Med-Surg Quiz 1 – Comprehensive Review (Copy 2)

Medsurg quiz 1 copy 2 - quiz1
Med Surg QUIZ 1

Pain (5th vital sign)

 Whatever pt says it is

Protective factors

 Good shape
 Positive emotions

Risk factors

 Co-morbidities

Pain Scale

 Adults 0-10 scale
 If can't communicate
Wong baker faces or if under 7 years old
Scale = adults who are unresponsive behavioral
cues

Flacc (Face Legs, activity cry consolable) scale for 2 months

plus How will acute pain affect vital signs?

 BP increases, tachycardia, diaphoresis

Acute pain

 Less than 3 months
 Affects vitals signs
o Tachycardia, increase BP, tachypnea, diaphoresis
 EX:
o PCA, nerve blocks

Chronic pain

 Last longer than 3 months
 Vitals can be normal and behavior (body has gotten used to pain)
 Ex:
o ATC (around the clock order)

Breakthrough pain

 Sudden worsening pain
 Expect prn med orders



Intermittent

 It comes and goes

,Intractable

 Does not go away even after interventions

Pt & family teaching on PCA

 Only pt can push the button
 Use early don’t wait for 7/10 pain
 When light (green) dose is available

How to classify pain ?

Neuropathic

 Abnormal or damaged nerves
 Usually intense, shooting burning, pins and needles, electric, paresthesia, numbness & tingling,
limited benefit from opioids
 EX conditions
o : phantom limb pain, peripheral neuropathy, diabetic neuropathy, post-herpetic
neuralgia, fibromyalgia
 Medication:
o Gabapentin, pregabalin, Duloxetine (Cymbalta) , Vitamin B6 (Pyridoxine)
Nociceptive

 Damage to or inflammation of tissue
 Throbbing, aching & localized
 Medication:
Responds to opioids & non-opioids
Referred pain Examples:

 Appendicitis = rovsing's sign
 Heart attack = chin, left arm
 Phantom limb pain
 Spleen rupture = Kehr's sign – left shoulder pain
 Cholecystitis= right shoulder pain

Appendicitis

 rovsing's sign
o push/palpate on left lower quad ( makes right quad hurt)
 McBurney's point/McBurney's sign
o Feel pain when appendix is
 Blumberg's sign
o When you push doesn’t hurt but when you release it there is pain
 Appendicitis S/S

, o Abd pain & anorexia, RLQ tenderness to palpation, N/V, low grade fever
 Plain appendicitis
o Gets laparoscopic surgery
 If it rupture and If pain goes away its not good! Medical emergency = pt gets opened

Psoas sign

 Pt lays on Left side, legs straight, push on hip & move right leg backwards

Rice (reduces swelling )

 Rest - initially
 Ice or cold
o Usually within 24-48 hrs once swelling is gone use heat
 Compression
o Helps decrease swelling/pain
 Elevation
o Above level of the heart to reduce swelling, Increases flow, ease muscle stiffening

Figure 8 dressing

 Start distal at toes & work proximal
 Check 6 P’s after wrapping and QHour
 Smooth wrinkles and don’t wrap to tight!
Opioids A/E

 N/V & sedation
 Respiratory depression
 Hypotension
 Urinary retention & constipation
 Addiction/ tolerance

Opioid toxicity triad

 Pinpoint pupils, resp depression, Aloc
 antidote
o Naloxone

* Stay with pt after giving for 2 hours antidote might wear off !! **

Plan to give pre treatment for painful procedures ( repositioning, wound care, working with PT)

APAP

 Max 4,000
 Can damage liver