Term
| the spinal anatomy consists of two spaces: |
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Definition
the epidural space and
the intrathecal space |
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Term
| the term _______ is used to encompass both the epidural and intrathecal spaces surrounding the spinal cord |
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Definition
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Term
| the intrathecal space is surrounded by the epidural space and seperated from it by the: |
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Definition
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Term
| the intrathecal space contains: |
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Definition
cerebral spinal fluid (CSF),
which bathes the spinal cord |
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Term
| the epidural and intrathecal spaces share a common center: |
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Definition
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Term
| the epidural space surrounds the spinal cord and intrathecal space and lies between: |
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Definition
| the ligamentum flavum and he dura mater |
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Term
| this is a potential space because the ligamentum flavum and the dura mater are not seperated until? |
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Definition
| medication or air is injected between them |
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Term
| this potential space contains a network of veins that are: |
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Definition
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Term
| this site has high activity of what blood cell to reduce the risk of infection? |
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Definition
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Term
| dividing the epidural and intrathecal spaces is a tough, fatty membrane called: |
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Definition
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Term
| the permiability of the dura is important in determining: |
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Definition
*how fast the epidural drugs cross into the intrathecal space and
*how long they remain there to be active |
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Term
| the epidural space also contains: |
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Definition
| fat, in proportion to a person's body fat |
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Term
| opiate receptor sites are cells contained in: |
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Definition
the dorsal horn of the spinal cord
--> at which point opioids combine with their respective receptor site to generate analgesia |
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Term
| epidural percutaneous catheters were used initially for : |
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Definition
| surgical and obstetric anesthesia |
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Term
| epidural- used later for: |
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Definition
| opioid postoperative analgesia |
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Term
| to initiate epidural anesthesia, the anesthesia provider administers one or more of these drugs: |
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Definition
- a local anesthetic
- an opioid
- a combination of both
- or a steroidal compound |
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Term
| they deliver the drugs into the epidural space via: |
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Definition
| a special needle or a microbore catheter |
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Term
| the medication diffuses through the: |
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Definition
- dura mater
- arachnoid mater
- and the pia mater
--> to the spine |
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Term
| the spinal cord and nerve roots are bathed in the medication, which: |
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Definition
| blocks pain impulses before they reach the brain |
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Term
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Definition
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Term
| epidural pain control is applicable to: |
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Definition
|
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Term
| there are various approaches to the administration of narcotics and anesthetics via the epidural route: |
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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 |
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Term
| dosages of medication can be titrated to effect: |
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Definition
the proper dermatome level;
like filling a tube, the volume of medication given determines which dermatome level is affected |
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Term
| there are two types of epidural catheters: |
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Definition
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Term
| the temporary epidural catheter is used in: |
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Definition
| periobstetric and perioperative period |
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Term
| the Temporary epidural catheter is designed for: |
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Definition
| short term use with materials that easily pass into the epidural and intrathecal spaces |
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Term
| Teflon catheters allow visualization of: |
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Definition
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Term
| Teflon catheters can become stiff and: |
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Definition
| migrate out of their original placement |
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Term
| teflon catheters are what type of catheter? |
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Definition
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Term
| temporary catheters are intended to be used for: |
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Definition
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Term
| use of the permanent catheters for _________ to _______ via the epidural route is supported by many pain specialists |
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Definition
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Term
| the advantages of the permanent catheters are that they have: |
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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 |
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Term
| permanent catheters are generally what type of catheter: |
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Definition
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Term
| a single injection of epidural opioid may be used for: |
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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 |
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Term
| continuous epidural infusion is administered for: |
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Definition
| short and long peroids of time |
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Term
| patients with pain from surgery, trauma, and acute medical disorders creating severe pain may benefit from: |
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Definition
| short-term continuous infusions |
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Term
| epidural and intrathecal medications: |
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Definition
baclofen
bupivacaine hydrochloride
clonidine
DepoDur
Fentanyl
hydromorphone hydrochloride
