4.) Pain (part 2) Flashcards
A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which?
a. ) Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure.
b. ) Use a combination of fentanyl and midazolam for conscious sedation.
c. ) Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure.
d. ) Apply a transdermal fentanyl (Duragesic) “patch” immediately before the procedure.
b.) Use a combination of fentanyl and midazolam for conscious sedation.
A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.
A child is in the intensive care unit after a motor vehicle collision. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning care, the nurse recognizes that the indicated action is which?
a. ) Give only an opioid analgesic at this time.
b. ) Increase dosage of analgesic until the child is adequately sedated.
c. ) Plan a preventive schedule of pain medication around the clock.
d. ) Give the child a clock and explain when she or he can have pain medications.
c.) Plan a preventive schedule of pain medication around the clock.
For severe postoperative pain, a preventive around the clock (ATC) schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present, but it is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Using a clock is counterproductive because it focuses the child’s attention on how long he or she will need to wait for pain relief.
The nurse is planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan so the nonopioid takes effect?
a. ) 15 minutes until maximum effect
b. ) 30 minutes until maximum effect
c. ) 1 hour until maximum effect
d. ) 1 1/2 hours until maximum effect
c.) 1 hour until maximum effect
Nonsteroidal antiinflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hour for effect, so timing is crucial.
The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse’s response should be based on which characteristic about preterm infants’ pain?
a. ) They may react to painful stimuli but are unable to remember the pain experience.
b. ) They perceive and react to pain in much the same manner as children and adults.
c. ) They do not have the cortical and subcortical centers that are needed for pain perception.
d. ) They lack neurochemical systems associated with pain transmission and modulation.
b.) They perceive and react to pain in much the same manner as children and adults.
Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.
The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching?
a. ) “We will allow the child to miss school if a headache occurs.”
b. ) “We will respond matter-of-factly to requests for special attention.”
c. ) “We will be sure to give much attention to our child when a headache occurs.”
d. ) “We will be sure our child doesn’t have to perform at a band concert if a headache occurs.”
b.) “We will respond matter-of-factly to requests for special attention.”
To modify behavior patterns that increase the risk of headache or reinforce headache activity, the nurse instructs the parents to avoid giving excessive attention to their child’s headache and to respond matter-of-factly to pain behavior and requests for special attention. Parents learn to assess whether the child is avoiding school or social performance demands because of headache.
The nurse is using the CRIES pain assessment tool on a preterm infant in the neonatal intensive care unit. Which are the components of this tool? (Select all that apply.)
a. ) Color
b. ) Moro reflex
c. ) Oxygen saturation
d. ) Posture of arms and legs
e. ) Sleeplessness
f. ) Facial expression
c.) Oxygen saturation
e.) Sleeplessness
f.) Facial expression
Need for increased oxygen, crying, increased vital signs, expression, and sleeplessness are components of the CRIES pain assessment tool used with neonates.
Color, Moro reflex, and posture of arms and legs are not components of the CRIES scale.
What is an important consideration when using the FACES pain rating scale with children?
a. ) Children color the face with the color they choose to best describe their pain.
b. ) The scale can be used with most children as young as 3 years.
c. ) The scale is not appropriate for use with adolescents.
d. ) The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.
b.) The scale can be used with most children as young as 3 years.
The FACES scale is validated for use with children ages 3 years and older. Children point to the face that best describes their level of pain. The scale can be used through adulthood. The child’s estimate of the pain should be used. The physiologic measures may not reflect more long-term pain.
Which are components of the FLACC scale? (Select all that apply.)
a. ) Color
b. ) Capillary refill time
c. ) Leg position
d. ) Facial expression
e. ) Activity
c.) Leg position
d.) Facial expression
e.) Activity
Facial expression, consolability, cry, activity, and leg position are components of the FLACC scale.
Color is a component of the Apgar scoring system.
Capillary refill time is a physiologic measure that is not a component of the FLACC scale.
Children as young as age 3 years can use facial scales for discrimination. What are some suggested anchor words for the preschool age group?
a. ) “No hurt.”
b. ) “Red pain.”
c. ) “Zero hurt.”
d. ) “Least pain.”
Which is the most consistent and commonly used data for assessment of pain in infants?
a. ) Self-report
b. ) Behavioral
c. ) Physiologic
d. ) Parental report
b.) Behavioral
Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain. Infants are not able to self-report. Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress. Parental report without a structured tool may not accurately reflect the degree of discomfort.
A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include?
a. ) The child will continue to sleep and be pain free.
b. ) Parents cannot administer additional medication with the button.
c. ) The pump can deliver baseline and bolus dosages.
d. ) There is a high risk of overdose, so monitoring is done every 15 minutes.
c.) The pump can deliver baseline and bolus dosages.
The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.
What describes nonpharmacologic techniques for pain management?
a. ) They may reduce pain perception.
b. ) They usually take too long to implement.
c. ) They make pharmacologic strategies unnecessary.
d. ) They trick children into believing they do not have pain.
a.) They may reduce pain perception.
Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. The nonpharmacologic strategy should be matched with the child’s pain severity and be taught to the child before the onset of the painful experience. Tricking children into believing they do not have pain may mitigate the child’s experience with mild pain, but the child will still know the discomfort was present.
The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching?
a. ) “With minimal sedation, the patient’s respiratory efforts are affected, and cognitive function is not impaired.”
b. ) “With general anesthesia, the patient’s airway cannot be maintained, but cardiovascular function is maintained.”
c. ) “During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation.”
d. ) “During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation.”
d.) “During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation.”
When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.
