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102 Cards in this Set
- Front
- Back
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Referred pain
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Pain perceived in area adjacent to or distant from site of injury
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Visceral pain
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Pain arising from the internal organs
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Somatic pain
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Generally well-localized pain that results from the activation of peripheral nociceptors without injury to the peripheral nerve or central nervous system. It is a type of nociceptor pain. Unlike visceral pain (another type of nociceptor pain), the nerves that detect somatic pain are located in the skin and deep tissues. These specialized nerves, called nociceptors, pick up sensations related to temperature, vibration and swelling in the skin, joints and muscles. Deep somatic pains are initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and are dull, aching, poorly-localized pains; examples include sprains, broken bones and myofascial pain. (Remember the slide of the open fracture.)
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Neuropathic pain
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Peripheral nerves are affected by injury or disease, causing pain that is generally more difficult to treat.
Symptoms often include a painful burning or lancinating (cutting, stabbing) sensation, numbness, paresthesis (“pins and needles”) Treated with certain types of anticonvulsants (Gabapentin) or antidepressants, along with other traditional pain meds. |
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Pain Ladder
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First Rung: Non-Opioid, ie aspirin, tylenol, NSAIDs
Second Rung: Add opioids for mild to moderate pain, ie Codeine Third Rung: Add opioids for moderate to severe pain, ie morphine, oxycodone, fentanyl |
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Cycle of Chronic Pain
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Increased pain - Anxiety - Sleeping Problems - Not Coping
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Lancinating
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cutting, stabbing pain
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Parasthesis
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pins and needles
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Treatment for Neuropathic Pain
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Anticonvulsants (Gabapentin)
Antidepressants Pain Medication |
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NSAIDs
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Acetylsalicylic Acid (Aspirin)
Ibuprofen (Motrin, Advil, etc) Ketoprofen Naproxen (Aleve) Celecoxib (Celebrex) |
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Opiod vs. Opiate
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Opiod: drug with action similar to morphine
Opiate: applies only to compounds found in opium (morphine, codeine) |
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Opiod Receptors
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Mu, Kappa, Delta
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Strong Opiods
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Morphine, Fentanyl, Methadone, Meperidine (Demerol)
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Moderate Opiods
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Codeine, Hydrocodone + Ibuprofen or Acetaminophen
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Hydrocodone + Acetaminophen
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Vicodin, Norco
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Hydrocodone + Ibuprofen
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Vicoprofen
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Morphine's Mechanism of Action (MOA)
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Binds to opioid receptors (Mu Receptors) in the CNS, mimics the action of endogenous opioid peptides (such as endorphin)
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Side Effects of Morphine
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Respiratory Depression, Sedation, Decreased GI Motility, Cough Suppression, Urinary Retention, Orthostatic Hypotension, Pruritis, Emesis, Miosis (Pinpoint Pupils)
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Miosis
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pupillary constriction
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Signs of Neurotoxicity with Morphine
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Delirium, agitation, myoclonus (twitching)
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Abstinence Syndrome
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Effects when a opioid is abruptly stopped: flu-like symptoms = goose bumps, abdominal craps
Taper over 3 - 7 days |
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Drug Enforcement Agency (DEA) Schedules
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Schedule I: No Medical Purpose
Schedule 2: Morphine Schedule 3: Vicodin Schedule 5: Limited Abuse Potential |
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Oxycodone + Aspirin
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Percodan
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Oxycodone + Acetaminophen
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Percocet
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Oxycodone + Ibuprofen
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Combunox
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Equianalgesic dose of an opiod =
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10 mg of Morphine Parenteral
Ex. Equianalgesic Does of Oral Morphine = 30 mg |
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Meperidine (Demerol)
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short half life, duration of action is 2 - 4 hours, with continuous use = dysphoria, irritability, tremors, and seizures, no more than 600 mg/24 hours, no longer than 24 hours, not good for chronic pain
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Pure Opioid Antagonist
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Naloxone: can reverse respiratory depression, coma, analgesia, and other effects of pure opioid agonists
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Gene Mutation
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Biochemical event such as nucleotide change, deletion, or insertion that produces a new allele
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Polymorphism
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a gene with more than one normal allele at the same locus
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Karyotype
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The total chromosomal characteristics of a cell; or the micrograph of chromosomes arranged in pairs in descending order of size
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Example of Autosomal Dominant Disorder
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Marfar
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Electrolytes
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substances that dissociate in a solution to form ions (charged particle)
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Lab Values: Sodium
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135-145 mEq/L
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Lab Values: Potassium
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3.5-5.0 mEq/L
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Lab Values: Chloride
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98-106 mg/dL
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Lab Values: Bicarbonate
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24-31 mg/dL
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Calcium
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8.5-10.5 mg/dL
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Magnesium
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1.8-3.0 mg/dL
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Hydrostatic Pressure
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Pushing force exerted by a fluid
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Colloidal Osmotic Pressure
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Pulling force of plasma proteins that cannot pass through the capillaries
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Transcelluar Spaces
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3rd Spacing: Pleural Effusion, Pericardial Effusion, Ascites
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Osmolarity
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The concentration of osmotically active particles in solution expressed in osmols or milliosmols per liter of solution.
