[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
Nursing Process Overview/Health Hx - Adolescent Pediatric Pain Tool: What does this involve and what age is this used for?
Involves three aspects of assessment. Identifies location of pain on two illustrations of body. For those 8-17 years.
Nursing Process Overview/Health Hx - Adolescent Pediatric Pain Tool: How is this done?
Child instructed to color areas where they are hurting. Then assess pain. And then use words that describe the pain.
Nursing Process Overview/Physical Exam - Observe for Manifestations: Body responds to acute pain via the sympathetic nervous system, leading to what?
Stimulation and a subsequent increase in VS
Nursing Process Overview/Physical Exam - Observe for Manifestations: What behavioral changes may a child exhibit?
Irritability, restlessness. Clenched fists, body stiffening, or increased muscle tension.
Nursing Process Overview/Physical Exam - Neonatal Infant Pain Scale: What is this?
Used to assess pain in preterm and full-term neonates.
Nursing Process Overview/Physical Exam - Neonatal Infant Pain Scale: What is measured here
Facial expression, cry, breathing patterns, arms, legs, and state of arousal . Each except cry scored 0-1
Nursing Process Overview/Physical Exam - Neonatal Infant Pain Scale: Higher score indicates what?
Increased pain.
Nursing Process Overview/Physical Exam - Riley Infant Pain Scale: What is this?
Behavioral assessment used for infants who lack verbal ability.
Nursing Process Overview/Physical Exam - Riley Infant Pain Scale: What parameters measured?
Facial expression, body movement, sleep , verbal, consolability and response to movement.
Nursing Process Overview/Physical Exam - Riley Infant Pain Scale: Scoring here?
All six scored from 0-3
Nursing Process Overview/Physical Exam - Pain observation Scale for Younger Children: What is this?
Behavioral assessment used for children between 1-4 years. Tool measures seven parameters. Maximum score is 7
Nursing Process Overview/Physical Exam - CRIES Scale for NEonatal PostOp Pain Assessment: What is this?
Quantifies postoperative pain in newborn. May also be used to monitor infants progress over time during recovery or after inverventions.
Nursing Process Overview/Physical Exam - CRIES Scale for NEonatal PostOp Pain Assessment: Tool assesses what?
Five parameters, which each being scored from 0-2
Nursing Process Overview/Physical Exam - r-FLACC Behavioral Scale for Nonverbal Children: What is this?
Useful in assessing childs pain when chjild cannot report accurately their level of pain. For those 2-7 months of age.
Nonpharmacologic Mx - Behavioral-Cognitive Strats: What does this require?
Child to focus on a specific area rather than the pain. Decreases negative attitudes, thoughts, and anxieites, thereby improving coping mechanisms.
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Relaxation: What does this help with
Aids in reducing muscle tension and anxiety. They focus on one area of the body and let that body part go limp.
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Distraction: What does this involve?
Having the child focus on another stimulus , thereby attempting to shield themselves from pain.
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Distraction: Methods for this includes what?
Counting, repeating specific phrasing, or listenign to music or singing
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Distraction: What to know for humor?
Demonstrated to be effective distracting technique, but make sure its age appropriate.
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Distraction: What would older or younger children enjoy?
Younger: Blowing pinwheels and blowing bubbles
OldeR: Enjoy computer or video gfames
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Imagery: What is this?
Imagination to create mental image. Usually a positive, pleasurbale image.
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Biofeedback: What does this involve?
Child gain awareness of their body functions and learn ways to modify them voluntarily. Client can control changes without apparatus with practice.
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Thought Stopping: What does this involve?
Substituting a pleasurable or positive thought for the painful experience. Examples include “It’s only for a short time”
Nonpharmacologic Mx - Behavioral-Cognitive Strats - Positive Self-Talk: What si this?
Involves use of positive statements. Say positive statements when experiencing pain
Nonpharmacologic Mx - Biophysical Intervention: What does this involve?
Interfering with transmission of pain impulses reaching the brain. Decreases ability of A-Delta and C Fibers to transmit pain
Nonpharmacologic Mx - Biophysical Intervention: Examples of this?
Sucking and sucrose, application of heat/cold, massage and pressure
Nonpharmacologic Mx - Biophysical Intervention - Sucking/Sucrose: Nonnutritive sucking can be used to do what?
