[Exam 3] Chapter 36 – Pain Management in Children Flashcards
Transduction: What are nociceptors?
They are at the end of the peripheral nerves which are specialized receptors.
Transduction: What do nociceptors become activated?
When they are exposed to noxious stimuli. They can be mechanical, chemical, or thermal
Transduction: Mechanical stimuli may include?
Intense pressure to an area, strong muscular contractions, or extensive pressure due to muscular overstretching
Transduction: Chemical stimulation may involve?
Release of mediators such as histamine, prostaglandings, or bradykinin as repsonse to tissue traumaa
Tranmission: What is this?
When the stimuli are converted to electrical impulses which are relayed along peripheral nerves to the spinal cord and brain
Tranmission: Pain transmitted by these fibers often referred to as fast pain, which is associated with
mechanical or thermal stimuli , which is due to A-delta fibers
Tranmission: What do unmyelinated small C fibers do?
Transmit the impulse slowly and are often activated by chemical stimuli or continued mechanical or thermal stimuli
Tranmission: What is the gate-control theory?
Dorsal horn of spinal cord contains interneuronal or interconnecting fibers. Large fibers when stimulated close the gate or pathway to the brain, inhibiting transmission of pain impulse
Perception: What happes here?
Nerve fibers divide then cross to the opposite side toward the thalamus.
Perception: Impulse carried by a fast-A give what perceptions of pain?
Sharp, stabbing localized pain that is commonly involves the reflex xresposne to withdraw from stimulus
Perception: Impulse carried by slow-c fibers give what perceptions of pain?
Diffuse, dull, burning, or aching pain.
Perception: What is pain threshold?
The point at which the person first feels the lowest intensity of painful stimulus
Modulation: What do neuromodulators do?
Modify the pain sensation. Substance shave been found to change persons perception of pain. This includes serotonin
Modulation: How can pain perception be modified peripherally?
In peripheral nerve fibers, chemical susbtances are release that either sitmulate the nerve fibers or sensitize them. Allows nerve fibers to react to stimulis that is lower intensity
Types of Pain - Acute Pain: What is this?
Pain that is associated with a rapid onset of varying intensity. Usually indicates tissue damage and resolves with healing
Types of Pain - Acute Pain: Acute pain reflects stimulation of what?
Nociceptors and serves a protective function .
Types of Pain - Chronic Pain: What is this?
Defined as pain that continues past the expected point of healing for injured tissue.
Types of Pain - Chronic Pain: Chronic, recurrnet pain is most commonly associated with?
Abdominal pain, nonspecific headache and limb pain.
Types of Pain - Nociceptive Pain: This reflects pain due to what?
Nixous stimuli that damages normal tissues or has potential to do so if prolonged. Ranges from sharm or burning to dull and aching.
Types of Pain - Nociceptive Pain: Examples that cause this?
Chemical burns, sunburn, cuts, appendicits and bladder distention
Types of Pain - Neuropathic Pain: Pain is due to what?
Malfunctioning of the peripehral or CNS.
Types of Pain - Neuropathic Pain: How is this described?
Burning, tingling, shooting, sqeezizng, or spasm-like pain.
Types of Pain - Neuropathic Pain: Examples of this include?
Posttraumatic and postsurgical peripheral nerve injuries, pain after spinal card, and phantom limb pain
Types of Pain - Somatic Pain: What is this?
Pain that develops in the tissues.
Types of Pain - Somatic Pain: What is superficial somatic pain?
Involves stimulation of nociceptors in the skin, subcutaneous tissue or mucous membranes. Pain is localized and described as charp.
Types of Pain - Somatic Pain: Superficial somatic pain may be due to
external mechanical, chemical, or thermal injury or skin disorders
Types of Pain - Somatic Pain: What is Deep somatic pain?
Involves muscles, tendons, joints, fasciae and bones. Can be localized or diffuse.
Types of Pain - Somatic Pain: What may cause this?
Strain from overuse or direct injury, ischemia and inflammation
Types of Pain - Visceral Pain: What is this?
Pain that develops within organs such as heart, lungs, GI or pancreas.
Types of Pain - Visceral Pain: This is often caused by what?
Disease. May be due to distention of the organ, organ muscular spasm, contractions, and pulling.
Factors Influencing Pain - Temperament: How will a child with a “difficult temperament” respond to pain?
More liekely to have increased distress response to pain
Developmental Considerations - Infants: How do they experience pain compared to older adults?
They experience pain at a greater intensity. Related to immaturity of the inhibitory mechanisms that develop higher in CNS.
Developmental Considerations - Infants: Behavioral indicators incldue what?
Facial expression, such as brow contracting and chin quivering
Body Movements
Crying
Developmental Considerations - Infants: Physiologic signs include what?
HR, RR, BP, O2 Sat Levels and Palmar Sweating
Developmental Considerations - Infants: What will an older infant often display?
Similar behvioral manifestations of pain, but with an angry facial expression adn eyes open.
Developmental Considerations - Toddlers: Behaviors here may include what?
They may bite hit, scream or kick.
They may be very quiet, pointing to where it hurts or saying words such as oww.
Developmental Considerations - Preschoolers: How will they respond to pain?
May become quiet or try to withdraw and hide.
Developmental Considerations - School-Age Children: Will often use what words to describe their pain?
Sharp as a kinfe, burning, or pulling to describe their pain. Are concerned with their fear about illness and its efects rather than pain
Common Fallacies and Myths about Pain - Nursing Process Overview/Assessment: What is the acronym to rememebr key principles of pain?
QUESTT
Question the child
Use Reliable Pain Scale
Evalaute childs behavior to determine baseline
Secure parents involvement
Take cause of pain into account
Take Action
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Questioning Child: How should you phrase questions?
In a manner that the child will be able to understand. Ask them what pain means to them.
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Questioning Child: Questions should be formulated to ascertain what?
Location, quality, severity, and onset of pain
Conditions that preceded onset of pain
Any associated symtpoms suhc as weight loss
Any recent trauma
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Questioning Parents: What examples can be use as a guide for assessing the childs pain?
Has child ever been in pain before?
How did they react to pain?
Does child let you know that you have pain
If there anything child does when they are hurting?
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: Can be used by children as young as what?
3-4 years of age.
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: What is the Oucher PAin Rating Scale?
Instead of illustrations, six photographs are used: “No hurt” placed on bottom and “most hurt” is on top.
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: What is the Poker Chip Tool?
Lay chips in front of child and explain ow left one means no hurt where right one means most hurt.
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: Poke Chip Tool is best for what age?
Age 4-7 years old
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: What is the visual analog
Endpoints are identified as no paina dn worst pain
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: What is the numeric scale?
Has endpoints of 9-10, reflecting no pain and worst pain
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: Visual scale is sued for what age?
Children 8 youngers or older.
Common Fallacies and Myths about Pain - Nursing Process Overview/Health Hx - Use Pain Scale: Numeric scale can be used with what aage?
Children 8 years or older