Term
| scientific definition of pain |
|
Definition
| an unpleasant sesory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage |
|
|
Term
| affective/emotional dimension of pain |
|
Definition
| concurrent feelings of anger, fear, depression, and anxiety that can make pain better wor worse |
|
|
Term
| behavioral dimension of pain |
|
Definition
| activities that express pain or are performed to control pain and how pain interferes with normal daily activities/behaviors |
|
|
Term
| cognitive dimension of pain |
|
Definition
| beliefs, attitudes, memories, expectations, and goals related to the pain and pain control |
|
|
Term
| sociocultural dimension of pain |
|
Definition
| factors such as age, gender, etc. that influence one's perceptions, beliefs, and means of coping with and managing pain |
|
|
Term
| spiritual dimension of pain |
|
Definition
| factors include religious beliefs and existential beliefs/outlook |
|
|
Term
| physiological dimension of pain |
|
Definition
| includes transmission, perception, modulation of pain related to physical and neuro-chemical processes |
|
|
Term
|
Definition
| processing of stimuli that damages normal tissues |
|
|
Term
|
Definition
| pain which arises from bone, join, muscle, skin, or connective tissue |
|
|
Term
|
Definition
| pain which arises from visceral organs |
|
|
Term
|
Definition
pain related to disease or dysfunction of the nervous system
*not well controlled by opioids alone |
|
|
Term
|
Definition
| physiologic process by which info about tissue damage is communicated to the CNS |
|
|
Term
|
Definition
|
|
Term
|
Definition
| large, myelinated, rapid conduction, precise localization, sharp pain |
|
|
Term
|
Definition
| small, unmyelinated, slow conduction, poor localization, diffuse aching/burning pain |
|
|
Term
| 4 steps of pain transmission |
|
Definition
1. transduction
2. transmission
3. perception of pain
4. modulation |
|
|
Term
|
Definition
1st step of pain transmission
occurs in the periphery when a stimulus causes tissue damage; celles release a substance that sensitize nociceptors and an action potential is generated |
|
|
Term
|
Definition
2nd step of pain transmission
action potential continues from the site of injury to the spinal cord and the brain |
|
|
Term
|
Definition
3rd step of pain transmission
conscious experience of pain |
|
|
Term
|
Definition
4th step of pain transmission
inhibition of nociceptive impulses in the brain stem and then the spinal cord to inhibit the transmission of nociceptive impulses |
|
|
Term
| sensitizing substances of transduction |
|
Definition
| prostaglandins, bradykinin, serotonin, substance p, histamine |
|
|
Term
| inhibition substances of modulation |
|
Definition
| endogenous opioids, serotonin, norepinephrine |
|
|
Term
|
Definition
|
|
Term
|
Definition
| gradual or sudden onset that continues 6 months or more past the normal recovery time |
|
|
Term
| most reliable indicator of pain |
|
Definition
|
|
Term
| least sensitive indicators of pain |
|
Definition
| physiologic measures such as changes in HR, BP, etc. |
|
|
Term
| hierarchy of pain assessment techniques |
|
Definition
1. obtain self-report
2. search for potential causes of pain
3. observe patient behavior
4. proxy reporting
5. attempt an analgesic trial |
|
|
Term
| sensory component of pain |
|
Definition
Pattern
Area
Intensity
Nature |
|
|
Term
|
Definition
| onset, duration, variations, associated symptoms |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| the joint commission requires pain to be documented and considers it to be this |
|
|
Term
|
Definition
| mimic endogenous neuropeptieds that inhibit transmission ofpain impulses in the central and peripheral nervous system |
|
|
Term
|
Definition
| characterized by the need for an increased opioid dose to maintain the same degree of pain relief |
|
|
Term
|
Definition
| an expected physical response manifested by a withdrawal syndrome that occurs when blood levels of the drug are abruptly decreased |
|
|
Term
| early withdrawal reponse (6-12 hrs) |
|
Definition
| characterized by anxiety, chills, tremors, diaphoresis |
|
|
Term
| late withdrawal response (48-72 hrs) |
|
Definition
| characterized by diarrhea, restlessness, nausea, vomiting, insomnia |
|
|
Term
|
Definition
| side effect of opioids that is most common in first days and tolerance usually develops within 1 week; preceded by sedation |
|
|
Term
| respiratory depression risk factors |
