Ella, a 23-year-old female, presents to the emergency room with an injured index finger. She reports a dull, throbbing pain (4/10). The finger is erythematous, swollen, and warm to the touch.
She initially declines oral pain medications, stating she prefers to "let the body heal naturally.”. Based on Ella's presentation, what are some non-pharmacologic alternatives that align with her preferences and the principles of the Gate Control Theory? (Select all that apply)
Transcutaneous electrical nerve stimulation (TENS).
Massage.
Acupuncture.
Local cold application.
Application of heat packs.
Administration of a non-steroidal anti-inflammatory drug (NSAID).
Correct Answer : A,B,C,D
Choice A rationale
Transcutaneous electrical nerve stimulation (TENS) operates on the Gate Control Theory by delivering low-voltage electrical current through electrodes to the skin. This non-painful sensory input stimulates large-diameter A-beta nerve fibers. These impulses reach the spinal cord faster than the smaller C-fibers carrying pain signals, effectively "closing the gate" and blocking the transmission of the noxious stimuli to the brain, thus providing pain relief.
Choice B rationale
Massage involves applying pressure and friction to the tissue, which stimulates large-diameter, myelinated A-beta fibers in the area. According to the Gate Control Theory, this non-noxious, tactile stimulation activates the inhibitory interneurons in the dorsal horn of the spinal cord. This sensory input is prioritized over the nociceptive input from the injured index finger, diminishing the perception of the dull, throbbing pain.
Choice C rationale
Acupuncture involves the insertion of fine needles into specific points, stimulating various nerve fibers, including the large A-beta fibers. This stimulation contributes to the "closing of the gate" mechanism in the spinal cord, modulating pain perception. Furthermore, it promotes the release of endogenous opioids (like endorphins and enkephalins) from the central nervous system, which naturally bind to opioid receptors to produce systemic analgesia.
Choice D rationale
Local cold application, such as an ice pack, decreases tissue temperature, leading to vasoconstriction and reduced local blood flow. This application reduces inflammation, edema, and metabolic rate, slowing the conduction velocity of nerve impulses, including those from the nociceptors. It also stimulates the A-beta nerve fibers, which provides a counter-irritant sensation that overrides the pain signals, aligning with the Gate Control Theory.
Choice E rationale
Application of heat packs increases blood flow (vasodilation) and metabolic rate, which can increase edema and potentially exacerbate the initial inflammatory response and pain in an acute injury like Ella's. While heat can relax muscle spasms and relieve chronic pain, it is generally contraindicated for acute inflammation and swelling (erythema and warmth), as it can worsen the immediate local inflammatory process.
Choice F rationale
Administration of a non-steroidal anti-inflammatory drug (NSAID) is a pharmacologic intervention, which directly contradicts the patient's stated preference to "let the body heal naturally" and her initial refusal of oral pain medications. NSAIDs reduce pain by inhibiting cyclooxygenase (COX) enzymes, decreasing prostaglandin synthesis, which is a biochemical mechanism, not a non-pharmacologic or Gate Control Theory intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Pseudoephedrine is a sympathomimetic drug that acts primarily as an alpha and beta agonist, stimulating the central nervous system (CNS). This stimulation usually leads to wakefulness, nervousness, and insomnia, rather than excessive sleepiness, which is a CNS depressant effect. Drowsiness can occur but is less common than CNS stimulation effects, as the drug promotes adrenergic activity.
Choice B rationale
Pseudoephedrine stimulates beta-1 adrenergic receptors in the heart, leading to an increase in heart rate (tachycardia) and force of contraction. This enhanced cardiac activity can be perceived by the patient as palpitations (irregular or rapid heartbeat). The normal adult heart rate is 60 to 100 beats per minute, and this drug can push it toward the upper limit or beyond.
Choice C rationale
Pseudoephedrine acts as a vasoconstrictor by stimulating alpha-1 adrenergic receptors on blood vessels, leading to an increase in systemic vascular resistance. This increase in resistance and cardiac stimulation typically results in a rise in blood pressure (hypertension), not hypotension. The normal adult blood pressure is less than 120/80 mm Hg.
Choice D rationale
Pseudoephedrine is generally a bronchodilator due to its beta-2 adrenergic receptor stimulation, which relaxes bronchial smooth muscles and improves (not worsens) respiration. Shallow respirations are a sign of respiratory depression or distress, which is not a common adverse effect of this sympathomimetic, which tends to increase the respiratory drive.
Correct Answer is C
Explanation
Choice A rationale
The trough level, typically drawn just before the next dose, measures the lowest concentration of the drug in the bloodstream. An elevated trough indicates drug accumulation and risk of toxicity. The peak level, measured at the highest concentration, is generally not needed after an elevated trough, and a repeat peak would not address the immediate concern of potential toxicity.
Choice B rationale
Increasing the dose of the medication would lead to an even higher trough level and peak level, significantly elevating the risk of drug toxicity, as the current dose is already causing accumulation (evidenced by the high trough). Therapeutic drug monitoring (TDM) is used to prevent toxicity and maintain efficacy; therefore, a higher dose is contraindicated.
Choice C rationale
An elevated trough serum level (normal range varies by drug, but often <2 mcg/mL for vancomycin) signifies that the drug is being eliminated too slowly or the interval between doses is too short, leading to accumulation and an increased risk of toxicity. Reducing the dose or lengthening the dosing interval is the priority action to bring the trough level back into the therapeutic range and prevent organ damage.
Choice D rationale
Many medications, especially renally-excreted ones, have levels affected by kidney function. While obtaining a creatinine level (normal range ∼0.6-1.2 mg/dL) or estimated Glomerular Filtration Rate (eGFR) is important for assessing drug clearance and adjusting future dosing, the priority immediate intervention is to modify the existing dose regimen to prevent acute toxicity from the current high level.
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