13 Pediatric Pain Management Rushing Flashcards
What are the Basic 5 Rights?
Right patient. Right drug. Right dose. Right routine. Right time
What is the major medication error?
Wrong dose
What are the key factors in assessment?
Self reporting. Behavioral observation. Diagnostic results/biologic measures. Physical examination
What are the key things to looking for in the N-Pass?
Behavior state. Vital signs: HR, RR, BP, SaO2. Can also look at: Crying/Irritability, Facial expression, Extremities tone
What is the FLACC Scale?
Behavior assessment scale. Looking at the face, legs, activity, cry, and consolability
When do you use the N-Pass assessment?
Pre-term up to the neonatal period of 44 weeks gestation
When do you use the FLACC assessment?
44 weeks post-conception to 3 years or any age for nonverbal cognitively impaired/delayed
When do you use the Wong-Baker FACES (0-10 intensity) assessment?
3+ years of age
What are Sugar Babies?
Sweet Ease (sucrose solution 24%, infants > 2000gms, indication: painful procedures. Dip pacifier in solution, 0.2ml. Give 2 minutes prior to procedure. May repeat in 1 minute
What is often used for Mild Pain?
APAP (10-15mg/kg/dose Q4h PRN)
What are the max daily doses for APAP?
Preterm: 40mg/kg/day. Infants: 60mg/kg/day. Children: 75mg/kg/day
What are ADRs with NSAIDs?
Renal. Wound/fracture healing. GI
Why are NSAIDs good?
Anti-inflammatory as well as analgesic and antipyretic
What is the total daily dose for PO Ibuprofen?
2400mg/day. 40mg/kg/day
What is Ketorolac?
IV/IM NSAID
What has to be used with Ketorolac?
Have to use GI protection when taking this (PPIs, H2-blockers)
Which NSAID has the lowest effect on platelets and is a good option for patients with thrombocytopenia risk?
Choline Magnesium Trisalicylate
What happens with Hypermetabolizers taking Codeine?
CYP2D6. Increased morphine exposure –> apnea –> death post tonsillectomy
How is Codeine dosed?
1mg/kg
What does Patient-Controlled Analgesic + Continuous Infusion allow?
Allows the child to self inject an opioid whenever uncomfortable. Allows the child to control over the pain. Concept is to give the patient a low dose continuous infusion so the patient can sleep at night
What is the 1st side effect of opioids?
Sedation, not apnea
What are the PCA Principles?
Continuous infusion low dose. Only patient to push button. Lockout intervals should be set at 6 minutes. NO BOOSTER DOSES. If patient injects > 15 PCA doses in 4 hours give a ‘loading dose’ then double the PCA dose
When is PCA used?
7+ yo only! If under 7 yo, continuous only
What types of opioids are often used in PCA?
Morphine. Hydromorphone. Fentanyl (ICU only)
