Nur 352 - Quiz 1 (Pain & Perioperative Nursing)

Front 1

THE MOST RELIABLE INDICATOR OF PAIN

Back 1

SELF-REPORT OF PATIENT

Front 2

PHYSIOLOGIC PROCESS THAT COMMUNICATES TISSUE DAMAGE TO THE CENTRAL NERVOUS SYSTEM

Back 2

NOCICEPTION

Front 3

MYELINATED FIBERS THAT MOVE PAIN IMPULSES ALONG VERY QUICKLY; OFTEN TRANSMIT SHARP PIERCING, LOCALIZED PAIN THAT TENDS TO BE INTERMITTENT

Back 3

A DELTA FIBERS

Front 4

UNMYELINATED FIBERS THAT MOVE PAIN IMPULSES ALONG SLOWER AND MORE DIFFUSELY; OFTEN TRANSMIT DULL, ACHY, CRAMPING PAIN THAT TENDS TO BE PERSISTENT

Back 4

C FIBERS

Front 5

Theory that suggests that the spinal cord contains a neurological "gate" that either blocks pain signals or allows them to continue on to the brain. Unlike an actual gate, which opens and closes to allow things to pass through, the "gate" in the spinal cord operates by differentiating between the types of fibers carrying pain signals. Pain signals traveling via small nerve fibers are allowed to pass through, while signals sent by large nerve fibers are blocked. It is often used to explain phantom or chronic pain.

Back 5

Gate Control theory

Front 6

These are thought to be responsible for opening and closing the "gates" noted in the Gate Control Theory of pain.

Back 6

Endorphins

Front 7

Why does distraction work to reduce pain in terms of the gate control theory?

Back 7

Distractions are thought to produce endorphins, which are thought to be responsible for controlling the gates in gate control theory.

Front 8

Ibuprofen inhibits these at the transduction stage of pain

Back 8

Prostaglandins

Front 9

Acute pain, often associated with injury; often sharp and burning pain

Back 9

Nociceptive pain

Front 10

This type of pain runs along nerve fibers (ex. phantom limb pain)

Back 10

Neuropathic pain

Front 11

This type of pain serves a biological purpose by acting as a warning sign; activates SNS; time-limited (less than 3 months or time for normal healing to occur); includes post-operative, labor, and trauma pain; treatment goal is pain control with eventual elimination

Back 11

Acute pain

Front 12

This type of pain does not go away; lasts greater than 3 months, difficult to localize, treat, determine underlying cause; treatment focuses on control while enhancing function and improving quality of life; gradual onset; characterized by waxing and waning

Back 12

Chronic pain

Front 13

This type of pain involves aching or throbbing that is localized; the result of injury to bones, joints, muscles, skin, or connective tissue

Back 13

Somatic pain

Front 14

This type of pain involves tumors or obstruction; arises from internal organs such as intestines and bladder

Back 14

Visceral pain

Front 15

This type of pain involves damage to the peripheral nerves or CNS; often burning, shooting, stabbing, or electrical in nature; sudden, intense, short-lived, or lingering

Back 15

Neuropathic pain

Front 16

The differences between acute pain and chronic pain are based on ___

Back 16

Cause, course, manifestation, and treatment

Front 17

This type of pain is transient, moderate to severe, occurs beyond treated pain, has rapid onset and brief duration, and exists through med treatment

Back 17

Breakthrough pain

Front 18

Pain treatment is best achieved with (drug/nondrug) therapy.

Back 18

Drug and nondrug (combination)

Front 19

Three categories of meds for pain treatment

Back 19

Nonopioid, opioid, and adjuvant (co-analgesic)

Front 20

This is when increasing the dose of meds above the upper limit produces no greater analgesia (Nonopioids)

Back 20

Analgesic ceiling

Front 21

Nonopioids are used for (mild/moderate/severe) pain

Back 21

Mild to moderate

Front 22

True or false - nonopioids do not produce tolerance or addiction

Back 22

True

Front 23

Advantages and disadvantages of ASA for pain treatment

Back 23

Advantages - also an anti-inflammatory; good for cardiac disease; does not produce tolerance or addiction

