AGACNP Barkley Review – Pain Management, Headaches, Electrolyte Disorders & Exam Questions with Answers

Description: This Barkley review exam document includes 100% verified answers covering pain assessment, WHO pain ladder, headache management, fever causes, and electrolyte imbalances. It provides detailed explanations ideal for quick reference and exam practice. Acute Pain - answerDuration is usually less than 6 months, Caused by tissue damage Chronic Pain - answerContinual or episodic pain of longer than 6 months Cutaneous - answerLocalize on the skin or surface of the body Visceral - answerPoorly localized such as with internal organs Somatic - answerOriginates in muscle, bones, nerves, blood vessels, and supporting tissue. Soft tissue Neuropathic - answerFrequently caused by a tumor, involves the nerve pathway Subjective Findings of pain - answerMost reliable indicator of the existence and intensity of acute pain WHO's pain management ladder Step 1 - answerASA, APAP, NSAIDs, and +- adjuvants WHO's pain management ladder Step 2 - answerAPAP or ASA, Codeine, Hydrocodone, oxycodone, dihidrocodeine, tramadol, +- adjuvants WHO's pain management ladder Step 3 - answerMorphine, Hydromorphone, methadone, levorphanol, fentanyl, oxycodone, +- Non opioid analgesics, +-adjuvants Fever definition - answerIncreased body temp above normal (37C) Causes of fever - answerAutoimmune, CNS, Malignant neoplastic disease, hematologic disease, CV disease, GI disease, Endocrine disease, Neuroleptic malignant syndrome (anti psychotics) Causes of non-infectious post-op fever - answer#1: Post-op atelectasis, increased metabolic rate, dehydration, and drug reactions Drugs that can cause fever - answerAmphotericin B, trimethoprim sulfamethaxazole, beta lactam antibiotics, procainamide, isoniazid, alpha-methyldopa, quinidine Infectious indicators of post-op fever? What are the WBC indicators? - answerUsually accompanied by subjective complaints and a WBC elevation with left shift. Increased 5-10000 is normal for elderly and immunocompromised. >20,000 septic shock. >40,000 leukemia Causes of infections post-op fever - answerSurgical incisions, IV sites, UTI, Lungs, abcess **sinusitis: NG tubes associated with increased incidence Increase in esosiophils are a sign of: - answerAllergic reaction Treatment of post op fever non infectious causes - answerFirst response is hydration and expand lung inflation Treatment of infections post-op fever - answerFluids, tylenol, treat underlying source, C&S, and gram stain Headache (components of evaluation) - answerChronology (most important) OLD CARTS Presence of triggers and menstral cycle What is the most common type of headache - answerTension headache S/S of tension headache - answerVise-like or tight in quality, generalized, most intense about the neck or back of head, no associated focal neurological symptoms, usually lasts for several hours Management of Tension H/A - answerOver the counter analgesics and relaxation Migraine H/A signs and symptoms and different types - answerClassic-Migraine with aura Common-Migraine w/o aura Related to dilation and excessive pulsation of branches of the external carotid artery. Lasts 2-72 hours following the trigeminal nerve pathway. Onset time and occurance and Triggers of Migraine H/A - answeronset is in adolescence or early adult years family hx females more often affected than males Nitrate containing foods Changes in weather S/S of Migraine H/A - answerUnilateral, lateralized throbbing h/a that occurs episodically dull or throbbing, builds gradually and lasts for several hours, focal neurologic disturbances, visual disturbances, aphasia, numbness, tingling, n/v, photophobia and phonophobia Lab/Diagnostics for Migraine - answerESR, CBC, BMP, VDRL, CT of head Treatment of Migraine - answerDark room and rest ASA Imitrex 6mg SQ at onset, may repeat in one hour (total of 3 times a day) Imitrex 25mg PO at onset of H/A Cluster Headache who gets them the most? - answerVery painful, mostly affecting middle aged men Causes s/s of Cluster H/A - answerNo family hx, ETOH, occurs at night, lasts less than 2 hours, severe unilateral periorbital pain occurring daily for several weeks, Ipsilateral nasal congestion, rhinorrhea and eye redness may occur Treatment of Cluster H/A - answerinhalation of 100% O2, Imitrex 6mg SQ Normal Albumin level - answer3.5-5 Hgb/Hct Ratio - answer1:3 Complications of enteral feeding - answerAspiration, diarrhea, emesis, GI bleed, mechanical obstruction, hypernatremia, and dehydration,refeedingsyndrome,Low-Phos,Low k,Low Mag,Low-Ca,Thiaminedeficiency Complications of parenteral nutrition - answerPneumothorax, hemothorax, arterial laceration, air emboli, catheter thrombosis, catheter sepsis, hyperglycemia, HHNK What is the most common electrolyte abnormality - answerHyponatremia Urine sodium normal value - answer10-20 Sodium Osmolality normal value - answer2xs Na 275-285 Urine sodium >20 suggestive of what? - answerSuggests renal salt wasting (problem with kidneys) Urine sodium 6.5 or cardiac toxicity or muscle paralysis is present, consider: Insulin 10U with one amp D50 (pushes K into cell) Calcium normal levels and Ionized CA+ level. What does albumin do to calcium - answerNormal total calcium: 8.5-10.5 I-Cal: 4.5-5.5 Check albumin with calcium albumin affects calcium level by binding to it I cal does albumin effect it? - answerDoes not vary with the albumin level What is Calcium Maintained by - answerVitamin D, parathyroid hormone and calcitonin Explain Binding of albumin to calcium - answercalcium is ~50% to albumin. If calcium is normal and albumin is low, calcium high. S/S of