-Hip fx: log rolling, avoid lying on the affected side, no external rotation , lots of pain (pain mngmt). Don’t rotate more than 90 degrees. -Strain involves muscle, sprain involves tendon and ligament (do RICE for both). -RICE for sprain to reduce swelling, then use warm heart after 24-48 hours for no more than 20 min. (cook rice, then warm) -Gout can exacerbate bursa (bursitis). Purines are mostly in meat (cause gout) -Compartment syndrome=s/s are inflammation, erythema, swelling. Perform fasciotomy (last resort). -Give opioid (very painful) -Give opioid analgesics but pt. Is still 8/10 pain, what do you do? Change dose or change times, TC, NPI, reassessed pt., you have exhausted all options, still same. Give adjuvant analgesics (antidepressants, anticonvulsants). Medication that is not primarily designed to control pain but can be used for this purpose. -Hydroxyzine -Equianalgesic: ex. 10 mg IV, to continue this PO it requires a different amount to equal the same strength. The strength has to be the same because the pt. Cannot take the IV home for ex. What is the “equivalent” dose? -Liver problem, can go only up to 3 g nonopioid analgesics (NSAIDs) per 24 hours (normally 4 g). -If you give too much analgesic, you will hit analgesic ceiling (you have taken max
dose, and no matter how much you take, the pain is not controlled. No matter how much more you take, there will be no more change in effect.) -Opioids don’t have an analgesic ceiling, they have an analgesic basement. -NSAIDs, you can take take take but will only relief a fixed amount of pain. -Modulation is the brain sending impulses (release endogenous opioids produced by CNS and pit. gland) back to site to relief pain -Nociceptive pain:normal processing of stimuli (ex. punch). What happens with that is transduction, transmission, perception, and modulation. -Transdermal patch: ex. Pt. doesn’t like IV. -Pain is not decreasing, so reassess pt., maybe patch has to be at a higher dose. -Breakthrough pain: cancer pt.’s. -oxycodone is short acting (for breakthrough pain) -oxycontin is long acting (scheduled) -Celecoxib is a non-opioid analgesic, it is an NSAID. Module 4 F&E (5 Q‘s) -Focus on FVD and FVE (deficit and excess) and renal exemplars -S/S FVE=bounding pulse, crackles ,medication to give would be lasix (if emergency situation?=IV) give slow -Lasix=K loss, and can over work kidneys (working harder now to flush out fluid) -prevention>fixing because when you try to fix one problem, other problems arise -Deficit= decreased concentration, decreased urine output (normal is 30 ml/hr), 100 ml by end of your shift? Suspect fluid volume deficit. You also see dry membranes and tenting. -Cog. Issues with hyper/hyponatremia. -Test for Na level with elderly pt. Coming in with confusion (could be too much or too little). Give diuretics to push out Na. -Hyponatremia. Could have seizures=precautions. Give 3% NS for hyponatremia, go slow so you don’t have pulmonary edema. -Potassium=cardiac dysrhythmias with K issues. If pt. Has K of 5, twitchy? Put them on a monitor/tele. Suspect before hand. You need a Dr. order for F&E panel, what you can do first is the nursing actions like put them on a monitor (3 lead, 4-5 lead, a heart monitor would normally just be put on a monitor if admit. To ER), if you suspect
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- Spring '18
- Dr. Julie Potter-Dunlop
- Prednisone, -Warfarin