S17 Skills Exam 2

Front 1

Who is the best person to tell you about a patients pain?

Back 1

The patient's self-report is the most reliable indicator of the existence and intensity of pain. (Perry 347)

Front 2

How do you assess for pain?

Back 2

PQRTSU

0/10 scale

Vital signs are not sensitive indicators for the presence of pain. (Perry 346)

Select an appropriate scale for each patient (e.g., visual analog scale or FACES scale); no one scale is required for all specific groups of patients. (Perry 346)

Front 3

Do different cultures share pain differently?

Back 3

Yes

The preferred pain rating scale depends on a patient's cognitive and physical ability, culture, developmental level, and availability. (Perry 347)

Pain assessment tools, along with explanations of how to use them, are now available in many different languages (Pasero and McCaffery, 2011). Cultures vary in recognition of pain, expression of pain, when to seek treatment, and what treatments are desirable. For example, some cultures tend to be stoic, whereas others tend to be more expressive.

Be sure to assess for cultural, ethnic, and genetic variations in tolerance and metabolism of analgesics and other medications (Manougian, 2010; Tennant, 2010). Be aware of cultural variables that may influence the operation of equipment such as PCA pumps. For example, Orthodox Jews may not use electrical equipment during the Sabbath and Holy Days; thus alternative methods of pain relief are needed during these times (Spector, 2008).

Explore a patient's beliefs about pain/discomfort. For example, cultures with a holistic worldview of health and illness mix religious/spiritual, natural (hot and cold), and the supernatural in their belief systems. When necessary use an interpreter to explain the pain tools and help a patient report the pain. (Perry 347-348)

Front 4

Is pain medication a type of

pharmacologic or non-pharmacologic intervention?

Back 4

pharmacologic

Front 5

What are types of non-Pharmacologic interventions?

Back 5

Massage (Perry 366)

Heat and Cold (Perry 367)

Relaxation (Perry 367)

Distraction (Perry 367)

Acupuncture

Front 6

Aspects of a back massage?

Back 6

Read up on it! (Skills 368)

Front 7

Effleurage

Back 7

Massaging upward and outward from vertebral column and back again (see illustration)

Front 8

Pétrissage

Back 8

Kneading tense muscle groups promotes relaxation and stimulates local circulation. (Perry 369)

Front 9

Addiction

Back 9

A primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addictive behaviors include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Front 10

Physical Dependence

Back 10

A state of adaptation that is manifested by a drug class–specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of an opioid, and/or administration of a drug that can act as an antagonist.

Front 11

Drug tolerance

Back 11

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

Front 12

Which is better? Non-pharm vs pharm

Back 12

One is not better then the other.

Using an integrated approach that considers both pharmacologic and nonpharmacologic therapies in managing pain is recommended (Perry 347)

Front 13

What is a chemical drug name?

Back 13

The chemical name describes the drug composition and molecular structure, such as N-acetyl-para-aminophenol, commonly known as Tylenol. The chemical name provides an exact description of its composition and molecular structure. It is rarely used in clinical practice. (Perry 473-474)

Front 14

Generic name for a drug

Back 14

The generic name is the official name that is listed in official publications (Perry 474)

A manufacturer who first develops a medication provides the generic name (e.g., acetaminophen is the generic name for Tylenol). (Perry 474)

Front 15

Trade or brand name for a drug

Back 15

A medication trade name or brand name is used to market the medication. The trade name has the symbol™ at the upper right of the name, indicating a manufacturer trademark of the name (e.g., Panadol™, Tempra™, Tylenol™). (Perry 474)

Front 16

Therapeutic Effects

Back 16

Each medication has a therapeutic effect, the intended or desired physiologic response of a medication. For example, you administer morphine sulfate, an analgesic, to relieve a patient's pain. Sometimes a single medication has many therapeutic effects. For example, aspirin relieves pain and reduces fever and tissue inflammation. Knowing the desired therapeutic effect for each medication allows you to provide patient education and accurately evaluate its desired effect. (Perry 474-475)

Front 17

Side Effects

Back 17

Every medication has the potential to harm a patient. No medication is totally safe and absolutely free of nontherapeutic effects. Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic drug dose. They are either harmless or cause injury. The intensity of side effects is often dose dependent. If the side effects are serious enough to outweigh the benefits of the therapeutic action of a medication, the prescriber will likely discontinue the medication. Patients commonly stop taking medications because of side effects such as anorexia, nausea, vomiting, dizziness, drowsiness, dry mouth, constipation, and diarrhea.

