Pain
When you cut your finger what are the steps to experiencing pain?
Nociceptors are stimulated, and afferent pathways send impulses to the spinal cord & then to the brain.
Name some disorders that affect recovery post surgery.
Diabestes
Heart disease
obstructive sleep apnea
immune system disorders
renal disease
malnurished / obese patients
What are the types of distributive shock?
Anaphylactic
Septic
Neurogenic
What are some common results when having prolonged pain?
Debilitating & destructive effect on pt life
Depression
Marital difficulties
Loss of self-esteem
Immobility
Isolation
Why are older adults at greater risk for surgical complications?
May have impaired healing and recovery if they have a chronic illness.
It takes them longer to regain strength following periods if inactivity.
Which is an example of acute pain w/ recurrent episodes is associated with:
1) low back pain
2) migraine headaches
3) rheumatoid arthritis
4) cancer pain
Migraine headaches
Describe Vital signs you would notice with pain
Sympathetic Nervous System: Increased in BP, Increased Pulse, Increased Respiratory, Dilated pupils, Perspiration, Pallor
Parasympathetic Nervous System: Constipation, Urinary retention
A nurse is concerned about cerebral perfusion in a pt who is in shock. Which assessment provides the best indicator of cerebral perfusion?
1) present reflexes
2) level of consciousness
3) emotional state
Level of consciousness
(most difficult to treat): the heart fails as a pump
Decrease in myocardial contractility = decrease in cardiac output
Acute myocardial infarction: diseased artery cannot meet demand
Dysrhythmias, cardiomyopathy, myocarditis, valvular disease, ventricular septal defects
What are some things the the nurse should educate the patient on before entering the OR?
The room will be cold
People will have special gowns on
the lights will be bright
you will be transported to the OR bed
May be restrained in the OR for your safety
Nalbuphine, butorphanol, & pentazocine (Talwin) are examples of?
opioid agonist-antagonists
What are some things that influence the response to pain?
Age, Type of surgery, Pain tolerance, Pain threshold.
What interventions would you take to reduce the risk of SIRS & MODs in a patient with pancreatitis?
maintain asepsis with invasive procedures
practice hand washing
administer eternal feedings as ordered
Why opioid agonist-antagonist given (especially to frail patients)?
Opioid agonist-antagonists block some of the effects of the pure opioid agonists.
Older adults are generally more sensitive to the analgesic effects of opioids bc of delayed excretion & slower metabolism & side effects are more pronounced in older adults.
Name some methods of general anesthetic agents can be given
Inhalation
Intravascular solution
Rectal administration
Intramuscular injection
Describe Addiction
Compulsive obtaining and use of drug for psychic effects. Psychological dependence characterized by continued craving for opioid for other then pain relief.
Explain pain tolerance and pain threshold.
Pain Threshold - the point at which a stimulus causes the sensation of pain.
Pain Tolerance - the intensity of pain that a person will endure
What medications are commonly used in the treatment of cardiogenic shock?
Inotropics, Vasopressors, Vasodilators, Vasoconstrictors.
Explain neurogenic Shock
distribution in vasomotor center in medulla.
Spinal cord injury of T4 or regional anesthesia
Disease of upper spinal cord, drug depression, bradycardia, warm, dry, pink skin below the spinal injury.
What are some complications that are most likely to occur immediately after surgery?
Shock
Hypoxia
What are some factors that close the gate, r/t gate control theory?
Massage, Position change, Guided imagery, heat application.
What are the three stages of shock and what are the biggest take-aways for each stage?
Pre-shock: S/S are very mild or not present. This stage is reversible. During this stage cells switch metabolisms and begin to produce lactic acid.
Shock: S/S: body may sense drop in BP and activate Sympathetic nervous system but it condition progresses: LOW= BP (MAP), urinary output, cardiac output, weak, thready pulses. HIGH: HR, RR, K+. Cell hypoxia & myocardial depression will begin. This stage is reversible.
End - Organ Dysfunction: Body will start to resort to MODS and SIRs. S/S MAP <60, oliguria, LOW= HR & RR. may be in a coma. widespread cell death.
A pt is admitted to the ED in distributive shock. What factors can lead to distributive shock?
Bacterial infection
Dilation of blood vessels
an antigen- antibody reaction
failure of the heart to pump
What is the difference between Obstructive and Distributive shock?
Obstructive Shock: blood flow is reduced and prevented from entering or leaving the heart by leaving the heart by mechanical obstruction
Distributive shock: excessive dilation of blood vessels or decreased vascular resistance causing improper distribution of blood.
In the PACU, pt vitals are
98 f, 66 pulse (reg), 14 RR, 100/56 mm HG.
What piece of information is most important for the nurse to know to evaluate these vitals?
The patients preop vital signs.