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154 exam 2
| Term | Definition |
|---|---|
| analgesics | medications that relieve pain without causing loss of consciousness |
| pain | whatever the patient says it is and occurs whenever they say it does |
| pain threshold | the level of stimulus needed to produce a painful sensation |
| pain tolerance | the patient's ability to tolerate or stand the pain; influenced by age, diseases, culture, previous experience |
| acute pain | sudden onset, usually localized with limited duration; increased hemodynamics, sweating, pallor |
| chronic pain | persistent or recurring pain lasting longer than 6 weeks; much more difficult to treat |
| somatic pain | originate from skeletal muscles, ligaments and joints; responds best to NSAIDs or nonopiates |
| superficial pain | originates from skin and mucous membranes; skinned knee, dental pain |
| visceral pain | originates from organs or smooth muscles; appendicitis, MI, gallbladder attack |
| vascular pain | originates from vascular or perivascular tissues; migraines |
| referred pain | pain is experienced in a place other than the point of origin; heart attack -> pain in left arm |
| Gate Theory | When gates are open, pain impulses are allowed through and the brain perceives pain; when gates are closed, impulses are stopped and perception is altered |
| A fibers | larger diameter fibers that conduct sharp and localized pain impulses; associated with acute pain |
| C fibers | small diameter fibers that slowly conduct dull and nonlocalized pain impulses; associated with chronic pain |
| pain control | The ultimate goal when addressing pain with a patient |
| Step 1 | the use of nonopioids with or without adjuvant medications once the pain has been identified and assessed |
| Step 2 | the use of opioids with or without nonopioids and with or without adjuvant medications |
| Step 3 | the use of opiods indicated for moderate to sever pain, administered with or without nonopioids or adjuvant medications |
| opioids | drugs that bind to opiate receptors to relieve pain |
| alter | Opiates ______ the perception of pain and do nothing to cure or heal what is causing the pain. |
| remove | You must ______ the old patch first. |
| Narcan | antidote for opiate overdosage; opiate antagonist; also reverses pain relief |
| opioid tolerant | patient has been receiving opiates for extended period of time and requires higher doses to control pain at same level |
| withdrawal symptoms | n/v/d, chills, mental agitation, tachycardia, increased BP, diaphoresis, runny nose, cramps |
| opiate naive | patients are not accustomed to taking opiates and require smaller dosages to relieve their pain |
| respiratory depression | Most serious adverse effect of opiates (think ABC) |
| histamine | All opiates cause the release of ______, which can lead to redness and itching. |
| Change positions slowly. Siderails should be up, call light within reach. | Because histamine causes vasodilation -> orthostatic hypotension, what precautions should be in place? |
| liver | Opiates may cause an increase in ______ enzymes, which means the nurse should assess them. |
| NSAIDs | work by suppressing some part of the inflammatory process and reduces the amounts of pain-mediating chemicals |
| stomach | NSAIDs are very hard on the _____ and you must assess for increased bleeding, abdominal pain |
| coontraindicated | NSAIDs are ___________ in patients with history of GI bleed, ulcers, anticoagulatnt/antiplatelet, renal problems |
| reduce blood flow | All NSAIDs except aspirin _____ _____ ____ to the kidneys |
| hepatotoxic | Tylenol is extremely _______ with acute overdose |
| acetylcysteine (Mucomyst) | treatment for Tylenol overdose; smells like rotten eggs, mix with juice and give with straw |
| LFTs | Examples: AST, ALT, alk. phos. |
| sedatives | reduce nervousness, excitability, and irritability without causing sleep |
| hypnotics | cause sleep and have a much more potent effect on the CNS |
| sedative-hypnotics | drugs that can act in the body as a sedative or a hypnotic |
| 3 | How many groups of sedative-hypnotics are there? |
| barbiturates | a class of drugs used to induce sedation; highly habit forming and narrow therapeutic window; NO antidote |
| ital | common ending of barbiturates |
| REM | Barbiturates deprive people of _____ sleep. |
| Maintain airway | Main consideration with barbiturate overdose |
| benzodiazepines | drugs most frequently prescribed as anxiolytic drugs |
| pam, lam | common endings for benzodiazepines |
| flumazenil (Romazicon) | benzo antidote used in extreme cases |
| muscle relaxers | used for the relief of skeletal muscle spasticity; relieve pain |
| Flexeril (cyclobenzaprine) | highly sedating; must watch for altered sensorium; high fall risk; take at bedtime |
| Lioresal (baclofen) | given to relieve extreme spasms in paraplegia and quadriplegia |