Ex: Salt water has a higher osmolarity than fresh water |
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Normal Obligatory Urine Output
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300-500 ml/24 hrs
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Hypodipsia
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Disorder causing diminished thirst
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Normal Feedback Mechanism for Fluid Balance
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Increased Extracellular water volume - Increased Blood Volume - Decreased Secretion of ADH - Decreased Reabsorption of Water by the Kidney - Extracellular Water Volume returns to normal
Increased Extracellular Water Volume - Decreased Serum Osmolarity - Decreased Thirst - Decreased Water Ingestion - Extracellular Water Volume returns to normal |
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Examples of Isotonic Fluid Loss and Treatment
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Vomiting, Diarrhea, Misuse of Diuretics
Treatment: Intravenous (IV) Fluid replacement with Isotonic (0.9% Saline) |
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Examples of Hypertonic Fluid Loss and Treatment
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More water is lost than sodium: Osmotic Diuresis, Excessive Sweating, Loss of Thirst Sensation, Being Unable to obtain/drink fluids
Treatment: drinking plain water or IV of Dextrose 5% in Water (D-5-W) |
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Examples of Hypotonic Fluid Loss and Treatment
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More sodium is lost than water: Excess Renal Losses of Sodium, aldosterone deficiency
Treatment: if mild, IV of 0.9 Saline (normal saline), if severe, a 3% solution of sodium might be ordered |
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Causes of Fluid Volume Excess
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Impaired Kidney Function - decreased urine output
Heart Failure (Cardiac Insufficiency) Excessive intake of water and sodium Fluid retention related to stress response |
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Clinical Findings of Fluid Volume Excess
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Acute Weight Gain, Increased blood pressure related to increased vascular volume, Bounding pulses, possible dyspnea (shortness of breath), JVD, edema
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Hematocrit
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Hct or Crit: blood test that shows the % or proportion of RBCs to fluid
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Normal Urine Specific Gravity
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1.010 - 1.025
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3 Examples of Diuretics
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Furosemide (Lasix)
Hydrochorothiazide (HCTZ) Spironlactone (aldactone) |
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Etiologies of Edema
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Increased hydrostatic pressure
Lowered plasma oncotic pressure Increased capillary permeability Lymphatic channel obstruction |
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Lasix:
Generic Name Mechanism of Action |
Furesomide
Blocks sodium and chloride reabsorption in the ascending loop of Henle |
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Lasix:
Adverse Effects |
Hyponatremia, hypochloremia, and dehydration; dry mouth, thirst, and oliguria; hypotension (monitor before giving); hypokalemia (check levels before giving); ototoxicity
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Lasix: Drug Interactions
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Drug interactions: digoxin induced dysrhythmias when hypokalemia is present; ototoxicity is increased with other ototoxic drugs such as aminoglycosides
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Other Strong Diuretics
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Edecrin (ethacrynic acid)
Bumex bumetanide) Demedex (torsemide) |
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Thiazide Diuretics:
Examples Method of Action |
hydrochlorothiazide Hydrodiuril
MOA: Blocks reabsorption of sodium and chloride in distal convoluted tubule |
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Thiazide vs Lasix
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Thiazides produce much less loss of urine
Lasix can cause ototoxicity |
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PIH
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Pregnancy Induced Hypertension
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Potassium Sparing Diuretics:
Examples Mechanism of Action Adverse Effect |
Spironolactone (aldactone)
MOA: Blocks the actions of aldosterone in the distal nephron, inhibits sodium uptake in exchange for postassium secretion. Not as much diuresis as thiazides. Adverse Effect: Hyperkalemia |
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Symptoms of Hyponatremia
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Muscle cramping and weakness
Abdominal cramping, N/V Headache Confusion Lethargy Seizures Coma Death |
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Hypernatremia: Signs and Symptoms
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Thirst
Oliguria (inability to form urine) Decreased skin turgor Decreased salivation Headache Agitation Decreased reflexes Seizures Coma Death |
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Hypokalemia: Signs and Symptoms
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Decreased urine specific gravity
Abdominal distention Constipation Diminished bowel sounds Postural hypotension Skeletal muscle weakness Paralysis Heart dysrhythmias Polyuria Confusion |
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Causes of Hypokalemia
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Anorexia
NPO (nothing by mouth) Unbalanced diet Potassium wasting diuretics Diarrhea Emesis Gastric suction |
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Treatment of Hypokalemia
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Replacement with potassium-containing foods when appropriate.
