NURS 125 Exam 3 - Concept Review PDF

# NURS 125 Exam 3 - Concept Review - When assessing patients always start with ABCs - considering airway, breathing, and circulation as the priority, and then move on to pain and other findings after ABCs are managed. ## Pain Scales | Scale | Description | |---|---| | Verbal Pain Intensity Scale...

# NURS 125 Exam 3 - Concept Review - When assessing patients always start with ABCs - considering airway, breathing, and circulation as the priority, and then move on to pain and other findings after ABCs are managed. ## Pain Scales | Scale | Description | |---|---| | Verbal Pain Intensity Scale | No pain, Mild pain, Moderate pain, Severe pain, Very severe pain, Worst possible pain | | 0-10 Numeric Pain Intensity Scale | No pain (0), Worst possible pain (10) | | Visual Analogue Scale | Worst possible pain, No pain | | Wong-Baker FACES® Pain Rating Scale | No hurt (0), Hurts little bit (2), Hurts little more (4), Hurts even more (6), Hurts whole lot (8), Hurts worst (10) | ## Terms to Review - **Opioid naive:** No prior opioid use - **Opioid Tolerance:** Requires higher doses of opioids to achieve the same pain relief - **Partial Agonist:** A medication that binds to an opioid receptor but has a weaker effect than a full agonist and can block the effects of other opioids - **Opioid Dependence:** Physical dependence on opioids, characterized by withdrawal symptoms when the drug is stopped ## Opioid Analgesics: Usage, Management, and Monitoring ### Hydromorphone (Dilaudid) vs Morphine - **Hydromorphone** is 7x stronger than **morphine** - administer in much smaller doses. - Used for severe pain relief, especially when morphine is ineffective. ### Respiratory Depression - **Critical monitoring:** Assess respiratory rate before administering opioids (must be ≥ 12/min). Opioids depress the CNS and can cause fatal respiratory failure. - **Older adult caution:** Post-op patients, especially older adults, are at higher risk. - **Naloxone (Narcan):** Commonly used for overdose or with surgical anesthesia - **Opioid antagonist:** Keep available for reversing opioid-induced respiratory depression - **Emergency use:** Administer if respirations drop significantly or patient is unresponsive. ### Discharge Teaching for Patients on Opioids - **Constipation management:** Encourage fluids, fiber intake, and regular use of stool softeners - **Opioid Safety:** Discuss the risk of tolerance (higher doses needed over time) and potential addiction. - **Side effects:** Warn about common side effects (drowsiness, dizziness) and advise against driving ## Non-Opioid Analgesics and NSAIDs - **Aspirin** - **Not for children** - **Risk for Reye's syndrome:** Acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. - Triggered by viral illnesses such as influenza as well as by salicylate therapy itself in the presence of a viral illness - Used for prophylactic therapy for adults who have strong risk factors for developing coronary artery disease or cardiovascular accident - **Salicylate (Aspirin) Intoxication in children:** Hyperventilation and drowsiness are common symptoms. - **Acetaminophen (Tylenol)** - **Max dosage:** Do not exceed 4 grams/day to prevent liver damage. - **Common uses:** Effective for mild pain and fever reduction. - **Preferred for children for pain/anti-pyretic** - **Ibuprofen (Advil) and NSAIDs** - **Action:** Reduces inflammation, pain, and fever. - **GI considerations:** Take with food to avoid GI upset or ulcers. - **Monitor for bleeding:** Prolonged use can increase bleeding risk - especially in elderly or those on anticoagulants ### Patient Teaching for NSAIDs - **Avoid alcohol:** Increases risk of liver and GI issues when combined - **Long-term use risks:** Educate on potential kidney damage with prolonged use, risk for bleeding, gastric ulcers ## Patient Teaching and Discharge Instructions ### Opioids - **Educate on risks of dependence and tolerance.** - **Teach signs of respiratory depression** (e.g., slowed breathing, confusion). - **Discuss safe storage and proper disposal of unused medications** to prevent misuse. ### NSAIDs - **Educate on GI risks:** Always take with food, and report any signs of stomach pain or black stools. - **Max doses:** Clarify daily maximums and potential risks with exceeding them. - **Contraindicated** for patients with renal disease ## Cultural Considerations in Medication Administration - **Tailor education:** Modify communication to accommodate different cultural preferences (e.g., use interpreters if necessary, provide written instructions in preferred language). - **Understand health beliefs:** Some cultures may use alternative therapies - respectfully inquire about these practices and provide guidance that incorporates their beliefs. - **Family involvement:** In some cultures, family may play a central role in decision-making - include them in patient education when appropriate. ## Anti-Gout - **Gout:** Is a type of arthritis caused by a buildup of uric acid crystals in the joints, leading to sudden and severe pain, swelling, redness, and tenderness, often in the big toe. It occurs when the body either produces too much uric acid or cannot remove enough of it. - **Common medications:** Allopurinol (Zyloprim) and Colchicine ## Gastrointestinal Drugs & Bowel Disorder Drugs - **Diphenoxylate with atropine (Lomotil):** OPIOID prescription laxative - Slows intestinal motility to increase fluid absorption, reducing diarrhea. - **Bismuth Subsalicylate (Pepto-Bismol):** May cause dark-colored stool, dark tongue and constipation. - **Simethicone (Mylicon):** Administered for excessive and painful intestinal gas. Safe for children/babies and adults. - **Calcium antacids:** Not commonly used due to potential - **Magnesium-containing antacids:** Use cautiously in patients with renal failure due to possible complications (e.g., kidney stones). - **(e.g., Omeprazole & Antibiotics):** Often used to treat H. pylori infections causing peptic ulcers. ### Antacid and Medication Administration - Administer medications at least 1 hour apart from antacids to avoid interaction. ### Cimetidine Side Effects - May cause confusion and disorientation in elderly patients. ### PPIs and ICU Patients - We may give PPIs for patients with - **PPIs and osteoporosis:** Long-term use can increase the risk of osteoporosis. - **Overuse of sodium bicarbonate:** May cause metabolic alkalosis. - **Proton pump inhibitors in ICU patients:** Used to prevent stress ulcers in patients with nasogastric tubes and ventilation. ### Long-Term Laxative Use - May result in dependency and decreased bowel tone. - **Histamine (H2)-Receptor Antagonists:** Know your meds.