Disadvantages - can produce GI bleed and inhibits clotting

Front 24

Maximum dose of Acetaminophen per day

Back 24

4 g (4000 mg) per day

Front 25

Adverse effect of Ibuprofen related to sodium

Back 25

May cause hypernatremia (high sodium, causing water retention)

Front 26

This type of pain med binds to receptors in the CNS, inhibiting the transmission of nociceptive input, altering limbic activity, and activating descending inhibitory pathways

Back 26

Opioids

Front 27

Examples of pure agonist opioids with no analgesic celing

Back 27

Morphine, oxycodone, and codeine

Front 28

This ingredient in cough medicine and antitussives is converted to morphine in the body

Back 28

Codeine

Front 29

Advantages and disadvantages of partial agonist opioids

Back 29

Advantages - Less respiratory depression

Disadvantages - more dysphoria, agitation; has analgesic ceiling; can precipitate withdrawal

Front 30

Common side effects of opioids

Back 30

Most common - constipation (decreases peristalsis)

Also - nausea and vomiting (usually decreases after 24 hours), sedation, respiratory depression, pruritis

Front 31

Given to patients experiencing pruritis from taking opioids

Back 31

Narcan (reverses effects of opioids) - given IV push

Front 32

Given to patients experiencing nausea and vomiting from taking opioids

Back 32

Antiemetics

Front 33

Side effects of using PCA (Patient-Controlled Analgesia)

Back 33

Inability to void; nausea and vomiting; pruritis; other symptoms associated with opioids

Front 34

Most common type of PCA

Back 34

Demand dose PSA (patient administers to self when needed)

Front 35

This is a form of continuous dosing PCA

Back 35

Basal dose

Front 36

Lockout intervals for PCA

Back 36

Patient given preset dose at preset intervals (ex. every 10 minutes)

Front 37

These are used in conjunction with opioids and nonopioids (combination therapies); generally used for other purposes but also effective for pain; examples include antidepressants, antiseizure meds, etc.

Back 37

Adjuvant therapies

Front 38

These types of drugs can be used in combination with opioids/nonopioids for neuropathic pain

Back 38

Antiseizure meds

Front 39

Why are beta blockers given in conjunction with pain meds to manage pain?

Back 39

Reduces tachycardia, sweatiness, and SNS symptoms associated with pain

Front 40

Constant pain requires med administration at what intervals?

Back 40

Around the clock (not PRN - do not wait for severe pain to develop)

Front 41

The route of choice for pain administration with functioning GI tract

Back 41

Oral

Front 42

This route of med administration for pain exempts drug from first-pass effect

Back 42

Sublingual and buccal

Front 43

When administering pain meds to the elderly, what is the general rule of thumb for dosage?

Back 43

Start slow, go low - use half of lowest recommended dose for elderly population and adjust from there

Front 44

What is the least frequently used route of med administration for pain management? Why?

Back 44

IM - poorly absorbed and many side effects

Front 45

This type of interventional pain therapy interrupts all afferent and efferent transmission, not only nociceptive input; used during and after surgery to manage pain

Back 45

Nerve blocks

Front 46

This type of interventional pain therapy is used for severe pain unresponsive to other therapy; it destroys nerves to stop pain transmission

Back 46

Neuroablative techniques

Front 47

This type of interventional pain therapy is usually for intractable back pain; it involves electrical stimulation of brain and spinal cord

Back 47

Neuroaugmentation

Front 48

Nondrug therapies for pain

Back 48

Massage, exercise, TENS or PENS, acupuncture, heat or cold therapy, cognitive therapies (distraction, hypnosis, imagery, relaxation); these all increase endorphins, decrease edema; advised to use in combination

Front 49

Common concerns for pain meds

Back 49

1. Tolerance
2. Physical dependence (over time with opioids)
3. Addiction (occurs over long period with psychological aspect)

Front 50

JCAHO guidelines for pain

Back 50

1. Recognize patient's rights
2. Identify pain
3. Educate providers, patients, and families in assessment and managemetn

Front 51

Ethical issues in pain management

Back 51

1. Fear of hastening death by administering analgesics
2. Requests for assisted suicide
3. Use of placebos in pain assessment and treatment (cannot give without permission)

Front 52

Three phases of perioperative nursing

Back 52

Preoperative, intraoperative, postoperative

Front 53

Phase of perioperative nursing that includes the period of time from the decision for surgery until the patient is transferred into the OR

Back 53

Preoperative phase

Front 54

Phase of perioperative nursing that includes the period of time when the patient is transferred to the OR to the admission to the post-anesthesia care unit (PACU)

Back 54

Intraoperative phase

Front 55

Phase of perioperative nursing that involves the period of time when the patient is admitted to the PACU and ends with the follow-up evaluation in the clinical setting or at home

Back 55

Postoperative phase

Front 56

If a patient scheduled for surgery is a smoker, when should the nurse listen to lung sounds?

