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Pain and GS

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jmnies's version from 2017-05-10 02:29

BMI

Question Answer
underweight<18.5
Normal18.5–24.9
Overweight25.0–29.9
Obesity I30.0–34.9
II35.0–39.9
Extreme obesity :III≥40
Target range≥18.5 and <25
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Temp

Question Answer
Colder in the morning or at nightin the morning and warmer at night
Rectal temperatures arehigher than oral temperatures (1F)
Tympanic temperatures arehigher than oral temperatures (1.4F)
axillary temperatures arelower than oral temperatures (1F)
hyperpyrexia>106°F (41.1 °C)
hypothermia< 95F cold, sepsis, EtOH, starvation, hypothyroidism, hypoglycemia, elderly
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Pulse/BP

Question Answer
Normal BPless than 120/80
Prehyp BP120-139/80-89
HTN stage 1140-159/90-99
HTN stage 2160 or higher/100 or higher
HTN crisis>180/110
Bladder width BP40% of upper arm circumference
Bladder length BP80% of upper arm circumference
Too small BP cuffhigher reading
Korotkoff sounds are heard better with thebell
Silent interval that may be present between the systolic and diastolic blood pressuresAuscultatory Gap
four components of assessing the pulserate, rhythm, amplitude and contour
Normal heart rate (adults)60 to 100 bpm
Bradycardiaslow pulse: < 60 bpm
Tachycardiarapid pulse: > 100 bpm
Bisferiens pulseValvular heart disease, Double systolic peak
Bigeminal pulseNormal beat alternating with premature contraction
Weak pulseheart failure, hypovolemia
Bounding pulsefever, anemia, hyperthyroidism, exercise, fear/anxiety
Paradoxical pulseDecrease in pulse amplitude on quiet respiration, Pericardial tamponade, restrictive pericarditis, COPD
Pulsus AlternansLeft ventricular dysfunction, Regular rhythm, Alternating strong/weak contractions, Radial or femoral arteries
Regular beatseach beat occurs at a regular interval from the previous beat. i.e., AV nodal or junctional rhythms
Regularly irregularirregular beats occur with predicted regularity. i.e., bigeminy and trigeminy
Irregularly irregularno pattern of beats is present. i.e., classic for atrial fibrillation
What to use for pulse in peds?brachial/femoral arteries
Small weak pulseheart failure, hypovolemia
Large bounding pulsefever, anemia, hyperthyroidism, exercise, fear/anxiety
Bisferiens pulse (double peak)valvular heart disease
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Respirations

Question Answer
What to observe in respirations?Observe rate, rhythm, depth and effort of breathing
Eupneanormal, 14-20 bpm
BradypneaSlow breathing, < 14 bpm, diabetic coma, drug induced, increased ICP
TachypneaRapid, shallow breathing, > 20 bpm
ApneusticInspiration longer than expiration, Brainstem damage
ObstructiveExpiration longer than inspiration, Asthma, COPD
RestrictiveShallow inspirations; rapid with exertion, Restrictive lung disease
HyperpneaRapid, deep inspirations (AKA hyperventilation), Pain, respiratory distress, acidosis, hysteria, exercise, hypoxia
Kussmauldeep gasping respirations such as found in diabetic acidosis
Cheyne-StokesDeep breath/apnea, Heart failure, brain damage, respiratory depression
An unpredictable, abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. As the breathing pattern deteriorates, it merges with agonal respirations.Ataxic (Biot’s)
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Pain

Question Answer
Sharp, well-localized pain lasting 7-10 daysacute
Pain lasting 10 days to 6-7 weekssub-acute
Non-cancer pain or pain from other medical conditions lasting >3-6 months, or pain >1 month beyond an acute illness or injury, or recurrent painchronic
Occurs in relation to actual injury to the body, responds to managementNocioceptive/Somatic
Pain resulting from direct trauma to the peripheral or central nervous systemNeuropathic
A result of an alteration of CNS processing of sensation, leading to amplification of pain signalsCentral sensitization
Responds best to meds that modify NTs like serotonin and dopamineCentral sensitization
Lower pain thresholdCentral sensitization
Multifactorial painPsychogenic
Pain without an identifiable causeIdiopathic pain
(Assessing Pain using ABCDE) AAsk about pain regularly
(Assessing Pain using ABCDE) BBelieve patients and their reports of pain
(Assessing Pain using ABCDE) CChoose appropriate pain control options
(Assessing Pain using ABCDE) DDeliver interventions (timely, logical, coordinated)
(Assessing Pain using ABCDE) EEmpower and enable patients & families to control their course as much as possible
Monitoring outcomes using 4A’sAnalgesia, Activities of daily living, Adverse effects, Aberrant drug-related behaviors
Toleranceadaptation to a drug over time that decreases the drug’s effect
Physical dependenceadaptation to a drug that produces a withdrawal syndrome when there is abrupt cessation or rapid dose reduction of a drug.
AddictionMulti-factorial. Genetic, biological, environmental, psychosocial factors leading to impaired control over drug use, compulsive use and continued use despite harm or craving.
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