exam III wks 7,8,9

When providing patient education regarding complementary and alternative medicine therapies for pain control, the nurse should include what important teaching point? A) "You may have to take more than the prescribed dose when starting a herbal therapy, to achieve the attended effect." B) "Herbal products are regulated by the FDA, so they are safe for consumers to take." C) "Due to your history of severe allergies, it is recommended that you speak with your provider before starting an herbal supplement." D) "Most herbal supplements are safe to take during pregnancy, if taken at the recommended dose."

"Due to your history of severe allergies, it is recommended that you speak with your provider before starting an herbal supplement."

Similar to morphine, what AEs do opioid agonists (i.e. codeine) produce?

- analgesia - sedation - euphoria - respiratory depression - constipation - urinary retention - cough suppression - miosis opioid agonist drugs (i.e. codeine) differ from morphine in that they: - produce less analgesia and respiratory depression - lower potential for abuse

When assessing pain on a pain scale, what clients are appropriate for the use of the Visual Analog Scale (VAS)?

- appropriate method for an adult client with no cognitive and verbal limitations - asks the client to make a place on a scale to align with their pain level

What are the classic triad of symptoms for opioid overdose?

- coma - respiratory depression - death

barriers to pain relief

- inadequate prescriber training - fears of addiction - healthcare system that until recently has put a low priority on pain management

define acute pain (x3)

- pain goes away in a short period of time - duration is short and limited - goal of tx is pain control with eventual elimination

List the principles of analgesic therapy

- pain is subjective - titrate therapy for maximum efficacy with the least adverse effects - consider tolerance

define chronic pain (x4)

- physical manifestation include flat affect, fatigue, withdrawal from social interaction and decreased physical activity - gradual onset - duration is greater than 3 months - goal of tx is maximal pain control to improve quality of life

Wong-Baker Face Scale - age indicated for use?

-ages 1-4 y/o - patients with lower cognitive abilities/disabilities

therapeutic uses of NSAIDS?

-decreased inflammation -analgesia for pain -fever reducer

When administering an opioid drug, what are the primary adverse effects you are watching for?

-respiratory depression -sedation

acute pain management for second degree burn to forearm/hands/fingers?

1) Complete a head to toe assessment. -allows the nurse to collect baseline information to continue care. - burned extremity should carefully be assessed compared to the non-burned extremity. 2) Evaluate pain on pain scale. -. It is important to evaluate the pain level using a pain scale -This helps to adequately keep the client comfortable. 3) Obtain a full set of vital signs. -This allows the nurse to recognize any changes that may be occurring throughout the illness. 4) Discuss infection control guidelines for the burned client. -The client is at risk for infection due to a disruption of the skin. -The client needs to be made aware of standard precautions and special instructions for those who have burn wounds. 5) Provide emotional support. -Providing emotional support will help ease the client's worry and help lessen any anxiety the client may have during the experience. -Encourage the client to verbalize concerns. This will facilitate communication regarding any fears that may be associated with the pain. *THINK Thinking: Nursing Process — The nurse needs to Assess, Intervene, and Evaluate multiple dimensions of the burned client, to provide appropriate care. Implementation. NCLEX®: Physiological Adaptation. QSEN: Patient-centered Care.

According to the American Burn Association, what are the criteria for which a pt is transferred to the Burn Care Center? List 5.

1) burns that involve face, hands, feet, genitalia, or major joints 2) 3rd degree burns, which can appear whitish, charred or translucent with no pinprick sensation in the burned area 3) burns that cover more than 10% of total body surface area 4) electrical or chemical burns 5)

What are the top 3 priority concerns or cues for acute pain management?

1. Circulation. There is a circumferential burn wound to the forearm and burns located on the hand and fingers. Both of these factors put the client's extremity at a higher risk for circulatory compromise. Clinical Hint: Circulation is the priority, despite the overwhelming pain. Physiological needs first. 2. Pain. The burns are second degree/partial thickness scald burns and are known to be painful. 3. Skin Integrity. The Epithelium and varying layers of dermis are destroyed. The skin is thinner in certain areas, and nerve cells can be exposed causing further pain.

The nurse reviews the most recent orders from the provider and develops a plan of care for an acute burn patient. In what order should the nurse perform the interventions? - Provide tetanus toxoid injection. - Obtain vital signs and perform neurovascular/circulatory assessment. - Elevate the burned extremity. - Insert peripheral IV and begin Ringers lactate infusion at 50mL/hr. - Medicate for pain with oxycodone/acetaminophen.

