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pharm unit one
epidural
76
Nursing
Undergraduate 3
09/04/2011

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Cards

Term
the spinal anatomy consists of two spaces:
Definition

the epidural space and

the intrathecal space

Term
the term _______ is used to encompass both the epidural and intrathecal spaces surrounding the spinal cord
Definition
intraspinal
Term
the intrathecal space is surrounded by the epidural space and seperated from it by the:
Definition
dura mater
Term
the intrathecal space contains:
Definition

cerebral spinal fluid (CSF),

which bathes the spinal cord

Term
the epidural and intrathecal spaces share a common center:
Definition
the spinal cord
Term
the epidural space surrounds the spinal cord and intrathecal space and lies between:
Definition
the ligamentum flavum and he dura mater
Term
this is a potential space because the ligamentum flavum and the dura mater are not seperated until?
Definition
medication or air is injected between them
Term
this potential space contains a network of veins that are:
Definition
large and thin walled
Term
this site has high activity of what blood cell to reduce the risk of infection?
Definition
leukocyte
Term
dividing the epidural and intrathecal spaces is a tough, fatty membrane called:
Definition
the dura
Term
the permiability of the dura is important in determining:
Definition

*how fast the epidural drugs cross into the intrathecal space and

*how long they remain there to be active

Term
the epidural space also contains:
Definition
fat, in proportion to a person's body fat
Term
opiate receptor sites are cells contained in:
Definition

the dorsal horn of the spinal cord

 

--> at which point opioids combine with their respective receptor site to generate analgesia

Term
epidural percutaneous catheters were used initially for :
Definition
surgical and obstetric anesthesia
Term
epidural- used later for:
Definition
opioid postoperative analgesia
Term
to initiate epidural anesthesia, the anesthesia provider administers one or more of these drugs:
Definition

- a local anesthetic

- an opioid

- a combination of both

- or a steroidal compound

Term
they deliver the drugs into the epidural space via:
Definition
 a special needle or a microbore catheter
Term
the medication diffuses through the:
Definition

- dura mater

- arachnoid mater

- and the pia mater

--> to the spine

Term
the spinal cord and nerve roots are bathed in the medication, which:
Definition
blocks pain impulses before they reach the brain
Term
if a steroid is used:
Definition
it reduces inflammation
Term
epidural pain control is applicable to:
Definition
 patients of all ages
Term
there are various approaches to the administration of narcotics and anesthetics via the epidural route:
Definition

- a single-bolus injection of opioid

-local anesthetic

- a continuous infusion of opioid with or without local anesthetics

- a continuous infusion of opioid with a patient- activated bolus

Term
dosages of medication can be titrated to effect:
Definition

the proper dermatome level;

 

like filling a tube, the volume of medication given determines which dermatome level is affected

Term
there are two types of epidural catheters:
Definition
temporary and permanent
Term
the temporary epidural catheter is used in:
Definition
periobstetric and perioperative period
Term
the Temporary epidural catheter is designed for:
Definition
short term use with materials that easily pass into the epidural and intrathecal spaces
Term
Teflon catheters allow visualization of:
Definition
aspirated fluid
Term
Teflon catheters can become stiff and:
Definition
migrate out of their original placement
Term
teflon catheters are what type of catheter?
Definition
external catheters
Term
temporary catheters are intended to be used for:
Definition
days to weeks
Term
use of the permanent catheters for _________ to _______ via the epidural route is supported by many pain specialists
Definition
weeks to months
Term
the advantages of the permanent catheters are that they have:
Definition

a dacron cuff to aide in the stabilization of the catheter to the tissues,

 and many have a second vitacuff inpregnated with silver to reduce antimicrobial activity

Term
permanent catheters are generally what type of catheter:
Definition
internal catheters
Term
a single injection of epidural opioid may be used for:
Definition

procedures that produce a short course of postoperative pain

 

** this method may be appropriate for a pateint having a cesarean section or vaginal hysterectomy, or after same- day surgical procedures

Term
continuous epidural infusion is administered for:
Definition
short and long peroids of time
Term
patients with pain from surgery, trauma, and acute medical disorders creating severe pain may benefit from:
Definition
short-term continuous infusions
Term
epidural and intrathecal medications:
Definition

baclofen

bupivacaine hydrochloride

clonidine

DepoDur

Fentanyl

hydromorphone hydrochloride

morphine sulfate

sufentanil

ziconotide

Term
what method of delivery can also be employed for the cancer patient with acute exacerbation of pain:
Definition
short-term continuous infusions
Term
the insertion of an epidural catheter is a ______________ procedure
Definition
sterile
Term
the insertion of the epidural catheter is a steril procedure performed by a:
Definition
physician or anesthesiologist
Term
administration of medication by a nurse through and epidural catheter must be in accordance with:
Definition
each state's nurse practice act
Term
nursing responsibilities for med administration with epidural catheter include:
Definition

