EXAM #1
Med-Surg Exam 1 CRAMMED STUDY
GUIDE
Core Topics:
1. Pain, Sleep, Comfort
2. Opioids & Non-opioid Analgesia
3. PCA & Safety
4. Neuropathic vs Nociceptive Pain
5. Substance Use Disorders (Alcohol, Opioids, Stimulants, Tobacco)
6. Withdrawal & Overdose Management
1️⃣ PAIN: FOUNDATIONS YOU WILL BE TESTED ON
Key Principles
● Pain is ALWAYS subjective
● Patient self-report is the gold standard
● Treat pain before it becomes severe
● Safety > comfort if oversedation suspected
OLD CARTS (memorize cold)
● Onset
● Location
● Duration
● Characteristics
● Aggravating/Relieving
● Radiation
● Treatment
● Severity (0–10)
📌 Exam Tip:
If pain increases after PT → Aggravating factor
If pain changes from 4/10 → 8/10 → Severity
,2️⃣ TYPES OF PAIN (HIGH-YIELD)
Nociceptive Pain = tissue damage
● Somatic: skin, bone, muscle
○ Sharp, aching, throbbing
● Visceral: organs
○ Cramping, pressure, poorly localized
✅ Responds well to NSAIDs + opioids
Neuropathic Pain = nerve damage
● Burning
● Shooting
● Electric
● Stabbing
🚫 Opioids alone are NOT effective
✅ First-line adjuvants:
● Gabapentin / Pregabalin
● TCAs (amitriptyline)
● SNRIs (duloxetine)
3️⃣ NOCICEPTION: 4 STEPS (NCLEX FAVORITE)
Step What Happens Targeted Therapy
Transductio Tissue injury → pain signal NSAIDs, ice
n
Transmissio Signal travels via nerves Opioids, epidurals
n
Perception Brain interprets pain Distraction, imagery
Modulation Brain blocks pain TCAs, SNRIs
📌 If asked “where do NSAIDs work?” → Transduction
, 4️⃣ PAIN SCALES (WHO USES WHAT)
Scale Use
Numeric (0–10) Verbal adults
Wong-Baker FACES Kids ≥3, communication issues
PainAD Advanced dementia
FLACC Infants/young children
PainAD Behaviors
● Facial expression
● Negative vocalization
● Body language
● Consolability
➡️ Behavior = pain until proven otherwise
5️⃣ OPIOIDS: MUST-KNOW SAFETY
Most Common Side Effect (DOES NOT improve)
🚨 CONSTIPATION
➡️ Start bowel regimen immediately
● Senna ± stool softener
Opioid-Induced Sedation
● Use POSS scale
● Score 3–4 = DANGER
○ Stop/decrease opioid
○ Assess respirations
○ Notify provider
Med-Surg Exam 1 CRAMMED STUDY
GUIDE
Core Topics:
1. Pain, Sleep, Comfort
2. Opioids & Non-opioid Analgesia
3. PCA & Safety
4. Neuropathic vs Nociceptive Pain
5. Substance Use Disorders (Alcohol, Opioids, Stimulants, Tobacco)
6. Withdrawal & Overdose Management
1️⃣ PAIN: FOUNDATIONS YOU WILL BE TESTED ON
Key Principles
● Pain is ALWAYS subjective
● Patient self-report is the gold standard
● Treat pain before it becomes severe
● Safety > comfort if oversedation suspected
OLD CARTS (memorize cold)
● Onset
● Location
● Duration
● Characteristics
● Aggravating/Relieving
● Radiation
● Treatment
● Severity (0–10)
📌 Exam Tip:
If pain increases after PT → Aggravating factor
If pain changes from 4/10 → 8/10 → Severity
,2️⃣ TYPES OF PAIN (HIGH-YIELD)
Nociceptive Pain = tissue damage
● Somatic: skin, bone, muscle
○ Sharp, aching, throbbing
● Visceral: organs
○ Cramping, pressure, poorly localized
✅ Responds well to NSAIDs + opioids
Neuropathic Pain = nerve damage
● Burning
● Shooting
● Electric
● Stabbing
🚫 Opioids alone are NOT effective
✅ First-line adjuvants:
● Gabapentin / Pregabalin
● TCAs (amitriptyline)
● SNRIs (duloxetine)
3️⃣ NOCICEPTION: 4 STEPS (NCLEX FAVORITE)
Step What Happens Targeted Therapy
Transductio Tissue injury → pain signal NSAIDs, ice
n
Transmissio Signal travels via nerves Opioids, epidurals
n
Perception Brain interprets pain Distraction, imagery
Modulation Brain blocks pain TCAs, SNRIs
📌 If asked “where do NSAIDs work?” → Transduction
, 4️⃣ PAIN SCALES (WHO USES WHAT)
Scale Use
Numeric (0–10) Verbal adults
Wong-Baker FACES Kids ≥3, communication issues
PainAD Advanced dementia
FLACC Infants/young children
PainAD Behaviors
● Facial expression
● Negative vocalization
● Body language
● Consolability
➡️ Behavior = pain until proven otherwise
5️⃣ OPIOIDS: MUST-KNOW SAFETY
Most Common Side Effect (DOES NOT improve)
🚨 CONSTIPATION
➡️ Start bowel regimen immediately
● Senna ± stool softener
Opioid-Induced Sedation
● Use POSS scale
● Score 3–4 = DANGER
○ Stop/decrease opioid
○ Assess respirations
○ Notify provider
