-
Morphine
- Pain control Opiate
- onset 5 mins
- duration 4-5 hrs
- 2-4 mg IV q 4hrs
- Most common used
-
Hydromorphone (Dilaudid)
- Pain control Opiate-
- Onset 15 mins
- duration 4-5 hrs
- 0.2-1mg IV q 2-3 hrs
- Synthetic version of Morphine and at least 7 times as potent.
-
Fentanyl
- synthetic opiate analgesic
- very potent
- -typical dose 50mcg-100mcg
- Onset 1-2min
- Short acting
- -IV duration .5 to 1 hour
- Useful for procedures and surgery
-
Titration
- Adjustment of a drug fro an individual level to provide the greatest comfort to the patient with minimal side effects.
- Often an independent nursing judgement.
-
Narcan
- Opiate reversal agent
- 0.1-0.2mgIV at two to three minute intervals
- caution: Narcan reverser all opiate effects including pain relief.
-
Sedation
- Midazolam (Versed)- a bensodiazepine
- Rapid onset-short duration 4 hours
- dosage can be weight based
- Reversed with Romazicon(Flumazenil 0.2mg every minute-maximum 4 dosages
- Treatment is more for agitation than pain
-
Lorazepam/Ativan
- Benzpdiazepine
- Slow onset 10-20 mins
- Long duration 12hrs
- Reversal agent romazicon/Flumazenil
- .2mg IV max 1mg
- Side effect : seizures
-
Propofol (Diprivan)
- Rapid onset-2mins
- Very short acting duration of 2-5 minutes
- As soon as the drug is stopped, the pt starts to wake up.
- White colored drug-dissolved in lipid emulsion so can raise cholestorol
- No reversal agent
- Metabolized in liver-can discolor urine green
-
Propofol Syndrome
- Cardiac failure
- Rhabdomolysis
- metabolic acidosis
- renal failure
-
Sedation Assessment
Richmond Agitation Sedation Score
(RASS)
- Uses 2 scores
- -Target score-Physician designated
- -Actual score-nurse assessed
- Uses positive and negative numbers
- Typical target score- 0 to -2
- Which is light sedation, briefly awakes to voices
- Actual score should match target score
-
Neuromuscular Blockade
- Creates a drug induced paralysis
- Vecuronium-effective within 3 minutes -duration of 30-40 minutes
- Pavulon onset 2-3 minutes - duration 45-60 minutes
- Paralyzes Skeletal muscles only- not the brain
- Don't forget sedation and analgesia
- Side effects- tachycardia and hypertension
-
Geriatric Critically ill Patient
- Co morbidities
- Polypharmacy
- Decreased reserve
- Reduced abilit for homeostasis
- Impaired immune response
- Decreased CNS reflexes, memory and BBB
-
Delirium
- Acute onset with difficulty with cognition, inattention, and confusion.
- Common in the critically ill patient
- Different than dementia - slow onset
- High risk for the elderly
- Will vary between lethargy/inattentiveness vs agitation, restlessness, combative
-
Delirium Factors
- Polypharmacy
- Infection
- Hyponatremia
- Alcohol withdrawal
- Hypoxia
- Lack of sleep
- Sensory overload
-
Nutrition
- Critically ill need increased calories for
- healing and immune response
- Strenghten muscles (protein)
- Decrease length of stay
- Glucose management in critical care
- Metabolic demands are elevated in these pts.
-
Non opioid Pain Therapy
- acetaminophen
- aspirin
- NSAIDS
- All have fewer side effects than opiods
- May be used in combination with opiods
-
Adjuvant Therapy
- Drugs that assist in reducing certain types of pain
- Used in addition to opioids
- ex: corticosterioids for cancer patients for relief of pain.
- Antideppressants and anticonvulsants for neuropanthic pain
|
|