Front 18

Adverse Effects

Back 18

Adverse drug events or effects (ADEs) are unintended, undesirable, and often unpredictable. Unfortunately, although they sometimes are apparent immediately, they often take weeks or months to develop.

Front 19

Toxic Effects

Back 19

Toxic effects develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. Excess amounts of a medication within the body sometimes have lethal effects, depending on the action of the medication.

For example, toxic levels of morphine, an opioid, cause severe respiratory depression and death. Antidotes are available to treat specific types of medication toxicity. For example, naloxone (Narcan), an opioid antagonist, reverses the effects of opioid toxicity. (Perry 476)

Front 20

Idiosyncratic Reactions

Back 20

Medications sometimes cause unpredictable effects such as an idiosyncratic reaction, in which a patient overreacts or underreacts to a medication or has a reaction different from normal. Predicting which patients will have an idiosyncratic response is impossible. For example, lorazepam (Ativan) is an antianxiety medication that may cause agitation and delirium when given to an older adult. (Perry 476)

Front 21

Allergic Reactions

Back 21

Allergic reactions also are unpredictable responses to a medication. Exposure to an initial dose of a medication causes a patient to become sensitized immunologically. The medication acts as an antigen, which causes antibodies to be produced. With repeated administration a patient develops an allergic response to the drug, its chemical preservatives, or a metabolite. An allergic reaction ranges from mild to severe, (Perry 476)

Front 22

Can you give tylenol for a headache?

Back 22

No, you can only give it for pain.

this was a tricky question shaunna taught us. Technically we do give tylenol for headaches, but its prescribed for the pain that comes from headaches.

Front 23

What is a trailing zero?

Is that ok to have?

Back 23

Never use a trailing zero (e.g., 1.0 mg) and always include a zero before a decimal point (e.g., 0.1 mL) (Perry 480)

Front 24

If you are about to give the patient a medication and you notice a discrepancy, what do you do?

Back 24

Clarify with the physician

Front 25

Oral (P.O.)

Sublingual (SL)

Buccal

Parenteral

Insertion

Instillation

Inhalation

Intranasal

Topical

Transdermal

Percutaneous

Back 25

Oral (P.O.).

Oral medication is administered by mouth (e.g., tablets, capsules, caplets, liquid solutions).

Sublingual (SL).

Sublingual medications are placed under the tongue and designed to be readily absorbed through the blood vessels in this area. They should not be swallowed. Nitroglycerin is an example of a medication commonly administered by the sublingual route.

Sustained-release (SR), extended-release (XL), or delayed-release (DR) tablets or capsules release medication into the bloodstream over a period of time at specific intervals. Therefore, these forms of medication should not be opened, chewed or crushed.

Buccal.

Buccal tablets are placed in the mouth against the mucous membranes of the cheek where the medication will dissolve. The medication is absorbed from the blood vessels of the cheek. Clients should be instructed not to chew or swallow the medication and not to take any liquids with it. Medications administered by the oral route will be discussed in more detail in Chapter 17, Calculation of Oral Medications.

Parenteral.

Parenteral medications are administered by a route other than by mouth or gastrointestinal tract. Parenteral routes include intravenous (IV), intramuscular (IM), subcutaneous (subcut), and intradermal (ID). Parenteral routes will be discussed in more detail in Chapter 18, Parenteral Medications.

Insertion.

Medication is placed into a body cavity, where the medication dissolves at body temperature (e.g., suppositories). Vaginal medications, creams, and tablets may also be inserted by using special applicators provided by the manufacturer.

Instillation.

Medication is introduced in liquid form into a body cavity. It can also include placing an ointment into a body cavity, such as erythromycin eye ointment, which is placed in the conjunctiva of the eye. Nose drops and ear drops are also instillation medications.

Inhalation.