|
Definition
| opioid naive patients, obesity, sleep apnea, respiratory compromise, etc. |
|
|
Term
|
Definition
| opioid antagonist used to reverse respiratory depression or somnolence |
|
|
Term
| Narcan side effects if reversal too rapid |
|
Definition
| severe pain, profound onset of withdrawal, seizures, arrhythmias, acute pulmonary edema |
|
|
Term
|
Definition
| side effect of opioids that patients do not typically develop a tolerance to |
|
|
Term
|
Definition
|
|
Term
| Fentanyl Patch (Duragesic) |
|
Definition
| for opioid sensitized patients with chronic pain; takes 12-18 hours to reach peak effect and to clear from system; do NOT heat |
|
|
Term
|
Definition
| weak binding to mu-opioid receptors and inhibition of reuptake of NE & seratonin to produce opioid-like effects with less respiratory depression |
|
|
Term
|
Definition
| weak oral opioid with toxic metabolites, long half-life that has been withdrawn from the market |
|
|
Term
|
Definition
| analgesic, anti-inflammatory, anti-platelet that can cause GI bleeding |
|
|
Term
|
Definition
| analgesic that is not anti-inflammatory or anti-platelet but does not cause GI upset; can cause liver injury |
|
|
Term
|
Definition
| only injectable NSAID that can't be used more than 5 days due to renal implications |
|
|
Term
| black box warning of NSAIDs |
|
Definition
| may cause an increased risk of serious CV thrombotic events, MI, and stroke |
|
|
Term
|
Definition
| drugs that provide non-tranditional analgesia that can be combined with pain meds, especially for neuropathic pain |
|
|
Term
| Anticonvulsants/Antiepileptic drugs |
|
Definition
| used to treat nueropathic pain and migranes by suppressing the spontaneous firing of action potentials that signal pain because the neuronal excitability is dampened |
|
|
Term
|
Definition
| block reuptake of NE & serotonin which enhances the action of inhibitory pain pathways; stabilizes neuron membrane through inhibition of Na channels |
|
|
Term
|
Definition
| decrease neuronal excitability at sodium channels |
|
|
Term
|
Definition
| mild pain (1-3); treat with nonopiod, adjuvant |
|
|
Term
|
Definition
| moderate pain (4-6); treat with opioid (codeine, hydrocodone, oxycodone) |
|
|
Term
|
Definition
| moderate to severe pain (7-10); treat with powerful opioids (morphine, fentanyl, hydromorphone) |
|
|
Term
|
Definition
| pain medication has a basal rate and a bolus that can be administered by the patient as needed |
|
|
Term
|
Definition
| continuous infusion of IV opioid in PCA |
|
|
Term
|
Definition
| patient can self-administer a pre-set amout of opioid on demand in a PCA |
|
|
Term
|
Definition
| pump is set to control the minimum interval between doses |
|
|
Term
| around the clock (ATC) scheduling |
|
Definition
| medications are scheduled continulously to be more effective than PRN dosing |
|
|
Term
|
Definition
| these are NOT to be used to assess the nature of pain |
|
|
Term
|
Definition
| pain produced by ordinarily innoculous stimuli |
|
|
Term
|
Definition
| exaggerated response to pain |
|
|
Term
| nociceptor classifactions |
|
Definition
| thermo, chemical & mechano |
|
|
Term
|
Definition
| best administration for managment of chronic pain |
|
|
Term
|
Definition
| develops if a drug is abruptly withdrawn or an antagonist were added |
|
|
Term
|
Definition
| a psychological phenomenon characterized by drug craving, overwhelming concern with drug acquisition, aberrant behavior, or unsanctioned dose escalation |
|
|
Term
|
Definition
| heard over large airways, "tubular" |
|
|
Term
|
Definition
| heard over most of the lung field |
|
|
Term
|
Definition
| caused by alveoli/airway opening |
|
|
Term
|
Definition
| caused by airway opening and secretions |
|
|
Term
|
Definition
| caused by airway narrowing, secretions |
|
|
Term
|
Definition
| caused by airway secretions & narrowing, but usually clear after caughing |
|
|
Term
|
Definition
| air under the surface of the skin |
|
|
Term
|
Definition
| pleural spaces around the lungs rubbing against one another |
|
|
Term
|
Definition
| percentage or fraction of air breathed that is oxygen |
|
|
Term
|
Definition
| respiratory tissue damage as a result of prolonged exposure to high FiO2 |
|
|
Term
|
Definition
| too much O2 can decrease ventilatory rate and cause tissue damage; s/s include somnolence, confusion, coma |
|
|
Term
|
Definition
| oxygen in the blood is low |
|
|
Term
|
Definition
