorption of lead on an empty stomach Signup and view all the answers

At what age does the female growth spurt typically start?

10 years Signup and view all the answers

Which statement about dietary needs during adolescence is true?

Adolescents have higher iron requirements than adults. Signup and view all the answers

What is the recommended maximum calcium intake for adolescents?

1,300 mg/day Signup and view all the answers

Which behavior is commonly observed in school-age children regarding food?

Consuming snacks primarily out of boredom Signup and view all the answers

What heart rate can the AV node sustain if the SA node fails?

40 to 60 beats per minute Signup and view all the answers

What is the most critical medication a nurse should prepare for a patient receiving magnesium sulfate?

Calcium gluconate for magnesium toxicity Signup and view all the answers

What characterizes the effect of sympathetic stimulation on heart rate?

Increases heart rate and conduction speed Signup and view all the answers

What is a serious concern when opioids are combined with lorazepam?

Potential for respiratory depression and sedation Signup and view all the answers

What is the normal sinus heart rate range?

60 to 100 beats per minute Signup and view all the answers

What is the primary function of dietary fiber in human digestion?

Aids digestion though indigestible Signup and view all the answers

Which carbohydrate type is recognized as a complex carbohydrate?

Starch Signup and view all the answers

What is the recommended daily limit for 100% juice consumption in toddlers?

4 to 6 oz Signup and view all the answers

What describes complementary proteins in nutrition?

Incomplete proteins that together provide all essential amino acids Signup and view all the answers

How does the human body respond to elevated blood glucose levels after consuming carbohydrates?

Stimulates insulin release from the pancreas Signup and view all the answers

Which type of fat is primarily solid at room temperature and sourced from animals?

Saturated fats Signup and view all the answers

What consequence does not result from protein underconsumption?

Kelvin syndrome Signup and view all the answers

What is the typical minimum daily carbohydrate intake necessary to fuel the brain?

130 g/day Signup and view all the answers

Study Notes

Pain Management and Pharmacology

IV Morphine Administration: Optimal safety achieved by administering over 4 to 5 minutes.
Urinary Output with Opioids: Minimum hourly output should be 30 ml/hr.
Buprenorphine for Breakthrough Pain: Unsuitable due to its agonist-antagonist properties, which may interfere with other opioids.
Respiratory Rate Monitoring: If below 12/min, withhold opioids and notify the physician.
Flumazenil Use: Primary goal is to reverse benzodiazepine effects in cases of toxicity.
Hydromorphone Pain Assessment: Most suitable to assess 30 minutes to 1 hour post-administration for effective management.
Vaso-Occlusive Crisis Pain Management: Caution against diminished perfusion which leads to increased pain.
Long-term Ibuprofen Therapy: Monitor closely for gastrointestinal bleeding and tinnitus.
Breakthrough Pain in Opioid Administration: Notify the physician for dosage adjustments.
Diazepam in Alcohol Detoxification: Prescribed to alleviate anxiety symptoms and minimize withdrawal effects.
Naproxen and Chronic Kidney Disease: Hold the medication and consult with the prescriber before administration.
Celecoxib Information: Important to inform clients about increased risks of heart attack and stroke.
Opioid Sedation Management: Monitor respiratory rate for changes if sedation occurs after administration.
Carbamazepine and Tremors: Immediate provider notification is crucial if tremors develop.
Naloxone for Newborns: Critical medication for treating acute narcotic toxicity.
Acetaminophen Monitoring in Warfarin Patients: Closely monitor INR levels due to potential interactions.
Fentanyl Monitoring: Closely evaluate respiratory rates as a priority.
Butorphanol Administration Guidance: Educate the client on recognizing signs of opioid withdrawal.
Amitriptyline and Ibuprofen: Increased CNS effects are a primary concern when used together.
Propranolol for Migraines: Important to monitor heart rate and blood pressure closely.
Chronic Arthritis Pain: Long-acting opioids are recommended for management beyond tissue healing.
Assessing Non-communicative Patients' Pain: Utilize behavioral and physiological indicators.

Nutritional Basics

Carbohydrate Function: Primarily serves to supply energy for the body.
Complex Carbohydrate Example: Starch is classified as a complex carbohydrate.
Daily Carbohydrate Requirement: Minimum daily intake of 130 g/day is necessary for brain function.
Insulin Response: The body releases insulin in response to elevated blood glucose levels.
Dietary Fiber Role: Aids in digestion as it is not digestible.
Complementary Proteins: Incomplete proteins that when paired provide a complete amino acid profile.
Essential Fatty Acids: Support metabolic processes and are crucial for blood clotting.
Protein Underconsumption Risks: Leads to conditions such as Protein Energy Malnutrition (PEM), Kwashiorkor, and Marasmus.
Saturated Fats: Primarily solid at room temperature and derived from animal sources.
Fiber Intake Recommendations: Adequate Intake (AI) for adult males is 38 g/day.
Toddlers and Juice Consumption: Limit to 4 to 6 oz to prevent excessive intake.
Iron Absorption Maximization: Combining peanut butter with vitamin C enhances absorption of plant-derived iron.
Maximum Milk Intake for Toddlers: Recommended limit is 24 oz to ensure iron-rich foods are not displaced.
Toddler Age Range: Defined as 1 to 3 years old.
Choking Risks for Toddlers: Nuts should be avoided to minimize choking hazards.
Preschool Nutritional Risks: Empty stomach habits can increase lead absorption.
Female Adolescent Growth Spurt: Typically begins around 10 years of age.
Adolescent Dietary Needs: Higher iron requirements compared to adults.
Calcium Intake for Adolescents: Recommended maximum intake is 1,300 mg/day.
School-age Children Eating Behavior: Often characterized by snacking when bored.

