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    4 - PCC Study Guide

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    Karina Ivanchenko
    This document provides information on delegation, hypertension stages, pain management techniques, perioperative care, and the differences between delirium and dementia. It defines delegation as giving someone a task while retaining accountability. It lists the stages of hypertension and notes an hypertensive crisis requires starting an IV. It discusses pain scales, the physiology of pain, and breakthrough pain. It also outlines monitoring for procedures requiring conscious sedation or anesthesia and describes delirium as a rapid onset complication compared to the progressive nature of dementia.

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    4 - PCC Study Guide

    Uploaded by

    Karina Ivanchenko
    39 views6 pages
    This document provides information on delegation, hypertension stages, pain management techniques, perioperative care, and the differences between delirium and dementia. It defines delegation as giving someone a task while retaining accountability. It lists the stages of hypertension and notes an hypertensive crisis requires starting an IV. It discusses pain scales, the physiology of pain, and breakthrough pain. It also outlines monitoring for procedures requiring conscious sedation or anesthesia and describes delirium as a rapid onset complication compared to the progressive nature of dementia.

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    4_PCC Study Guide

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    This document provides information on delegation, hypertension stages, pain management techniques, perioperative care, and the differences between delirium and dementia. It defines delegation as giving someone a task while retaining accountability. It lists the stages of hypertension and notes an hypertensive crisis requires starting an IV. It discusses pain scales, the physiology of pain, and breakthrough pain. It also outlines monitoring for procedures requiring conscious sedation or anesthesia and describes delirium as a rapid onset complication compared to the progressive nature of dementia.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    39 views6 pages

    4 - PCC Study Guide

    Uploaded by

    Karina Ivanchenko
    This document provides information on delegation, hypertension stages, pain management techniques, perioperative care, and the differences between delirium and dementia. It defines delegation as giving someone a task while retaining accountability. It lists the stages of hypertension and notes an hypertensive crisis requires starting an IV. It discusses pain scales, the physiology of pain, and breakthrough pain. It also outlines monitoring for procedures requiring conscious sedation or anesthesia and describes delirium as a rapid onset complication compared to the progressive nature of dementia.

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    Delegation:

    Definition: giving someone else a task to do, while retaining accountability that the task gets done

    Right task, person, circumstances, direction, supervision (TP CDS) TOILET PAPER CDS

    Safe tasks for unlicensed: (skip)

    Most appropriate staff for skills: IV, meds, vitals etc.: LPNs cannot give more than 2mg pain med via IV
    Hypertension:

    Hypertension stages

    normal <120 AND <80


    prehypertension 120-129 AND <80
    stage I 130-139 OR 80-89
    stage II 140- OR 90-
    hypertensive crisis >180 OR >120…..get IV started b/c will prolly need medicines

    Potassium rich foods


    potatoes, avocadoes, broccoli, fruits, mushrooms, peas, cucumbers, etc.

    Medication education: taking even if feeling better, same time daily, etc.

    Reversible vs. irreversible risk factors: skip


    Pain management:

    Pain scales…..0-10, faces, FLACC 

    Physiology of pain:
    1- transduction: receptors are stimulated
    2- transmission: signal travels along peripheral nerves to spinal cord along fast A and slow C fibers,,
    then continues along ascending spinal tracts
    3-perception: central cortex recognizes the pain stimulus
    4-modulation: limbic system reacts to pain; modulating signals sent along descending tracts

    Nociceptive pain: most common. Nociceptors could be somatic (musculoskeletal) or visceral (organs) in location
    Neuropathic pain: when nervous system damaged due to injury or illness. Usu chronic

    Myths….rewritten here as TRUTHS:


    -CLIENTS WHO ABUSE SUBSTANCES DO NOT ALWAYS OVERRACT TO DISCOMFORT
    -TAKING ANALGESICS PROPERLY WILL NOT LEAD TO ADDICTION
    -TISSUE DAMAGE AMOUNT DOES NOT CORRELATE TO PAIN INTENSITY
    -THE BEST AUTHORITY OF A PERSON’S PAIN IS THE PERSON THEMSELVES
    -CHRONIC PAIN IS NOT ALL PSYCHOLOGICAL (ALTHOUGH IT CAN CAUSE PSYCHOLOGICAL DISTRESS)
    -CLIENTS WHO CAN’T SPEAK CAN STILL FEEL PAIN

    Breakthrough pain:
    good short video https://www.youtube.com/watch?v=8bRtfQUWvpk

    breakthrough pain is ONLY when a person has persistent pain that’s usually under control
    types of breakthrough pain:
    1-incident: voluntary (hurts when walk) or involuntary (hurts when get a bladder spasm)
    2-end-of-dose deterioration: so increase dose or dosing interval
    3-non-volitional: out of the blue