1. Obtain vital signs and perform a neurovascular/ circulatory assessment. Assessment of vital signs and circulation is the first intervention the nurse should do when caring for a client with a burned extremity. 2. Elevate Burned extremity. extending the hand and arm minimizes edema and promotes circulation and should be done after an assessment is completed. 3. medicate for pain with oxycodone/acetaminophen. analgesics should be promoted to maximize the client's comfort. 4. insert peripheral IV and begin Ringers lactate infusion. Establishing intravenous access is important for fluid resuscitation and access for medication administration. 5. Provide tetanus toxoid injection. Tetanus toxoid is given routinely to all burn clients b/c of likelihood of anaerobic wound contamination

The nurse is preparing to teach Molly about the PCA machine and the important considerations. Which instructions are essential for the nurse to give the client? A) Plan to teach the client in the preoperative period rather than postoperatively. B) As the pain lessens, the client can adjust to lower doses and eventually stop the analgesic. C) Emphasize the safety features of the machine. D) Wait for the nurse's assistance when feeling the need for pain medication. E) How to self-administer the pain medication.

A) Plan to teach the client in the preoperative period rather than postoperatively. C) Emphasize the safety features of the machine. E) How to self-administer the pain medication.

The nurse educates the client about alternative therapies for comfort. What options should the nurse discuss? Select all that apply. Acupuncture Hypnosis Massage Dietary supplements Reiki

Acupuncture. Acupuncture is proven to improve chronic pain for some people. Hypnosis. Hypnosis is proven to improve pain, especially chronic pain, in some people. Massage. Massage is relaxing and improve pain. Reiki. Reiki is shown to improve the quality of life, providing comfort. Dietary supplements. Dietary supplement is not beneficial for pain and comfort.

The nurse is setting up a PCA for morphine delivery. Which action is most important before beginning the medication?

Ask another nurse to double-check the set up

The nurse provides comfort measures to a client before bedtime to facilitate sleep. SATA Ask what helps the client sleep best. Offer a back massage. Offer a prescribed sleep aid. Position for comfort. Provide oral care.

Ask what helps the client sleep best. Offer a back massage. Offer a prescribed sleep aid. Position for comfort. Provide oral care.

The nurse is reviewing the side effects of naloxone. What clinical manifestations can the nurse expect to find after its administration? A) Urticaria, drowsiness and nausea and vomiting. B) Increased BP and ventricular arryhthmias. C) Rapid pulse, nervousness and diarrhea. D) Respiratory depression, palpitations, and urinary retention.

B) Increased BP and ventricular arryhthmias.

The nurse is reviewing the most recent orders from the provider. In reviewing the prescriptions, the nurse anticipates the possibility of administering naloxone. Which description would indicate the proper rationale for the nurse to administer the medication? A) The client's pain and anxiety goals are unmet, and there is the need for adjuvant therapy for better control. B) The client has a decrease in the level of consciousness and breathing pattern as a result of the alprazolam. C) The client has a decrease in alertness; vital signs remain within desired parameters. D) The client has a decrease in the level of consciousness and breathing pattern as a result of the hydromorphone.

D) The client has a decrease in the level of consciousness and breathing pattern as a result of the hydromorphone. naloxone will reverse the effects of opioids and should be administered if the client is not arousable or have severe respiratory depression.

Which pain scale is best to use when a patient is confused and/or nonverbal?

FLACC Pain Scale

The nurse is caring for a client using patient-controlled analgesia (PCA) with IV morphine delivered at 1mg every 10 minutes to control pain. Several times during the night, the client awakens in severe pain, and it takes more than an hour to regain pain relief. What is the nurse's best action?

Request an order for adding a continuous low-dose morphine infusion to the PCA regimen at night.

An overwhelming compulsion to take drugs repetitively, despite serious health and social consequences, is known as:

addiction

The nurse considers the teaching components and importance in helping Molly have adequate pain control. Before the teaching, what is most important for the nurse to assess?

client's willingness to learn

A client that has a long history of abusing alcohol, is admitted to the emergency department with symptoms of hallucinations, confusion, disorientation, agitation and severe anxiety. The nurse caring for the client understands that the client is most likely experiencing:

delirium tremens

Salicylism

excessive intake of aspirin

After administering morphine, you reassess your patient and note the patient is breathing 8 respirations/minute. You anticipate administering which medication?

naloxone

2 major forms of pain?

nociceptive (injury to tissues)

A patient diagnosed with a sleep disorder is prescribed 2mg of a sedative to take at bedtime. After taking the medication for several months, the patient mentions to the provider that it now takes 4-6mg of the same sedative to fall asleep. The provider assumes the patient has developed what biological condition?

tolerance

Salicylism Adverse Effects? Interventions?

with excessive use of aspirin, adverse effects include: - tinnitus* - headache - dizziness interventions -monitor stool for gastric bleed - stop 2 weeks before surgery and not for pain after surgery - only NSAID used for stroke and CV

In what ways are all strong opioid agonists essentially equal to morphine?

with regard to: - analgesia - abuse liability - respiratory depression