AGACNP - Based on Frances Guide
Review Materials
Acute Pain - ANS-Pain caused by tissue damage, usually < 6 months
Chronic Pain - ANS-Continual or episodic pain of longer duration (> 6 months);
combination therapy usually needed
Cutaneous Pain - ANS-Localized on skin or surface of body. Herpes or sunburn.
Visceral Pain - ANS-Poorly localized such as with internal organs. Gallbladder.
Somatic Pain - ANS-Non localized; originates in muscle, bone, nerves, blood vessels
and supporting tissue.
Neuropathic Pain - ANS-Frequently caused by a tumor; involves nerve pathway injury or
compression. Sciatica
Step 1 of WHO's Ladder of Pain Management - ANS--ASA
-APAP
-NSAIDS
+/- adjuvants
Step 2 of WHO's Ladder of Pain Management - ANS--APAP or ASA
-Codeine
-Hydrocodone
-Oxycodone
-Dihidrocodeine
-Tramadol (not available with APAP or ASA)
+/- Adjuvants
Step 3 of WHO's Ladder of Pain Management - ANS--Morphine
-Dilaudid
-Methadone
-Levorphanol
-Fentanyl
-Oxycodone
+- nonopioid analgesics
,+- Adjuvants
Recommendation for breakthrough cancer pain - ANS-Fentanyl patches for sustained
release
Normal body temperature in C - ANS-37
101.5 degrees F - ANS-38.6 degrees C
Causes of Fever - ANS--Bacterial, viral, rickettsial, fungal or parasitic infection
-Autoimmune disease (SLE, arteritis)
-CNS disease (cerebral hemorrhage, brain tumor, MS) interference with
thermoregulatory process rather than fever
- Malignant neoplastic disease (primary liver metastasis of cancer)
-Hematologic disease (lymphoma/leukemia)
- CV disease (MI, phlebitis, PE)
- GI disease (IBD, alcoholic hepatitis)
- Endocrine disease (hyperthyroidism, pheochromocytoma)
-Misc causes (Familial Mediterranean fever, hematoma)
- Neuroleptic malignant syndrome-->caused by antipsychotics causing a serotonin like
response
Treatment of Fever - ANS--Antimicrobials only when microbe is present
-Antipyretics
-Treat underlying condition
NON INFECTIOUS causes of post-operative fever - ANS-1. Atelectasis
2. Increased basal metabolic rate
3. Dehydration (can spike temp)
4. Drug reactions:
-Amphotericin B
-TMP-SMZ - often persistent, not a spike
-Beta Lactams
-Antibiotics
-Procainamide
-Isonazid
-Alpha Methyldopa
-Quinidine
, INFECTIOUS causes of post-operative fever - ANS-1. Usually w/ subjective complaints,
WBC elevation and left shift (bandemia)
2. WBC > 30,000 not usually from infection
3. Surgical incisions
4. IV sites
5. Point of entry for any catheter: culture?
6. UTI
7. Lungs
8. Sinusitis
9. Abscess (ie: intra-abdominal)
Initial Treatment of Post-Operative Fever - ANS-In the absence of infection-first step is
hydration and lung expansion
Treatment of Infectious Post-Op Fever - ANS-1. Supportive therapy and APAP
2. Treat the apparent underlying source
3. Gram stain and C&S all invasive lines or catheters, as indicated
Differential Value Indicative of Allergic Reaction - ANS-Increased eosinophil count
Components of Headache Evaluation - ANS-1. Chronology **most important**
2. Location, duration and quality should also be evaluated
3. Associated activity: exercise, sleep, tension, relaxation
4. Timing of menstrual cycle
5. Presence of associated symptoms
6. Presence of "triggers"
Most common type of headache - ANS-Tension Headache
Tension Headache Signs and Symptoms - ANS-1. Vise-like or tight in quality
2. Usually generalized
3. May be most intense around the back of the head
4. No associated focal or neurological symptoms
5. Usually lasts for several hours
Tension Headache | Management - ANS-1. OTC analgesics
2. Relaxation
Migraine Headaches - ANS-Dilation and excessive pulsation of the branches of the
external carotid artery, usually lasting 2-72 hours along the Trigeminal nerve pathway
Review Materials
Acute Pain - ANS-Pain caused by tissue damage, usually < 6 months
Chronic Pain - ANS-Continual or episodic pain of longer duration (> 6 months);
combination therapy usually needed
Cutaneous Pain - ANS-Localized on skin or surface of body. Herpes or sunburn.