Medication is administered into the respiratory tract, for example, through nebulizers used by clients for asthma. Bronchodilators and corticosteroids may be administered by inhalation through the mouth using an aerosolized, pressurized metered-dose inhaler (MDI). In some institutions, these medications are administered to the client with special equipment, such as positive pressure breathing equipment or the aerosol mask. Other medications in inhalation form include pentamidine, which is used to treat Pneumocystis jiroveci, a type of pneumonia found in clients with acquired immunodeficiency syndrome (AIDS). Devices such as “spacers” or “extenders” have been designed for use with inhalers to allow all of the metered dose to be inhaled, particularly in clients who have difficulty using inhalers.

Intranasal.

A medicated solution is instilled into the nostrils. This method is used to administer corticosteroids, the antidiuretic hormone vasopressin, and a nasal mist influenza vaccine.

Topical.

The medication is applied to the external surface of the skin. It can be in the form of lotion, ointment, or paste. (Morris 138-139)

Percutaneous.

Medications are applied to the skin or mucous membranes for absorption. This includes ointments, powders, and lotions for the skin; instillation of solutions onto the mucous membranes of the mouth, ear, nose, or vagina; and inhalation of aerosolized liquids for absorption through the lungs. The primary advantage is that the action of the drug, in general, is localized to the site of application.

Transdermal.

Transdermal medication, which is becoming more popular, is contained in a patch or disk and applied topically. The medication is slowly released and absorbed through the skin and enters the systemic circulation. These topical applications may be applied for 24 hours or for as long as 7 days and have systemic effects. Examples include nitroglycerin for chest pain, nicotine transdermal (Nicoderm) for smoking cessation, clonidine for hypertension, fentanyl (Duragesic) for chronic pain and birth control patches. (Morris 139)

Front 26

How would you prioritize patients

Back 26

Using Maslows?

Front 27

Who would you not give oral meds to?

Back 27

Aspirations
G tube
Unconsciousness
NPO (nothing by mouth)
people who cant swallow pills
nausea and vomiting

Front 28

If you are disposing of narcotics what do you need to do?

Back 28

Have another nurse witness the disposal.

Front 29

What is a nurse most worried about while giving a new medication. 6 rights of check have all ready been done, and the patient just took the medication.

Back 29

Allergy to the medication

Front 30

Do you hold the medication cup up to your eye level in order to pour medication?

Back 30

No, you put the medication cup on the table and go eye level with it.

Front 31

If a medication is to be given at 9 am, what is your time frame to give the med?

Back 31

30 min before and 30 min after

Front 32

How to protect the patient from aspiration while giving meds.

Back 32

• Assess patient's ability to swallow and cough and check for presence of gag reflex.

• Prepare oral medication in form that is easiest to swallow.

• Allow patient to self-administer medications if possible.

• If patient has unilateral (one-sided) weakness, place medication in stronger side of mouth.

• Administer pills one at a time, ensuring that each medication is properly swallowed before next one is introduced.

• Thicken regular liquids or offer fruit nectars if patient cannot tolerate thin liquids.

• Avoid straws because they decrease control patient has over volume intake, which increases risk of aspiration.

• Have patient hold and drink from a cup if possible.

• Time medications to coincide with mealtimes or when patient is well rested and awake if possible.

• Administer medications using another route if risk of aspiration is severe. (Perry 494-495)

Front 33

what position is best for medication administration with a patient who has a risk for aspiration.

Back 33

Help patient to sitting or Fowler's position. Use side-lying position if he or she is unable to sit. Have patient stay in this position for 30 minutes after administration. (Perry 498)

Decreases risk for aspiration during swallowing. (Perry 498)

Front 34

Would you lay a patient on his back to give him medication?

Back 34

No

Front 35

Know Skill:

Skill 21-4 Instilling Eye and Ear Medications (Perry 509)

Back 35

Skill 21-4 Instilling Eye and Ear Medications (Perry 509)

Front 36

Would you rotate sites for a sub q injection? Or would you keep injecting in the same spot?

Back 36

Rotate sites

Front 37

Read up on heparin

Back 37

Special Considerations for Administration of Heparin

(Perry 557)

Front 38

What is the reason we give 2 liters of oxygen to someone

Back 38

To prevent or treat hypoxia

Front 39

Is 100% o2 saturation what we want?

Back 39

No, that would be bad for COPD patient

Front 40

Which number is bigger? Pounds or Kilograms?

Back 40

1 kilogram = 2.2 pounds.

Front 41

Patient looks like crap and feels like crap. Assuming there are no problems with his ABC's, what is the first thing you should assess?

Back 41

The patients pain