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CHA Exam 1
Pain & Hematology
| Question | Answer |
|---|---|
| visceral pain | inside pain, not localized, comes from c fibers, dull achy descriptors |
| chronic pain | lasts longer than 6 months, vital signs are stable, depression, pain can be constant or intermittent |
| acute pain | vital sign changes in first 30 minutes, increased BP, P, RR, anxiety, diaphoresis,dilated pupils |
| pain threshold | universal, when do you feel the sense of pain |
| pain tolerance | what is the patient willing to put up with, ability to tolerate will depend on fatigue, stress, anger or scared |
| adverse effects of opioid | constipation, n/v,decreased RR, urinary retention, itching and hypotension |
| categories of co-analgesics/adjutant meds | antiemetic, anticonvulsant, corticosteroids and antidepressants |
| when doing a pain assessment, what do you ask? | PQRST |
| Client teaching when on Vicodin? | constipation, limit driving, no alcohol, only take recommeneded dose, |
| different types of pain scales | NIPS - newborn to 6 weeks FLACC newborn to 2 years Faces - two to five years Numeric 5 and older |
| four factors that affect pain perception | age, gender, culture and emotional status |
| client teaching with ibuprofen? | watch for bruising/bleeding, no NSAIDS, take on full stomach, check stools for color |
| Interventions to calm a child about to get IV? | distractions, role play, EMLA/Lidocaine, explain on their level and give choices |
| Nursing interventions when caring for a client with an epidural? | maintain safety, catheter placement, urinary/bowel function, prevent respiratory depression, vitals every hour, respiratory status, have NARCAN at bedside |
| Client teaching about pain patch? | rotate sites every three days, it may take up to 24 hours to become therapeutic, additional meds may be needed for breakthrough pain, overdose can occur, absorption is enhanced by fever, inflammation, stress, exercise and heating pad |
| referred pain | pain in arm or jaw with heart attack, pain in back and shoulder with gallbladder |
| when should you do a pain assessment | always with vitals |
| what is the priority pain assessment | pain scale, what is the patients pain level, if a drug is ordered you may give it if necessary |
| PQRST | what do you ask in pain assessment |
| opioids are used for which kind of pain | moderate to severe |
| examples of opioids | morphine/codine/fentanyl |
| there is no ceiling limit with opioids, means what? | even if you increase the dose, it won't make a difference |
| NARCAN must be available when using which type of drug | opioids |
| side effects of opioids | sedation, drowsiness and dizziness |
| adverse effects of opioids | n/v |
| avoid or use caution with opioids with which patients | COPD |
| increase the intake of fiber and fluids with which meds | opioids |
| non-opioids are used with which pain | moderate to mild |
| examples of non-opioids | tylenol, NSAIDs, torodol, ibuprofen |
| adjuvant pain meds are used why? | to treat anxiety and fear |
| what drugs are used to treat neuropathtic pain | anticonvulsants and antidepressants |
| types of non-pharmaceutical pain managements | TENS units, heat/cold therapy, therapeutic touch, massage, vibration, guided imagery, hypnosis, biofeedback and nutrition |
| PCA | patients over 5 years can have one, only patient can control it, no overdose, discontinued when patient can eat/drink after surgery |
| epidural nursing care | fast absorption, may cause respiratory depression after first 24 hours, NARCAN at bedside, RN to monitor infusion and site as well as dose, assess patient and notify MD if no pain relief |
| two most common epidural meds | morphine and fentanly |
| acute pain | less than 6 months |
| chronic pain | over 6 months, depression, no vital changes, not always constant |
| visceral pain | inside pain, dull, achy, not localized |
| somatic pain | incisional pain, located at the site |
| phantom pain | located at site of no limb, it is real |
| referred pain | pain that isn't felt where it is located |
| radiating pain | pain that moves from injury site |
| neuropathic | cannot find the source of the pain |
| incident pain | something happens to cause the pain, patient moved to quickly, RN should know to pre medicate these patients |
| breakthrough pain | pain that occurs between scheduled doses |
| central/intractable pain | caused by a lesion in the brain |
| sickle cell anemia | fatigue, jaundice, pallor and irritably |