morphine sulfate
sufentanil
ziconotide |
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Term
| what method of delivery can also be employed for the cancer patient with acute exacerbation of pain: |
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Definition
| short-term continuous infusions |
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Term
| the insertion of an epidural catheter is a ______________ procedure |
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Definition
|
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Term
| the insertion of the epidural catheter is a steril procedure performed by a: |
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Definition
| physician or anesthesiologist |
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Term
| administration of medication by a nurse through and epidural catheter must be in accordance with: |
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Definition
| each state's nurse practice act |
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Term
| nursing responsibilities for med administration with epidural catheter include: |
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Definition
1- patient and family education,
2- site and dressing management
3- medication administration(depending on state practice)
4- evaluation of pain relief |
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Term
| most commonly epidural medication is administered by: |
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Definition
| certified nurse anesthetist or anesthesiologist |
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Term
| the epidural medication catheter is managed by: |
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Definition
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Term
| epidural morphine as a single bolus dose has demonstrated analgesia that lasts up to ____________ with DepoDur. |
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Definition
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Term
| in clinical trials, 90% of respiratory depression occured: |
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Definition
| within the first 24 hours after administration |
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Term
| patient monitoring requirments for epidural patients include: |
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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 |
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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 |
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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 |
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Term
| epidural medication administration permits control or alleviation of __________ pain without the sedative effects |
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Definition
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Term
| epidural medication administration permits delivery of __________ doses of a narcotic to achieve the desired level of analgesia |
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Definition
|
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Term
epidural medication administration prolongs the analgesia:
average ?
extended release epidural morphine? |
|
Definition
average- about 14 hours
extended release morphine- 24 to 48 hours |
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Term
| epidural medication administration _____________ analgesia |
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Definition
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Term
| epidural medication administration allows for _____________ infusion, if needed |
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Definition
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Term
| epidural medication administration allows terminal cancer patients treated with epidural narcotics to be: |
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Definition
| more comfortable and more mobile |
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Term
| epidural medication administration can be used for : |
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Definition
| short or long term therapy |
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Term
| epidural medication administration does not produce: |
|
Definition
|
|
Term
epidural medication administration:
only ________________-______ opioids can be used |
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Definition
|
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Term
| epidural medication administration complications may occur such as: |
|
Definition
paresthesia
urinary retention
respiratory depression ( greatest 6-10 hrs after injection)
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Term
| epidural medication administration catheter-related risks: |
|
Definition
| e.g. infection, dislodgement, and leaking |
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Term
epidural medication administration
what can occur on the face, head, and neck or may be generalized? |
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Definition
|
|
Term
| unless the epdural catheter and medication are clearly labeled, an intravenous infusion could cause: |
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Definition
| serious complications or death |
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Term
| a pain specialist will make sure the catheter is patent by: |
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Definition
| aspirating to check for blood and checking the ablility to administer medication throughout the catheter |
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Term
| INS standard, medication shall be: |
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Definition
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|
Term
for intraspinal infusions,
a 0.2 micron filter needle that is: |
|
Definition
| surfactant- free, particulate- retentive, and air- eliminating shall be used |
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Term
| sterile technique, including what, should be used when accessing, caring for and maintaining and intraspinal access device? |
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Definition
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|
Term
| ineffective pain control shoudl be: |
|
Definition
| reported to the physician or anesthesiologist who is managing care of the epidural catheter |
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Term
| the catheter used depends on: |
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Definition
|
|
Term
| in the hospital, external catheters are in place: |
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Definition
|
|
Term
| external catheters are securred to: |
|
Definition
| the patients back --> thenattached to an infusion into the patients epidural space |
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Term
| epidural pt's recieve immediate relief and are: |
|
Definition
| less likely to recieve post op complications |
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Term
| epidural access advantages: |
|
Definition
- alleviates pain quickly
- prolongs analgesia
-does NOT produce moto paralysis or hypotension |
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Term
| epidural access disadvantages: |
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Definition
- typically catheter related- usually accidental dislodgement and leaking
- catheter is placed in the OR
-medication is prepared by the pharmacy |
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Term
| why does the pharmacy handle epidural medication preparation? |
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Definition
| so it is not confused with opioid preparations that are used with PCA's |
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Term
| every epi patient should have which assessments per hospital policy, usu every 2 hours for status changes? |
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Definition
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