Replacement with oral supplements or intravenously K-Dur Intravenous Potassium Chloride |
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Potassium Indications
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Can be given both IV and oral
MUST be diluted when giving IV or will always cause death NEVER push potassium IV, must be given by IV infusion |
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Hyperkalemia Signs and Symptoms
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Nausea
Vomiting Intestinal cramps Diarrhea Heart dysrhythmias-cardiac conduction affected Muscle weakness Decreased neuromuscular excitability |
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Causes of Hyperkalemia
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Decreased renal function
Potassium IV fluid: too much or too fast Crushing injury Potassium sparing diuretics Excessive oral ingestion |
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Treatment of Hyperkalemia
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Hold potassium-containing foods and
potassium-sparing medications Sodium polystyrene (Kaexalate) Combination of glucose and insulin Calcium gluconate |
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Causes of Hypocalcemia
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Insufficient intake of calcium and vitamin D
Pancreatitis Steatorrhea Chronic diarrhea (including laxative abuse) Hypoparathyroidism |
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Hypocalcemia: Signs and Symptoms
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Neuromuscular irritability
Paresthesias Muscle cramping Hyperactive reflexes Tetany Hypotension Cardiac dysrhythmias |
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Treatment for Hypocalcemia
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Calcium chloride
Calcium gluconate |
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Hypercalcemia: Signs and Symptoms
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Anorexia
Nausea Emesis Constipation Fatigue Muscle weakness Decreased neuromuscular excitability Headache Stupor Cardiac dysrhythmias (ventricular) |
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Causes of Hypercalcemia
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Vitamin D overconsumption
Hyperparathyroidism Bone tumors Increased intestinal absorption of calcium secondary to large amounts of vitamin D |
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Treatment of Hypercalcemia
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Correct underlying cause of serum calcium excess
Promote urinary excretion of calcium Calcitonin |
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Causes of Hypomagnesium
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Malabsorption of magnesium
Malnutrition Chronic alcoholism Diuretic therapy Hyperparathyroidism Diabetic ketoacidosis Pancreatitis |
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Signs and Symptoms of Hypomagnesemia
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Tetany
Personality changes Nystagmus Choreiform movements Trousseau signs + Babinski |
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Medications to treat Hypomagnesemia
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Magnesium hydroxide (Milk of Magnesia)
Magnesium Sulfate |
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Causes of Hypermagnesemia
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Excessive intravenous (IV) administration of magnesium
Excessive oral intake of magnesium-containing medications (e.g. antacids) Kidney disease |
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Signs and Symptoms of Hypermagnesemia
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Lethargy
Hyporeflexia Confusion Drowsiness Coma Hypotension Respiratory depression Cardiac arrhythmias Cardiac arrest |
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Treatment of Hypermagnesemia
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Cessation of magnesium administration.
Administration of calcium |
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Lab Values: Plasma Protein (albumin)
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3.4 - 4.7g/dL
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Normal Hematocrit
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Men 40-50%, Women 37-47%
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Urethrovesical reflux
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urine from the urethra is drawn back into the bladder due to increases in intra-abdominal pressure from coughing, sneezing.
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Vesicoureteral reflux
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urine from the bladder moves into the ureters due to defects of the ureter.
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Cystitis
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urinary bladder infection
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Medications used to treat UTIs
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Trimethoprim/Sulfamethoxazole
(Bactrim, Septra) Nitrofurantoin (Macrodantin, Macrobid) |
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Renal Calculi
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Kidney Stones
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4 Types of Kidney Stone
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calcium
magnesium ammonium uric acid cystine |
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ESRD
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End Stage Renal Disease
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CRF
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Chronic Renal Failure
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Causes of Chronic Renal Failure
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Conditions that cause permanent loss of nephrons:
Diabetes Hypertension Glomerulonephritis Systemic lupus erythematosus Polycystic kidney disease |
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Stages of Chronic Kidney Disease
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1. Damage with normal or increased GFR
2. Mild reduction of GFR to 60–89 mL/min/1.73 m2 3. Moderate reduction of GFR to 30–59 mL/min/1.73 m2 4. Severe reduction in GFR to 15–29 mL/min/1.73 m2 5. Kidney failure with a GFR < 15 mL/min/1.73 m2 , with a need for renal replacement therapy |
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A-Delta Fiber vs. C-Fiber
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A-Delta: cold, pressure, convey pain fast
C-Fiber: convey slow, burning pain |
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Sensory/Discriminative Pain
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Sense of the intensity, location, quality and duration of the pain
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Motivational/Affective Pain
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Unpleasantness and urge to escape the unpleasantness
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Cognitive/Evaluative Pain
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Cognitions such as appraisal, cultural values, distraction and hypnotic suggestion
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Neosplinothalamic vs Paleosphinothalamic
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Neo=fast
Paleo=slow |
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Hereditary Deficiency in a1-antitrypsin
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2nd most common cause of COPD
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