Reduce pain behviors in neonates undergoing painful procedures. Adding glucose show reduced pain behaviors
Nonpharmacologic Mx - Biophysical Intervention - Heat/Cold: Cold does what?
Vasoconstriction and alters capillary permeability, leading to decrease in edema . Blood flow reduced along with pain.
Nonpharmacologic Mx - Biophysical Intervention - Heat/Cold: What does heat do?
Vasodilation adn increases blood flow in the area. Decrease in nociceptive sitmulation.
Nonpharmacologic Mx - Biophysical Intervention - Massage/Pressure: What does thsi inhibit?
A delta and C fibers. RElax muscles adn reduce tension.
Nonpharmacologic Mx - Biophysical Intervention - Massage/Pressure: How is acupressure performed?
Pressure may be applied in one motion followed by releasing in a circular motion for several minutes and then releasing with vibrating motion.
Nonpharmacologic Mx - Biophysical Intervention - Massage/Pressure: Motion of applying and then relasin pressure is thought to facilitate release of what
endogenous endorphin
Pharmacologic Mx - Nonopioid Analgesics: What does this include?
Acetaminophen and NSAIDS like Ibuprofen.
Pharmacologic Mx - Nonopioid Analgesics: What does thsi treat?
Mild-to-moderate pain, headache, dental pain and menstrual pain
Pharmacologic Mx - Nonopioid Analgesics: Why should aspirin not be used in infants?
Because of high risk of Reye Syndrome
Pharmacologic Mx - Nonopioid Analgesics: For line treatment for treatment of pain?
Acetaminophen and NSAIDs
Pharmacologic Mx - Nonopioid Analgesics: Why is IM Injection here not recommended?
Can cause significant pain and onset of pain releif is not increased
Pharmacologic Mx - Nonopioid Analgesics: Why is Acetaminophen used instead of NSAIDs?
Helps in those with children, bleeding or clotting or children on anticongulations
Pharmacologic Mx - Nonopioid Analgesics: Adverse effects associated with NSAIDs include?
GI irritation, blood clotting problems, and renal dysfunction.
Pharmacologic Mx - Opioid Analgesics: Typically used for what?
Moderate-to-severe pain. Classified as agonsits or antagonists
Pharmacologic Mx - Opioid Analgesics: Opioid agents that act as agonists include
morphine , fentanyl, meperidine, oxycodone adn hydrocodone
Pharmacologic Mx - Opioid Analgesics: How can they be administered
Orally, rectally, intramuscularly, or intravenously
Pharmacologic Mx - Opioid Analgesics: Gold standard for opioid agonists?
Morphine
Pharmacologic Mx - Opioid Analgesics: What is Tramadol ?
Opioid used in treating moderate pain and is associated with lower risk of respiratory depression
Pharmacologic Mx - Opioid Analgesics: Opioids stimulate chemoreceptor trigger zone, leading to what
N/V
Pharmacologic Mx - Adjuvant Drugs: What are these?
Used to promote more effective pain relief, either alone or in combination with nonopoiods or opioids
Pharmacologic Mx - Adjuvant Drugs: Primary use for this?
Diagnoses other than pain. This includes benzodiazepines to help relieve anxiety.
Drug Administration Methods: How often should analgesia be administerd for continuous pain?
Around the clock at scheduled intervals to achieve necesssary effect
Drug Administration Methods - Oral Method: Effectiveness occurs how quickly?
1-2 hours after administration
Drug Administration Methods - IV Method: When is this used?
In emergency situations and when pain is severe and quick relief
Drug Administration Methods - IV Method: How fast for this to take effect?
Within 5 minutes.
Drug Administration Methods - Patient-Controlled Analgesia (PCA): Most common drugs used here?
Morphine, hydromorphone and fentanyl
Drug Administration Methods - Patient-Controlled Analgesia (PCA): Dosage for morphine is usually what?
0.01 to 0.04 mg/kg/hr
Drug Administration Methods - Patient-Controlled Analgesia (PCA): Serious adverse effects of this?
Oversedation, respiratory depression, and even death. Can occur with others administer PCA
Drug Administration Methods - Local Anesthetic Application - Topical Forms: Most common choice for effective, painless local anesthesia is
EMLA (Eutectic mixture of local anesthetics), which should be done 2-3 before the procedure
Drug Administration Methods - Local Anesthetic Application - Topical Forms: Achieves anesthesia to a depth of what?
