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NRSG258 > NRSG258 - part 4 > Flashcards

NRSG258 - part 4 Flashcards

1
Q

Nociceptive pain – cont

A

Visceral

Muscle spasm

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2
Q

Nociceptive pain – cont. - Visceral

A
  • Walls of organs – liver, pancreas
  • Deep
  • Diffuse
  • Associated with N&V

Examples

  • Bowel obstruction
  • Major surgery
  • Pain maybe referred
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3
Q

Nociceptive pain – cont - Muscle spasm

A
  • Skeletal or smooth muscle
  • Mediated by prostaglandins
  • Worse on movement
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4
Q

Neuropathic pain

A

Primary lesion or dysfunction

  • Inflammation
  • Trauma
  • Degeneration
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5
Q

Neuropathic pain - Occurs in

A
  • Neuralgia

* Diabetic neuropathy

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6
Q

Neuropathic pain - Described as

A

Burning
Shooting
Tingling

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7
Q

Neuropathic pain - Does not respond well to

A

opioids and NSAIDs

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8
Q

Neuropathic pain - Adjunctive medication

A

Tricyclics
tramadol
ketamine

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9
Q

Post operative pain - severe

A

Hip replacement

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10
Q

Post operative pain - Moderate

A

Abdominal

Thoracic

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11
Q

Post operative pain - Less severe

A

Limbs

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12
Q

Post operative pain - Multimodal analgesia

A 
Opioids
Infusions
PCA
Peripheral nerve blocks
Oral analgesia
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13
Q

Characteristics of drugs

A

Potency
Selectivity
Specificity

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14
Q

Characteristics of drugs - Potency

A

Amount of chemical to produce an effect

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15
Q

Characteristics of drugs - Selectivity

A

The narrowness of the range of actions on receptors, processes or tissues

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16
Q

Characteristics of drugs - Specificity

A

Relationship between its structure and its pharmacological action

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17
Q

Drug Classifications

A 
Source
Chemical formula or structure
Pharmacokinetics
Activity
Mechanism of action
Clinical use
Body system affected
Drug schedule
Pregnancy safety
Popularity
Approved for sporting activities
18
Q

Role of the nurse - medication

A 
Assess patient and take medication history
6 rights of medication administration
Identify problems
Documentation of dose
Safe storage on the ward
Follow policies and procedures
Education 
Refuse to administer
19
Q

Adverse drug reaction

A

Any response to a drug which is noxious, unintended, and which occurs at doses normally (and appropriately) used in man for the prophylaxis, diagnosis, or therapy of a disease

20
Q

Adverse drug event

A

Injury resulting from medical interventions related to a drug

21
Q

Adverse effect

A

Unwanted effect that occurs in a different mechanism from the pharmacological effect and may or may not be dose related

22
Q

Adverse drug reaction - Risk factors

A 
Age
Gender
Multiple chronic conditions
Renal insufficiency
Hepatic disease
Genetic factors
History of past drug reactions
Poly pharmacy – 5 or more drugs
Multiple prescribers
Chemical characteristics – large molecules
Class of drug
Route of administration
Dose
Duration
Frequency
23
Q

Opioid Analgesics

A 
Morphine
Pethidine
Fentanyl
Hydromorphone
Oxycodone
Tramadol
Methadone
24
Q

morphine

A
  • Mimics the actions of enkephalins and endorphins
  • Moderate to severe pain
  • Chronic pain
  • Increased GI tone
  • Decreases peristalsis
25
Q

morphine - Adverse Reactions

A 
Constipation
N&V
Pruritis
Sedation
Urinary retention
Circulatory and respiratory depression
26
Q

fentanyl

A 
Strong opioid
Similar action to morphine
Adjunctive in general anaesthesia
Epidurals with local anaesthetic
Many forms
27
Q

fentanyl - Adverse reactions

A 
Bradycardia
Pruritis
Constipation
Nausea
Sleepiness
headache
28
Q

naloxone (Narcan)

A 
Opioid antagonist
Reverse the effect or adverse reactions of opioids
Short acting
Competes with receptors sites
Shorter half life than morphine
29
Q

naloxone (Narcan) - Adverse reactions

A

Tachycardia
Hypotension
N&V
sweating

30
Q

Antiemetic

A

Prevents or alleviates nausea or vomiting

Work by blocking neurotransmitters

  • Vomiting centre
  • Chemoreceptor trigger zone (CTZ)
  • Vestibular apparatus
31
Q

Vomiting reflex

A

Coordinated response between

  • CTZ
  • Vomiting centre

Vomiting or emetic centre receives input from

  • CTZ
  • Vestibuar apparatus
  • Higher brain centres – pain, smell, sight
  • Organs – heart, testes, GI tract
32
Q

Chemoreceptor Trigger centre (CTZ)

A

Does not induce vomiting

Stimulated by:

  • Smells
  • Strong emotions
  • Severe pain
  • Labyrinth and endocrine disturbances
  • Toxic reactions to drugs
  • Radiation and Chemotherapy

Relays information to the vomiting centre via the neurotransmitters:

  • Acetylcholine (ACh)
  • Serotonin (5-HT)
  • Histamine
  • Dopamine
33
Q

Sympathetic and Parasympathetic nervous system responses

A

Salivation
Sweating
Tachypnoea
Cardiac dysrhythmias

34
Q

Vomiting

A

The forceful expulsion of the contents of the stomach through the mouth

Impulses sent from the emetic centre to:

  • Upper GIT,
  • Diaphragm
  • Abdominal muscles
  • Contents forced past oesophageal sphincter into the mouth
  • Relaxation of muscles allows contents to return to stomach
  • Repeated cyclic process
  • Protective mechanism
  • May lead to fluid and electrolyte imbalances
35
Q

Drugs for nausea and vomiting

A

Antiemetics block the neurotransmitters in:

  • Vomiting centre
  • CTZ
  • Vestibular Apparatus
Target specific receptors
* ACh- muscarinic receptors
* Histamine - H1receptors
* Dopamine – D2receptors
* Substance P – Neurokinin (NK1) receptors
5-hydroxytryptamine – 5-HT3receptors
36
Q

Non pharmacological interventions for nausea and vomiting

A
  • Remove noxious smells
  • Sips of water
  • Dry crackers
  • If NGT in situ, aspirate

Positioning

  • Fowlers
  • Semi fowlers
37
Q

Pyrexia

A

Increased body temperature

Fever

38
Q

Antipyretic

A

Agent that reduces fever

39
Q

Pyrogen

A

a substance produced by a bacterium, which produces fever when introduced or released into the blood

40
Q

Analgesic

A

an agent producing diminished sensation to pain without loss of consciousness

41
Q

Fever

A
  • Non-specific immune response to infection
  • Does not necessarily need to be treated
  • Physiological state of heat generation and heat loss in response to pyrogens
  • Axillary temperature - 37.5oC or higher
  • Core temperature - 38oC or higher

NRSG258 (9 decks)

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