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Flashcards in The Nurse's Role Pt-3 Deck (60)
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1
Q

How do we prevent patient’s from developing cancer?

A

We do that through education and encouraging them to maintain healthy weight and lifestyle. Educating them on what that means, not everybody knows what that means.

2
Q

There is always stuff in the news about healthy ____ but be cautious because in the past there has not been a lot of research behind them. It’s people saying eat this or eat that, and you think that it makes sense, but recently in the news there has been a lot of talk about the _______ diet and I do believe that there is research to actually back that up; just be careful when you are promoting healthy diets, to be sure that what you are talking about does have some research base otherwise it’s just opinion.

A

Diets

Mediterranean

3
Q

What are the primary ways to prevent cancer?

A

Maintain healthy weight
Physically active lifestyle
Healthy diet, emphasis on plant sources

4
Q

What are secondary sources to prevent cancer?

A

Screening, encourage men and women to:
Self-breast & testicular exams, cancer screening, mammograms,

PSA: an antigen specific to prostate cancer that as men get older there is controversy about whether or not that is really necessary to do PSA’s because it doesn’t really have any impact on outcomes, but there are just a lot of things we can do for screening.
Men should do self-breast exams too they can get cancer, monthly testicular exams.
There are also many screening tools for those that may be more at risk also; it will be more specific to your pt and what their risk factors, family and personal history are

5
Q

What should you ask a pt diagnosed w/ cancer? -All hospital pts after having a dx are probably a bit worried.

A

How are you feeling? Allow the pt to talk about how they’re feeling. -This is meaningful and has an impact on the pt. Those are the pts that say I had this nurse who was wonderful, she was an angel, she made me feel ok, they gave me hope,

Please don’t be afraid to ask how they are feeling and how they are dealing with it; a lot of times someone gets the dx of cancer everybody they know abandons them friends don’t call anymore, family might stay away because they don’t know what to say; there is nothing that you can say that will make it go away; there is nothing that they have to say; what you need to do is be present, be there for them, let them talk and don’t worry about saying the right thing because you are not going to make it worse, just be there.

6
Q

What are the 3 main treatment modalities?

A
  1. Surgery
  2. Radiation
  3. Chemotherapy

Any one patient can have 1 or all of these, it just depends on what the cancer is, type of cancer, where it’s located and what the desired outcome is.

7
Q

What do you do for care of the pt undergoing surgery? General _____ care, your pre-op teaching, all the consents, labs, there might be extra lab work depending on what the dx of cancer is, the type of cancer it is;

A

Perioperative

8
Q

What to do for post-op care: Post-op care is going to be the same, basically ;you need to know that when you have a pt with cancer that has surgery they are at increased risk for _____, they are increase risk of infection, and impaired wound healing because why?

A

complications
Their immune system might be compromised; remember that somebody that has cancer their immune system dropped the ball already because it’s your immune system, your T cells specifically, remember those T lymphocytes that are supposed to destroy any abnormal cells any mutated cells, so the immune system let he cancer cells slip by and allowed it to reproduce and become a problem in the form of the cancer; so that is still going on so whatever that defect was and that can make the pt more vulnerable to infection and also delay wound healing.

9
Q

What are more risk of complications?
Infection, Impaired wound healing, Altered pulmonary function: this is a problem post op; you might have somebody who has lung cancer or something else that is going on related to their specific cancer that can cause respiratory difficulties
Altered ____ function: the kidneys are really affected by substances, medications, things like that;
Deep vein thrombosis: all perioperative pts are at risk for DVT, but pts with cancer sometimes have altered _____ and is called coagulopathy, so the will also have an increased risk of a DVT or a VTE which is a venous ________; they are especially at risk and more so if this surgery pt is also receiving chemo and radiation; so it is just riskier with a pt with cancer.

A

renal
coagulation
thromboembolism

10
Q

What might this patient have surrounding surgery?