Back 56

Before surgery (admission to OR) and after (compare)

Front 57

How may complementary and alternative medicine impact surgery?

Back 57

Some therapies may cause bleeding, etc

Front 58

At what age is a patient at risk for age-related complications from surgery?

Back 58

65

Front 59

Rare life-threatening condition triggered by exposure to most anesthetic agents, involving drastic and uncontrolled increase in skeletal muscle oxidative metabolism (breakdown) that can overwhelm body's capacity to supply O2, remove CO2, and regulate body temperature (patient will have high temp); leads to circulatory collapse and death if untreated; often inherited

Back 59

Malignant hyperthermia

Front 60

What types of labs/diagnostic tests should be taken prior to surgery?

Back 60

Urinalysis, blood type and screening, CBC, clotting studies, electrolytes, creatinine and BUN, pregnancy tests, CXR, and ECG (if over 40 or history of heart disease)

Front 61

This common anti-clotting agent is contraindicated for surgical procedures

Back 61

Coumadin (Wayfarin)

Front 62

Why are patients over 65 years of age at increased risk for surgery-related complications?

Back 62

May have chronic illnesses; may have delayed wound healing; often have decreased muscle mass and body water

Front 63

How does body weight affect surgical risk?

Back 63

Malnourishment affects wound healing negatively; obesity increases risk due to absorptive qualities of fat for analgesic meds, decreased mobility due to obesity and increased DVTs, and potential evisceration

Front 64

What parts of the body are more risky for surgical procedures?

Back 64

Neck, oral, facial (highest); chest or high abdomen; abdomen

Front 65

What information must be part of informed consent prior to surgery?

Back 65

Nature and reason for surgery, who will be performing the surgery and who else will be present, all available options and risks with each, risks with surgery and potential outcomes, risks with anesthesia

Front 66

What are nursing safety priorities that go with informed consent?

Back 66

Nurse must clarify facts and dispel myths, verify that consent was signed, and signature must be witnessed

Front 67

What is the purpose of lower extremity exercises post-operatively?

Back 67

Prevent emboli

Front 68

What is the proper technique for splinting post-operatively?

Back 68

Splinting – towel and pillow, held firmly in place over surgical site – 3 slow deep breaths, cough to clear secretions

Front 69

What is the purpose of splinting after surgery?

Back 69

Breathing gets difficult when you break a rib or have surgery between your waist and shoulders. When you move broken bone ends against each other or flex muscles stitched together with wire or twine, you experience pain. Splinting is a way to immobilize or cushion those movements so you can fully expand your lungs or cough with a little less discomfort,

Front 70

Why are patients encouraged to use incentive spirometers post-operatively?

Back 70

To prevent atelectasis

Front 71

Who are the members of the surgical team?

Back 71

Patient; anesthesiologist or anethetist; surgeon and surgical assistant; perioperative nursing staff

Front 72

What zones make up the surgical environment?

Back 72

Unrestricted zone; semirestricted zone; restricted zone

Front 73

All materials in contact with a wound and within a sterile field must be __

Back 73

Sterile

Front 74

Gown are sterile in the front from ___ and sleeves are sterile from ___

Back 74

Chest to level of sterile field; 2 inches above elbow to cuff

Front 75

What part of a draped table is considered sterile?

Back 75

Only the top

Front 76

At least __ (distance) from the sterile field must be maintained.

Back 76

1 foot

Front 77

What are the two aspects of general anesthesia?

Back 77

Analgesia (no pain) and amnesia (no memory)

Front 78

What are the stages of anesthesia?

Back 78

1. Analgesia and sedation, relaxation
2. Excitement and delirium (patient no longer aware; loss of reflexes)
3. Operative anesthesia and surgical anesthesia
4. Danger

Front 79

What are the 4 main complications related to anesthesia during surgery?

