Exam #2 Watkins Study Guide.pdf

1.Acute Vs Chronic Pain Acute pain is protective, usually has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. It is common after acute injury, disease, or surgery. Acute pain is protective because it warns people of injury or disease. It eventually...

1.Acute Vs Chronic Pain Acute pain is protective, usually has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. It is common after acute injury, disease, or surgery. Acute pain is protective because it warns people of injury or disease. It eventually resolves, with or without treatment, after an injured area heals. Patients in acute pain are often frightened and anxious and expect relief quickly. It is self-limiting. Because acute pain has a predictable ending (healing) and an identifiable cause, health team members are usually willing to treat it aggressively, and patients understand that their pain will eventually go away. Unlike acute pain, chronic pain is not protective. It is prolonged, varies in intensity, and usually lasts longer than 3 to 6 months and beyond the expected or predicted healing time (ACPA & Stanford Medicine, 2021; Huether and McCance, 2019). Chronic pain does not always have an identifiable cause. Examples of chronic noncancer pain include arthritis, low back pain, headache, fibromyalgia, and peripheral neuropathy. It may result from an initial injury such as a back sprain, or there may be an ongoing cause such as illness. Chronic noncancer pain may be viewed as a disease since it has a distinct pathology that causes changes throughout the nervous system that may worsen over time. It has significant psychological and cognitive effects and is sometimes considered a serious, distinct disease. Chronic noncancer pain is usually non–life threatening. In some cases an injured area healed long ago, yet the pain is ongoing and does not respond to treatment. Cues for acute pain include an identifiable cause, a sudden onset, and a short duration. In contrast, chronic pain is not protective, may not have an identifiable cause, and has a dramatic effect on a person’s quality of life; it varies in intensity, and usually lasts longer than 3 to 6 months, beyond the expected or predicted healing time. Acute Pain: Has protective effect, usually has an identifiable cause, eventually resolves with out witrhout treatment VS Chronic Pain: Last more then 3-6 months, dramatically effects quality of life, viewed as a disease 2. Cancer Pain Vs Neuropathic Pain Cancer pain varies among patients and can be either chronic or acute. Pain is commonly experienced in patients with metastatic, advanced, or terminal cancer; patients receiving cancer treatment; and patients following their treatment. Organizations such as the APS and the National Comprehensive Cancer Network (NCCN) have published guidelines for assessing and treating cancer-related pain. The guidelines support comprehensive and aggressive treatment, including many options for pain relief. The best choice of pain treatment often changes as a patient’s condition and the characteristics of pain change. Use multimodal pharmacological strategies and nonpharmacological interventions to optimize pain management (ACPA & Stanford Medicine, 2021). Many patients with cancer experience breakthrough cancer pain (BTCP), a temporary increase in pain in someone who has relatively stable and an adequately controlled level of baseline pain (ACPA & Stanford Medicine, 2021). It occurs either spontaneously or in relation to a specific predictable or unpredictable trigger (Scarborough and Smith, 2018). BTCP is a challenging aspect of cancer because, even though it is self-limiting in nature, its presence has a significant, negative impact on the quality of life of patients and family caregivers (Scarborough and Smith, 2018). Individualized assessment is critical for understanding how BTCP affects a patient’s life. A holistic approach to care is often needed Neuropathic pain results from peripheral nerve injury. Neuropathic pain is caused by nerve malfunction or injuries resulting from trauma, disease, chemical, infections, and tumors. The pain may be due to peripheral or central nerve damage. Neuropathic pain: Pain caused by a lesion or disease of the somatosensory nervous system; treatment usually includes adjuvant analgesics. Cancer pain vs Neuropathic pain Some patients with cancer experience acute and/or chronic pain. Nociceptive(type of pain caused by damage to body tissue) pain is more common(for cancer pain), resulting from tissue injury. Neuropathic pain results from peripheral nerve injury. 3. Phantom Limb Pain- What type is it? Phantom limb pain is the perception of pain or discomfort in a limb that is no longer there. Phantom Limb Pain Is CHRONIC PAIN and NEUROPATHIC Pain 4. Education on pain medication- opioid vs non opioid Non-opioid analgesics are frequently prescribed for mild to moderate pain because they are considered safer than opioid (narcotic) analgesics and are nonaddictive. Patients can, however, become dependent on non-opioid pain medications. Examples of non-opioid analgesics include acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen and aspirin. Opioid analgesics, or narcotics, play an essential role in pain management and are used to treat moderate to severe pain. Misuse and improper prescribing and administering of opioids has led to a crisis in the United States, although short-term use of opioids is generally not problematic. Nurses should monitor patient response when opioids are administered to identify potential misuse or prolonged unnecessary use. The health care provider should prescribe the lowest effective dose of immediate-release opioids when starting opioid therapy.Check vital signs before administering opioid analgesics. Overdose of opioids may cause respiratory depression. Respiratory depression is defined as fewer than 10 respirations per minute. There are many types of opioid analgesics, but the two most common are agonist and agonist-antagonist analgesics Agonist examples:Morphine, hydromorphone, oxycodone, fentanyl, and meperidine Agonist-Antagoinist examples: Pentazocine, butorphanol, dezocine, and nalbuphine Patient Education:On patient discharge, the nurse educates the patient, family, and caregivers regarding administration of medications. Patient education is documented in the nurse's notes, and the patient is provided with a medication education handout explaining the medication, its intended purpose, how to take it, and side effects. Evaluation of patient education often includes the teach-back process to validate that the patient, family, and caregivers understand what was explained  5.Opiod toxicity opioid toxicity, also known as opioid overdose, is characterized by pinpoint pupils, respiratory depression, and decreased level of consciousness (the "opioid overdose triad") and is treated primarily with the medication Naloxone (Narcan). Key points about opioid toxicity: ​ Signs and Symptoms: Constricted pupils (pinpoint pupils) Slowed breathing (bradypnea) or absence of breathing (apnea) Decreased level of consciousness (drowsiness, lethargy, coma) Slurred speech Muscle weakness ​ Treatment: Naloxone (Narcan): The immediate antidote for opioid overdose, administered via nasal spray or injection. 