| Dantrium (dantrolene) | used for acute management of malignant hyperthermia; can cause liver problems |
| malignant hyperthermia | genetic predisposition when patients receive anesthesia; uncontrolled shivering, extreme increase in temp |
| drive | Cannot _____ when taking a muscle relaxer |
| CNS stimulants | drugs that stimulate specific areas of the brain or spinal cord |
| ADHD | symptoms of inability to maintain attention span, presence of hyperactivity must be present for greater than 6 months and occur in 2 different settings |
| narcolepsy | syndrome characterized by sudden sleep attacks, cataplexy, sleep paralysis, and visual or auditory hallucinations at the onset of sleep |
| amphetamines | drugs used to treat ADHD and narcolepsy |
| mental alertness | Amphetamines stimulate areas of the brain associated with _____ ________ |
| C-II | Which classification of scheduling are amphetamines? |
| speed up | Amphetamines _____ ___ all body systems |
| never | CNS stimulants should ______ be given at bedtime |
| baseline height and weight | Key assessment point when taking amphetamines |
| anorexiants | drugs used to control or suppress appetite |
| cardiac patients | Phentermine (an anorexiant) is contraindicated in |
| lipase | What enzyme does orlistat (Xenical) inhibit, leading to oily stool? |
| migraine | common type of recurring painful heachace with throbbing, pain, and photophobia caused by vasodilation; can last 4 to 72 hours |
| aura | predictive set of altered visual or other senses |
| antimigraine medications | drugs that stimulate the serotonin receptors, causing vasoconstriction |
| abortive | Antimigraines are used as an _______ therapy, not prophylaxis |
| triptan | common ending for antimigraines |
| cardiovascular, hypertension | Antimigraines are contraindicated in patients with: |
| analeptics | drugs used to stimulate respirations; stimulates parts of CNS that control respiration, mainly medulla and spinal cord |
| caffeine | CNS stimulant contained in many foods, drinks, and drugs |
| yes | Can you overdose on caffeine? |
| Doxapram | hastens arousal and treats respiratory depression from anesthesia |
| peptic ulcer, cardiac dysrhythmias, MI | Caffeine contraindications |
| unknown | The cause of most seizures is ______ |
| primary epilepsy | epilepsy where there is no identified cause |
| secondary epilepsy | epilepsy has a distinct or known cause such as trauma, infection, CVA |
| partial seizures | only part of the brain is involved; also called focal/local seizures |
| simple seizures | patient remains conscious; have one-side movement of an extremity, unusual sensations, increased HR, flushing and epigastric discomfort |
| complex seizures | patients loses consciousness for 1-3 minutes; has automatisms |
| generalized seizures | seizures that affect all or most of the brain |
| tonic-clonic seizures | muscles become very rigid and patient loses consciousness (tonic); patient has jerky movements and muscle contraction (clonic) |
| absence seizures | brief loss of consciousness and blank staring; more often in children |
| myoclonic seizures | seizures with sporadic or isolated jerking movements which may involve one or more extremity and may occur on one or both sides of body |
| atonic seizures | seizures with sudden loss of muscle tone for a few seconds followed by a postictal phase |
| status epilepticus | life threatening emergency characterized by tonic-clonic seizures which occur in succession; can cause brain death; treated with Valium, Atavan |
| 2nd | Many physicians will not start medication until after the ____ seizure has occurred |
| neuropathic pain | Anticonvulsants can be used to treat _______ _____ because of the effect they have on neurons. |
| narrow therapeutic windows | The most common antiepileptic drugs have _______ _________ _______. |
| Dilantin (phenytoin) | The gold standard of epilepsy drug therapy |
| 10-20 | Dilantin therapeutic level |
| normal saline | IV Dilantin can only be given with ______ _______ |
| drug level, liver function | Key assessments when patient is taking Dilantin |
| gingival hyperplasia | overgrowth of the gums caused by long term Dilantin |
| vitamin D | Patients taking Dilantin may need to take a ______ ___ supplement because long term use can cause osteoporosis |
| Dilantin facies | a change in appearance by acne, hirsutism, gingival hyperplasia, and hypertrophy of SQ tissue (pudgy) |
| hepatotoxicity, pancreatitis | Depakote fatal side effects |
| 50-100 | Depakote therapeutic level |
| 4-12 | Tegretol therapeutic level |
| Tegretol | has an unusual property called autoinduction; drug increases own metabolism over time |
| Neurontin, Lyrica | commonly used to treat neuropathic pain |
| same time | Patients must take seizure meds at the ____ ____ every day. |
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mpvought
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