Visceral Pain - ANS-Poorly localized such as with internal organs. Gallbladder.
Somatic Pain - ANS-Non localized; originates in muscle, bone, nerves, blood vessels
and supporting tissue.
Neuropathic Pain - ANS-Frequently caused by a tumor; involves nerve pathway injury or
compression. Sciatica
Step 1 of WHO's Ladder of Pain Management - ANS--ASA
-APAP
-NSAIDS
+/- adjuvants
Step 2 of WHO's Ladder of Pain Management - ANS--APAP or ASA
-Codeine
-Hydrocodone
-Oxycodone
-Dihidrocodeine
-Tramadol (not available with APAP or ASA)
+/- Adjuvants
Step 3 of WHO's Ladder of Pain Management - ANS--Morphine
-Dilaudid
-Methadone
-Levorphanol
-Fentanyl
-Oxycodone
+- nonopioid analgesics
,+- Adjuvants
Recommendation for breakthrough cancer pain - ANS-Fentanyl patches for sustained
release
Normal body temperature in C - ANS-37
101.5 degrees F - ANS-38.6 degrees C
Causes of Fever - ANS--Bacterial, viral, rickettsial, fungal or parasitic infection
-Autoimmune disease (SLE, arteritis)
-CNS disease (cerebral hemorrhage, brain tumor, MS) interference with
thermoregulatory process rather than fever
- Malignant neoplastic disease (primary liver metastasis of cancer)
-Hematologic disease (lymphoma/leukemia)
- CV disease (MI, phlebitis, PE)
- GI disease (IBD, alcoholic hepatitis)
- Endocrine disease (hyperthyroidism, pheochromocytoma)
-Misc causes (Familial Mediterranean fever, hematoma)
- Neuroleptic malignant syndrome-->caused by antipsychotics causing a serotonin like
response
Treatment of Fever - ANS--Antimicrobials only when microbe is present
-Antipyretics
-Treat underlying condition
NON INFECTIOUS causes of post-operative fever - ANS-1. Atelectasis
2. Increased basal metabolic rate
3. Dehydration (can spike temp)
4. Drug reactions:
-Amphotericin B
-TMP-SMZ - often persistent, not a spike
-Beta Lactams
-Antibiotics
-Procainamide
-Isonazid
-Alpha Methyldopa
-Quinidine
, INFECTIOUS causes of post-operative fever - ANS-1. Usually w/ subjective complaints,
WBC elevation and left shift (bandemia)
2. WBC > 30,000 not usually from infection
3. Surgical incisions
4. IV sites
5. Point of entry for any catheter: culture?
6. UTI
7. Lungs
8. Sinusitis
9. Abscess (ie: intra-abdominal)
Initial Treatment of Post-Operative Fever - ANS-In the absence of infection-first step is
hydration and lung expansion
Treatment of Infectious Post-Op Fever - ANS-1. Supportive therapy and APAP
2. Treat the apparent underlying source
3. Gram stain and C&S all invasive lines or catheters, as indicated
Differential Value Indicative of Allergic Reaction - ANS-Increased eosinophil count
Components of Headache Evaluation - ANS-1. Chronology **most important**
2. Location, duration and quality should also be evaluated
3. Associated activity: exercise, sleep, tension, relaxation
4. Timing of menstrual cycle
5. Presence of associated symptoms
6. Presence of "triggers"
Most common type of headache - ANS-Tension Headache
Tension Headache Signs and Symptoms - ANS-1. Vise-like or tight in quality
2. Usually generalized
3. May be most intense around the back of the head
4. No associated focal or neurological symptoms
5. Usually lasts for several hours
Tension Headache | Management - ANS-1. OTC analgesics
2. Relaxation
Migraine Headaches - ANS-Dilation and excessive pulsation of the branches of the
external carotid artery, usually lasting 2-72 hours along the Trigeminal nerve pathway