6. Orthostatic Hypotension a. Definition: A decrease in blood pressure upon a change in position, such as from lying to sitting to standing. Orthostatic hypotension, also referred to as postural hypotension, occurs when a normotensive person develops symptoms (e.g., light-headedness or dizziness) and a drop in systolic pressure by at least 20 mm Hg or a drop in diastolic pressure by at least 10 mm Hg within 2 to 5 minutes of quiet standing or 5 minutes of supine rest. Orthostatic hypotension occurs when patients are unable to constrict their lower extremity blood vessels to maintain their BP. Patients who are dehydrated, anemic, or have recent blood loss are at risk for orthostatic hypotension, particularly in the morning. Orthostatic changes in vital signs are effective indicators of blood volume depletion. Some medications cause orthostatic hypotension, especially in young patients and older adults. Orthostatic hypotension is a risk factor for falls, especially among older adults with hypertension. Checking for Orthostatic Hypotension: Assess for orthostatic hypotension during measurements of vital signs by obtaining BP and pulse in sequence with the patient supine, sitting, and standing. Obtain BP readings within 3 minutes after the patient changes position. In most cases orthostatic hypotension is detected within a minute of standing. If it occurs, help the patient to a lying position and notify the health care provider or nurse in charge. While obtaining orthostatic measurements, continually monitor for changes in pulse rate and observe for other symptoms of hypotension such as fainting, weakness, blurred vision, or light-headedness. Orthostatic hypotension is a risk factor for falls, especially among elderly patients who take antihypertensive medications. When recording orthostatic BP measurements, record the patient’s position in addition to the BP measurement (e.g., 140/80 mm Hg supine, 132/72 mm Hg sitting, 108/60 mm Hg standing). The skill of orthostatic blood pressure measurements cannot be delegated; this skill requires ongoing assessment and clinical judgment when anticipating the patient’s physiologic response to changing positions from lying to sitting or sitting to standing when patients are at risk for orthostatic hypotension. 7. Radiation,Convection, Evaporation, Conduction Heat loss and heat production occur simultaneously. The structure of the skin and exposure to the environment result in constant, normal heat loss through radiation, conduction, convection, and evaporation. Radiation is the transfer of heat from the surface of one object to the surface of another without direct contact between the two. As much as 85% of the surface area of the human body radiates heat to the environment. Peripheral vasodilation increases blood flow from the internal organs to the skin to increase radiant heat loss. Peripheral vasoconstriction minimizes radiant heat loss. Radiation increases as the temperature difference between the objects increases. Radiation heat loss can be considerable during surgery when the patient’s skin is exposed to a cool environment. However, if the environment is warmer than the skin, the body absorbs heat through radiation The patient’s position enhances radiation heat loss (e.g., standing exposes a greater radiating surface area, and lying in a fetal position minimizes heat radiation). Help promote heat loss through radiation by removing clothing or blankets. Covering the body with dark, closely woven clothing decreases the amount of heat lost from radiation.Radiation involves no actual contact between objects because the heat is transferred through waves or particles of energy. Example:The heat you feel on your hands when you put it near a bonfire Conduction is the transfer of heat from one object to another with direct contact. Solids, liquids, and gases conduct heat through contact. When the warm skin touches a cooler object, heat is lost. Conduction normally accounts for a small amount of heat loss. Applying an ice pack or bathing a patient with a cool cloth increases conductive heat loss. Applying several layers of clothing reduces conductive loss. The body loses heat by conduction when it makes contact with materials cooler than skin temperature (e.g., application of an ice pack).Conduction involves direct contact to transfer heat. Example:Touching a hot stove top or burning ur feet on sand Convection is the transfer of heat away by air movement. A fan promotes heat loss through convection. The rate of heat loss increases when moistened skin comes into contact with slightly moving air.Convection involves the transfer of heat away from or off the body’s surface by movement or circulation of air or water. Example: using a fan to cool yourself in the summer Evaporation is the transfer of heat energy when a liquid is changed to a gas. The body continuously loses heat by evaporation. Approximately 600 to 900 mL a day evaporates from the skin and lungs, resulting in water and heat loss. By regulating perspiration or sweating, the body promotes additional evaporative heat loss. When body temperature rises, the anterior hypothalamus signals the sweat glands to release sweat through tiny ducts on the surface of the skin. During physical exercise over 80% of the heat produced is lost by sweat evaporation.Evaporation involves changing a liquid to a vapor to reduce body temperature. For example, diaphoresis (excessive sweating) causes the liquid drops to turn to vapor, lowering body temperature. Example:Sweating, hot tea getting cold, wet clothes drying in the sun 8. Vital signs (Normal Ranges)- Review clinical skills mini test for all vitals Print out all Mini tests for Vital Signs Week 3 in Clinical Essentials Normal Ranges: Systolic/Diastolic Adult: Temperature Pulse Respirations SPO2% Blood Pressure Adult 95.9°–99.5°F 60–100 12–20 >95% 90–