Chapter 9: Pain Management Flashcards
Who is in pain based off these signs?
- Loud cry
- Rigid body or thrashing
- Local reflex withdrawal from pain stimulus
- Expressions of pain (eyes tightly closed, mouth open in squarish shape, eyebrows lowered and drawn together)
- Lack of association between stimulus and pain
Young infant
Who is in pain based off these signs?
- Loud cry
- Deliberate withdraw from pain
- Facial expressions of pain
Older infant
Who is in pain based off these signs?
- Loud cry or screaming
- Verbal expressions of pain
- Thrashing of extremities
- Attempt to push away or avoid stimulus
- Noncooperation
- Clinging to significant person
- Behaviors occur in anticipation of painful stimulus
Toddler
Who is in pain based off these signs?
- Stalling behavior
- Muscular rigidity
- Any behavior of the toddler, but less intense in the anticipatory phase and more intense with painful stimulus
School-age child
Who is in pain based off these signs?
- More verbal expressions of pain with less protest
- Muscle tension with body control
Adolescent
What are 3 assessments for pain intensity?
- Behavioral measures
- Physiologic measures
- Self report
At what age can children give self-report?
4 years old +
Can the parent or caregiver be involved in rating an infant or child’s pain?
Yes
What 3 things to assess with pain?
Location
Quality
Severity
What age uses the FLACC scale and what does FLACC stand for?
How do you score it?
2 months-7 years
Face Legs Activity Cry Consolability
Each level pain is from 0-2 (2=worst)..the pain can be a total of 0-10
What age gets the face scale? How do you rate the pain?
3 years+
Pain rated on scale of 0-5 using diagram of 6 faces (0=no hurt, 5=hurts worst)
Substitue 0-5 for a number on a 1-10 scale 0=0 1=2 2=4 3=6 4=8 5=10
What age gets the Oucher scale? How do you rate?
3-13
Pain rated on scale of 0-5 using 6 PHOTOGRAPHS
*Score the pain the same way you do for FACES scale
What age gets the numeric scale?
5 years+
What age gets the non-communicating children’s pain checklist?
How long are behaviors observed?
What are the 6 subcategories?
What do you rate pain as?
What number indicates moderate to severe pain?
What number indicated mild pain?
3-18 years 10 minutes Vocal, social, facial, activity, body & limbs, and physiological 0(not at all)-3(very often) 11+ 6-10
Where should treatments be avoided?
“Safe places”–the bed or the playroom
Are IM medications for pain control recommended for children?
No
Intranasal medications are not recommended for children younger than __
18 years
What meds are used for skin anesthesia prior to procedures?
Intradermal
What is EMLA?
Eutectic mixture of local anesthetics
What does EMLA contain?
Equal quantities of lidocaine and prilocaine in the form of a cream or disk
When do you use EMLA for superficial puncture? deep puncture?
superficial: 60 minutes prior
deep: 2.5 hours prior
What is indication of an adequate response to EMLA?
Reddened or blanched skin
What age can children get fantanyl?
Older than 12 years
What is the onset of fentanyl and duration?
onset: 12-24 hours
duration: 72 hours
Why is a bolus used?
Rapid pain control in approx. 5 min
What meds are bolus?
Morphine, hydromorphone
A nurse is completing a pain assessment of an infant. Which pain scales should the nurse use?
FLACC
A nurse is planning care for a child following a surgical procedure. Which of the following interventions should be included in the plan of care?
A. Administer NSAID for pain greater than 7
B. Administer intranasal analgesics PRN
C. Administer IM analgesics for pain
D. Administer IV analgesics on a schedule
D
A nurse is assessing an infant. Which of the following are clinical manifestations of pain in an infant? (select all that apply) A. Pursed lips B. Loud cry C. Lowered eyebrows D. Rigid body E. Pushes away stimulus
B, C, D
A nurse is preparing a toddle for an IV catheter insertion using atraumatic care. Which of the following are appropriate interventions? (select all that apply)
A. Explain the procedure using the child’s favorite toy
B. Ask the parents to leave during the procedure
C. Perform the procedure with the child in his bed
D. Allow the child to make one choice regarding the procedure
E. Apply EMLA cream to 3 potential insertion sites
A, D, E
A nurse is planning care for an infant who is experiencing pain. Which of the following should be included in the plan of care? (select all that apply) A. Offer a pacifier B. Use guided imagery C. Use swaddling D. Initiate a behavioral contract E. Encourage kangaroo care
A, C, E
