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Review E 2
Terms in this set (56)
Describe acute pain?
intense and short duration, usually lasting less than 6 months
What type of pain creates a flight or fight response?
What is referred pain?
felt at a different site than injured or diseased organ body part
What are the some non-pharmacologic interventions for pain that work on the gate control theory of pain management?
Back rub, warm compress. Ice application, auditory or visual distraction
What are the subjective characteristics of pain?
Characteristics of Pain, pain relief measures, interventions that don't relieve pain, what makes pain worse, pain medications name dose and effectiveness
What some of objective, physiological signs of pain?
Tachycardia, increased depth and frequency to respirations, increased BP, pallor, diaphoresis, dilated pupils, increased muscle tension, nausea and vomiting with sever pain
What are 2 examples of pain scales?
Categorical, numerical scales and visual analog scales
How should a nurse reduce the client's anxiety level r/t pain?
Tell the patient that you believe and that you will assist them their pain relief
Why should the nurse reduce the client's anxiety level when the patient is in pain?
The nurse should clarify concerns, answer quest ions and supply all the necessary information the patient needs to make decisions about their care
Why should a nurse control pain before it gets severe?
If you wait until the pain is too severe relief and may require increased doses of pain medications it will take longer to get pain
When should the nurse offer pain medications?
Before activities, prn for moderate severe pain
Who determines if the pain medication/intervention is effective?
Name three classifications of medications used for pain management?
Nonopiodes, Opiodes and Adjuvant analgesics
What are the factors that affect sleep?
lifestvle, sleep patterns, stress Physical lllness, anxiety depression, drugs and substances, environment, exercise, fatigue and nutrition
The use of pure oils, produced from plants to provide health benefits
Why should some aromatherapy agents be avoided during pregnancy?
They may have potential abortifacient effects
How does magnet therapy work?
The increase energy, increase circulation and decrease pain But HOW is not known
smallest amount of a drug that produces a therapeutic level
the largest amount of a medication that be given
One drug increases the action or effect of another
Drug block the action of another drug
Reduced response to medication after repeated exposure to it. larger dose is required to achieve the same effect
Adverse Drug Reaction:
harmful, unintended reaction to a drug administered at the normal dose
Wh t he 8 factors that affect the clients response to medication?
Gender, Amount, Age, Weight, Physical Health, Psychological status, environmental temperatures, amount of food in the stomach, Dosage form
What are the two ways that medications are supplied in the hospital? Describe each.
Unit Dosage (pre-packaged and pre- labeled) and stock (Multi- dose packaging)
Describe how an order is discontinued on the client's Medication Administration Record?
Write DC date time initials on the line across remaining sign off blocks on the medication administration record. Highlight makes it more visual
Explain the security procedures r/t narcotics.
Drugs need to be double locked with a separate narcotic key that require accountability or a specialized computer entry
When is a narcotic count done?
During Change of shift
What are the procedures for doing a narcotic count?
All narcotics are signed in a log, the drugs will be counted and compared to the log and they should be the same. No staff will be let go until drug count is done.
What is the TKO rate?
30mL/hr or 7-10gtts/min
What is an example of a diagnosis that cryoprecipitate is used for?
What is the only product that can be infused with blood components?
Normal Saline .9 %
How long should it take to infuse a unit of blood? What is the risk if it takes longer?
2 to 4 hours blood cell damage and infection
How far in advance can a client sign a consent form for blood products?
What nursing interventions are indicated for an air embolism?
Administer 100 % oxygen , position client in left Trendelenburg position and notify physician
What is needed to obtain a blood product from the blood bank?
Two witnesses and some form of client identification required
How soon after receiving a unit of blood from the blood bank must the transfusion be started?
Within 30 minutes
Who must verifty a unit of blood prior to the beginning of the transfusion?
Two licensed nurses, one of which has to be an RN
What information needs to be checked?
Donor numbers, ABO grouping, and Rh type. and expiration date
After starting the blood transfusion, how lona should the nurse remain at with the client? Why?
A minimum of 15 minutes. If is going to have a reaction it generally occurs within the first 15 minutes.
What should the flow rate be set at for the first 15 minutes of the blood transfusion? Why?
2 mL/minute, closely monitor for reaction
What is the schedule for taking vital signs during a blood transfusion?
Baseline before infusion. 15 minutes after infusion, then 30 minutes after the start of the transfusion then every 30 minutes until complete
What are the 9 signs/symptoms of a transfusion reaction?
"Not feeling right", chills, fever, low bank flank pain, pruritis, rash, hypotension, nausea and vomiting, decreased urine output, chest pain, dyspnea, wheezing, and flushed skin and cyanosis
incompatibility of blood
and sensitivity of the clients WBC, platelets and plasma protein
severe antibody-antigen reaction
administered faster than circulation accommodate
contaminated blood administered
Minimum Time frequency for I/O
every 8 Hours
Urine Volume less than
0.5cc/kg/hr with a specific gravity of 1.030 indicate dehydration
Bounding pulse indicates
Skin will become taut, shiny, and cyanotic
in severe overhydration/load
CVP readings of _______ indicate fluid overload
When apply heat/cold therapy check patient temperature
every 15mins, vitals are every 30mins
softening of tissue by soaking
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