Pain 🥴
damage to somatic or visceral tissue. usually responsive to opioids and non-opioid meds.
ex: surgical incision, broken bone, arthritic.
nociceptive pain
What kind of headache is bilateral and band-like with the duration of 30 minutes-7 days 😰
S/S: palpable neck and shoulder muscle tension, tenderness, stiff neck.
what is the treatment?
tension headache
tx: non-opioid analgesics, aspirin, muscle relaxants ‼️, NSAIDs, caffeine
what are some of the nurses roles pre-op? 👩🏼⚕️
-identify the reason the pt. is having surgery & co-morbidities
-assess the pts. response to the stress of surgery
-review pre-op diagnostic test results
-identify potential risks and complications (malignant hyperthermia!)
-witness signature of consent and pts. understanding
which actions would the nurse prioritize when admitting a patient to the PACU?
A. assess the surgical site, noting presence & character of drainage.
B. assess for airway patency & quality of respirations and obtain vitals.
C. assess the amount of urine output and the presence of bladder distention
D. review results of intra-op lab values and meds received.
ANS: B
what is analgesic ceiling associated with pain meds?
increasing the dose beyond an upper limit provides no greater analgesia
activation of nociceptors in the internal organs and lining of the body cavities. responds to inflammation, stretching, ischemia, and generalized pain.
visceral pain
what are some s/s of a migraine headache?
AURA: visual (flashes of light, blind spots, distortions, zig-zag lines), sensory, aphasic (dysphasia)
irritability, sweating, N/V, photophobia, phonophobia, prodromal symptoms (sensory, motor, or psychic phenomena)
which meds are given to decrease oral/respiratory secretions to decrease the risk of aspiration?
A. benzodiazepines (valium, Ativan)
B. anticholinergics (atropine)
C. antiemetics (reglan, sofrían)
D. B-adrenergic blockers (metoprolol)
ANS: B
benzodiazepines are used for sedation/amnesic, antiemetics are used to prevent N/V, and B-blockers are for hypertension
which position is best for an unconscious patient post-operatively?
lateral "recovery" position to aid airway patency and reduce the risk for aspiration if vomiting occurs
for a CONSCIOUS patient, place them in a supine position with the HOB elevated.
what is the first non-opioid drug of choice that has analgesic and antipyretic effects and does not have anti platelet or anti-inflammatory effects (can cause liver toxicity)
Tylenol
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.
A-adrenergic blockers
serotonin receptor agonists (almotriptan, eletriptan, sumatriptan)
high-flow 100% O2 ‼️
corticosteroids, CGRP antagonists, lithium, verapamil
A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. The patient replies that he had a light breakfast a couple of hours before coming to the surgery center. Which action should the nurse take?
A. tell the pt. to come back tomorrow since he ate a meal.
B. have the patient void before giving any pre-op meds.
C. proceed with the pre-op checklist, including site identification.
D. notify the anesthesia care provider of when and what the patient last ate.
ANS: D
all post-op pts. are at risk for atelectasis (lung collapse). what can the nurse do to help promote gas exchange?
deep breathing, coughing, deep breathing, use of an incentive spirometry, diaphragmatic or abdominal breathing, change the pts. position every 1-2 hours to help with chest expansion. ambulate asap!
what is administered for respiratory depression/opioid overdose?
common side effects of opioids
CONSTIPATION (most common)
N/V
sedation
respiratory depression
itching
non-pharmacological therapies for headaches could include...
yoga, tai chi, exercise (in moderation), acupuncture, acupressure, herbals, meditation, biofeedback, cool/dark/quiet room (especially for migraines), 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.
ANS: C
TRUE
T/F: constant pain requires PRN administration of medication.
False, constant pain requires around-the-clock med administration!
Do NOT wait for pain to be severe to administer meds!
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 per minute. The most important nursing action in this situation is to...
A. stop the PCA infusion
B. obtain an O2sat
C. continue to closely monitor the patient.
D. administer naloxone and call the provider.
C.
The nurse would expect a low respiration rate for a patient on a PCA.
Note: the nurse and/or family cannot push the PCA button for the patient; do not wait for pain to be severe to push button.
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.
ANS: C
when should the nurse instruct the patient to be NPO before surgery to prevent pulmonary aspiration and N/V?
NPO at midnight, the night before surgery
A 70-kg postoperative patient has an average urine output of 25 mL/hr during the first 8 hours. Which interventions would the nurse prioritize? (Select all that apply.)
a. Obtain a bladder ultrasound scan.
b. Perform a straight catheterization.
c. Continue to monitor this normal finding.
d. Evaluate the patient’s fluid volume status.
ANS: A, D
which route of administration is the route of choice with a functioning GI system? which route is useful for N/V?
Oral
rectal