    Difference between:
    tolerance: body adjusts to current dose so a higher dose is needed to be effective
    dependence: when body experiences physical and/or mental withdrawal upon quitting a medication
    addiction: a disease (unlike the top 2) where a person cannot stop despite detrimental effects on life @ home/school/work etc.
    abuse: using a drug for something other than its intended use
    https://www.fortbehavioral.com/addiction-recovery-blog/the-differences-between-tolerance-dependence-and-addiction/

    ABCDE of pain management

    A = Ask about pain regularly; assess systematically

    B = Believe the client & family about reports of pain & what relieves it

    C = Choose pain control options appropriate for the client, family & setting

    Pharmacological options:
    Patient-controlled analgesia (PCA pump)
    topical, local/regional
    MONITOR: every 15-30 mins and vital signs every 2 hours

    Invasive options:
    perineural local anesthetic infusion (nerve block?)
    intrathecal implantable pumps/injections  picture
    spinal cord stimulators
    deep brain stimulators  picture
    trigger point injections
    MONITOR: every 15 mins

    Non-pharmacological options:
    acupuncture (great w/ chronic pain but bad w/ bleeding problems), guided imagery (better the more senses are involved), aromatherapy, etc.

    D = Deliver interventions in a timely, logical & coordinated fashion

    E = Empower clients & families; enable them to control their course to the greatest extent possible

    Reversal agents for

    Benzos (Versed (midazolam)/Ativan (lorazepam)/Valium (diazepam)): flumazenil (Romazicon)

    Narcotics: naloxone (Narcan)


    Perioperative:

    Types of anesthesia:
    -general…loss of consciousness and sensation…BREATHING TUBE
    -CS (conscious sedation)…lowered awareness and sensation but still conscious and NO BREATHING TUBE
    -regional…no effect on consciousness; numbs a relatively large area of the body
    -local…no effect on consciousness; numbs a relatively small area of the body

    Role of circulating RN
    advocate for the safety of the patient since they’re under anesthesia

    Common surgery complications:


    Paralytic ileus…malfunction in nerves/muscles of digestive tract; bowel stops working
    (absent bowel sounds).
    Can cause necrosis and peritonitis. REPORT TO DR. prevent…? See pic 
    DVT…blood clot. Prevent by early and consistent ambulation and SCDs

    Informed Consent (10th ed p. 313)


    what is it: legally binding document that the pt signs stating they have been informed about risks/benefits of a procedure, what the procedure
    involves, AND that they agree to have the procedure done.
    Those who CAN provide their own consent:
    -adults (18 or over) not under the influence who are cognitively intact
    -someone who is illiterate CAN provide own consent (need a witness to prove the X mark they make on the signature line is the pt’s mark)
    Those who CANNOT provide their own consent
    -minors/children
    -cognitive disability deemed by assessment or court order
    -under the influence of a substance (whether of their own accord or admin. in the hospital like pain meds. Need to wait until out of their system
    and they are able to understand the info)
    -someone who does not understand the language of the provider (use interpreter services to provide the language most comfortable)
    -Alzheimer’s or dementia pts usually not able to, unless recently diagnosed and still fully intact

    The person performing the procedure MUST be the one to obtain informed consent…this is where nurses can advocate for patients. If a patient has a
    question, call the provider and have them come back down and answer the question. RNs don’t answer questions involving procedures requiring
    informed consent, even if they know the answer!

    Patients can change their mind even after signing consent. As nurses, we can ask for reason, encourage communication, etc.
    Definition for classifications of surgery:
    urgent: get surgery within a couple days
    emergent: get surgery now or die/be permanently disabled

    Surgery vs Procedure
    all surgeries are procedures, but not all procedures are surgeries
    Procedure: something done in order to achieve a result in the delivery of healthcare
    Surgery: something done in order to achieve a result that involves cutting tissues

    Types of procedures (pg 1322 box 50.1)


    diagnostic: to figure out what’s going on (biopsy)
    ablative: removing something (cholecystectomy, appendectomy)
    palliative: to alleviate pain or make easier to breathe, although does not solve the cause. Alleviates symptoms
    restorative: breast reconstruction after mastectomy, scar revisions, skin grafting w/ burns
    transplants: obvious
    cosmetic: face lifts, breast augmentation, rhinoplasty

    Monitoring equipment needed for conscious sedation


    -crash cart w/ intubation equipment if airway needs to be established
    -oxygen source if needed
    -Monitors for heart (ECG), blood pressure (cuff), oxygen (pulse ox), temp (thermometer)

    Using Aldrete tool to determine patient condition: 8 or higher is acceptable for discharge (even though slides say 10, use 8 or higher for test)

    Delirium vs. Dementia


    #1 difference is onset of symptoms (rapid vs. progressive)
    Delirium: complication when coming out of anesthesia, often in older ppl. Takes longer for body to clear the anesthetic. Can be confused,
    agitated when waking up. Will have rapid onset and causative factor (injury, illness, post-op), and once the cause is fixed, the delirium goes
    away
    Dementia: progressive process; no cure. Will only get worse. Not rapid onset.

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