A

Anxiety- remember that this is fear of the unknown, or worry about the unknown, fear is specific “oh I’m afraid of spiders” anxiety is just oh something might be wrong but I don’t know what it is.

11
Q

Anxiety regarding: What is the Outcome going to be; sometimes surgery is done to ____ or grade tumors so they might be wondering what’s going to happen, how bad is it,
Changes in body image if they had to have something removed particularly if it is something that’s associated with sexual identity like a breast or maybe a testicle;
Changes in body functioning: am I going to be able to do what I was doing before surgery
______: if we have done staging or grading of tumors that lets us prognosticate and the prognosis is the likely outcome; are they going to survive was it open and shut, sometimes they will take a pt to surgery and they will open the up and the cancer just everywhere and so they just don’t do anything they just close them right back up and those ppl have a poor prognosis.

A

stage

Prognosis

12
Q

What types of things does the nurse do for a patient after surgery? Assesses patient needs and doesn’t just focus on the _____ needs. Provides _____ and ______ support. Allow them time to discuss fears and just their ability to talk to somebody openly and honestly about their fears is very therapeutic for the pts. Encourage them to discuss and encourage family members to talk to each other. Encourage ____ role in care if you are doing dressing changes or if there is some other thing that they can do to participate, give them choices about things.

A

physical
emotional
educational
When telling a pt to talk to family= This is on an individual basis; you can’t just use one approach for everybody.
active
Choices= The more that they do the more they will be able to have some type of power and control.

13
Q

What does the nurse do if a patient does not understand something?

A

Clarify information
If the doctor comes in and tells them something and the pt doesn’t really understand it or thinks they understand it and they start thinking about it more and then they don’t you as the nurse can clarify that; you can say well this is what that meant; help them if they have questions, to maybe write them down so the next time the physician is in they can ask questions; they might be meeting with other depts., like PT, dietary or social services so you can work as a liaison and help them if they need more information or things clarified; if you can’t clarify you can get in touch with another member of the health team to get it clarified for the pt

14
Q

What other things does a nurse do after surgery for a pt?_______ with physician, other health team members.
D/C _____ starts when the pt is admitted, but they need to know about follow up care, home care, if they are going to have home health are they going to have dressing changes or need a home health nurse for something else they might be going to a skilled nursing facility for a brief period of time.

A

Communication

planning

15
Q

What should you encourage the patient to use after surgery?

Remember to treat your whole pt _____, spiritually, and physically to get all realms of them

A

Use any resources that they have available to them, so like any surgical pt but there is an added depth to it because of the emotional impact of a cancer dx but also the physical impact.
emotionally

16
Q

This pt may have also under gone surgery; and if you think about _____, like the radiation from the sun, it can be damaging to tissues; if somebody has had surgery and then they had radiation in the same area that would be a reason that radiation might make it more difficult for _____ to occur because it extends the damage; radiation is prescribed by a radiation oncologist and they’ll say give this pt 4000 centigrays of radiation (centigrays is the unit of measure used for radiation therapy) they will write a total dose, so 4000 Cgy and then the fractionation is how much they get for each visit; so the fractionation might be 250 Cgy; so that pt to get their 4000 Cgy of radiation will have 16 treatments; they are usually done Mon-Fri and will give them 2 days off; so that pt will basically go for 3 weeks for radiation oncology. Dose and _____ dependent, Measured in _____ (Cgy)

A

radiation
healing
fractionation
centigrays

17
Q

Most frequently affected tissues by radiation side effects are what?

A

Skin, Mucosal lining of GI tract, Bone marrow

If you have somebody who is getting radiation in their lung, let’s say that there is a perihilar mass, and that is right in the middle of the chest, we have radiation that the radiation oncologist has mapped out exactly where that beam of radiation needs to be focused so that the highest concentration of the radiation is hitting that mass that is in the lung, but it is going through tissue to get there and it’s coming in at a cone shaped so it’s spread over a larger area and then concentrates down into a point when it gets to that tumor so all that tissue that it’s going through will be effected by radiation; it is going through the skin 1st, the skin can get burned, if it is near the esophagus, where this perihilar mass would be it can affect the lining of the esophagus and if you think about it, your GI tract goes from your mouth to your anus so any radiation around it can affect your GI tract and then bone marrow is a problem if large bones are in the field of radiation; it does not affect the bone if they are not in the field.

