Acute PAIN AND Pneumonia STUDY GUIDE PDF

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ACUTE PAIN AND PNEUMONIA MED SURGE STUDY GUIDE...

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ACUTE PAIN AND PNEUMONIA ACUTE PAIN 1. Pain and discomfort ● Result of: ○ Trauma from surgery ■ Reflex muscle spasms ○ Anxiety/fear ○ Positioning ■ Internal devices ○ Deep breathing, coughing, ambulating ● Deep visceral pain may signal complications such as…. ■ oxygen ○ Pain.. ■ Can contribute to complications such as: ● dysfunction of the immune and coagulation systems ○ delay return to normal gastric function ○ Increase risk of atelectasis and impaired respiratory function 2. Definition of pain ● Whatever the person experiencing pain says it is ○ Subjective in nature ○ Self report is most valid assessment ● Special populations

3. Acute pain ● Autonomic nervous system activated ○ Fight or flight ■ BP &HR

4. Pain assessment ● Nurse responsible to ○ Figure out persons pain ● Pain is the 5th vital sign ● Goals ○ Manage pain in a safe way ● Elements ○ Direct interview ○ Observation ■ Contraindications to what they are saying? ○ Physical exam

5. OLDCART

6. Pain treatment principles ● Follow principles of assessment ● Every client deserves adequate pain management ● Treatment based on client goals ● Use drugs and nondrug therapies ○ Hot and cold therapy

7. Nursing management pain ● IV opioids- most rapid relief ● Epidural catheters, PCA, or regional anesthetic blockade ○ Left in place ● NSAIDs ○ Not post op ○ Musculoskeletal issues ● Comfort measures 8. Pain assessment: management ● Inquire about strategies used. ○ What is effective and ineffective ● Impact of pain ○ Beliefs, expectations, goals ○ Non-drug therapies ○ Complementary & alternative therapies ○ Relaxation strategies 9. Drug therapy ● Categories of medications ○ Nonopioid ○ Opioid ■ Respiratory depression ■ Look at RR 10. Administration-pain medication ● Focus on prevention control ● Do not wait for severe pain ● Constant pain required around the clock administration ● Fast acting drugs for breakthrough 11. Administration routes ● Benefits of variable routes

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Target a particular source Achieve therapeutic blood levels rapidly ■ iv/inhaling- immediate ■ Tongue- quick ■ Oral- longer

12. administration ● Scheduling ○ Focus on prevention or control ● Titration ○ Use the smallest dose to provide effective pain control with fewest side effects 13. Administration routes ● Intraspinal delivery ○ Highly potent-smaller dose ● PCA- patient controlled analgesia ○ Use of PCA begins with client teaching 14. Interventional therapies ● Nerve blocks ○ Interrupt all afferent and efferent transmission ○ Used during and after surgery to manage pain

15. Nondrug therapy ● Massage ○ Trigger point massage ● Exercise ○ Critical for chronic pain ● Acupuncture ● PENS ● Heat therapy ● Cold therapy ● Cognitive therapies ○ Distraction ○ Hypnosis ○ Imagery ○ Relaxation 16. Nursing management pain ● Nursing assessment ○ Self-report is best indicator. ■ If not possible, look for other indications of pain ● SUCH AS???

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○ Identify location. Nursing diagnoses ○ Acute pain ○ Anxiety Nursing implementation ○ IV opioids ~most rapid relief ○ Epidural catheters, PCA, or regional anesthetic blockade ○ NSAIDs ○ Comfort measures

17. Ethical issues- pain management ● Fear of hastening death by administering analgesics ● Unrelieved pain is one of the reasons that clients make requests for assisted suicide ○ Use of placebo in pain assessment and treatment ■ Condemned by several professional organizations.

18. Gerontologic considerations ● Chronic pain ○ 50% to 80% of older adults are estimated to have chronic pain problems. ● Most common painful conditions ○ Musculoskeletal ■ Osteoarthritis ■ Low back pain ■ Previous fracture sites ● Treatment cautions!! ○ Metabolize drugs more slowly ○ Risk of GI bleeding with NSAIDs ○ Multiple drug use (interactions) ○ Cognitive impairment, ataxia can be exacerbated by analgesics

PNEUMONIA 1. Etiology Likely to result when defense mechanisms become incompetent or overwhelmed ➔ ↓ Cough and epiglottal reflexes may allow aspiration ➔ Mucociliary mechanism impaired a. Aspiration: inhaling b. Inhalation: microbes in air

c. Hematogenous: infection somewhere else

2. Types of Pneumonia ➔ Can be classified according to causative organism ➔ Clinical classification: ◆ Community-acquired (CAP) ◆ Health Care associated Pneumonia (HCAP) ◆ Hospital-acquired (HAP) ● Ventilator-associated (VAP)

3. Community acquired Pneumonia ➔ →lower respiratory tract infection w/onset in community or in first 2 days of hospitalization ➔ Most common cause in Streptococcus pneumoniae ➔ Haemophilus influenza in older adults ➔ C. pneumoniae 4. Risk factors ➔ Advanced age ➔ Immunosuppression ➔ History of antibiotic use ➔ Prolonged mechanical ventilation ➔ Smoking

5. Hospital acquired Pneumonia ➔ HAP: Occurs 48 hours or longer after hospitalization and not present at time of admission ➔ Most colonized with multiple organisms ➔ Associated with longer hospital stays, increased costs, sicker patients, and increased risk of morbidity and mortality

6. Types of pneumonia ➔ Multidrug-resistant (MDR) organisms are major problem in treatment ➔ Staphylococcus aureus ➔ Gram-negative bacilli 7. Aspiration pneumonia ➔ Results from abnormal entry of secretions into lower airway ➔ Major risk factors:

➔ Decreased level of consciousness ➔ Difficulty swallowing ➔ Insertion of nasogastric tubes with or without tube feeding

8. Clinical manifestations ➔ Physical examination findings ◆ Fine or coarse crackles ◆ Bronchial breath sounds ◆ Egophony ◆ ↑ Fremitus ◆ Dullness to percussion if pleural effusion present 9. Complications ➔ Atelectasis ➔ Pleurisy ➔ Pleural effusion ➔ Bacteremia ➔ Pneumothorax

10. Diagnostic tests ➔ History ➔ Physical exam ➔ Chest x-ray ➔ Sputum analysis ➔ CBC with differential ➔ Pulse oximetry or ABGs

11. Collaborative care/ health considerations ➔ Antibiotic therapy ➔ Supportive measures ◆ Fluids, walking, energy, breathing, nebulizer ➔ Vaccine

12. Azithromycin ➔ Pharmacologic class - macrolides ➔ Therapeutic class- antibiotic ➔ Indications- bacterial exacerbations of COPD, CAP ➔ Can be taken without regard to food

13. Acute Care ➔ Assess respiratory status q4h or as frequently as indicated by patients condition ➔ Fluids ➔ Pain assessment ➔ Small meals ➔ Monitor response to activity ➔ Pulse ox...