exam 2 Flashcards by Callie Wanek

superficial pain, usually involves the skin or subcutaneous tissue

cutaneous pain

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severe pain that resistant to relief measures – cancer, spinal cord injury

intractable pain

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pain that involves nerves, peripheral nerves, legs and lower extremities, spinal cord injuries, shingles, diabetic neuropathy

neuropathic pain

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poorly located, originating in body organs

visceral pain

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tendons, ligaments, bone, sprains

somatic

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perception of pain - involves peripheral and CNS

noxious stimuli

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free nerve endings, respond to painful stimuli

nociceptors

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neurologic transmission of pain impulses

nociception

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chemicals that reduce/inhibit transmission/perception of pain – morphine like neurotransmitters

endorphins, enkephalins, dynorphins

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ncreased  metabolic rate, insulin response, risk of physiological disorders.
 Pain can be harmful to patients whose health is already compromised by age, injury, or illness
 Effective pain relief results in faster recovery and improved outcomes

effects of pain on patient

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 Intensity  pain scale (none, mild, severe)
 Influenced by pain threshold, and pain tolerance
 Location of pain
 Quality – words to describe the pain
 Nurses Role  assess past history and what analgesics have worked, provide education, relive pain with interventions, assess effectiveness of interventions, monitor for adverse effects, be an advocate for patient when interventions are ineffective

nurse assess pain the her role

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opioid analgesic agents
Morphine
	Oxycodone
	Meperidine (Demerol)
	Tramadol (Ultram)
	Codeine
	Propoxyphene (Darvan)
	Hydrocodone (Vicodin)

side effects

respiratory depression and sedation, N&V, constipation, pruritus (severe itching) , urinary retention

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maximum pain the person can tolerate

tolerance

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smallest stimulus a person can take before reporting pain

threshold

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 Use of more than one form of analgesia concurrently to obstain more pain relief w/ fewer side effects

balanced analgesia

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medications that can be used to supplement an opioid medication in pain management

NSAID
• Ibuprofen (Advil, Motrin), Celecoxib (Celebrex)
• NSAIDs use w/ Opioids (not taken together, but at fixed times) may be effective in managing moderate to severe cancer pain. NSAIDs may cause bruising, stomach irritation and GI bleeding
ANTIDEPRESSANT/ANTISEIZURE
• Used for neuralgia paint (intense burning or cutting type pain)
• Does are smaller than generally used for depression and seizures
• Amitriptyline (Elavil), Imipramine (Toframil) – antidepressants
• Phenytoin (Dilantin) carbamazepine (tegretol) antiseizure meds

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 Numeric Pain Intensity Scale (0 no pain, 5 moderate pain, 10 worst possible pain)
 Simple Descriptive Pain Scale – (no pain, mild, moderate, severe, very severe, worst possible)
 Visual Analogues Scale

uses of a pain scale

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who is at risk for skin integrity issues - why?

	Very thin or very obese
	Fluid loss through fever, dehydration, diarrhea
	Excessive perspiration
	Jaundice (itching, dry)
	Diseases of skin (eczema, psoriasis) 
	Poor nutrition/hydration
	Problems with circulation

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interventions for age related skin problems

 Try not to use tape to skin
 Check skin frequently for breakdown – skin assessments
 Pad bony prominences if needed
 No need for full bath daily; apply lotions
 Push fluids for hydration

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Wound with a localized tissue necrosis
 Majority in older adults b/c of aging skin, chronis illnesses, immobility, malnutrition, fecal and urinary incontinence
 Spinal cord injuries, traumatic brain injuries, neuromuscular disorders
 Back of head, shoulder, base of spine, butt, heel, toes, hip, inner knee, ankle, elbow

pressure ulcer

areas that are prone to one

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intact skin with nonblanchable redness (does not turn white when pressed)

stage 1 pressure ulcer

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Partial thickness loss, shallow open ulcer with red pink wound bed, intact, open/rupture or intact fluid filled blister

stage 2 pressure ulcer

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Full thickness tissue loss, subcutaneous tissue may be visible

stage 3 pressure ulcer

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Full thickness with exposed bone, tendon or muscle

stage 4 pressure ulcer

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unable to determine the depth, may have necrotic tissue

unstageable pressure ulcer

 Predicting pressures sore risk

braden scale

edges well approximated  surgical wounds w/ sutured edges

primary wound healing

edges are not approximated.  burns, large open wounds from trauma, take longer to heal, more scar tissue

secondary wound healing

those wounds left open due to infection, packed wounds

tertiary wound healing

exudate

hemorrhag

separation or splitting open layers of surgical wound

dehiscence

extrusion of viscera or intestine through a surgical wound | wound or organs coming out

evisceration

fistula formation

abnormal

clear and watery

serous drainage

consists of RBC's and blood

sanguineous drainage

light pink to blood tinged

serosanguineous

WBC, thick and foul odor | can be dark yellow or green

purulent drainage

types of drains

1. penrose 2. hemovac 3. JP 4. t-tube

take off dead tissue

debridment

necrotic black tissue

eschar

inadequate blood supply to organ or body

ischemia

regulates ECF, maintain blood volume, transmit nerve impulse and contract muscles. 135-145 mEq/L

