Critical Care > CCN 2 > Flashcards

CCN 2 Flashcards

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1
Q

Is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

A

Pain

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2
Q

Stimulation of the skin evokes nervous impulses transmitted by three systems in the spinal cord (substantia gelatinosa, dorsal column fibers, central transmission cells) that influence nociceptive impulses.

A

Gate Control Theory

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3
Q

All pain results from a signal cascade traveling through the peripheral to central nervous system for processing.

A

Physiology of Pain

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4
Q

Fast sharp pain is carried by

A

A-delta fibers

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5
Q

Slow burning chronic pain is carried by

A

Unmyelinated C fibers

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6
Q

Harmful, poisonous, or very unpleasant stimuli that initiate nociception.

A

Noxious Stimuli

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7
Q

Physiologic process by which information about tissue damage is communicated to the CNS.

A

Nociception

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8
Q

Conversion of a noxious mechanical, thermal, or chemical stimulus into an electrical signal (action potential).

A

Transduction

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9
Q

Process by which pain signals are relayed from the periphery to the spinal cord and then to the brain.

A

Transmission

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10
Q

Occurs when pain is recognized, defined, and assigned meaning by the individual experiencing it.

A

Perception

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11
Q

Activation of descending pathways that exert inhibitory or facilitatory effects on pain transmission.

A

Modulation

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12
Q

Specialized receptors in tissue injury initiating pain transmission.

A

Nociceptors

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13
Q

Tissue injury triggers mast cell degranulation, histamine release, chemotactic agents, and infiltration by neutrophils and eosinophils.

A

Inflammatory Response

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14
Q

Endogenous cytokines that suppress pain induction, acting as mediators.

A

Endorphins

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15
Q

Sudden, temporary, localized, lasting less than 3 months with an identifiable cause.

A

Acute Pain

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16
Q

Prolonged, ongoing pain, often without an identifiable cause, may arise from an acute situation.

A

Chronic Pain

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17
Q

Pain perceived distant from the site of stimulus due to visceral fibers synapsing near other sensory fibers in the spinal cord.

A

Referred Pain

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18
Q

Pain occurring between doses of analgesia.

A

Breakthrough Pain

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19
Q

Pain triggered by activity, procedures, or dressings, predictable and preventable with prior analgesia.

A

Incident Pain

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20
Q

Pain from brain or spinal cord lesions causing spontaneous high-frequency impulses.

A

Central Pain

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21
Q

Common in advanced cancer, mixture of nociceptive and neuropathic pain with acute, persistent, breakthrough, and incident features.

A

Cancer Pain

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22
Q

Pain felt in amputated or removed body parts, often resembling pre-injury pain.

A

Phantom Pain

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23
Q

Point at which neurochemicals reach the brain, causing conscious awareness of pain.

A

Pain Threshold

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24
Q

Amount of pain a person endures after reaching threshold.

