Med Surge - Test 1 P. 1-6

Front 1

6 rights of drug administration

Back 1

medication, dose, route, time, patient, documentation

Front 2

Simple conversions of standard to metric

oz=mL

Back 2

1oz = 30mL

Front 3

Simple conversions of standard to metric

tsp=mL

Back 3

1tsp=5mL

Front 4

Simple conversions of standard to metric

in=cm

Back 4

1in=2.54cm

Front 5

Simple conversions of standard to metric

kg=lb

Back 5

1kg=2.2lb

Front 6

Simple conversions of standard to metric

__cup = ___ mL = ___ oz

Back 6

1 cup=240mL=8oz

Front 7

Simple conversions of standard to metric

tbsp = mL

Back 7

1tbps=15mL

Front 8

Simple conversions of standard to metric

pound = g

Back 8

1 pound= 454 g

Front 9

Simple conversions of standard to metric

oz = g

Back 9

1oz=28g

Front 10

IV infusions with gtt tubing

micro drip =

Back 10

micro drip=60gtt/mL


USED FOR WHAT KIND OF PATIENTS??
- pts who have renal disease, cardiac disease, infants and children

Front 11

IV infusions with gtt tubing

macro drip =

Back 11

macro drop= 10-15gtt/mL

Front 12

medical asepsis and sterile technique

aka “clean technique”

Back 12

medical asepsis

Front 13

medical asepsis and sterile technique

- includes procedures used to reduce the number of and prevent the spread of microorganisms.

Back 13

medical asepsis

Front 14

medical asepsis and sterile technique

-ex: hand hygiene, barrier techniques, washing hands before preparing food

Back 14

medical asepsis

Front 15

medical asepsis and sterile technique

aka “surgical technique

Back 15

sterile technique

Front 16

medical asepsis and sterile technique

-includes procedures used to eliminate all microorganisms from an area

Back 16

sterile technique

Front 17

medical asepsis and sterile technique

-sterilization destroys all microorganisms and their spores.

Back 17

sterile technique

Front 18

medical asepsis and sterile technique

-nurses in the operating room (OR), labor and delivery area, and procedural areas practice _______ technique when using sterile instruments and supplies

Back 18

sterile technique

Front 19

medical asepsis and sterile technique

procedures that require intentional perforation of a patient’s skin (insertion of IV catheters), when the skin integrity is broken due to surgical incision or burns

Back 19

sterile technique

Front 20

medical asepsis and sterile technique

-these practices are designed to make and maintain objects and areas free from pathogenic microorganisms

Back 20

sterile technique

Front 21

Intramuscular injection: IM

-considerations:

Back 21

aspirate

Front 22

Intramuscular injection: IM

needle choice

Back 22

½ to 1 ½ inch needle

(PP says 5/8 to 3 inches)

Front 23

Intramuscular injection: IM

-gauge

Back 23

18-22 depending on medication




----------------

Front 24

Intramuscular injection: IM

-angle of insertion:

Back 24

90 degrees

Front 25

Intramuscular injection: IM

-solution dose

Back 25

: 1-3mL


(PP says 0.1-3mL)

Front 26

Intramuscular injection: IM

-sites:

Back 26

ventrogluteal, vastus lateralis, deltoid

Front 27

what is preferred site for immunizations to infants, toddlers, and children.

Back 27

-vastus lateralis

Front 28

deltoid:
-use this site for small medication volumes, such as:

Back 28

0.5-1mL

what size gauge??????


21-22






needle size??



1 or 1/2 inch

Front 29

Intradermal: ID

-considerations:
where do you inject to?

what happens if a bleb does not appear?

Back 29

inject into dermis where blood supply is reduced and drug absorption occurs slowly, used for skin testing.

if a bleb does not appear, or if the site bleeds after needle withdrawal, the medication may be entered subcutaneous tissue and the skin test is not valid

Front 30

Intradermal: ID

-needle choice:

Back 30

use a TB syringe, 3/8


pp= 3/8 to 5/8th of an inch

Front 31

Intradermal: ID

-gauge:

Back 31

25-27 gauge

Front 32

Intradermal: ID

-angle of insertion:

Back 32

5-15 degrees

Front 33

Intradermal: ID

-solution dose:

Back 33

0.01-0.1 mL

(module says 0.1 to 0.3mL)

Front 34

Intradermal: ID

-sites:

Back 34

inner forearm and upper back

Front 35

Subcutaneous:

-considerations:
where do you inject the medication into?