Cardiovascular Insights

AV Node Backup Heart Rate: Can sustain a heart rate of 40 to 60 beats per minute if the SA node fails.
Sympathetic Stimulation Effect: Increases heart rate and conduction speed.
Coronary Artery Supply: Circumflex artery supplies the left atrium and lateral surfaces of the left ventricle.
Normal Sinus Heart Rate: Ranges from 60 to 100 beats per minute.
Purkinje Fibers Functionality: Can act as a pacemaker with a rate of 20 to 40 beats per minute if both SA and AV nodes fail.
Baroreceptor Activity Response: Elevated arterial pressure decreases heart rate and arterial pressure.
S4 Heart Sound Cause: Heard due to ventricular hypertrophy or wall injury.
Hormonal Regulation of Vascular Volume: Antidiuretic hormone plays a significant role.
Third Heart Sound (S3): Generally considered normal in individuals younger than 30 years.
Endocardium Function: Lines the inner chambers of the heart and valves.
Myocardium Role: Primarily responsible for contracting to pump blood.
Tricuspid Valve Function: Prevents blood from flowing back into the right atrium.
Visceral Pericardium Role: Provides a protective layer around the heart.
Semilunar Valves during Relaxation: Function to prevent blood from refluxing back into the ventricles.
Left Ventricle Functionality: Crucial for pumping oxygenated blood into systemic circulation.
SA Node: Initiates and regulates heartbeats for proper rhythm.
Right Atrial Blood Reception: Receives deoxygenated blood from the body.### Cardiac Diagnostics and Procedures
Typical pericardial fluid volume in the pericardial space: 5 to 20 mL.
Recommended fasting duration before sampling a lipid profile: 12 to 14 hours.
Troponin I is the primary cardiac enzyme for diagnosing myocardial infarction.
A lipid profile mainly assesses cholesterol levels.

Cardiovascular Imaging and Monitoring

Transthoracic echocardiogram's purpose: Diagnose valve disorders and evaluate heart structure.
Normal total cholesterol range: Less than 200 mg/dL.
Pre-transesophageal echocardiography requirement: Patient must be NPO (nothing by mouth) for 4 to 6 hours.

Hemodynamic Monitoring

Mild atrial fibrillation is NOT an indication for hemodynamic monitoring.
Correct positioning for pulmonary artery catheter insertion: Supine or Trendelenburg position.
Mixed venous oxygen saturation (SvO2) measures the balance between oxygen supply and demand.

Post-Procedure Care

Following an exercise stress test, monitor the patient's vital signs and blood pressure closely.

Heart Failure

Diastolic heart failure leads to inadequate left ventricle output and poor tissue perfusion.
Stage B in the ACC/AHA classification indicates cardiac structural abnormalities without heart failure manifestations.
NYHA Class IV indicates manifestations at rest related to heart failure.
Left-sided heart failure causes pulmonary edema.

Complications and Symptoms

Common outcome of right-sided heart failure: Peripheral edema.
High-output heart failure is typically due to septicemia.
Jugular vein distention is NOT a common manifestation of left-sided heart failure.

Laboratory Tests and Medications

B-type natriuretic peptides (BNP) provide a direct indication of heart failure severity.
Expect increased central venous pressure (CVP) in heart failure during hemodynamic monitoring.
Fluid restriction is crucial for patients at risk of heart failure.
Furosemide is a high-ceiling loop diuretic that causes significant diuresis even in renal impairment.

Medication Side Effects and Monitoring

Potential complication from loop diuretics includes hypotension when changing positions.
Hypokalemia is characterized by potassium levels below 3.5 mEq/L.
Monitor daily weight in patients receiving high-ceiling loop diuretics for dehydration.

Drug Interactions and Efficacy

Hypokalemia may increase the risk of digoxin toxicity.
Thiazide diuretics are contraindicated in renal impairment, affecting potassium levels.
Essential laboratory monitoring for patients on loop diuretics: Electrolyte levels.

Antidysrhythmic Medications

Class III antidysrhythmic medications like Amiodarone work by prolonging action potential and refractory period.
Beta-adrenergic blockers prevent sympathetic stimulation of the heart.
Significant complication of loop diuretics: Risk of ototoxicity.

Patient Education and Reporting

Patients should report symptoms of digoxin toxicity, such as cardiac arrhythmias.
Timing strategy for taking ACE inhibitors: 1 hour before or 2 hours after meals.
Patients should avoid caffeine before an exercise stress test.

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Description

Test your knowledge on the administration of IV morphine and urinary output expectations for patients receiving opioid analgesics. This quiz covers acute pain, cancer pain, and the pharmacological approaches used in nutrition and pain management during the first week of study.