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Thera X > 13 Pediatric Pain Management Rushing > Flashcards

13 Pediatric Pain Management Rushing Flashcards

1
Q

What are the Basic 5 Rights?

A

Right patient. Right drug. Right dose. Right routine. Right time

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3
Q

What is the major medication error?

A

Wrong dose

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3
Q

What are the key factors in assessment?

A

Self reporting. Behavioral observation. Diagnostic results/biologic measures. Physical examination

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4
Q

What are the key things to looking for in the N-Pass?

A

Behavior state. Vital signs: HR, RR, BP, SaO2. Can also look at: Crying/Irritability, Facial expression, Extremities tone

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5
Q

What is the FLACC Scale?

A

Behavior assessment scale. Looking at the face, legs, activity, cry, and consolability

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6
Q

When do you use the N-Pass assessment?

A

Pre-term up to the neonatal period of 44 weeks gestation

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7
Q

When do you use the FLACC assessment?

A

44 weeks post-conception to 3 years or any age for nonverbal cognitively impaired/delayed

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8
Q

When do you use the Wong-Baker FACES (0-10 intensity) assessment?

A

3+ years of age

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9
Q

What are Sugar Babies?

A

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

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10
Q

What is often used for Mild Pain?

A

APAP (10-15mg/kg/dose Q4h PRN)

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11
Q

What are the max daily doses for APAP?

A

Preterm: 40mg/kg/day. Infants: 60mg/kg/day. Children: 75mg/kg/day

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12
Q

What are ADRs with NSAIDs?

A

Renal. Wound/fracture healing. GI

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13
Q

Why are NSAIDs good?

A

Anti-inflammatory as well as analgesic and antipyretic

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14
Q

What is the total daily dose for PO Ibuprofen?

A

2400mg/day. 40mg/kg/day

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15
Q

What is Ketorolac?

A

IV/IM NSAID

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16
Q

What has to be used with Ketorolac?

A

Have to use GI protection when taking this (PPIs, H2-blockers)

17
Q

Which NSAID has the lowest effect on platelets and is a good option for patients with thrombocytopenia risk?

A

Choline Magnesium Trisalicylate

18
Q

What happens with Hypermetabolizers taking Codeine?

A

CYP2D6. Increased morphine exposure –> apnea –> death post tonsillectomy

19
Q

How is Codeine dosed?

A

1mg/kg

20
Q

What does Patient-Controlled Analgesic + Continuous Infusion allow?

A

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

21
Q

What is the 1st side effect of opioids?

A

Sedation, not apnea

22
Q

What are the PCA Principles?

A

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

23
Q

When is PCA used?

A

7+ yo only! If under 7 yo, continuous only

24
Q

What types of opioids are often used in PCA?

A

Morphine. Hydromorphone. Fentanyl (ICU only)

25
Q

How is a step down to PO therapy done (conversion of IV –> PO)?

A

Calculate total amount of IV morphine in 24hr period. If non-morphine convert to morphine equivalent. Multiply total IV dose x3 (conversion IV to PO). Order rescue morphine 5-15% of 24hr amount given Q4-6h PRN

26
Q

Which opioid has a 1:1 conversion with Morphine IV?

A

Methadone

27
Q

How is the conversion of IV Morphine to PO Methadone done?

A

Calculate total amount of IV morphine in 24hr period. If non-morphine convert to morphine equivalent. Use 1:1 conversion; divide daily dose Q8h. Order rescue morphine 5-15% of 24hr amount given Q4-6h PRN

28
Q

What is given to manage vomiting side effect?

A

Ondansetron (max 4mg). Prochlorperazine (Compazine)

29
Q

What is given to manage itching side effect?

A

Naloxone infusion (can ‘Y’ into line with opioid). Diphenhydramine. Nalbuphine

30
Q

What is given to manage constipation side effect?

A

Bisacodyl (Dulcolax). Docusate (Colace). Senna. Senna-S. Miralax

31
Q

What is Methylnatrexone (Relistor)?

A

Reverses opioid effects. SQ dosing according to body weight. Administer 1 dose QOD PRN (Max 1 dose/24 hours)

Thera X (25 decks)

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