Back 79

1. Malignant hyperthermia
2. Overdose
3. Hypoventilation
4. Intubation complications

Front 80

What are the four main positions for surgery?

Back 80

Laparotomy, trendelenberg, lithotomy, side-lying

Front 81

Why are elderly patients at increased risk for complications due to surgery and anesthesia?

Back 81

1. Increased likelihood of coexisting conditions
2. Aging heart and pulmonary systems
3. Decreased homeostatic mechanisms
4. Changes in responses to drugs and anesthetic agents due to aging changes such as decreased renal function, and changes in body composition of fat and water

Front 82

In this surgical environment, this zone represents the open area where scrubs and caps are not required

Back 82

Unrestricted zone

Front 83

In this surgical environment, this zone requires you to wear scrubs and caps but not aseptic technique

Back 83

Semirestricted zone

Front 84

In this surgical environment, this zone requires everyone to maintain aseptic technique; you must wear scrubs, caps, gloves, shoe covers, and masks

Back 84

Restricted zone

Front 85

The environmental controls in OR involve __ air exchanges per hour and a colder environment

Back 85

15

Front 86

This OR nurse coordinates the surgical environment, including getting consent from the patient, maintaining the temperature of the room, initiating a timeout at beginning of the procedure, and is clean but not sterile

Back 86

Circulating nurse

Front 87

This OR nurse is the assistant to the surgeon, handing the surgeon the tools and maintaining aseptic technique; this nurse usually works with the same surgeon for every procedure

Back 87

Scrub nurse

Front 88

What is a surgical "time-out"?

Back 88

At beginning of surgery, the whole OR team stands around patient to discuss what is going on and what they think will happen (WHO - surgical safety checklist); this decreases errors significantly

Front 89

This involves the use of sedation in surgery to depress the level of consciousness without altering the patient's ability to maintain a patent airway and to respond to physical stimuli and verbal commands; involves a hypnotic, a sedative, and an opioid in combination; short-acting

Back 89

Moderate sedation

Front 90

How soon can a patient eat after receiving moderate sedation?

Back 90

30 minutes and not until gag reflex returns

Front 91

What are the advantages and disadvantages of local or regional anesthesia?

Back 91

Advantages - allows patient to participate and has no food restrictions

Disadvantages - not as much control as general anesthesia; short-acting

Front 92

This type of anesthesia produces its effect when inhaled

Back 92

Inhaled anesthetic agents

Front 93

All inhaled anesthetic agents are administered in combination with __ and usually __ as well

Back 93

Oxygen; nitrous oxide

Front 94

Epidural anesthesia is achieved by injecting a local anesthetic agent into the epidural space that surrounds the __ of the spinal cord

Back 94

Dura mater

Front 95

Spinal anesthesia is achieved by injecting a local anesthetic agent through the dura mater into the __ surrounding the spinal cord

Back 95

Subarachnoid space

Front 96

(Epidural/spinal) anesthesia uses higher doses

Back 96

Epidural

Front 97

What is the main advantage of epidural anesthesia over spinal anesthesia? The main disadvantage?

Back 97

No headache; more difficult to introduce the anesthetic agent into the epidural rather than the subarachnoid space

Front 98

This type of anesthesia produces anesthesia of the lower extremities, perineum, and lower abdomen

Back 98

Spinal anesthesia

Front 99

__ may be an after-effect of spinal anesthesia

Back 99

Headache

Front 100

Local anesthesia is often administered in combination with __, which constricts blood vessels, preventing rapid absorption of the anesthetic agent and thus prolongs its local action

Back 100

Epinephrine

Front 101

If a patient gags during the intraoperative period, what is the first intervention the nurse must use?

Back 101

Patient is turned to the side, the head of table lowered, and basin is provided to collect vomitus

Front 102

Why is hypoxia a risk with the use of anesthesia in surgery?

Back 102

Respiratory depression caused by anesthesia, aspiration of respiratory secretions, and patient's positioning on operating table

Front 103

Why may metabolic acidosis occur during surgery?

Back 103

Glucose metabolism is reduced

Front 104

What are the initial symptoms of malignant hyperthermia?