sodium | 135-145 mEq/L

8.5-10.5 mEq/L 99% is in bones, 1% in ECF – most abundant electrolyte. Forms bones/teeth, transmit nerve impulses, regulating muscle contractions, maintaining cardiac pacemaker

calcium | 8.5-10.5

1.3 – 2.1 mEq/L – intracellular metabolism, sodium potassium pump, relax muscle contractions, transmit nerve impulses

magnesium | 1.3-2.1

transmits nerve and other chemical impulses, regulates cardiac and muscle contraction. 3.5-5mEq/L

potassium | 3.5-5

molecules from higher to lower concentration

diffusion

requires energy to move substances call pump mechanism

active transport

dehydration, hypovolemia, decreased intake, third spacing

fluid volume deficit

hypervolemia, edema, excessive sodium intake

fluid volume excess

assessment of fluid electrolyte imbalance

```  Skin turgor  Tongue  Moisture and oral cavities  Tearing and salvation  Facial appearance  Edema  Body temp  Pulse (tachycardia = loss of fluid)  Lung sounds (moist crackles – excess)  Blood pressure (falls in fluid volume decrease) ```

converted to glucose and put into blood stream to use for energy  Protein – formation of all body structures

carb

formation of all body structure

protein

cholesterol, absorption of vitamins, insulation, temperature control

lipids/fats

aides in digestion, absorption, circulation and excretion, regulates body temp, mucous secretions, movement of joints

water

metabolism of carbs, proteins and fats

vitamins

contract muscles, bone formation, nerve impulses, metabolism

minerals

most important – pg 1206 | o Calcium, phosphorus, magnesium, sulfur, sodium, potassium, chloride

macrominerals

C and B vitamins • C – collagen formation, antioxidant, enhances iron absorption • B - produce energy, metabolism of carbs, protein, and fats,

water soluble

A, D, E, K • K  synthesis of certain proteins necessary for blood clotting • A – visual activity in dim light, mucous membranes formation, immune function • D – calcium and phosphorus metabolism, stimulates calcium absorption • E – antioxidant, protects vitamin A, heme synthesis

fat soluble

BMI

 >30 is obese | 

science-based strategies – guidelines provide advice to promote health and reduce risk for major chronic diseases through diet and physical activity

dietary guidelines for americans

clear, full, soft, pureed, mechanical diet

 Clear – see through liquids only  Full – regular diet  Soft – only soft food  Pureed  all food must be pureed (in blender) – consistency of thick pudding  Mechanical  can be blended, pureed, ground, or finely chopped

NPO

nothing by mouth

Feeding tube, can deliver total or supplemental nutrition

enteral nutrition

types of feeding tubes

• Nasogastric tube (NG) – through nose into stomach • Dabhoff (smaller diameter than NG) though nose into stomach • Nasointestinal (NI) – through nose, into upper small intestine All SHORT term interventions

 PEG – percutaneous endoscopic gastrostomy tube  J tub – directly into jejunum  Both directly into stomach  Both LONG term interventions

PED and J tube

 X-ray to see placement is correct  Measure tub length and mark – to make sure tube doesn’t move  Take precautions to prevent infections  Make sure all medications are crushed and liquefied

complications of enteral feeding

 Elevated levels of glucose  Effects eyes, kidney, heart, neuro, muscular skeletal  Pancreas – secretes insulin, produces insulin, controls insulin/blood glucose. Insulin secreted by beta cells. Uses potassium (so lowers potassium) super high potassium level - can treat w/ insulin.  Pancreas stops produces insulin  glucagon (alpha cells) and stimulates liver to release stored glucose which increases blood sugar. Liver stores it as glycogen and breaks it down to give off sugar.

patho of type 1 and type 2

function of insulin

decrease serum potassium

alpha cells make...

glucagon

signs of type 1

 Three P’s  polyuria, polydipsia, polyphagia -> urination, thirst, hunger

```  Family history  Obese/overweight BMI over 25  Ethnicity  native Americans  Over 45  Previous impaired glucose tolerance  Hypertension  High HDL cholesterol, high triglycerides  History of gestational diabetes or delivery of baby of 9 pounds ```

risks for type 2

 Reflects average blood glucose levels over 2-3 months  Normal 4-6%  Used to diagnose diabetes, and check balance for diabetic patients

Hgb A1C and normal value

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) – onset 15 minutes, peak 1 hour, duration 3-5 hours

rapid acting insulin

Regular (Humulin –R) (Novolin – R) Onset 30-60 minutes, peak 2-3 hours, duration 4-6 hours

short acting insulin

NPH (Humulin N) (Novolin N) Onset 2-4 hours, peak 6-8 hours, duration 12-16 hours

intermediate acting insulin

Glargine (Lantus) Detemir (levemir) Onset 2 hours. Absorbed very slowly do not have peak time of effect

long acting insulin

signs and symptoms of hypoglycermia

 Shakiness, sweating, confusion, tremors, hunger, weakness  Causes – too much insulin, exercise, not enough food  Treat: 15gm carbs – then follow with snack of starch and protein

exam 2 Flashcards

(78 cards)