Pain Assessment
List some assessment questions to ask your patient regarding pain?
How often does it occur? When did it start? Rate level? Location? Intensity or description? What alleviates or makes it worse? Location?
Asking pain level prior and reassessment post treatment are the most important interventions.
Can cause tinnitus (ringing in the ears) and is an adverse reaction.
Aspirin. Signs of toxicity also include hyperventilation, headache, CNS depression, convulsions and coma.
Examples of nonopioid analgesics.
What are acetaminophen and NSAIDS?
What is the most important assessment prior to giving an SSRI or any medication for depression and to reassess 2 weeks after the start of the medication?
What is suicidal thoughts
When taking this drug, avoid avocadoes, chocolate, bleu cheese, wine and beer (foods high in tyramine)
Monoamine Oxidase Inhibitors (MOI's). MAO's are used for depression. This can cause a HTN crisis.
Nonpharmacological pain-relief interventions.
What are repositioning, relaxation, distraction, music, heat or cold measures, and herbs?
Salicylic acid (aspirin), naproxen (Aleve) and Ibuprofen (Motrin) are what type of drugs?
What is a nonsteroidal anti-inflammatory drug (NSAID)?
Max dose of acetaminophen in 24 hours for a nonalcoholic or cirrhosis patient.
3,000- 4,000 mg
What is lip smacking, protrusion of the tongue, involuntary movements of the body and extremities?
Tardive dyskinesia caused by many drugs including antipsychotics and need to be reported to the provider right away. These are characterizes of extra-pyramidal symptoms (EPS) and need to be recognized early to reduce long term effects. Others are pseudo parkinsonism, akathisia, acute dystonia.
Restlessness, increased sweating, high blood pressure, confusion, agitation and tremors.
What is signs of serotonin syndrome
A patient presents to the emergency department with sharp, stabbing abdominal pain. The patient states it started 2 hours ago. This patient is experiencing what type of pain?
What is acute pain?
List side effects of NSAIDS.
What is bleeding (ex. black tarry stool or vomiting blood), irritation of stomach and intestines, ulcers, HTN, fluid retention, kidney damage.
Side effects of opioids.
What are constipation, nausea and vomiting, sedation, hypotension, respiratory depression?
Elevated temperature, muscle rigidity, and unstable blood pressure.
What is neuroleptic malignant syndrome (NMS). This can be caused by many antipsychotic drugs.
Teaching points for a patient taking tricyclic antidepressant, amitriptyline (Elavil) for depression.
What is take at night, causes constipation, dry mouth, blurred vision, dizziness and drowsiness. Increased risk of falls. Never stop abruptly.
You are about to give hydrocodone-acetaminophen (Norco) to your patient. When would you hold and notify provider unless your patient was a hospice patient.
RR less than 12, sb/p less than 90, over sedation, falling, < 92% on pulse oximetry, hypothermia.
What is the reversal for opioids (narcotics)?
Naloxone (Narcan)
Give slow.
Examples of adjuvant analgesics.
What are antidepressants, anticonvulsants, and coricosteriods?
Side of effects/toxicity of this drug are hyponatremia (low sodium), excessive thirst, fine and course hand tremors, GI discomfort such as N/V, muscular weakness, dizziness, drowsiness, lack of coordination, delirium, renal failure, NMS, coma, death.
Lithium. Must have frequent levels checked, maintain sodium levels, do not become dehydrated.
Teach patients to avoid this OTC supplement while taking antidepressants.
What is St. Johns wort. Also interacts with many other medications.
This describes the relationship between pain and fear and anxiety.
Anxiety and fear increase the perception of pain and pain causes fear and anxiety.
How do you teach a patient with rheumatoid arthritis to give subcutaneous adalimumab (Humira) which is a DMARD (disease-modifying antirheumatic drug).
What is rotate the injection site of the thighs and abdomen frequently. Do not rub site or shake the vial. Do not continue if you have an infection and notify provider.
What are dietary restrictions to teach your patient with gout?
Avoid Sea fish, (shellfish, salmon, tuna, anchovies), organ meats, and ETOH. They should drink lots of water and do not stop taking allopurinol as it is for prevention.
What is the reversal for benzodiazepines?
Flumazenil (Romazicon)
Weight disturbances (usually weight gain), insomnia and drowsiness, sexual side effects, dizziness, constipation, dry mouth and suicidal ideation.
What are common side effects of all meds used for depression and antipsychotics.