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
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