18
Q

These side effects depend on how much radiation the pt gets and they can be: ____ or Chronic, Mild or _____ Usually local but can be a few ____ effects

A

Acute
Severe
systemic

19
Q

What are things that affect the degree of severity of the side effects of radiation treatments?

A
  1. Size and location of area treated-If it’s a bigger area it’s going to be more severe and depending on where it is, that example I gave you of the mass in the lungs in the perihilar area and that’s where the lungs branch off, that’s the hilum, in that area we have lungs, esophagus, the heart so there are a lot of things that can be affected and those can all suffer from side effects of radiation treatment; some of it now like the GI tract might have short term complications, but years down the road they may suffer from pericarditis because of the radiation.
  2. Type of radiation used; there are actually types that can encircle an area, some are straight beams so it will go right into the target tissue and not maybe damage as much of the other tissue; it is also dependent on how much they are getting; so the Total dose and fractionation schedule; if they have other treatments: chemo and Ra+ combined that would make it more severe; and don’t forget that they might have other illnesses, so our pt with lung cancer may also have COPD or diabetes and diabetes is going to make everything worse so just pay attention to that
  3. Performance status of Co-morbidities
20
Q

Early/ Acute: Nausea especially when the GI tract is in the field of _____; can also get diarrhea. Skin Reactions; the skin will have a burned _____, flake and blister.
Mucositis is the inflammation of the _____ of the GI tract; it can be very unpleasant if it happens in their mouth. Some1 that is getting their neck radiated if they have head or neck cancer the mouth is going to be in there, the salivary glands, the trachea, the esophagus, and the skin also; _____ is dry mouth so if we have the salivary glands affected by radiation they could have a very dry mouth which can be pretty uncomfortable. ____ is a systemic effect and it affects up to 100% of pts; they’re not really sure why, but they have this overwhelming fatigue. ____ has to do with bone marrow suppression; so with bone marrow suppression you will have pts that are immune-compromised because they have decreased lymphocytes you will also have decreased platelets, so they are at risk for infection and bleeding. ____ which is hair loss occurs in the field of radiation; so if someone gets their stomach radiated the hair on the head will not fall out but if they have chemo also then the chemo might make it happen if they are getting radiated to their brain, then their hair is going to fall out.

A
radiation
appearance
mucosa 
xerostomia
Fatigue
Myleosuppression
Alopecia
21
Q

Nausea: usually occurs ___ hours after chemo so it’s an early effect. You as a nurse want to maintain fluid ____. Small ____ meals. Consider premed with _____.
I would make that a standard of care that somebody would have an anti-nausea medication ordered and it’s not just like anti-emetics we might use GI stimulants like metoclopramide, sometimes we use _____ like dexamethasone can be used to help prevent nausea too.

A
1-2
intake
frequent
antiemetic
corticosteroids

It’s better to prevent side effects than to treat them after they have happened and with nausea that is especially true

22
Q

The goal with nausea is to what?
We also: Avoid ____ from clothing, perfume, deodorants, heat, trauma unless prescribed; lotions and creams that are prescribed from the doctor are ok, but perfumes and deodorants should not be used on the site, keep it from extremes in temperature both heat & cold and prevent injury to the site. _____ dressings, prn if clothing is going to be over it like a telfa or something like that non-adhesive (telfa is the brand name) these won’t stick and they generally have a shiny appearance and you put the shiny side to the skin and it won’t stick the way a gauze would stick. Keep ___, if possible. Topical creams, per order of health care practitioner. _____ avoid direct sunlight because this is already a burn; sunlight will just make it worse.