Back 35

involves depositing medication into the loose connective tissue underlying the dermis

Front 36

Subcutaneous:

-____ needle inserted at a 45 degree angle


-____needle inserted at a 90 degree angle

Back 36

-25G 5/8th needle inserted at a 45 degree angle

-25G ½ inch needle inserted at a 90 degree angle

Front 37

Subcutaneous:

-a child usually requires a ___ g, ____inch needled inserted at a ____degree angle

Back 37

26-30 g, ½ inch needled inserted at a 90 degree angle

Front 38

Subcutaneous:

-what is the best site for patients with little peripheral subcutaneous tissue

Back 38

the abdomen

Front 39

Subcutaneous:

-needle choice:

Back 39

3/8 to to 3/4

Front 40

Subcutaneous:

-gauge:

Back 40

23, 25, 27

Front 41

Subcutaneous:

-angle of insertion:
2 rules

Back 41

45/ 90 degrees

-if you can grab 2 inches of tissue, insert needle at 90 degrees


-if you can grab 1 inch of tissue, insert needle at 45 degrees

Front 42

Subcutaneous:

-solution dose:

Back 42

PP 0.1- 1mL

0.5 to 1mL, they are isotonic, nonirritating, nonviscious, and water soluble. examples include: epinephrine, insulin, allergy medications, narcotics, and heparin

Front 43

Subcutaneous:

-sites:

Back 43

outer aspect of the upper arms, the abdomen from below the costal margins to the iliac crests, and the anterior aspects of the thighs. (p. 592 PP)

Front 44

General lab values for: (adult Male)

CBC:
-what does it measure?

Back 44

measures complete blood count, measures red blood cell count, volume of red blood cells, and concentration of hemoglobin, which reflects patient’s capacity to carry oxygen.

Front 45

General lab values for: (adult Male)
*CBC*

Hemoglobin (HGB):

RBC:

Hematocrit (HCT):

WBC:

Platelet:

Back 45

Hemoglobin (HGB): 14 to 18 g/dl
--Hemoglobin is a protein contained in red blood cells that carries oxygen to, and carbon dioxide away from, the body's cells


RBC: 4.2-5.6 mill/mcl
-A RBC count is the number of red blood cells per volume of blood, and is reported in either millions in a microliter or millions in a liter of blood.



Hematocrit (HCT): 40-54%
-Hematocrit is a blood test that tells us what proportion, by volume, of total blood cells are made up of red blood cells. Hematocrit is given as a percentage


WBC: 3.8-10.8 thous/mcl


Platelet: 130-140 thous/mcl
-Very small fragments of cells about one-tenth the size of a red blood cell.
-When a blood vessel is broken, platelets group up at the injury site and stick together, sealing the leak and preventing bleeding.
-Platelets are produced in your bone marrow.

Front 46

General lab values for: (adult Male)

Basic Chem/Metabolic Panel:
-Calcium
-Carbon Dioxide

Back 46

-Calcium: 8.5-10.3 mEq/dl
-Carbon dioxide: 22-32 mEq/L

Front 47

General lab values for: (adult Male)

Basic Chem/Metabolic Panel:
-Chloride
-Potassium
-Sodium

Back 47

-Chloride: 95-112 mEq/L
-Potassium: 3.5-5.5 mEq/L
-Sodium: 135-146 mEq/L

Front 48

General lab values for: (adult Male)

Basic Chem/Metabolic Panel:
-Magnesium
-Phosphorus

Back 48

-Magnesium: 1.3-2.5 mEq/L
-Phosphorus: 2.5-4.5 mEq/dl

Front 49

Pain management (adult)

Non-pharmacologic

Back 49

ice, heat, elevation, distraction, imagery, relaxation, biofeedback, and music (big push for nurse to try first before giving meds)

Front 50

Pain management (adult)

Pharmacologic:

Back 50

-non-opiod analgesic (Tylenol, ASA),

NSAIDS (Ibuprofen, Toradol, Celebrex),

opioids (morphine, dilaudid, Demerol, fentanyl patch)

PCAs,

epidurals,

adjuvant drugs (enhance effects of opioids and lessen anxiety, like anti-depressants such as Zoloft and paxil)

Front 51

What type of assessment tool is used to assess the pt in pain?

