Page 45 - Critical Care Notes

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Nonopioid Analgesics
■ Ketamine.
Alpha-Adrenergic Receptor Agonists
■ Dexmedetomidine (Precedex).
Nonbarbiturate Sedatives
■ Propofol (Diprivan).
■ Etomidate (Amidate).
Physiological Responses to Pain and Anxiety
■ Tachycardia
■ Diaphoresis
■ Sleep disturbance
■ Hypertension
■ Tachypnea
■ Nausea
Signs of Sedative or Analgesic Withdrawal
■ Nausea, vomiting, diarrhea
■ Cramps, muscle aches
■ Increased sensitivity to pain
■ Tachypnea, ↑ HR, ↑ BP
■ Delirium, tremors, seizures, agitation
Medication Management
■ Administer analgesics as scheduled doses or continuous infusions; avoid
prn analgesics.
■ Other routes include oral, rectal, transdermal, subcutaneous, and spinal.
■ Opioids preferred: fentanyl, hydromorphone, and morphine.
■ Have naloxone (Narcan), an opioid antagonist, available.
■ Monitor body and limb movements, facial expression, posturing, muscle
tension for signs of pain.
■ Monitor for acute changes or fluctuations in mental status, LOC, disorienta-
tion, hallucinations, delusions.
■ Evaluate arousability.
■ Monitor neurological status including pupillary response, response to
verbal commands and pain.
■ Monitor respiratory rate and respiratory effort, respiratory depression,
BP, HR.

BASICS