A

Keep skin intact
To prevent this from happening if at all possible so we will want to avoid anything that will irritate the skin if possible it is good for them to leave it open to air.

irritation
Non-adhesive
dry
ABSOLUTELY

23
Q

Mucositis/Xerostomia affects: mouth, pharynx, esophagus, trachea, bowel, bladder, rectum; it is going to be site ____, It’s part of the mucous that is in the field of ____ and remember that radiation spreads out a little bit so anything that is in the neighborhood of the cancer can be affected by the radiation.

A

specific

radiation

24
Q

Mucositis/Xerostomia symptoms: pain anywhere from the mouth to the rectum, dysphagia, altered taste/smell and think about it how important it is for a pt with cancer to maintain their _____ _____; sometimes their favorite foods will have a funny taste and if they are on chemo it can make it even worse like foods will taste _____ or they just won’t have any taste at all and sometimes there are only a couple of types of foods that they can even stand because of the _____ taste and smell, they might have a cough, hoarseness if it’s up the area of the larynx, the vocal chords, ____-difficulty urinating, abdominal cramping, diarrhea.

A

nutritional status
metallic
altered
dysuria

25
Q

Mucositis/Xerostomia interventions: depend on site and we will treat the ____

A

symptoms

26
Q

This is for the whole GI tract: Avoid irritation: Just like w/ skin, avoid anything that is going to irritate the mucosa so soft ____, we don’t want them straining to pass hard stools so keep stools soft by giving ____ softeners, encourage fluid intake, ambulation, things that we do to keep their bowels regular. Topical _____; miracle mouthwash has a topical anesthetic in it to numb pain in their mouth and make it possible for them to eat. _____: dry mouth, artificial saliva, sometimes sucking on hard candies helps with that. Antibiotics to prevent or treat infections and that irritated tissue & steroids, anti-inflammatory medication prn. Maintain hydration. Low residue diet will make stool less plentiful. _____.

A
foods
stool
anesthetics
Xerostomia
Anti-diarrheals=think how with that the GI tract is really irritated, they are more likely to have diarrhea so we will want to prevent that too because that will be hard on their skin.

Maintain hygiene of affected area ex. oral and you may have to, sometimes it will be painful to clean them up a little bit but clean and get rid of the scabs, the crusting the dead skin, and then apply creams or ointments as ordered and keep their mouths clean.

27
Q

Fatigue= Occurs in ___ to ____% of patients; It starts mid to late treatment and may last weeks afterwards. Educate them on ____. Light to _____ exercise with frequent rest and the best is ____ and resistance training which might seem _____ but light, moderate aerobic, resistance training is the best at dealing with this fatigue that can be very overwhelming; we might also have ____. If they have pain, we’ll treat that, depression, insomnia, nutritional defects so we will look at the whole person and see what’s going on that might be causing their fatigue. Treat any other underlying conditions.

A

65 – 100
fatigue= It may be hard for ppl to understand why they are still tired and they haven’t had radiation for 4 weeks; that is something that we will need to educate them about.
moderate
aerobic
counter-intuitive
anemia= If we have mylosuppression it is mostly going to be thrombocytopenia and leukopenia but we could also have decrease rbc’s we will want to treat the anemia if that’s going on.

28
Q

Myelosuppression: ______ of the bone marrow and bone marrow is where cells are formed (blood cells); It’s worse with Ra+ and chemo together; so you are going to be monitoring ___, the differential on your pt when they are on chemo and radiation both. Primarily: _____ and thrombocytopenia
Treatment: medications; we have meds that can stimulate the production of wbc and rbc we will sometimes administer ____ there is nothing to stimulate, platelet production, precautions.

A

Depression
CBC
neutropenia
platelets

29
Q

Alopecia: Occurs in field of radiation so remember that somebody is getting their head ____ their hair is going to fall out, if they are getting radiation to their left toe it is not going to cause the hair on their head to fall off.
Usually occurs 3rd to 4th weeks along, Emotional/psychosocial support, Anticipatory grieving, Buying a ____

A

radiated
wig(s)

The lecture cuts off on this one, said we didn’t need to know in depth.

