Pain 🥴
Damage to somatic or visceral tissue. Surgical incision, broken bone, or arthritis. Usually responsive to opioids and nonopioid meds.
What is nociceptive pain?
Bilateral, band-like headache. duration of 30 min-7 days. 😰
s/s: palpable neck and shoulder muscle tension, tenderness, stiff neck
tx: nonopioid analgesics, aspirin, muscle relaxants, NSAIDs, caffeine
tension headache
Which actions would the nurse prioritize when admitting a patient to the PACU?
a. Assess the surgical site, noting presence and character of drainage.
b. Assess for airway patency and quality of respirations and obtain vital signs.
c. Assess the amount of urine output and the presence of bladder distention.
d. Review results of intraoperative laboratory values and medications received.
b. assess for airway patency and quality of respirations and obtain vital signs.
Most common type of glaucoma
outflow of aqueous humor is decreased in trabecular meshwork
caused by age, pupil dilation (could be drug induced)
Clinical manifestations?
Primary Open-Angle Glaucoma
clinical manifestations: develops slowly, typically no symptoms, unnoticed until peripheral vision is severely compromised
difference b/w conductive and sensorineural hearing loss? 👂🏼
which one uses cochlear implants??
Conductive: sound transmission to inner ear impaired, patients actually hear better in noisy environment! pts. often speak softly
Sensorineural: able to hear sound but unable to understand speech (misunderstanding is a big issue); hearing aids make sounds louder but not clearer. caused by impairment of inner ear, CN VIII damage, noise trauma, aging, Meniere's disease; uses COCHLEAR IMPLANT
activation of nociceptors in the internal organs and lining of the body cavities. respond to inflammation, stretching, ischemia. generalized pain.
what is visceral pain?
s/s of migraine headache
aura: visual (flashes of bright lights, blind spots, distortions, zig-zag line), sensory, aphasic (difficulty with speech), irritability, sweating, N/V, photophobia, phonophobia, prodromal symptoms: sensory, motor, or psychic phenomena
nurses role pre-op 👩🏼⚕️
-identify the reason the pt. is having surgery & any co-morbidities (more than 1 disease?)
-assess the pts. response to the stress of surgery
-review preop diagnostic test results
-identify potential risks and complications of the surgical procedure
normal IOP level
AACG IOP level
POAG IOP level
normal: 10-21 mm Hg
AACG: >50 mm Hg
POAG: 22-32 mm Hg
most common and, typically, the first symptom of hearing loss
Tinnitus (ringing in the ears)
treatment goals for acute vs. chronic pain
acute - pain control with the ability to take part in recovery activities
chronic - control to the extent possible; focus on enhancing function and quality of life
treatment for a cluster headache
a-Adrenergic Blockers
Serotonin receptor agonists (almotriptan, eletriptan, frovatriptan, sumatriptan, etc.)
High-flow 100% oxygen ❗️
Corticosteroids, CGRP antagonists, Lithium, Verapamil
what is included in the health history assessment? 📄
-health problems and surgeries
-understanding of reasons for surgery
-problems with previous surgeries
-menstrual/obstetric hx.
-family health (inherited traits, heart & endocrine diseases)
-reactions/problems to anesthesia (pt. or family) -- MALIGNANT HYPERTHERMIA
microvascular damage to the retina, blurred vision, progressive loss of vision.
most common with HTN or DM.
retinopathy
diabetic retinopathy: nonproliferative-loss of central vision; proliferative-advanced disease; severe vision loss
HTN retinopathy: Tx - lower BP to restore vision
nursing management/health promotion for hearing loss
what is the most preventable cause of hearing loss?
-environmental noise control
-noise is the most preventable cause of hearing loss
-hearing loss caused by noise is NOT reversible ❗️
-avoidance of continued exposure to noise levels greater than 70 DB is essential!
-assistive devices and techniques
-sign language/interpreter
-lip reading
common side effects of opioids
constipation (most common)
N/V
sedation
resp. depression
itching
non-pharmacological therapies for headaches would include...
yoga, tai chi, exercise (in moderation), acupuncture, acupressure, herbals, meditation, biofeedback, cool/dark/quiet room, HOB elevated, wear sunnies to reduce light/glare
Why is IV induction for general anesthesia the method of choice for most patients?
a. The patient is not intubated.
b. The agents are nonexplosive.
c. Induction is rapid and controlled.
d. Emergence is longer but with fewer complications.
c. induction is rapid and controlled
risk factors for retinal detachment
clinical manifestations?
age, AMD, diabetic retinopathy, eye surgery, eye trauma, family or personal hx. of retinal detachment, severe myopia, thinning of the peripheral retina
flashes of light, floaters, cobweb/hairned or ring in field of vision
condition of the inner ear caused by the disruption of debris located in semicircular canal.
sudden onset, weeks to years.
S/S: alterations in balance, dizziness, N/V
Vertigo
Tx: bed rest, Meclizine, Zofran, Benadryl, Scopolamine, Diuretic
Pt. teaching: dark, quiet room, SLOW position changes, use cane/walker, clutter free, avoid caffeine/alcohol, avoid salty foods
A patient is receiving a patient-controlled analgesia (PCA) infusion after spinal surgery. She is sleeping soundly, awakens when the nurse speaks to her in a normal tone of voice, and reports her pain as “mild and tolerable.” Her respirations are 8 breaths/min. The most appropriate nursing action in this situation is to
a. stop the PCA infusion.
b. obtain an oxygen saturation level.
c. continue to closely monitor the patient.
d. administer naloxone and contact the provider.
c. continue to closely monitor the patient
A patient in urgent care reports a stabbing headache around his left eye and nasal stuffiness. He says, “This pain is horrible; it is worse than my heart attack last year.” The provider orders sumatriptan nasal spray now for headache relief. The nurse would take what action?
a. Administer a puff to each nostril now.
b. Take vital signs prior to administration.
c. Contact the provider about administering the medication to this patient.
d. Teach the patient to self-administer the medication at the start of the migraine.
c. contact the provider about administering the medication to this patient
A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. Which action would the nurse take?
a. Tell the patient to come back tomorrow since he ate a meal.
b. Have the patient void before giving any preoperative medication.
c. Proceed with the preoperative checklist, including site identification.
d. Notify the anesthesia care provider of when and what the patient last ate
d. notify the anesthesia care provider of when and what the patient last ate.
leading cause of irreversible central vision loss?
difference b/w dry and wet?
risk factors?
s/s?
Age-related macular degeneration
Dry (nonexudative): atrophy of macular cells -- more common, slow, progressive, painless loss of vision
Wet (exudative): more severe, abnormal blood vessels develop in or near macula, rapid onset of vision loss
risk factors: family hx., obesity, HTN, being white, smoking
s/s: blurred and darkened vision, sctomas (blind spots), and metamorphosia (vision distortion), acute vision loss
Diagnostic studies: visual acuity measurements, opthalmoscopy, amsler grid test!
Interprofessional care: meds injected every 4-6 weeks into vitreous cavity to stop new vessel formation. Photodynamic therapy (laser to activate Verteporfin to create blood clots to block abnormal blood vessels; pts. avoid sunlight for 5 days), nutrition: vitamin C and E; beta-carotene, zinc, lutein; smoking cessation!
Severe vertigo accompanied with tinnitus and progressive low-frequency sensorineural hearing loss
Tx?
Meniere's Disease
Tx: similar to vertigo, biofeedback, physical therapy, stress management, positional exercises
surgery: pressure point treatment, labyrinthectomy (removal of labyrinth of the inner ear)