Hypocalcemia - answerincreased DTRs, muscle abdominal cramps, Carpopedal spasm (trousseau's sign)convulsions, chvostek's sign (cheek twitch), and prolonged QT interval Management of hypocalcemia - answerCheck pH for alkalosis, if acute give IV calcium gluconate, if chronic give oral supplements, vitamin d, and aluminum hydroxide Acidemia _____Ionized calcium - answerincreases Alkalemia_____ionized calcium - answerdecreases Hypercalcemia causes - answerCauses: hyperparathyroidism, hyperthyroidism, Vitamin D intoxication, prolonged immobilization, thiazide diuretics S/S of hypercalcemia - answerFatiguability, muscle weakness, depression, anorexia, n/v, constipation, severe hypercalcemia can cause coma or death. Serum Ca >12 is considered medical emergency Management of Hypercalcemia - answerCalcitonin if impaired cardiovascular or renal fx, dialysis, if >12 begin NS and loop diuretics. Respiratory Acidosis PH and PCO2 levels - answerpH 45 Causes of Resp Acidosis what happens in acute And what happens in chronic states - answerDecreased alveolar ventilation In acute resp failure there is a sharp rise in pCO2 with only a small increase in plasma HCO3. Afte 6-12 hours the increase in pCO2 will evoke the renal compensatory mechanism, this takes several days to manifest S/S of Resp. Acidosis - answerSomnolence and confusion Myoclonus with asterixis increased cerebral blood flow causes increased CSF pressure causing increase ICP Lab/Diagnostics of Resp Acidosis - answerLow arterial pH PCO2> 45 Serum HCO >26 Low serum chloride (7.45 Low PCO2 < 35 Serum HCO3 low if chronic Management of Resp Alkalosis management if acute and chronic - answerManage underlying cause If acute hyperventilation, have pt breath into paper bag decrease rate of vent sedation may be necessary rapid correction of chronic alkalosis may result in metabolic acidosis Metabolic Acidosis Hallmark sign - answerHallmark sign is a low serum HCO3 Anion Gap normal values. What does an increase indicate? - answerNormal: 7 to 17 12 - or +5 either way If gap is increased the clinical situation is generally more acute Increased anion gap causes - answerDKA, Alcoholic Keto Acidosis, Lactic Acidosis, Drug or chemical anion anion gap can still be normal in these conditions - answerdiarrhea, ileostomy, renal tubular acidosis, recovery from DKA Increased gap treatment - answerunderlying disorder, fluid resuscitation HCO3 not indicated if acidosis is due to hypoxia or DKA HCO3 is indicated if significant hyperkalemia is present Normal gap treatment for chronic conditions - answerCommon with chronic conditions like renal failure Bicitra 10-30 cc with meals and h.s. Metabolic Acidosis with normal gap causes "Hard ASS" - answerHyperalementation, Addisons,Renal tubular necrosis, Diarrhea, Acetazolamine, Spironolactone Metabolic Acidosis with wide gap causes MUD PILES" - answerMethanol, Uremia (kidney failure) DKA, Popylene gylcol, IRON/INH, Lactic Acidosis/lack of O2, Ethylene glycol (oxalic acid) Salicylates (late response) Metabolic Alkalosis how is HC03 affected? pCO2? - answerHigh plasma HCO3 and compensatory pCO2 rarely exceeds 55mmHg. If PCO2 is >55, superimposed resp. acidosis is likely Causes of metabolic alkalosis - answerpost-hypercapnia alkalosis NG suctioning Vomiting Diuretics Saline responsive (volume contraction) most common Management of Saline Responsive Alkalosis - answerCorrect volume deficit with NaCl and KCL D/C diuretics H2 blockers in pts with GI loss Acetazolamide 250-500mg IV q4-6hr if volume replacement is contraindicated S/S of metabolic alkalosis - answerNone normally Weakness and hyporeflexia may be present if K is very low Lab/Diagnostics of metabolic alkalosis - answerArterial pH 7.45 Arterial HCO3 >26 Arterial pCO2 >45 and < 55 Serum K and Cl --decreased May see increased anion gap R-O-M-E - answerRespiratory opposite, Metabolic equal Resp: pH and CO2 are opposite Metabolic: pH and CO2 are equal (moving in same direction) First Degree Burns - answerdry, red, no blisters, involves epidermis only Second degree (partial thickness) - answerMoist, blisters, extends beyond epidermis Third degree (full thickness) - answerDry leathery, black, pearly, waxy, extends beyond epidermis to dermis to underlying tissues, fat, muscle and/or bone Rule of nines - answerEach Arm=9 leg=9 Thorax= 18 front and 18 back Head=9% Perineum/genitals=1 Fluid resuscitation for burns parkland formula - answer4ml/kg X TBSA in the first 24 hours 1/2 of all fluid should be given in the first 8 hours the remaining fluid given over the next 16 hours. ALL NS or LR **Fluid resuscitation begins at time of burn injury Monitor what electrolyte during fluid resuscitation for burns? - answerMonitor for hyperkalemia during the first 24-48 hours then monitor for hypokalemia following fluid resuscitation/diuresis around 3 days post burn. Indication for prophylactic intubation post burn - answerburns to the face singed nares or eyebrows dark soot/mucous from nares and/or mouth Emergent management of burns - answersubmerse injured area in clean water as soon as possible wrap area in clean wet towel and transport sterile NS in initial treatment Affected areas wrapped with sterile towels maintain normal tem IV fentanyl and/or morphine Silver Sulfadiazine- used to treat second and third degree burns Tar burn treatment - answeruse petroleum based product to remove the burning tar What wounds should be left open - answerwounds of hands or lower extremities or any wound older than 6 hours Abx given for what type of bite - answerHuman and animal bites, give 3-7 day course of p.o prophylactic abc for coverage of both staph and anaerobes