O
L
D

C
A
R
T

Back 51

O Onset –when did it happen, when did it start?
L- Location –where is it at? “If I touch you here, do you have pain anywhere”
D - Duration- how long has this been going on? 4 days? 6 hours?
C- Character -what does this pain feel like? Leave it in their words. (white hot pain is talking about an intense burning pain)
A- Associated/aggravating symptoms -what makes the pain worse? Ex: movement,
R- Relieving factors –what things have you tried to make the pain better? ex: heat..
T- Types of treatments patient has tried

Front 52

What type of assessment tool is used to assess the pt in pain

P
Q
R
S
T

Back 52

P – Provokes or Palliative -what makes the pain worse? What brings the pain on? Ex: food (lets you know if your dealing with an ulcer..coffee or caffeine, and acid forms) anxiety produces acid in the body..
Q – Quality -
R – Radiation-
S – Severity -0-10
T – Time - What were you doing when this started how long have you had it.

Front 53

Components addressed in a pain assessment

Back 53

A. - Mental status
- Pain scale
- VS
- Any other symptoms present
- Check your site prior to administration
B. - Follow the 6 rights
C. - Reassess in a timely manner

Front 54

Pt education related to narcotic administration

Back 54

-Teach the names of the medications
-Promote adherence to the pain regime – medication on a scheduled basis vs. prn (teach about constipation, sedation)
-Don’t wait until the pain is unbearable
-Keeping a “pain diary”
-Mechanisms of action of the medications(s): long-acting vs. short-acting (relates to half life)
-Review adjuvant therapy – i.e., anti-anxiety (we want them to exercise which releases chemicals that helps with pain management),

Front 55

Physiological and behavioral response of pain related to acute and chronic



ACUTE PAIN
-physiologic response :

5

Back 55

increased BP initially
increased pulse rate
increase RR
dilated pupils
perspiration

Front 56

Physiological and behavioral response of pain related to acute and chronic

ACUTE PAIN
-behavioral response:

4

Back 56

restlessness
inability to concentrate
apprehension
distress

Front 57

Physiological and behavioral response of pain related to acute and chronic
CHRONIC PAIN
-physiologic response:


5

Back 57

normal BP
normal pulse rate
normal RR
normal pupils
dry skin

Front 58

Physiological and behavioral response of pain related to acute and chronic

CHRONIC PAIN
-behavioral response:

3

Back 58

-behavioral response:
immobility or physical inactivity
withdrawal
despair

Front 59

-what is the unpleasant sensory and emotional experience associated with actual or potential tissue damage

Back 59

pain

Front 60

Acute vs Chronic pain

serves a biologic purpose

Back 60

• Acute

Front 61

Acute vs Chronic pain

It acts as a “warning signal” because it can activate the sympathetic nervous system causing various physiologic responses, similar to “fight or flight”

Back 61

• Acute

Front 62

Acute vs Chronic pain

results from acute injury, disease or surgery

Back 62

• Acute

Front 63

Acute vs Chronic pain

Has a short duration

Back 63

• Acute

Front 64

Acute vs Chronic pain

Usually has a well-defined cause

Back 64

acute

Front 65

Acute vs Chronic pain

Decreases with healing

Back 65

acute

Front 66

Acute vs Chronic pain

Is reversible

Back 66

acute

Front 67

Acute vs Chronic pain

May be accompanied by anxiety and restlessness

Back 67

acute

Front 68

Acute vs Chronic pain

an example is post-op pain (aka: pain from surgery)

Back 68

acute

The severity of postoperative pain may be a predictor of long-term pain

Front 69

Acute vs Chronic pain

ex is trauma (car crash and broken leg)

Back 69

acute

Front 70

Acute vs Chronic pain

ex is burns

Back 70

acute

Front 71

Acute vs Chronic pain

ex is procedural

Back 71

acute

Front 72

Acute vs Chronic pain

ex is obstetric (labor)