| sickle cell anemia crisis | severe pain, low pulse ox, cyanosis, SOB, fever and obstructed capillary blood flow |
| sickle cell treatment | pain control and fluids, prevent stressors, hydroxyurea |
| sickle cell RN interventions | administer meds, oxygen, high calorie and high protein diet |
| Acute lymphocyte leukemia | onset younger than 15 years old, fever, infection, bone pain and weight loss |
| acute myeloid leukemia | onset between 15-39 years old, fatigue, fever, bleeding, low WBC count and platelets and bruising/petechaie |
| chronic myeloid leukemia | onset in 40's, weakness, fatigue, weight loss, bleeding |
| chronic leukocyte leukemia | onset after 50's, may not treat, fatigue, pallor and infections |
| leukemia affects | bone marrow, causing anemia from low erythrocytes, infection from neutropenia and bleeding from thrombocytopenia |
| leukemia risk factors | genetic, viral, immune system, exposure to chemicals |
| treatment involves what for myeloid leukemia | chemo and stem cell transplant |
| treatment for leukocyte leukemia | bone marrow transplant, chemo and stem cell transplant |
| monitor for signs of infection with which patients | leukemia, they are immunocompromised |
| hodgkins disease | possibly caused by viral infection or exposure to chemicals, good prognosis, monitor for signs of infection, enlarged lymphnodes, fever, night sweats, fatigue and weight loss |
| non hodgkins disease | more common in older adults, environmental factors, genetic factors, enlarged lymph nodes, fever, night sweats, LOC, headaches |
| thrombocytopenia | low platelets, risk for bleeding and medication, prednisone, pheresis and stop heparin and splenectomy |
| neutropenia | genetic or caused by chemotherapy, infections, fever and fatigue, protective isolation |
| hemophilia | bleeding disorder, abnormal bleeding, nose bleeds, joint bleeding, platelets are normal, clotting factor not normal, wear medic alert bracelet |
| hemolytic anemia | caused by autoimmune disorder or infections, jaundice, pallor, spleen enlarged, bone marrow expansion causing fractures |
| hemolytic anemia assessment findings | fatigue, SOB, dizziness, chronic bleeding, diet, color of stools, meds, surgeries, chemical exposures pain and cap refill time |
| normal RBC count | men 4.7-6.1 women 4.2-5.4 |
| normal WBC count | 4,500-11,000 |
| normal platelets | 150,000-400,000 |
| normal male hemoglobin | 14-18 |
| normal female hemoglobin | 12-16 |
| normal hematocrits | male 42-52% females 35-47% |
| low red blood cells associated with what | anemia |
| low white blood cells associated with what | leukocytosis |
| decreased platelets are seen with which disorder | leukemia |
| hematocrit is decreased in which disorder | leukemia |
| staging of cancer | 1 localized 4 spread |
| a stage cancer | not systemic |
| b stage cancer | systemic |
| bone marrow aspiration | used to diagnose aplastic anemia |
| shows an abnormal number of immature cells | bone marrow aspiration |
| bone marrow transplant | used to replace damaged cells caused by radiation or chemo |
| treatment for leukemia and lymphoma | bone marrow transplant |
| new stem cells delivered through central line | bone marrow transplant, stem cell transplant |
| WBC and erythrocyte count begin to rise as well as platelet count | BMT and stem cell transplant |
| engraftment takes place | 2-5 weeks |
| watch for bleeding, infection, neutropenia and thrombocytopenia | bone marrow transplant and stem cell transplant |
| radiation therapy | used to kill cancer cells directed at one location |
| effective on tissues directly in patient beam | radiation therapy |
| watch and treat side effects, watch for skin changes, alopecia, fatigue and altered taste sensation | radiation therapy |
| kills or inhibits reproduction of neoplastic cells and normal cells | chemotherapy |
| drugs are given IV if at all possible | chemotherapy |
| alopecia, fatigue, n/v, mucositis, skin changes, neutropenia, anemia and thrombocytopenia | chemotherapy |
| granulocyte colony stimulating factor | used to rescue bone marrow following chemotherapy |
| bone pain is common with this drug | granulocyte colony stimulating factor |
| fever, chills, anorexia, muscle aches and lethargy | granulocyte colony stimulating factor |
| epogen is used to treat this | anemia |
| headache, n/v, weight loss, joint pain, sores in mouth, difficulty sleeping, depression, site complications | epogen complications/side effects |
| MS contin | oral morphine |
| gabapentin | anticonvulsant used in pain treatment |
Created by:
bkgrota
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