A

Pain Tolerance

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25
A state marked by apprehension, agitation, autonomic arousal, fearful withdrawal, or combinations of these.
Anxiety
26
Are interrelated, cyclical, and exacerbate each other.
Pain & Anxiety
27
Involves five-step hierarchy, prompt assessment, reassessment, patient engagement, and quality improvement monitoring.
Pain Assessment
28
Identify characteristics such as cause, severity, location, duration, and aggravating/alleviating factors.
Pain Measurement Tools
29
Provocation/Position, Quality, Radiation, Severity/Symptoms, Timing/Trigger.
PQRST Pain Scale
30
Uses facial expressions to indicate pain severity, requiring emotional processing.
Faces Pain Scale
31
Assesses pain in nonverbal, mechanically ventilated patients.
Behavioral Pain Scale
32
Assesses pain in critically ill patients with or without endotracheal tube; validated in cardiac surgery patients.
Critical Care Pain Observation Tool
33
10-point scale measuring sedation/agitation from: 4 (combative), 0 (calm, alert), (- 5 unarousable). Useful in detecting changes in sedation status over consecutive days of CCU.
Richmond-Agitation Sedation Scale (RASS)
34
6-point scale evaluating wakefulness and sedation in postoperative patients. Visual and Cognitive Assessment
Ramsay Sedation Scale
35
7-point scale describing behaviors from unarousable to dangerously agitated; seen in the continuum of sedation to agitation.
Sedation Agitation Scale
36
Drugs inducing chemical paralysis to facilitate intubation, ventilation, ICP control, or bedside procedures.
Neuromuscular Blockade
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Includes sedation, eye lubrication, DVT prophylaxis, repositioning, monitoring, and passive ROM.
Nursing Care For Patient Receiving NMB
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Strategies to reduce pain and anxiety without drugs, including environmental, relaxation, imagery, distraction, biofeedback, hypnosis, music, animal therapy, and manual therapies.
Nonpharmacological Management
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Use of clocks, calendars, reorientation, family support, and room modifications to reduce anxiety.
Environmental Manipulation
40
Techniques like diaphragmatic breathing, progressive muscle relaxation, and meditation to increase pain tolerance and control.
Relaxation
41
Directed daydreaming to promote relaxation and pain control.
Guided Imagery
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Redirecting attention away from pain using enjoyable activities or laughter.
Distraction
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Electronic monitoring of physiologic responses to give patients control over stress and pain.
Biofeedback
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Trance state induced by suggestion to enhance relaxation and pain relief.
Hypnosis
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Diversionary pain and anxiety relief using music participation or listening.
Music Therapy
46
Interaction with trained animals to reduce anxiety and improve well-being.
Animal-Assisted Therapy
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Can offer a range of pain management strategies.
Physiotherapy
48
Assists in postsurgical abdominal and thoracic surgery pain.
Massage
49
Relieve pain with variable effectiveness.
Heat And Cold Therapy
50
Ancient Chinese method stimulating meridian points to enhance chi flow and reduce pain.
Acupuncture
51
Low-voltage electrical stimulation relieving persistent benign pain.
Transcutaneous Electrical Nerve Stimulation (TENS)
52
Intermittent 100% oxygen at high pressure to manage neuropathic, cancer, and postoperative pain.
Hyperbaric Oxygen Therapy
53
Drug therapy for pain and anxiety improves outcomes, mobility, and stress response.
Pharmacological Management
54
Mainstay for severe pain.
Opioids
55
Example opioid that is potent, rapid-acting, and often used in critical care.
Fentanyl
56
Example opioid that is the standard reference for opioid analgesics.
Morphine
57
Example opioid that is stronger than morphine and used for severe pain.
Hydromorphone
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Pump system allowing patient-administered bolus opioid doses.
Patient-Controlled Analgesia (PCA)
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Opioids or anesthetics delivered into epidural or intrathecal spaces for pain interruption.
Epidural Analgesia
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Inhibit cyclooxygenase for analgesia but risk GI bleeding, platelet inhibition, and renal injury.
NSAIDs
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For mild to moderate pain, synergistic with opioids, used cautiously in hepatic dysfunction.
Acetaminophen
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Include antidepressants, anticonvulsants, ketamine, nitrous oxide, local anesthetics, bisphosphonates, and radiopharmaceuticals for neuropathic and cancer pain.
Adjuvants
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Adjuvant drug used for neuropathic pain by modulating mood and serotonin/norepinephrine.
Antidepressants
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Adjuvant drug reducing neuronal excitability in neuropathic pain.
Anticonvulsants
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Adjuvant drug that blocks NMDA receptors and reduces pain hypersensitivity.
Ketamine
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Adjuvant inhaled agent used for analgesia and sedation. Used for women in labor, dressings and procedures.
Nitrous Oxide
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Adjuvant drugs that block nerve conduction at specific sites.
Local Anesthetics
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Adjuvant drugs used for cancer-related bone pain.
Bisphosphonates
69
Adjuvant radioactive agents used for bone metastasis pain.
Radiopharmaceuticals
70
Benzodiazepines, propofol, and dexmedetomidine for anxiety and sedation in critical care.
Sedative Agents
71
Sedative agent from the benzodiazepine group commonly used for anxiolysis.
Benzodiazepines
72
Sedative agent used for rapid induction and short-term sedation. Has no analgesic properties
Propofol
73
Sedative agent that provides sedation with less respiratory depression. Short term use (less than 24 hrs.) patients with mechanical ventilation.
Dexmedetomidine
74
Occur with prolonged high-dose opioid or sedative use; tapering required to avoid withdrawal.
Tolerance & Withdrawal
75
Includes rhizotomy, sympathectomy, cordotomy, and neurectomy for pain relief by disrupting nerve pathways.
Surgery
76
Surgical procedure that involves severing nerve roots in the spinal cord to relieve pain.
Rhizotomy
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Surgical procedure that removes part of the sympathetic nervous system to relieve chronic pain.
Sympathectomy
78
Surgical procedure that involves cutting tracts of the spinal cord to interrupt pain transmission.
Cordotomy
79
Surgical procedure that involves removal or destruction of a peripheral nerve to relieve pain.
Neurectomy
80
Pain gets through; feel more pain
Open Gate
81
Pain blocked or reduced; feel less pain
Closed Gate
82
Carry messages from your body to your brain; affect
Afferent Nerves (Sensory)
83
Carry messages from your brain to your body.
Efferent Nerves (Motor)
84
records spontaneous brain activity
Electroencephalogram (EEG)
85
Aberrant drug seeking behavior, compulsive use, cravings, loss of control
Addiction
86
usage other than a medical purpose; cause a disintegration of the person and life commitments.
Substance Abuse Disorder
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Psychological need for a substance; if not supplied (substance) withdrawal symptoms occur such as anxiety & irritability.
Psychological Drug Dependence
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body requires a progressively greater amount of drug to achieve the same results.
Drug Tolerance
89
Having the same analgesic effect when administered to the same individual.
Equianalgesic
90
behaviors resembling drug seeking; result of receiving inadequate analgesia.
Pseudoaddiction
91
When a patient is experiencing the following; it is called - Transient and Reversible - Acute Change in Consciousness and Cognition - Decrease ability to maintain or shift attention
Delirium
92
PINCH ME ACRONYM
Pain Infection Constipation and Urinary Retention Hydration Medications & Substances Environmental Triggers
93
Altered Level of Consciousness are:
Alert: Normal Vigilant: Hyperalert Lethargic: Drowsy but arousable to verbal stimuli; answers appropriately but slowly Obtunded: Very drowsy, difficult to arouse; confused when awakened; limited interaction Stupor: Only responds to vigorous or painful stimuli; minimal verbal response Comatose: No response to any stimuli; unconscious
94
The goal of NMB
Complete Chemical Paralysis
95
Criteria for CCPOT
Facial Expression Body Movements Muscle Tension in Upper Extremities Compliance with Ventilator Nonventilator, Vocalization
96
Criteria for Behavioral Pain Scale
Facial Expression Upper limbs Compliance with ventilation
Critical Care
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