Back 104

Tachycardia (HR faster than 150 bpm); SNS stimulation signs; muscle rigidity

Front 105

True or false - high temperature is one of the earliest signs of malignant hyperthermia

Back 105

False - high temp is one of the late signs

Front 106

What are the general nursing goals for care of a patient during surgery?

Back 106

Reduced anxiety, absence of latex exposure, absence of positioning injuries, freedom from injury, maintenance of patient dignity, and absence from complications

Front 107

In laparotomy position during surgery, a strap is placed ___

Back 107

Above the knees

Front 108

Sims or side-lying position is used for what type of surgery?

Back 108

Renal surgery

Front 109

This is partial or complete separation of wound edges

Back 109

Dehiscence

Front 110

This is the protrusion of organs through the surgical incision

Back 110

Evisceration

Front 111

This method of healing involves a wound whose edges are surgically approximated (with stitches or staples) and integumentary continuity is restored without granulation

Back 111

First intention

Front 112

This is an area where postoperative patients are monitored as they recover from anesthesia; formerly referred to as the recovery room

Back 112

Postanesthesia Care Unit (PACU)

Front 113

This method of healing involves a wound whose edges are not surgically approximated and integumentary continuity is restored by the process known as granulation

Back 113

Second Intention

Front 114

This method of healing involves a wound whose edges are not initially approximated (delayed closing) and integumentary continuity is restored by apposing areas of granulation

Back 114

Third Intention

Front 115

What are the three phases of postanesthesia care?

Back 115

1. Phase 1 PACU (immediate recovery phase, with intensive nursing care)
2. Phase 2 PACU (patient prepared for self-care or care in hospital)
3. Phase 3 PACU (patient is prepared for discharge)

Front 116

How often are vital signs checked after initial assessment in the PACU?

Back 116

Every 15 minutes

Front 117

True or false - a systolic blood pressure of 90 mm Hg in the PACU is considered acceptable

Back 117

False - it is considered immediately reportable

Front 118

What is the primary objective in the immediate postoperative period of the nurse with the patient?

Back 118

Maintain ventilation, thus preventing hypoxemia and hypercapnia; both can occur with hypoventilation (airway is obstructed and ventilation is reduced)

Front 119

Because movement of the thorax and diaphragm does not necessarily indicate the patient is breathing, the nurse needs to do what with a patient who has had prolonged anesthesia?

Back 119

Place palm of hand at the patient's nose and mouth to feel the exhaled breath

Front 120

How is hypopharyngeal obstruction treated after anesthesia?

Back 120

Tilt head back and push forward on angle of lower jaw, as if to push the lower teeth in front of the upper teeth; this pulls the tongue forward and opens the air passages

Front 121

Why does hypopharyngeal obstruction occur?

Back 121

Neck flexion permits the chin to drop toward the chest during surgery; often occurs when head is in midposition, blocking off the airway

Front 122

What are the classic signs of hypovolemic shock?

Back 122

Pallor; cool, moist skin; rapid breathing; cyanosis of lips, gums, and tongue; rapid weak thready pulse; narrowing pulse pressure; low BP; concentrated urine

Front 123

When should a patient void before having surgery?

Back 123

Right before going to the OR

Front 124

What is the rule concerning wearing jewelry during surgery?

Back 124

A patient should not wear any jewelry in the OR; some institutions may allow a ring to be worn if taped to the finger

Front 125

How is the patient's skin prepared prior to surgery?

Back 125

No shaving; clipping of hair may be necessary; patient may be instructed to use a soap containing a detergent-germicide to clean the skin for several days prior to surgery to reduce skin organisms

Front 126

What is the major purpose of withholding fluids and food before surgery?

Back 126

To prevent aspiration

Front 127

What are the new guidelines for food and fluids prior to surgery?

Back 127

Generally, adults may be advised to fast for 8 hours prior to surgery (except for surgery that involves the GI tract); many patients are now allowed to have clear fluids up to 2 hours prior to an elective procedure

Front 128

Why is a patient kept in bed with side rails up after being given preanesthetic medication?

Back 128

May cause drowsiness or lightheadness (fall risk)

Front 129

Why are patients encouraged to cough post-operatively?

Back 129

Mobilize secretions so that they can be removed; prevents atelectasis