2-4 mm, so that phlebotomy, and imtramuscular injectiosn for up to 24 hours after injection
Drug Administration Methods - Local Anesthetic Application - Topical Forms: Requires how much time for intact skin using an occlusive dressing?
60-90 minutes
Drug Administration Methods - Local Anesthetic Application - Topical Forms: What is Synera?
It enhances delivery of lidocaine. Labeled for childen older than 3 years old and applied only 20-30 mins before procedure
Drug Administration Methods - Local Anesthetic Application - Topical Forms: What is TAC and LET?
Commonly used for lacerations and require suturing. Applied directly to wound with cotton ball for 20-30 mins until are anumb
Drug Administration Methods - Local Anesthetic Application - Topical Forms: What is ELA-Max?
Massaged into the skin without the use of occlusive dressing. Takes 15-30 mins and lasts 60 minute.s
Drug Administration Methods - Local Anesthetic Application - Topical Forms: What is Liposomal Lidocaine 4% cream?
Short onset (30 mins) and minimal vascular effects as benefits.
Drug Administration Methods - Local Anesthetic Application - Topical Forms: What is needle-free powder lidocaine?
Labeled for children 3-18 years. Uses single-use, prefilled disposable system that provides analgesia in 1-3 mins.
Drug Administration Methods - Local Anesthetic Application - Topical Forms: What is numy stuff?
Provides deeper analgesia in a shorter duration (10-25 mins) and is used voer itnact skin.
Drug Administration Methods - Local Anesthetic Application - Topical Forms: What is Vapocoolant spray?
Sprayed onto skin or administered using cotton ball. Effect lasts 1-2 minutes
Drug Administration Methods - Local Anesthetic Application - Injectable Forms: How can they be administered and how long od they last?
SQ or Intradermally 5-10 mins before procedure. There may be bruising from admin
Drug Administration Methods - Epidural Analgesia: How is this done?
Catheter inserted into epidural space suually between the lumbar and thoracic area.
Drug Administration Methods - Epidural Analgesia: Drug normally used here?
Fentanyl or morphine.
Drug Administration Methods - Epidural Analgesia: What is usually given in conjunction wiht a long-acting local anesthetic
Morphine, fentanyl, or hydromorphone
Drug Administration Methods - Epidural Analgesia: How long does this last?
12-14 hours.
Drug Administration Methods - Epidural Analgesia: What is not given with this?
Narcotic analgesics to prevent complications such as respiratory depression, pruritus, N/V, and urinary retention
Drug Administration Methods - Epidural Analgesia: How often is assessment done and for what?
Every 1-2 hours and for HR, RR, and Depth of SEdation and every 2-4 hours for BP, ppain level and motor function
Drug Administration Methods - Moderate (Conscious) Sedation: When is moderate sedation used?
For painful and stressful procedures. Suggested instead of using restraints in toddlers and preschoolers.
Drug Administration Methods - Moderate (Conscious) Sedation: Other indications include situations that include?
Evidence that child experencing heightened stress reaction
Verbalization by child that they are firghtened
Inability to remain immobilized
The nurse is preparing to assess the pain of a 3-year-old child who had surgery the day before. Which pain assessment method would be most appropriate for the nurse to use?
FACES pain rating scale and poker chip tool FACES pain rating scale, observation of the child, and parent report Asking the parents to rate their child’s pain using the word-graphic rating scale Visual analog scale
FACES pain rating scale, observation of the child, and parent report
When developing the plan of care for a child in pain, the nurse identifies appropriate strategies aimed at modifying which factor influencing pain?
Gender Cognitive level Previous pain experiences Anticipatory anxiety
Anticipatory Anxiety
An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, “I’ve been practicing really hard and long to get myself ready for my meet this weekend.” The area is tender to the touch. The nurse determines that the adolescent is most likely experiencing which type of pain?
Cutaneous pain Deep somatic pain Visceral pain Neuropathic pain
Deep Somatic Pain
After teaching a child’s parents about the different methods of distraction that can be used for pain management, which statement by the parents indicates a need for additional teaching?
“We’ll have her focus on her hand and count each finger slowly.” “We’ll read some of her favorite stories to her.” “We’ll have her imagine that she’s at the beach this summer.” “She likes to play video games, so we’ll bring in some from home.”
“We’ll have her imagine that she’s at the beach this summer.”