| PaO2 reading meaning hypoxemia |
|
|
Term
|
Definition
| SpO2 reading meaning hypoxemia |
|
|
Term
|
Definition
| at what oxygen flow can you no longer use bubble to humidify? |
|
|
Term
| change the colored adaptor |
|
Definition
| to increase FiO2 when using a venturi mask you must do this |
|
|
Term
|
Definition
| open face design, feels less restrictive |
|
|
Term
|
Definition
| mask with a bag reservoir ~60-90% FiO2 |
|
|
Term
|
Definition
| flow rate of a high flo nasal canual |
|
|
Term
|
Definition
| portable, beta2 agonists, anticholinergic, or corticosteroid; always use a spacer! |
|
|
Term
|
Definition
| steroids or combinations in a disk |
|
|
Term
| Combivent Respimat inhaler |
|
Definition
| no propellant or inhalers, more efficient, no spacer needed, mist |
|
|
Term
|
Definition
| measures oxygen saturation of the blood by measuring the % of Hgb molecules saturated with oxygen |
|
|
Term
|
Definition
| CO2 content in exhaled gas |
|
|
Term
|
Definition
| one pressure, requires spontanuous breathing |
|
|
Term
|
Definition
| inspiratory and expiratory phases for tighter control of tidal volume and better ventilation |
|
|
Term
|
Definition
| technique patient is able to do to mobilize secretion |
|
|
Term
|
Definition
| vibratory therapy to mobilize secretions and increase thoracic pressure |
|
|
Term
| 3 components of chest physiotherapy |
|
Definition
1. positioning (postural drainage)
2. percussion
3. vibration |
|
|
Term
|
Definition
| the pressure exerted by an individual gas in a misture of gases; indicates how much gas is dissoved in the blood |
|
|
Term
|
Definition
| movement of air into and out of the lungs |
|
|
Term
|
Definition
| distribution of blood to the lungs |
|
|
Term
|
Definition
| movement of gases across the respiratory membrane |
|
|
Term
|
Definition
| decreased oxygen tension of arterial blooed due to (need all 3) 1. altered ventilation 2. altered perfusion 3. altered diffusion |
|
|
Term
|
Definition
| elevated partial pressure of CO2 in the arterial blood related to hypoventilation of alveoli |
|
|
Term
|
Definition
| a subjective sensation of uncomfortable or difficult breating |
|
|
Term
| ventilation/perfusion ratio (V/Q ratio) |
|
Definition
| relationship between ventilation and perfusion of the lungs |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| well-perfused pulmonary capillaries surround poorly ventilated alveoli affecting V/Q ratio |
|
|
Term
| pulmonary vasculature obstruction |
|
Definition
| well-ventilated alveoli are surrounded by poorly perfused capillaries affecting V/Q ratio |
|
|
Term
|
Definition
| collapse of lung tissue at any structural level |
|
|
Term
|
Definition
| caused by external pressure by tumor, fluid, or air in the pleural space |
|
|
Term
|
Definition
| alveolar collapse resulting from the removal of air into the blood stream from alveoli distal to an obstruction |
|
|
Term
| adhesive (surfactant) atelectasis |
|
Definition
| collapsed lung tissue due to insufficient surfactant increasing surface tension and resulting in airway collapse |
|
|
Term
|
Definition
| dyspnea, dullness, cough, decreased breath sounds, fever |
|
|
Term
|
Definition
|
|
Term
|
Definition
| infection of mucous membranes in bronchial trees |
|
|
Term
|
Definition
| infection of alveoli & bronchials |
|
|
Term
|
Definition
| infection of lung perichymal |
|
|
Term
|
Definition
| most common infectious cause of death in the US |
|
|
Term
| routes of microorganism invasion |
|
Definition
1. inhalation
2. bloodstream from another site
3. aspiration |
|
|
Term
| community acquired pneumonia (CAP) |
|
Definition
| pneumonia diagnosed within 2 days of admit |
|
|
Term
| community acquired pneumonia |
|
Definition
| pneumonia usually associated with staph so s/s include abrupt onset of fever and chills |
|
|
Term
|
Definition
| leading cause of healthcare acquired pneumonia |
|
|
Term
| healthcare acquired pneumonia (HAP) |
|
Definition
| pneumonia diagnosed 48+ hours after admission |
|
|
Term
| s/s of bacterial pneumonia |
|
Definition
| fever, tachycardia, tachypnea, cough, etc. |
|
|
Term
|
Definition
1. hyperemia
2. red hepatization
3. gray hepatization
4. resolution |
|
|
Term
|
Definition
| antibiotic therapy for previously healthy client with pneumonia |
|
|
Term
| Fluoroquinolone OR B-lactam plus macrolide |
|
Definition
| antibiotic therapy for client with comorbidities |
|
|
Term
|
Definition
| black box warning of fluoroquinolone |
