Ch 21 Flashcards
Chronic pain
Lasts longer than 3 months
Nociceptive pain
Normal process of pain stimuli caused by tissue damage
Neuropathic pain
Abnormal processing of pain stimuli
Why kid may not complain of pain-4
- Unable to give details due to limited words/experiences
- Need to be brave, don’t worry parents
- May assume RN knows
- Afraid treatment will hurt more
Infant 0-6mo response to pain
Generalized body movements, chin quivering, face grimace, poor feeding
Infant 6-12 mo response to pain -4
- Demonstrates fear of painful situations
- May resist with entire body or localized withdrawal
- Aggression
- Disturbed sleep
Preschool 3-6yr response to pain -4
- pain is punishment or someone else is responsible for their pain, unable to understand why painful procedures help to feel better
1. Active physical resistance
2. Directed aggressive behavior
3. Easily frustrated
7-9 yr old response to pain -4
- Passive resistance
- Clenched fists, holds body rigidly still
- Emotional withdrawal
- Plea bargain
10-12 yr old response to pain -2
- May pretend comfort to project bravery
2. May regress w stress and anxiety
13-18 yr response to pain -3
- Controlled behavior response
- Immersion in activity as distraction
- May not complain about pain
Respiratory response to pain -3
- Rapid shallow breathing- alkalosis
- Inadequate lung expansion- decreased O2 sat, atelectasis
- Inadequate cough- retention of secretions
Neurological response to pain -2
- Increase sympathetic nervous system activity and release of catecholamines
- Tachycardia, elevated blood pressure, change in sleep pattern
Metabolic response to pain -3
- Increase metabolic rate with increase perspiration
- Increase loss of fluid and electrolytes
- Increase blood glucose and cortisol level
Immune system response to pain -2
- Depression of immune and anti inflammatory response
2. Increase risk of infection, delayed wound healing
GI response to pain -2
- Decreases gastric acid secretion and intestinal motility
2. Impaired GI function, nausea, anorexia, ileus
Neonatal infant pain scale-NIPS-2
- Up to 6 wks old- preterm and full term
2. Measure facial expression, cry quality, breathing, arm and leg position, state of arousal
CRIES scale
Post op pain in preterm and full term
FLACC observational tool-3
- Face, legs, activity, cry, consolability
- 2mo-7 yrs
- Observe during routine care 1-5min
Readiness to use self-report pain rating tools-2
- Ability to use words in sequence, follows simple directions, answer simple questions
- Understand rank, order, and magnitude
Faces pain rating scale- Wong-Baker scale
Cartoon faces
Toddler + can use
Numeric pain scale
0-10 rate, good cognitive ability and 8yrs+
Opioid common side effects -5
Sedation, N/V, constipation, urine retention, itching
Morphine-3
equianalgesic- oral 30mg, parenteral 10mg
Start- oral 0.3 mg/kg q 3-4 hrs
Parenteral 0.05-0.1 mg/kg q 3-4 hrs
Codeine-3
Equianalgesic- oral 120mg, parenteral 75mg (IV, subcutaneous)
Start- oral 0.5-1 mg/kg q 3-4 hrs
