Week 3: Postop Complications/PCA & Epidurals

Question 1

Postoperative ileus

Answer 1

the delayed return of the GI systems normal peristalsis
- characterized by abdominal distension/tenderness/pain

Question 2

Paralytic ileus

Answer 2

impairment of the intestinal motility
- N/V, distension, poor appetite, pain

Question 3

Olguria

Answer 3

persistent low urine output (30mL/hr)

Question 4

Integument complications

Answer 4

SSIs

Question 5

What are the 3 types of pain

Answer 5

Nociceptive
Visceral
Neuropathic

Question 6

Nociceptive pain

Answer 6

injury to body tissue

Question 7

Visceral pain

Answer 7

pain that comes from the visceral organs (e.g GI, heart etc)

Question 8

Neuropathic Pain

Answer 8

central and/or peripheral nerve pain

Question 9

How do NSAIDs work in body

Answer 9

block prostaglandin production

Question 10

How do local anesthestics work in body

Answer 10

block action potential initiation

Question 11

how do antiseizure drugs work in the body

Answer 11

block action potential initation

Question 12

how to corticosteroids work in the body

Answer 12

block action potential initiation

Question 13

How do opioids work in the body

Answer 13

block release of substance P

Question 14

How do cannabinoids work in the body

Answer 14

inhibit mast cell degranulation and response of nociceptive neurons

Question 15

PCA

Answer 15

a method of pain
management via med infusion (usually opioids) that
permits patients to self-administer small amounts of
pain relieving medications via a specially designed pump

Question 16

PCA routes

Answer 16

Intravenous, Subcutaneous or Patient
Controlled Epidural Anesthesia (PCEA)

Question 17

Benefits of using a PCA

Answer 17

overall patient satisfaction
patient has sense of control over pain and healing
fewer post op complications because earlier and easier ambulation occurs
pharmacokinetic control much more stable

Question 18

Pre requisites to using a PCA

Answer 18

must cognitively understand concept
able to physically press the button
willing to control their own pain this way
not sedated from other medications

Question 19

Safety risks with PCA

Answer 19

medication errors
use of narcotic drugs side effects
patient understanding

Question 20

PCA side effects

Answer 20

increased risk of respiratory depression
sedation
N/V
urinary retention
pruritis
constipation

Question 21

When should narcan be used

Answer 21

RR <8/minute OR sedation scale of 4

Question 22

How much narcan is given in emergencies?

Answer 22

0.1mg may repeat q2min x 4 until patient is awake

Question 23

Pt teaching points for PCA

Answer 23

• safety features (max dose)
• pressed by only the pt
• importance of good prophylactic pain management
• how to use pain scale/communicate pain
• setting realistic pain goal
• addiction
• side effects of opioids

Question 24

epidural

Answer 24

the intermittent or continuous infusion of analgesic agents into the epidural space for the purpose of providing pain control

Question 25

what spinal nerves innervate the diaphragm

Answer 25

C3 4 5 keeps the diaphragm alive

Question 26

what is epidural opioid therapy

Answer 26

involves inserting a catheter int the epidural space and injecting an analgesic, either by intermittent bolus doses or continuous infusion

Question 27

Epidural medications consist of

Answer 27

1. Opioids (morphine, hydromorphone, fentanyl) 2. Local anesthetics (bupivacaine, ropivacaine, lidocaine)

Question 28

Where does the autonomic blockade usually extend to?

Answer 28

about 2 dermatomes above the sensation

Question 29

The progression of the epidural blockade in

Answer 29

sympathetic (vasodilation, temperature) sensory motor

Question 30

Recovery from an epidural block in order

Answer 30

motor nerves sensation sympathetic (vasodilation, temperature)

Question 31

Pros of epidural medications

Answer 31

- high satisfaction levels and higher pain control - reduce incidence of pulmonary complications - reduce incidence of cardiac complications - much lower doses of analgesics are needed for intraspinal delivery

Question 32

Risks with epidural medications

Answer 32

- higher leve of care required from HCPs - potentially serious or life threatening complications - higher cost than oral or IV analgesia

Question 33

What specific areas is epiural analgesia/anesthetic particularly effective at managing pain?

Answer 33

chest, abdomen, pelvis, lower limbs

Question 34

What does a nurse need to assess with an epidural?

Answer 34

epidural catheter length insertion site and dressing use ice to assess sensation and dermatome levels assess motor function of lower extremities pain level sedation score S&S of complications vital signs urinary output

Question 35

PCEA

Answer 35

a continuous background epidural infusion plus patient controlled doses

Question 36

PCEA involves

Answer 36

BOTH opioid and local anesthetic

Question 37

Complications that can occur from PCEAs and epidurals

Answer 37

epidural hematoma postural puncture headache local anesthetic toxicity opioid induced respiratory depression nausea and vomiting urinary retention (leading to CAUDI)

Question 38

Spinal epidural

Answer 38

into the subarachnoid space into CSF affects motor function BELOW level of injection

Question 39

Epidural

Answer 39

into the epidural space sensory block and sometimes motor block

Question 40

How often is an epidural check done

Answer 40

Q4H