30
Q

Does the hair fall out all at one time?

A

No, it doesn’t just fall out a little at a time. They will wake up and they will have a bald spot with a huge clump of hair on the pillow which can be pretty emotionally devastating, so we warn them about that ahead of time to cut their hair before it starts to fall out, help them to select a wig if that’s what they want to do beforehand.

31
Q

Side effects of radiation: Infertility, 1 of the cancers that I think about when infertility is _____ cancer; that usually affects young men; starting in their late teens and if that is someone that wants to have babies sometime in their life we might have to store some sperm; if we’ve got radiation going on in the pelvic area then we are going to worry about that sometime down the road.

A

testicular

32
Q

Long term side effect of radiation: Dentition; remember the pt that we talked about that was getting radiation to the head and neck, might have trouble down the road with gum and _____ disease.

A

dental

33
Q

Side effect of radiation: _____ if the lymph system has been damaged by radiation, remember the lymph vessels carry fluid back to the heart, so if there is any edema in your feet the lymph vessels are pick that up and deliver it back up to right near your right atrium so if we have issues with ____ vessels, we will have edema that is not going to go away and it’s going to get worse and worse.

A

Lymphedema
lymphatic
Lymphedema is terrible, people will swell up like balloons, something you will have to watch for and is one of the reasons that we don’t use the side of a mastectomy for blood draws or IV’s or anything like that because if there has been damage to the lymph system, if we put a tourniquet on and we occlude circulation then we can cause them to get lymphedema or make any that is there worse.

34
Q

Side effects of radiation: _____ in the affected areas, dry skin, mouth. Cardiac, when talking about radiating the ____ mass, the heart is probably going to get some of that radiation too; it can cause scaring in the pericardial sac, it can cause damage there, scar tissue and cause restrictive pericarditis down the road .

A

Dryness

perihilar

35
Q

Side effects of radiation: Pulmonary fibrosis: the lungs can be affected and develop ___ tissue and ____ fibrosis; so scared lung tissue isn’t going to work the way your healthy elastic, healthy lung tissue does.

A

scar

pulmonary

36
Q

Long term side effects of radiation: GI: scarring that may cause problems later on; _____, difficulty digesting foods.

A

obstruction

37
Q

Long term side effects of radiation: Secondary cancers: somebody beats cancer in their 20’s and then they are 50 and they come up with another cancer; most common ____ of bone; they come up with another cancer and they are told probably due to the radiation that you had when you were 20.

A

sarcomas

38
Q

Goals of chemo: Cure: Defined as prolonged ____ of detectable cancer cells; not always possible; might have a pt that can’t tolerate the chemotherapy, might have a cancer that has gone too far to be cured.

A

absence

39
Q

Goals of pt undergoing chemo: Control: extension of life if cure isn’t possible and we can prevent ____ cancer growth and that will help with some symptom ____ too, but we do control when cure is not possible.

A

further

management

40
Q

Goal of pt undergoing chemo: Palliation: used when _____ is not possible and this is just for management of symptoms; we reduce the size of the ____ hopefully to decrease some of the effects/reduction of side effects and symptoms, including ___ which is very important

A

cure/control
tumor
pain

41
Q

There are now over __ types of chemo drugs. Higher doses of multiple drugs for cure or optimal ____. We use higher doses of multiple drugs as the pt can tolerate it; sometimes they can’t, so we will start at a higher dose and if their ____ effects are so great, like it has totally wiped out their bone marrow, n/v so bad, then we might have to _____ the dose; there is a certain point that some ppl have such horrible side effects we decrease the chemo dose so much it’s not effective anymore and that is when they sorry there is nothing more we can do for you.

A

30
palliation
adverse
decrease

May be primary treatment or adjunct to other tx’s and we have already discussed that some people get chemo, radiation and surgery.

