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Terms in this set (51)
Do women or men experience more pain after cardiac surgery?
______ is the leading cause of insufficient sleep in ICU pts
Pain causes catabolic hypermetabolism which includes what?
Breakdown of muscle
______ results from damage to or dyfunction of the peripheral or central nervous system, rather than stimulation or pain receptors
______ is considered protective and physiologic
Nociceptive pain can be either _____ or _____
Somatic or Visceral
Somatic pain arises from were
Skin, bone, joint, muscle , or connective tissue
(throbbing and well localized)
Visceral pain arises from where?
Internal organs such as the intestine or pancreas
What are considered as the first-line drug class of choice to treat non-neuropathic pain in critically ill pts
T/F) All available IV opioids, when titrated appropriately, are equally effective
What are the opioids that have renal or hepatic dose requirements?
Which opioid is best in pts with renal or hepatic impairment
What metabolite of morphine can accumulate in pts with renal failure can cause neurologic toxicities?
respiratory depression longer than analgesia
Causes QT prolongation (not typically used for pain control)
Why is Meperidine (Demerol) usually avoided in ICU pts?
Potential for neurologic toxicity -->Siezures (normeperidine)
What are some nonopioid analgesics?
What else should be used with vital signs to assess the pts pain?
BPS or CPOT
Behavioral Pain Scale uses what 3 things to classify a patients pain
Upper Limb Movement
Compliance with Mechanical Ventilation
BPS score ranges from __-___
3-12 (3 being no pain)
Critical-Care Pain Observation Tool
Consequences of unmanaged pain
Limited activities, sleep interruptions, anxiety, delirium
Increases hospital stay
Is heavy sedation or light sedation in adults improve clinical outocmes
What are some agitation inducers? on guide
Stress, sleep deprivation, hypoglycemia (hunger), noise
Are BZDs or non-BZDs preferred for sedation
(propofol or dexmedetomidine)
Dexmedetomidine < propofol < midazolam pust < continuous midazolam or lorazepam
What is Dexmedetomidine FDA-approved for?
Non-mechanically ventilated patients
Ventilated ICU pts
MOA of Precedex
Alpha-2 adrenergic agonist
T/F) Dexmedetomidine has a very slow clearance
False; high clearance and short elimination half-life
MOA of Propofol
Binds to multiple receptors in the CNS: GABA-A, glycine, nicotinic, M1 muscarinic receptors
What is the max dose of propofol?
What happens if Propofol exceeds 72 hours of usage?
PRIS (propofol infusion syndrome)
What formulation does propofol come in?
Lipid emulsion (10mg/mL) --> 1.1kcal/mL
BZD potency in sedation
Lorazepam > midazolam > diazepam
_____ and ____ are more lipid soluble than ________
Midazolam and Diazepam
More lipid soluble results in slower/quicker onset of seadtion and smaller/larger Vd
Lorazepam IV formulation contains what?
Propylene glycol (metabolic acidosis and AKI)
Which BZD does not require renal dosing?
Richmond Agitation-Sedation Scale
Riker Sedation-Agitation Scale
_____ is assocaited with increased mortality, ICU and hospital LOS, and development of post-ICU cognitive impairment
What are the 4 risk factors for delirium?
-History of HTN
-History of alcoholism
-Severity of illness at admission
What is commonly used for sedation in pts that are mechaanically ventilated taht are at risk for developing delirium
Dexmedetomidine (lower prevalence of delirium compared to BZD infusions)
What is used to detect delirium?
CAM-ICU and ICDSC
Confusion Assessment Method for the ICU
Intensive Care Delirium Screening Checklist
What is a way to prevent delirium?
Early mobilization of ICU pts
Pts with delirium should be treated with what?
don't use if pt is at risk for Torsades de Pointes
What should be used if a pt has delirium due to alcohol or BZD withdrawl?
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