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NUR 2407: PHARMACOLOGY ADDENDUM TO CONCEPT REVIEW EXAM 2, Latest 2019/2020 complete A+ Help

RASMUSSEN COLLEGE
NUR 2407: PHARMACOLOGY
ADDENDUM TO CONCEPT REVIEW
EXAM #2
Pain and Inflammation : Dr. Laningan stated “you need to know”
Pain Why is pain hard to manage?
Evaluation of pain
o The patient’s respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery

The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon to report which condition?
a. Paralytic ileus
b. Respiratory depression
c. Somnolence
d. Urinary retention
ANS: B
The patient’s respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery

o What population is pain management difficult to distinguish ?
o Know the Tolerance of pain
o Know the pain threshold
o Know what pain medications are used for Mild, Moderate and severe
• To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given.

The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having “bad pain.” What will the nurse do first?
a. Administer acetaminophen (Tylenol).
b. Ask the patient to rate the pain on a 1 to 10 scale.
c. Attempt to determine what type of pain the patient has.
d. Request an order for an intravenous opioid analgesic.

ANS B
To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given.

What is Nephrotoxicity?
o How can we determine signs and symptoms of nephrotoxicity?
o How can we treat it?
o How can we prevent it ?
o What is expected in patients with nephrotoxicity?
o BUN and Creatinine ? what is this for and why is it done?
Celebrex
NSAIDs
Aspirin
o Toxicity
o With water
o Works on the periphery

Tylenol
o safety concerns with children
o hypotoxic
o 2 of these are equal to one codeine and Tylenol
o know the agonist/antagonist antidote
o recommended dose is 4g a day for a healthy adult
o 3g for an older adult
o Children dosage depends on??


 There are three categories of drugs that support the treatment of pain:
o Nonopioid analgesics
o Opioid analgesics
o Opioid antagonists

 There are four types of nonopioid analgesics that treat pain.
1.First-generation nonsteroidal anti-inflammatory drugs (NSAIDs) - COX-1 and COX-2 inhibitors- Prototype drug: aspirin, ibuprofen (Advil, Motrin)
o Other drugs: naproxen (Naprosyn, Aleve), indomethacin (Indocin), ketorolac

2.Second-generation nonsteroidal anti-inflammatory drugs (NSAIDs) - COX-2 inhibitors- Prototype drug: celecoxib (Celebrex)

3.Acetaminophen (Tylenol)- Prototype drug: acetaminophen (Tylenol)

4.Centrally-acting nonopioids- Prototype drug: tramadol (Ultram)




Anti-inflammatories
NSAIDs

Nonopioid Analgesics

Prototype Drug

 Aspirin , ibuprofen( Advil, Motrin)

Other drugs:
 naproxen (Naprosyn, Aleve),
 indomethacin (Indocin),
 ketorolac

First-generation nonsteroidal anti-inflammatory drugs (NSAIDs)
first generation non-steroidal anti-inflammatory drugs, or NSAIDs, which are
 COX-1 and COX-2 inhibitors

What is it for?
 Inflammation suppression
 Analgesia for mild to moderate pain
 Fever reduction
 Dysmenorrhea

 Inhibition of platelet aggregation (aspirin)- Aspirin also inhibits platelet aggregation, making it an effective option as an anticoagulant when the stronger drug warfarin, also called Coumadin, is not needed.

 For this reason, you can often give aspirin when prophylactic or long-term treatment against the development of thrombi is needed.


o Effects/side effects/patient teaching


 Take with food, milk, or 8 oz of water; avoid alcohol
 Report persistent gastric irritation, unusual or prolonged bleeding
 Report changes in urine output, weight gain, or fluid retention
 Do not give to children or adolescents under age 19 who have viral infections
 Non-aspirin NSAIDS: Report symptoms of embolic event; low-dose aspirin
 Report tinnitus, sweating, headache, and dizziness; stop aspirin


When providing instructions about COX-1 and COX-2 inhibiting NSAIDs, tell patients to take the drug with food, milk, or eight ounces of water to minimize gastrointestinal effects.
Avoiding alcohol also minimizes adverse gastrointestinal effects.
Tell patients to report persistent gastric irritation and signs of bleeding such as easy bruising, petechiae, and excessive bleeding from minor injuries.
tell patients to report any unusual or prolonged bleeding, as well as changes in urine output, weight gain, or signs of fluid retention such as edema or bloating.
Tell parents to avoid giving aspirin or NSAIDs to children or adolescents under age 19 who have viral infections. Let them know that they can use acetaminophen instead. Due to the risk of development of thrombi when taking a non-aspirin NSAID, tell patients to immediately report to the provider chest pain or heaviness, shortness of breath, sudden and severe headache, one-sided numbness, weakness, visual disturbances, or confusion.
Reinforce the use of low-dose aspirin once daily to reduce the risk of myocardial infarction and cerebrovascular accident if the provider recommends it.
Instruct patients to report ringing or buzzing in the ears immediately, as this is the first sign of salicylism,
as well as unwarranted sweating, headache, and dizziness. They should stop taking aspirin if these symptoms develop

o Aspirin side effects and patient teaching
.
Be sure your patients know the signs of salicylism and measures to take if they begin experiencing its symptoms.


 Salicylism is the name for aspirin toxicity. It can happen accidentally by patients who self-medicate with aspirin and by patients who take the drug regularly for a chronic condition such as rheumatoid arthritis

 If patients quit taking aspirin at the first sign of tinnitus, the blood level of will gradually drop as it is excreted by the kidneys.


 If patients continue to take aspirin they will begin to experience nausea and vomiting, diarrhea, and diaphoresis (excessive sweating), and with continued ingestion, convulsions, or coma.



Interventions with Cox-1 and Cox-2 inhibiting NSAID MONITOR
 monitor for signs of bleeding, including black or dark-colored stools, abdominal pain, nausea, and hematemesis.

 It’s also a good idea to test for and treat Helicobacter pylori. or patients who are at high risk for gastric bleeding, recommend that they receive a proton pump inhibitor concurrently during therapy.


 Monitor for signs of easy bruising, petechiae, which are pinpoint hemorrhages just below the skin, and excessive bleeding from minor injuries such as a facial nick while shaving.

 Monitor I&O, BUN, and creatinine, which reflect a decrease in kidney function.








CONT. Interventions with Cox-1 and Cox-2 inhibiting NSAID MONITOR

 In relation to the potential for salicylism in patients taking aspirin, monitor for patient reports of tinnitus, dizziness, and/or headache, as well as diaphoresis (or excessive sweating) and tachypnea, which can result in respiratory alkalosis.

 If any of these signs or symptoms manifest, stop aspirin therapy immediately so the serum level of aspirin does not continue to rise


 To prevent Reye's syndrome in children and adolescents who have viral infections, recommend the use of acetaminophen, also called Tylenol, instead of aspirin or NSAIDs.

 When NSAID therapy is necessary, recommend non-aspirin NSAIDs for short periods and in low doses to help minimize side effects.


 Monitor for signs of embolic events.

 If a provider prescribes COX-1 and COX-2 inhibiting NSAID for long-term therapy, make sure the provider also prescribes low-dose aspirin to prevent embolic events.








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