AGACNP ANCC Board Review-
Common Problems
Cutaneous Pain - ANS-localized on the skin or body surface
-eg bad sunburn or blister
Visceral Pain - ANS-poorly localized such as with internal organs
eg. gallbladder pain, PUD pain
Somatic Pain - ANS-non localized
-originates in muscle, bone, nerves, blood vessels
eg. soft tissue injury
Neuropathic pain - ANSinvolves nerve pathway injury or compression
WHO Pain Ladder - ANSStep 1: ASA, NSAIDs, tylenol +/- adjuvant (eg is a TCA like
amitryptiline for migraine)
Step 2: step 1 + codeine, hydrocodone, oxycodone, tramadol +/- adjuvants
Step 3: morphine, hydromorphone, methadone, fentanyl plus non-opiods plus adjuvants
Break-through cancer pain - ANSuse of fentanyl patch for sustained release
Stage 1 pressure ulcer - ANSintact skin w erythema that does NOT blanch
Stage 2 pressure ulcer - ANSpartial thickness loss of skin w exposed dermis
can present as intact or ruptured serum filled blister
stage 3 pressure ulcer - ANSfull thickness skin loss, visible adipose tissue
stage 4 pressure ulcer - ANSfull thickness skin & tissue loss w exposed or palpable fascia,
muscle, tendon, ligament or bone
unstageable pressure ulcer - ANSobscured by slough or eschar
causes of non-infectious post op fever - ANS# 1 is post-op atelectasis
2. increase basal metabolic rate
3. dehydration
4. drug reactions (increase eosonophils, drug fever comes on insidiously and tends to linger;
drugs inlcude ampthericin B, bactrim, procainamide, beta-lactam abx and others
Risperidone toxicity (anti-psychotic) - ANSneuroleptic malignant syndrome
tx w dantrolene
most commonly cultured organisms inpatient - ANSstaph epi (on your skin) & staph aureus
, infectious causes of post-op fever - ANS-usually w increase in WBC and left shift
(neutrophils go up in bacterial infxn up to like 85% normal range is 57-67% on differential)
-if WBC >30k usually not infxn
-surgical incision site- red, pus from suture line
-point of entry from catheter
-urinary tract
-lungs
-sinusitis from NGT
Initial Tx of post-op fever - ANSno indicators for infection, hydrate and measures to promote
lunge expansion
tension headache - ANS-single most common type
-vise like pain
-neck/back common area
-no focal neuro deficits
-tx ots OTCs and relaxation
Classic migraine - ANSmigraine with aura
Common migraine - ANSmigraine without aura
Migraine Patho - ANSrelated to dilation and excessive pulsation of branches of the external
carotid artery
-follows the TRIGEMINAL NERVE pathway
Migraine symptoms - ANS-unilateral, lateralized throbbing headache
-builds up gradually and lasts for hours
-focal neuro disturbances may precede or accompany a migraine
-neuro findings can resemble a TIA but it will likely be a young pt with a headache which is
unusual for TIA
Migraine workup - ANS-if its a new migraine need baseline studies to rule out organic
causes
BMP, CBC, VDRL (r/o syphillis), ESR, CT head to r/o tumor
Migraine Mgmt - ANS-avoid trigger foods
-prophylaxis w/ Amitryptiline (TCA) Propanolol or Gabapentin
-acute attack give Sumatriptan
Cluster Headache - ANS-severe, unilateral, periorbital pain occuring daily for several weeks
-may see eye redness, rhinorrhea
TX with 100% oxygen + Sumatriptan
Pre-albumin (transthyretin level) - ANSindicator for nutritional status in the last week or so
Enteral nutrition - ANS< 6 weeks = nasoenteric tube
Common Problems
Cutaneous Pain - ANS-localized on the skin or body surface
-eg bad sunburn or blister
Visceral Pain - ANS-poorly localized such as with internal organs
eg. gallbladder pain, PUD pain
Somatic Pain - ANS-non localized
-originates in muscle, bone, nerves, blood vessels
eg. soft tissue injury
Neuropathic pain - ANSinvolves nerve pathway injury or compression
WHO Pain Ladder - ANSStep 1: ASA, NSAIDs, tylenol +/- adjuvant (eg is a TCA like
amitryptiline for migraine)
Step 2: step 1 + codeine, hydrocodone, oxycodone, tramadol +/- adjuvants
Step 3: morphine, hydromorphone, methadone, fentanyl plus non-opiods plus adjuvants
Break-through cancer pain - ANSuse of fentanyl patch for sustained release
Stage 1 pressure ulcer - ANSintact skin w erythema that does NOT blanch
Stage 2 pressure ulcer - ANSpartial thickness loss of skin w exposed dermis
can present as intact or ruptured serum filled blister
stage 3 pressure ulcer - ANSfull thickness skin loss, visible adipose tissue
stage 4 pressure ulcer - ANSfull thickness skin & tissue loss w exposed or palpable fascia,
muscle, tendon, ligament or bone
unstageable pressure ulcer - ANSobscured by slough or eschar
causes of non-infectious post op fever - ANS# 1 is post-op atelectasis
2. increase basal metabolic rate
3. dehydration
4. drug reactions (increase eosonophils, drug fever comes on insidiously and tends to linger;
drugs inlcude ampthericin B, bactrim, procainamide, beta-lactam abx and others
Risperidone toxicity (anti-psychotic) - ANSneuroleptic malignant syndrome
tx w dantrolene
most commonly cultured organisms inpatient - ANSstaph epi (on your skin) & staph aureus
, infectious causes of post-op fever - ANS-usually w increase in WBC and left shift
(neutrophils go up in bacterial infxn up to like 85% normal range is 57-67% on differential)
-if WBC >30k usually not infxn
-surgical incision site- red, pus from suture line
-point of entry from catheter
-urinary tract
-lungs
-sinusitis from NGT
Initial Tx of post-op fever - ANSno indicators for infection, hydrate and measures to promote
lunge expansion
tension headache - ANS-single most common type
-vise like pain
-neck/back common area
-no focal neuro deficits
-tx ots OTCs and relaxation
Classic migraine - ANSmigraine with aura
Common migraine - ANSmigraine without aura
Migraine Patho - ANSrelated to dilation and excessive pulsation of branches of the external
carotid artery
-follows the TRIGEMINAL NERVE pathway
Migraine symptoms - ANS-unilateral, lateralized throbbing headache
-builds up gradually and lasts for hours
-focal neuro disturbances may precede or accompany a migraine
-neuro findings can resemble a TIA but it will likely be a young pt with a headache which is
unusual for TIA
Migraine workup - ANS-if its a new migraine need baseline studies to rule out organic
causes
BMP, CBC, VDRL (r/o syphillis), ESR, CT head to r/o tumor
Migraine Mgmt - ANS-avoid trigger foods
-prophylaxis w/ Amitryptiline (TCA) Propanolol or Gabapentin
-acute attack give Sumatriptan
Cluster Headache - ANS-severe, unilateral, periorbital pain occuring daily for several weeks
-may see eye redness, rhinorrhea
TX with 100% oxygen + Sumatriptan
Pre-albumin (transthyretin level) - ANSindicator for nutritional status in the last week or so
Enteral nutrition - ANS< 6 weeks = nasoenteric tube
