Unit 1

Front 1

Populations at Higher Risk for Poor Pain Assessment

Back 1

1. Infants and children
2. Older adults, especially those cognitively impaired
3. Developmentally disabled children and adults
4. Those with communication problems such as limited English proficiency or limited health literacy
   
5. Those unable to communicate due to the illness or treatment process

Front 2

Enzyme helps to maintain the stomach lining

Back 2

cyclooxygenase-1 (COX-1)

Front 3

Enzyme triggers pain and inflammation

Back 3

cyclooxygenase-2 (COX-2)

Front 4

NSAIDs: Actions

Back 4

thought to work by inhibiting action of enzyme cyclooxygenase responsible for prostaglandin synthesis; NSAIDs inhibit two related enzymes

Front 5

Inhibits only COX-2; less potential for GI adverse reactions

Back 5

Celecoxib

Front 6

NSAIDs: Uses

Back 6

Used for osteoarthritis, rheumatoid arthritis, and other musculoskeletal disorders; mild to moderate pain; primary dysmenorrhea; fever reduction

Front 7

NSAIDs: Adverse Reactions GI

Back 7

Nausea, vomiting, dyspepsia, diarrhea, constipation, epigastric pain, indigestion, abdominal distress or discomfort, intestinal ulceration, stomatitis, jaundice, bloating, anorexia, dry mouth

Front 8

NSAIDs: Adverse Reactions CNS

Back 8

Anxiety, lightheadedness, vertigo, headache, drowsiness, somnolence, insomnia, confusion, depression, stroke, psychic disturbances

Front 9

NSAIDs: Adverse Reactions Cardio

Back 9

Congestive heart failure, decrease or increase in blood pressure, cardiac arrhythmias, myocardial infarction

Front 10

NSAIDs: Adverse Reactions Renal

Back 10

Hematuria, cystitis, elevated blood urea nitrogen, polyuria, dysuria, oliguria, acute renal failure in those with impaired renal function

Front 11

NSAIDs: Adverse Reactions Sensory

Back 11

Blurred or diminished vision, diplopia, swollen or irritated eyes, photophobia, reversible loss of color vision, tinnitus, taste change, rhinitis

Front 12

NSAIDs: Adverse Reactions Hema

Back 12

Neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, aplastic anemia

Front 13

NSAIDs: Adverse Reactions Skin

Back 13

Rash, erythema, irritation, skin eruptions, exfoliative dermatitis, Stevens-Johnson syndrome, ecchymosis, purpura

Front 14

NSAIDs: Adverse Reactions Metabolic

Back 14

Decreased appetite, weight increase or decrease, hyperglycemia or hypoglycemia, flushing, sweating, menstrual disorders, vaginal bleeding

Front 15

Cross-sensitivity

Back 15

if allergic to one NSAID, there is increased risk of allergic reaction to others

Front 16

Ibuprofen Contraindications

Back 16

Hypertension, peptic ulceration, or GI bleeding

Front 17

Celecoxib Contraindications

Back 17

Allergic to sulfonamides, or history of cardiac disease or stroke

Front 18

NSAIDs: Interactions

Back 18

1. Anticoagulants
2. Lithium
3. Diuretics
4. Antihypertensive drugs

Front 19

Acetaminophen in long-term use: Increased risk of

Back 19

renal impairment

Front 20

Pain associated with migraine headaches is believed to be caused by

Back 20

vascular spasms

Front 21

The symptoms of migraine headaches are believed to be caused by

Back 21

local cranial vasodilation and stimulation of trigeminal nerves

Front 22

Migraine Drug Actions

Back 22

Activation of the 5-HT receptors causes vasoconstriction and reduces the neurotransmission, which in turn produces pain relief

Front 23

Migraine Drug Adverse Reactions

Back 23

The most common are dizziness, nausea, fatigue, pain, dry mouth, and flushing

Front 24

Migraine Drug Contraindications

Back 24

ischemic heart disease (such as angina or myocardial infarction), transient ischemic attacks (TIAs), or uncontrolled hypertension or those patients taking monoamine oxidase inhibitor (MAOI) antidepressants

Front 25

Migraine Drugs should only be used

Back 25

when a clear diagnosis of migraine headache has been established

Front 26

Migraine Drugs should be used cautiously in patients with

Back 26

hepatic or renal function impairment, such as the elderly or patients requiring dialysis

Front 27

Migraine Drugs Preadministration assessment

Back 27

History: Allergies, GI bleeding, cardiovascular disease, stroke, hypertension, peptic ulceration, or impaired hepatic or renal function; if present notify PHCP

Front 28

Migraine Drugs Ongoing assessment

Back 28

1. reassess pain rating 30 to 60 minutes following administration
2. Assess and document severity, location, and intensity; monitor vital signs at least every 4 hours

Front 29

Migraine Drugs Nursing Diagnoses

Impaired Skin Integrity

Back 29

related to photosensitivity when using 5-HT agonists

Front 30

Migraine Drugs Nursing Diagnoses

Risk for Injury

Back 30

related to adverse reaction of NSAID causing damage to optical field

Front 31

Migraine Drugs Nursing Diagnoses

Impaired Physical Mobility

Back 31

related to muscle and joint stiffness

Front 32

Elderly more vulnerable to GI bleeding due to

Back 32

higher incidence of rheumatoid arthritis and osteoarthritis and use of NSAIDs on long-term basis