42
Q

Adverse effects: Chemotherapeutic drugs affect ____ cells and rapidly dividing normal cells. People at the highest risk for chemo induced nausea are those that are very young, women, anyone who has a hx of alcohol intake, a woman who has had a problem with ____ during pregnancy, someone who has a hx of abuse or ____ quality of life and anyone that has had previous chemo.

A

neoplastic
emesis
decreased

43
Q

Adverse effects: Anorexia, nausea, vomiting are common. ____ related to emetic potential of drug; depends on the medication used. Occurs within minutes or hours of ____ of the medication. Usually ____ in 24 to 48 hours . Often relieved by _____.

A

Severity
administration
subside
anti-emetics

44
Q

REALLY important to _____ pts before they receive chemo; premedicate them with an _____, we can give them Dexamethasone which is a corticosteroid, but the use of ______ is based on 1 study, but it is widely used; they will hydrate them to make sure that their _____ are working, give them their anti-emetics, and they might give them other things too and sometimes they will be given Reglan to move contents through the GI system

A

premedicate
anti-emetic
Dexamethasone
kidneys

45
Q

Adverse reactions: Diarrhea- can be due to Lactose intolerance or increased gastric motility. Stomatitis which can happen with radiation and chemo. Bone marrow _____, pt a risk for bleeding and infection. Fatigue. Hair loss. Amenorrhea (absence of period). Low sperm count. Fetal abnormalities; very likely to cause fetal abnormalities in a pregnant person.

A

suppression
Pregnant nurses shouldn’t administer chemo; if you are working on a chemo floor and someone needs chemo on an oncology floor and you’re pregnant you should not be the one to administer the chemo and every employer knows that; nobody should be asking you to do it and if they do ask you to do it then you should look for another employer

46
Q

When we are taking care of pts with cancer, pain is an issue and a pt with ____ pain is different than a pt with acute pain.

A

chronic

47
Q

What are the 4 types of pain?

A

Visceral, Musculoskeletal, Bone and Neuropathic

It is important to know the type a pain your pt has because different types of pain responds to different types of medications.

48
Q

Why can’t we give morphine to everybody?

A

Morphine doesn’t help everything, it does help with some things but it doesn’t help with neuropathic pain; its not the best for bony pain either

49
Q

Acetaminophen: it can be used for somatic, visceral, and musculoskeletal sometimes it’s better for ______ pain than an opioid.
Use cautiously with ____ disease.

A

musculoskeletal
liver

Be aware that Percocet & Vicodin contain acetaminophen do not exceed 3000mg.

50
Q

NSAIDS are used for bony what? it can be more effective than an opiate. Naproxen – do not exceed ____ mg in 24 hrs Use with caution in ____ failure, liver failure and low platelets because of the bleeding risks, bleeding tendencies you would be really careful; monitor ____ functions with these and also with _____ and if there is an issue with the liver you may want to consider not giving it.

A
metastasis (mets)
1250
renal- (because it decreases blood flow to the kidneys)
liver
Tylenol
51
Q

Corticosteroids are used for ____ metastasis-Somatic pain and be aware that you don’t always have to give an opiate, some of the side effects of these drugs are ____ than we might see with opioids. Ex of corticosteroid: _____

A

bony
less
Dexamethasone

Note: Remember it may cause elevated serum glucose, elevate mood, and increase appetite (which could be good for your cancer pts) and remember that you NEVER stop suddenly, taper dose

52
Q

Not seen: Tricyclic Antidepressants: there’s a couple of different neuro meds that we give for ______ pain so these
Seen: Nortriptyline and Amitriptyline given for neuropathic pain we administer with ____ to decrease GI symptoms.
Amitriptyline: do NOT use with ____ patients. Titrate dose based on response.

A

neuropathic
food
geriatric

Amitriptyline: do NOT use with ____ patients
causes increased risk of falls and that’s common enough that this is a warning because we don’t want our older people to fall, break their bones and then end up dying from that.