1- patient and family education,

2- site and dressing management

3- medication administration(depending on state practice)

4- evaluation of pain relief

Term
most commonly epidural medication is administered by:
Definition
certified nurse anesthetist or anesthesiologist
Term
the epidural medication catheter is managed by:
Definition
the staff nurse
Term
epidural morphine as a single bolus dose has demonstrated analgesia that lasts up to ____________ with DepoDur.
Definition
24-48 hours
Term
in clinical trials, 90% of respiratory depression occured:
Definition
within the first 24 hours after administration
Term
patient monitoring requirments for epidural patients include:
Definition

pain score

respiratory rate

sedation scale rate- every hour for 2 hours, then every two hours for the remainder of the 48 hours from the time of administration

Term
candidates for epidural anesthesia are patients with:
Definition

1- general surgeries of the thoracic or abdominal area

2- labor pains

3- acute and chronic pain (chronic lumbar pain)

4- cancer pain

5- phantom limb pain

6- pancreatic pain

7- incisional pain

Term
epidurals are contraindicated in the following situations:
Definition

1- active infection near the epidural catheter insertion site

2- use of systemic anticoagulation and anti platelet therapy.

3- in patients on long term use of aspirin products or nonsteroidal anti-inflammatory drugs

4- hypovolemic shock

5- identified allergy to drugs being used for epidural or intrathecal anesthesia

6- heart failure or aortic stenosis

7- patients who cannot understand the procedure well enough to give informed consent

8- a scarred, distorted, or obliterated epidural space from previous thoracic or lumbar spinal surgery

9- a severe spinal curvature such as scoliosis

Term
epidural medication administration permits control or alleviation of __________ pain without the sedative effects
Definition
severe
Term
epidural medication administration permits delivery of __________ doses of a narcotic to achieve the desired level of analgesia
Definition
smaller
Term

epidural medication administration prolongs the analgesia:

 

average ?

extended release epidural morphine?

Definition

average- about 14 hours

extended release morphine- 24 to 48 hours

Term
epidural medication administration _____________ analgesia
Definition
prolongs
Term
epidural medication administration allows for _____________ infusion, if needed
Definition
continuous
Term
epidural medication administration allows terminal cancer patients treated with epidural narcotics to be:
Definition
more comfortable and more mobile
Term
epidural medication administration can be used for :
Definition
short or long term therapy
Term
epidural medication administration does not produce:
Definition
motor paralysis
Term

epidural medication administration:

 

 

only ________________-______ opioids can be used

Definition
preservative-free
Term
epidural medication administration complications may occur such as:
Definition

paresthesia

urinary retention

respiratory depression ( greatest 6-10 hrs after injection)

 

Term
epidural medication administration catheter-related risks:
Definition
e.g. infection, dislodgement, and leaking
Term

epidural medication administration

 

what can occur on the face, head, and neck or may be generalized?

Definition
pruritus
Term
unless the epdural catheter and medication are clearly labeled, an intravenous infusion could cause:
Definition
serious complications or death
Term
a pain specialist will make sure the catheter is patent by:
Definition
aspirating to check for blood and checking the ablility to administer medication throughout the catheter
Term
INS standard, medication shall be:
Definition
preservative free
Term

for intraspinal infusions,

 a 0.2 micron filter needle that is:

Definition
 surfactant- free, particulate- retentive, and air- eliminating shall be used
Term
sterile technique, including what, should be used when accessing, caring for and maintaining and intraspinal access device?
Definition

mask

sterile gloves

Term
ineffective pain control shoudl be:
Definition
reported to the physician or anesthesiologist who is managing care of the epidural catheter
Term
the catheter used depends on:
Definition
the reason for use
Term
in the hospital, external catheters are in place:
Definition
3 days - 1 week
Term
external catheters are securred to:
Definition
the patients back --> thenattached to an infusion into the patients epidural space
Term
epidural pt's recieve immediate relief and are:
Definition
less likely to recieve post op complications
Term
epidural access advantages:
Definition

- alleviates pain quickly

- prolongs analgesia

-does NOT produce moto paralysis or hypotension

Term
epidural access disadvantages:
Definition

- typically catheter related- usually accidental dislodgement and leaking

- catheter is placed in the OR

-medication is prepared by the pharmacy

Term
why does the pharmacy handle epidural medication preparation?
Definition
so it is not confused with opioid preparations that are used with PCA's
Term
every epi patient should have which assessments per hospital policy, usu every 2 hours for status changes?
Definition

neuro

pain

resp.

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