Back 72

acute

Front 73

Acute vs Chronic pain

aka: persistent pain

Back 73

chronic

Front 74

Acute vs Chronic pain

Lasts more than 3 or more months

Back 74

Chronic pain

Front 75

Acute vs Chronic pain

May or may not have well defined cause

Back 75

Chronic pain

Front 76

Acute vs Chronic pain

poorly localized

Back 76

Chronic pain

Front 77

Acute vs Chronic pain

Begins gradually and persists

Back 77

Chronic pain

Front 78

Acute vs Chronic pain

Is exhausting and useless

Back 78

Chronic pain

Front 79

Acute vs Chronic pain

May be accompanied by depression, fatigue and decreased functional ability

Back 79

chronic pain

Front 80

Chronic pain (non-cancer vs cancer)

ex: diabetic neuropathy

Back 80

chronic pain

Front 81

the nerve endings that are coming down the arm are severed, when the nerve is stimulated its hurts your hand. nerves are filled with thousands of fibers and 1 fiber can say your middle finger still hurts.

Back 81

“phantom limb pain”

Front 82

Acute vs Chronic pain

ex: low back pain

Back 82

chronic pain

Front 83

Acute vs Chronic pain

no identifiable cause

Back 83

chronic pain

Front 84

Acute vs Chronic pain


serves no biological purpose

Back 84

chronic pain


..after the initial warning signal of pain, the body must learn to adapt to the persistent pain impulses by blocking or adjusting to the SNS response, because of this adaptation, the symptoms associated with acute pain are absent

Front 85

Chronic pain

Cancer pains is caused by a the disease itself:

Back 85

-Nerve compression
-Invasion of tissue
-Bone metastasis
-Tumor invasion
-HIV-related pain

Front 86

Acute vs Chronic pain


-treatment related pain (radiation, surgery, chemotherapy)

Back 86

chronic cancer pain

Front 87

Types of pain:

superficial originates in the skin or SQ tissue, has an abrupt onset with a sharp stinging quality

Back 87

• Cutaneous:

Front 88

Types of pain:

is either visceral or somatic

Back 88

Nociceptive Pain

Front 89

Types of pain:

pain that arises from the skin and musculoskeletal structures

Back 89

Somatic

Front 90

Types of pain:

Somatic
-2 categories under this:

Back 90

-Cutaneous or superficial

-Deep somatic

Front 91

Types of pain:

Originates in skin

Back 91

cutaneous /superficial

Front 92

Types of pain:

Has an abrupt onset, with a sharp, burning, stinging quality

Back 92

cutaneous /superficial

Front 93

ex is a paper cut

Back 93

somatic pain: cutaneous /superficial

Front 94

Types of pain:

Originates in the bone, muscle, blood vessels, connective tissue

Back 94

-Somatic: Deep somatic

Front 95

Types of pain:

Has a slower onset, a burning quality, & lasts long

Back 95

-Deep somatic

Front 96

Types of pain:

ex is a sprained ankle

Back 96

-Deep somatic

Front 97

Types of pain

sharp and burning

Back 97

cutaneous somatic

Front 98

Types of pain


Bony metastases

Back 98

Chronic somatic

Front 99

Types of pain

Low back pain

Back 99

Chronic somatic

Front 100

types of pain


Peripheral Vascular Disease (PVD)

Back 100

Chronic somatic

Front 101

Types of pain


Arthritis (Osteoarthritis and Rheumatoid arthritis)

Back 101

Chronic somatic

Front 102

Types of pain


Incisional Pain

Back 102

Acute post-op somatic

Front 103

Types of pain


Pain at insertion of IVs, catheters, drains

Back 103

Acute post-op somatic

Front 104

Types of pain


skeletal muscle spasms

Back 104

acute somatic

Front 105

Types of pain:

arises from the organs and linings of the body cavities

Back 105

• Visceral

Front 106

Types of pain:

Stimulation of pain receptors in the:
-Abdominal cavity
-Thorax

Back 106

• Visceral

Front 107

Types of pain:

Poor localization
Diffuse

Back 107

• Visceral

Front 108

Types of pain:

splitting, sharp, stabbing

Back 108

• Visceral

Front 109

Types of pain:

Deep cramping, aching, feeling of pressure

Back 109

• Visceral

Front 110

Types of pain:

ex include: chest tube, pancreatitis, bowel obstruction,

Back 110

• Visceral

Front 111

Types of pain:

ex include appendicitis, bladder distension or spasms

Back 111

• Visceral

Front 112

Types of pain


Pancraetitis

Back 112

Chronic Visceral pain

Front 113

Types of pain

Appendicitis

Back 113

Chronic Visceral pain

Front 114

Types of pain


Cholecystitis

Back 114

Chronic visceral

Front 115

Types of pain


Liver metastases

Back 115

Chronic visceral

Front 116

Types of pain

Bladder and bowel distention

Back 116

Post op acute visceral

Front 117

Types of pain

Chest tubes

Back 117

Post op acute visceral

Front 118

Types of pains

abdominal drains

Back 118

Post op acute visceral

Front 119

Types of pain:

chronic non-cancer pains, results from some type of nerve injury. dividend into centrally or peripherally generated pain.

Back 119

• Neuropathic

Front 120

Types of pain:

it is described as burning, shooting, stabbing, and feeling “pins and needles”

Back 120

• Neuropathic

Front 121

Types of pain:

-Results from current or past damage to the nerve fibers, spinal cord, central nervous system

Back 121

• Neuropathic

Front 122

Types of pain:

Characteristics include: long-lasting, poorly localized, shooting, burning, sharp, numb, shock-like

Back 122

• Neuropathic

Front 123

Types of pain:

some ex are: chemotherapy-induced neuropathies

Back 123

• Neuropathic

Front 124

types of pain

Cholecystitis

Back 124

Chronic visceral

Front 125

types of pain

Liver metastases

Back 125

Chronic visceral

Front 126

Types of pain:

Bladder and bowel distention

Back 126

Post op acute visceral

Front 127

Types of pain:

Chest tubes

Back 127

Post op acute visceral

Front 128

Types of pain:

Abdominal drains

Back 128

Post op acute visceral

Front 129

Types of pain:

chronic non-cancer pains, results from some type of nerve injury. dividend into centrally or peripherally generated pain.

Back 129

• Neuropathic

Front 130

Types of pain:

it is described as burning, shooting, stabbing, and feeling “pins and needles”

Back 130

• Neuropathic

Front 131

Types of pain:

-Results from current or past damage to the nerve fibers, spinal cord, central nervous system

Back 131

• Neuropathic

Front 132

Types of pain:

Characteristics include: long-lasting, poorly localized, shooting, burning, sharp, numb, shock-like

Back 132

• Neuropathic

Front 133

Types of pain:

some ex are: chemotherapy-induced neuropathies

Back 133

• Neuropathic

Front 134

Types of pain:

example is diabetic neuropathy

Back 134

• Neuropathic

Front 135

Types of pain:

Nerve compression: back injury

Back 135

• Neuropathic

Front 136

Types of pain:

HIV related pain,

Back 136

• Neuropathic

Front 137

Types of pain:

chemotherapy and cancer related nerve injuries

Back 137

• Neuropathic

Front 138

Types of pain:

Perceived at the source of pain and extends into nearby tissues

Back 138

• Radiating

Front 139

Types of pain:

An example being: Cardiac pain that goes down the left shoulder and arm

Back 139

• Radiating

Front 140

Types of pain:


diffuse pain around the site of origin that is not well localized

Back 140

• Radiating

Front 141

Types of pain:

Perceived in an area distant from the site of painful stimuli

Back 141

• Referred

Front 142

Types of pain:

Ex. pain in your gallbladder that is felt in your right shoulder

Back 142

• Referred

Front 143

Types of pain:

o Moderate to severe pain that cannot be relieved by any known treatment, or pain that is highly resistant to relief methods

Back 143

• Intractable

Front 144

Types of pain:

Nurses are challenged to use a variety of pharmacologic & non-pharmacologic methods of relief

Back 144

• Intractable

Front 145

Types of pain:


o Example: Advanced Bone Cancer Pain –as the tissue becomes destroyed, the pain becomes worse

Back 145

• Intractable

Front 146

Types of pain:

chronic pain that cannot be managed using standard therapies

Back 146

• Intractable

Front 147

Types of pain:

Phantom
-Considered acute form
true or false

Back 147

true

Front 148

Types of pain:

mastectomy & tooth extractions

Back 148

• Phantom

Usually pain that follows a limb amputation

Front 149

Types of pain:

A type of neuropathic pain

Back 149

• Phantom

Front 150

Types of pain:


Specific cause is unknown, but research suggests that is a somatosensory “memory” that does not reside in a specific region of the CNS, but may involve complex interactions of neural networks in the brain

Back 150

• Phantom

Front 151

Definitions for narcotics: Addiction, Physical dependence, and Tolerance

persistent craving for and abuse of a drug for recreational reasons

Back 151

Addiction

Front 152

Definitions for narcotics: Addiction, Physical dependence, and Tolerance

it is a psychological phenomenon, not a physical one.

Back 152

Addiction

Front 153

Definitions for narcotics: Addiction, Physical dependence, and Tolerance

-characterized by impaired control over drug use, compulsive use, continued use despite harm and craving

Back 153

Addiction

Front 154

Definitions for narcotics: Addiction, Physical dependence, and Tolerance

a physiological adaptation of the body tissues so that continued administration of the drug is required for normal tissue function.

Back 154

Physical dependence

Front 155

Definitions for narcotics: Addiction, Physical dependence, and Tolerance


Withdrawal is suffered if drug is discontinued!

Back 155

Physical dependence

Front 156

Definitions for narcotics: Addiction, Physical dependence, and Tolerance

common physiologic result of chronic opioid use; larger doses of opioid are required to achieve the same level of analgesia

Back 156

Tolerance

Front 157

Definitions for narcotics: Addiction, Physical dependence, and Tolerance

Ex: cancer pt. in order to get the same effect they need more of the drug

Back 157

Tolerance

Front 158

Definitions for narcotics: Addiction, Physical dependence, and Tolerance

a state of adaptation in which exposure to a drug induces changes that result in a decrease in one or more of the drugs effects over time

Back 158

Tolerance

Front 159

What types of therapies are considered complementary therapies for pain management

Back 159

non pharmacologic pain management

Front 160

What is adjunctive pain management?


what are some examples of medications used for this?

Back 160

enhances the effects of opioids and lessens anxiety

antidepressants, muscle relaxers, and Antianxiety (Tegretol, Dilantin, Neurotin, elavil, Zoloft, and Paxil

Front 161

Types of pain

dull

Back 161

deep somatic pain

Front 162

Types of pain

cramping

Back 162

deep somatic

Front 163

Types of pain

aching

Back 163

deep somatic

Front 164

Types of pain

spained ankle

Back 164

deep somatic

Front 165

Types of pain

deep cramping

Back 165

visceral pain

Front 166

Types of pain

splitting

Back 166

visceral

Front 167

Types of pain


stabbing

Back 167

visceral

Front 168

Types of pain

pressure

Back 168

visceral

Front 169

Types of pain

bowel obstruction

Back 169

visceral

Front 170

Types of pain

shooting

Back 170

neuropathic

Front 171

Types of pain

fiery

Back 171

neuropathic

Front 172

Types of pain

shock like

Back 172

neuropathic

Front 173

Types of pain

numb

Back 173

neuropathic

Front 174

General lab values for: (adult Male)

Bicarb

Glucose

Back 174

Bicarb 22-29 mEq/L

Glucose: 70-100 mg/dl

Front 175

General lab values for: (adult Male)

BUN

Creatinine

Back 175

BUN: 7-25 mg/dl
-BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down.

A test can be done to measure the amount of urea nitrogen in the blood.
-done to check kidney function





Creatinine: 0.7-1.4mg/dl
-The test is done to evaluate kidney function. Creatinine is removed from the body entirely by the kidneys

Front 176

assessing pain in children:

what would you expect a toddler to say

Back 176

have a limited vocabulary
difficulty making comparisons

Front 177

assessing pain in children:

what would you expect a toddler to look like: (4)

Back 177

crying

rocking (unconscious comfort to reduce stress and anxiety inside themselves)


not wantign to be touched- withdrawing

behavior changes

Front 178

assessing pain in children:

what would you expect a preschooler to say

Back 178

they can describe pain but have trouble with intensity

Front 179

assessing pain in children:

what would you expect a preschooler to look like: (3)

Back 179

gritting teeth

covering painful areas with hands

unusual behavior