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Original Research

The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care

Contrada, Emily

AJN The American Journal of Nursing: July 2018 - Volume 118 - Issue 7 - p 32,43
doi: 10.1097/01.NAJ.0000541434.66712.af
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The Efficacy and Safety of an RN-Driven Ketamine Protocol for Adjunctive Analgesia During Burn Wound Care

GENERAL PURPOSE:

To present the details of a study done to evaluate the efficacy and safety of a critical care RN–driven protocol for IV ketamine administration during burn wound care.

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LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be able to

  • outline the mechanism of action and adverse effects of ketamine.
  • identify components of the monitoring protocol implemented in this study.
  • discuss the study results and their implications for practice.
  1. Inadequate pain control during burn care procedures has been associated with pain-related experiences that can eventually result in
    1. poor wound healing.
    2. substance use disorders.
    3. posttraumatic stress disorder.
  2. Ketamine is a derivative of
    1. phencyclidine.
    2. heterocyclic acetic acid.
    3. opium from poppy plants.
  3. There is some evidence that ketamine has minimal effects on patients’
    1. bladder function.
    2. respiratory drive.
    3. cardiovascular status.
  4. Adverse effects associated with ketamine include
    1. hallucinations.
    2. blurry vision.
    3. melena.
  5. In the authors’ study, opioid requirements were expressed in equivalent dosages of
    1. diazepam.
    2. lorazepam.
    3. fentanyl.
  6. In the authors’ study, secondary outcomes included changes in
    1. benzodiazepine requirements.
    2. oxygen requirements.
    3. body temperature.
  7. For this study, the authors defined tachycardia as
    1. a heart rate of 110 beats per minute or higher.
    2. an increase in heart rate of 10 beats per minute.
    3. an increase in heart rate of 20 beats per minute or more.
  8. For this study, the authors defined agitation in terms of Richmond Agitation–Sedation Scale (RASS) scores assessed within 4 hours of ketamine administration. Accordingly, which RASS scores indicated agitation?
    1. +2 to +4
    2. –1 to +1
    3. –3 to –5
  9. With the study protocol, opioid requirements were reduced by
    1. 19%.
    2. 29%.
    3. 39%.
  10. With the study protocol, benzodiazepine requirements were reduced by
    1. 20%.
    2. 30%.
    3. 40%.
  11. On average, how long did each wound care session last?
    1. 52 minutes
    2. 63 minutes
    3. 74 minutes
  12. The recommended dose of midazolam was administered before nearly all ketamine doses, with
    1. 1 exception.
    2. 3 exceptions.
    3. 5 exceptions.
  13. How many of the 27 patients in the study developed respiratory depression from oversedation?
    1. 1
    2. 3
    3. 5
  14. The study findings indicated that, besides reducing the need for opioids and benzodiazepines, adjunctive ketamine also provided
    1. sleep.
    2. comfort.
    3. stability.
  15. In the authors’ experience, one short-term adverse effect associated with the high doses of opioids and anxiolytics often required for pain control during burn wound care is
    1. tolerance.
    2. physical dependence.
    3. prolonged hospitalization.
  16. In a study by Kundra and colleagues, patients preferred ketamine to dexmedetomidine despite significant issues with delirium and
    1. urinary incontinence.
    2. excessive salivation.
    3. insomnia.
  17. Findings from the authors’ study support which of the following statements?
    1. The use of ketamine definitively limited secondary hyperalgesia.
    2. The study protocol helped to maximize the capabilities of the participating RNs.
    3. The use of ketamine significantly reduced the time required to complete wound care.
  18. Which of the following statements about the RASS is inaccurate?
    1. It assesses pain intensity.
    2. It has high validity and reliability.
    3. It is viewed favorably by nurses.
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