|
|
Term
| B-lactam PLUS another antibiotic (usually double doses) |
|
Definition
| antibiotic therapy in the ICU |
|
|
Term
|
Definition
| positioning of a patient with pneumonia for proper drainage |
|
|
Term
|
Definition
| pneumonia caused by contaminated water in cooling/air conditioning systems |
|
|
Term
|
Definition
| opportunistic infection caused by a fungus in immunodificient patients (not found in healthy people) |
|
|
Term
|
Definition
| sudden onset, rigors common, productive cough, pleuritic pain common, dull percussion, localized x-ray, WBC >15,000/mm3 |
|
|
Term
|
Definition
| gradual onset, headache common, rigors rare, nonproductive cough, pleuritic pain rare, minimal physical findings, diffuse x-ray, WBC <15,000/mm3 |
|
|
Term
|
Definition
1. airborne
2. remains viable for 8 months
3. prolonged exposure |
|
|
Term
|
Definition
| multiplies in alveoli, surrounded by PMNs and macrophages |
|
|
Term
|
Definition
| inactive bacilli, skin test positive, x-ray normal, sputum smears negative, asymptomatic |
|
|
Term
|
Definition
| active bacilli in body, skin test positive, x-ray abnormal, sputum smears positive, symptomatic (cough, fever, wt loss), infections |
|
|
Term
| extrapulmonary TB (disseminated) |
|
Definition
| TB spread by blood or lymph to any system |
|
|
Term
|
Definition
| no TB exposure, not infected |
|
|
Term
|
Definition
| TB exposure, no evidence of infection |
|
|
Term
|
Definition
| TB infection, no TB disease (latent) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| previous TB disease (not clinically active) |
|
|
Term
|
Definition
|
|
Term
|
Definition
0.1mL intradermal injection of a TB "purified protein derivative"
*to be positive, exposure must have been at least 2-3 months ago |
|
|
Term
|
Definition
| "booster" phenomenon is used to detect false negatives by using the PPD antigen to reawaken/enhance immune response to antigen |
|
|
Term
|
Definition
| sign of a positive skin test reaction |
|
|
Term
|
Definition
| vaccine used for TB prevention that will cause a positive skin test |
|
|
Term
|
Definition
| lab test diagnosing latent TB by incubating blood with antigen and measuring interferon-gamma released from WBCs |
|
|
Term
|
Definition
| low-grade fever, chills, night sweats, fatigue |
|
|
Term
|
Definition
| reveals nodules in UPPER lobes |
|
|
Term
1. 3 consecutive negative sputum samples
2. treated 2+ weeks
3. symptoms reduce/improve |
|
Definition
| 3 requirements for being considered non-infectious of TB |
|
|
Term
1. isoniazid*
2. rifampin*
3. pyrazinamide
4. ethambutol or streptomycin |
|
Definition
| 4 medications used to treat TB; all 4 for 1st 2 months, then 2* daily or twice weekly for 4 additional months |
|
|
Term
| hepatotoxicity - don't drink alcohol |
|
Definition
| important consideration for patients on TB medications |
|
|
Term
|
Definition
| a preventable, treatable, progressive disease that limits airflow in the lungs and may include extrapulmonary effects |
|
|
Term
|
Definition
| characterized by a cough that occurs on most days at least 3 months a year for 2 consecutive years (inflammation, secretions, edema) |
|
|
Term
|
Definition
| abnormal, permanent enlargement of terminal airspaces (distal to the terminal bronchioles); destruction of alveolar walls |
|
|
Term
|
Definition
| name to describe pt with chronic bronchitis |
|
|
Term
|
Definition
| name to describe pt with emphysema |
|
|
Term
| forced vital capacity (FVC) |
|
Definition
| maximum exhalation after maximum inspiration |
|
|
Term
| forced expiratory volume (FEV) |
|
Definition
| volume forcibly exhaled during 1st second (usually 75-80% of FVC) |
|
|
Term
|
Definition
| volume remaining in the lungs after maximum exhalation |
|
|
Term
|
Definition
| volume of air in the lungs after maximum inspiration |
|
|
Term
|
Definition
| increased residual volume and total lung capacity due to hyperinflation |
|
|
Term
|
Definition
| measures lung volume and air flow & used to diagnose pulmonary disease |
|
|
Term
|
Definition
| number 1 priority of COPD treatment/management |
|
|
Term
|
Definition
| selectively activate beta2-adrenergic receptors to relax smooth muscle of lungs |
|
|
Term
|
Definition
| block acetylcholine at muscarinic receptros |
|
|
Term
| ways to manage COPD exacerbation |
|
Definition
1. supplemental O2
2. bronchodilators
3. add glucocorticoids
4. antibiotics
5. noninvasive positive pressure ventilation |
|
|