Note: Nortriptyline – Despiramine – Amitriptyline

53
Q

Muscle Relaxants used for neuropathy pain
A lot of times you will see Lioresal or _____ given to pts that are quadriplegics or paraplegics because even though they are _____ they still get muscle cramps and spasms that cause problems as does the pt with chemo.
Treats ______ muscle movements

A

Baclofen
paralyzed
uncontrolled

54
Q

Anticonvulsants used for neuropathy pain
You see ______ (Neurontin) -a lot of diabetic pts getting this if they have neuropathy. In cancer pts a lot of the chemo drugs can cause ____ damage so they’ll have neuropathy.
Side effect!!!!: it can cause _____ so that’s why they take it at night.
It should not exceed _____ mg a day. Titrate dose based on response. Give with food to decrease GI symptoms.

A
Gabapentin 
nerve
drowsiness
3600
GI
55
Q

Topical Anesthetics is used for neuropathic pain. There is a patch called: _____ (5% patch)

A

Lidocaine

Note: It’s important that it only be on 12 hours/Off 12 hours so they might wear it during the day and take it off at night and Do not exceed 3 patches in a 12 hour period

56
Q

Maintenance and ______ pain medication. OxyContin and “contin” is short for continuous; if you give an oxycontin or ms contin your giving something that is delayed _____ medication. Delayed course of action; give it every 12 hours so they have some pain relief 24 hours a day and that is their _____ pain reliever. If they have pain in between, we call that breakthrough pain because it’s breaking through the maintenance dose that was given. Acute pain- not a big deal, you know it’s going to get better. Chronic pain/ cancer pain= not going to get better.

A

breakthrough
response
baseline
Note Only gets worse put them on a maintenance dose of meds, they will have a breakthrough and then you evaluate it and if it looks like their maintenance dose may not be high enough is their pain getting worse or they are developing a tolerance to the medication, then we can increase the maintenance dose and hopefully decrease the # of breakthrough doses that they have to take; If they have to take breakthrough doses, they are having pain and it can have a negative impact on their quality of life so that concept is keep them on a maintenance dose, taking a maintenance dose if it’s 9 am and it’s time for their maintenance dose and their scale is 0/10 they should still take their maintenance dose because that is why their pain is a 0 so that is what we want to see; the breakthrough pain medication is when we ask their pain level and it is a 2/10 well maybe they don’t need a breakthrough dose, but you don’t withhold the maintenance dose for that

57
Q

Bowel Protocol is really important for pts receiving _____ especially the pts that are on long term; they should always have a routine stool softener like ____ which they can take 1 – 8 tabs daily and also prn that is the standard of care that’s a core measure in hospice Is that we make sure that our pts are on some type of a bowel regiment.

A

opioids

Senna

58
Q

Nociceptive/Visceral Pain; these are pains in organs, vague, but the quality is going down the chart and they are poorly located; they will give you the general region where it hurts; might do some radiation to remote sites; gallbladder pain can radiate to the back. What are these 6?

A
  1. Vague distribution and quality
  2. Poorly located
  3. Deep, aching, pressure
  4. Squeezing, cramping
  5. Spasms
  6. Maybe referred to remote sites
59
Q

Nociceptive Somatic/Bony Pain; they can tell you right where it hurts; moving makes it worse. What are these 5?

A
  1. Well localized and constant
  2. Deep, dull ache
  3. Usually musculoskeletal
  4. Ranges from general aching to sharp stabbing pain with movement
  5. Movement intensifies
60
Q

Neuropathic Pain; this is nerve pain described below; is going to follow a nerve path. What are these 6?

A
  1. Tingling, burning, “pins & needles”, shock like.
  2. Intermittent, brief, shooting (key word that you will hear a lot) or stabbing pain, numbness.
  3. Allodynia: an exaggerated response to a non-painful stimulus; something like barely touching somebody
  4. Hyperalgesia: is an exaggerated response. To painful stimulus; so yeah it hurts but they act like it hurts a lot more than you. Think it would.
  5. Pain in area of numbness
  6. Usually follows a nerve path