There are questions that they may have long term cardiac effects Nursing

There are questions that they may have long term

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Similar to adrenergic drugs (tachycardia, elevated BP, nervousness, tremors, HA, etc.) There are questions that they may have long term cardiac effects Nursing Management Weigh weekly (especially in PEDS and elderly), food diary Sleep pattern assessment (because these are stimulants) Need for drug holidays? (need to work out with family when they need to take it) C-II restriction Selected CNS Stimulants dextroamphetamine sulfate (Dexedrine), amphetamine (Adderall), benzphetamine (Didrex), (C-II) Didrex is used for weight loss methylphenidate hydrochloride (Ritalin, Metadate, Concerta) (C-II) Ritalin is used the most and 90% is given in the US, more often given in boys o BIG RISK for abuse (can crush it, snort it, sell it, etc.) atomoxetine (Strattera) modafenil (Provigil, Alertec) Used often for narcolepsy and sleep attacks Overview of Pain (Chapter 25) Pain is an extremely complex subjective, individualized, physical and psychological experience that cannot be quantified; it is both a sensory and emotional experience and is associated with actual or potential tissue damage Terminology Pain threshold: Level of stimulus needed to produce the perception of pain; a physiologic response, similar in all individuals (although we often use “threshold” to mean tolerance, as in “he has a low pain threshold”) Pain tolerance: A person’s response to pain; a psychologic response; affected by many factors including age, gender, culture, previous pain experiences, anxiety etc. Acute pain: Pain of sudden onset, usually subsides with treatment Chronic pain: Persistent and/or recurring pain, often difficult to treat Nociceptive pain: Pain from injury to tissues; responds well to opioid and non-opioid analgesics; includes: Somatic pain: Pain originating from skeletal muscles, ligaments, joints; responds well to non-opioids Visceral pain: Pain originating from organs or smooth muscle; usually requires opioids for pain relief Superficial pain: Pain originating from skin or mucus membranes; also often requires opioids for pain relief Neuropathic pain: Pain originating from injury to peripheral nerves ; does not respond well to opioid drugs, responds to “adjuvant” agents (e.g., some antidepressants, anticonvulsants, anesthetics) 6 6
“Gate Theory” of pain: The pathways of pain perception: A fibers (large, inhibitory, “close” the gate) and C fibers (small, facilitatory, “open” the gate) involved, depending on which is stimulated; brain can also control gate selectively (helps identify, evaluate and “localize” pain); enkephalins and endorphins also act on this system and can be useful theory in understanding both drug and non-drug interventions (i.e., what shuts the gate?) Physiology of Pain Tissue injury releases many mediators (e.g., bradykinen, prostaglandins, histamine, etc.) and stimulates sensory nerve endings; information transmitted to brain (via dorsal horn of spinal cord); A and C fibers open or close the “gate” of nerve pathways (up to brain) and whether pain is perceived (pain sensations are “processed” in many areas in brain: limbic system, thalamus, cortex etc.)

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