L2: pain, etc...

Question 1

Define 3 types of pain according to pathology

Answer 1

• Nociceptive: Somatic or visceral pain as a response to injury.
• Neuropathic: injury to or improper functioning of nervous system that causes pain. Damage can be in CNS or PNS
• Nociplastic pain: An amped up nervous system that over-sensitizes normal stimuli into pain.

Question 2

Action when you suspect resp distress

Answer 2

1. call for help
2. Alertness, Breathing, Circulation (pulse)
3. Take glucose levels

Specific interventions would be check airway, reposition child, apply suction, oxygen, manual ventilation,

Question 3

How do you know if you’re doing compressions right

Answer 3

check pulse, appropriate colour comes back

Question 4

What should you look for when assessing IV site

Answer 4

• Touch: feels warm, dry, pain free
• Look: dry, uncovered, not red
• Compare: to other arm

Check TLC every hour (even during sleep) and during HEAL checks. Teach pt when to call nurse

Question 5

What is HEAL check

Answer 5

A safety check that stands for:

• High alert and all infusions
• Equipment: all safety equipment is in the room (resp mask, etc..)
• Armband: check if it is on patient and identify
• Lines: all infusions lines are good

Question 6

What is gold-standard of pain report and what else is used

Answer 6

Self-report, behaviour, and physiological data

Question 7

What are the symptoms of nociceptive pain? and How’s it treated?

Answer 7

• Localized aching and throbbing pain if somatic
• Cramping intermittent pain if visceral
• Treated with Opioids and non-opioids

Question 8

What are symptoms of Neuropathic pain

Answer 8

• burning
• Paresthesia: pins/needles feeling
• hyperalgesia: Heightened pain experience
• Allodynia: pain from touch/pressure to deep tissues
• Treated with analgesics that depress NS activity (anti-depressants and anti-convulsant)
• Opioids do not work

Question 9

Symptoms for nociplastic pain

Answer 9

• Other symptoms associated with an overstimulated NS

- Mix bw nociceptive and neuropathic pain

Question 10

3 types of pain according to longevity

Answer 10

• Acute: lasts 3 months and is caused by an identifiable cause. Pain management subsides with healing.
• Chronic : lasts longer than 3 months. Pain outlasts healing of the source and because of this chronic pain can be classified as a disease as well as a symptom. Can be neuropathic or nociplastic. The focus shifts to functioning and rehabilitation.
• Persistent post-surgical pain (PPP): Surgical pain that continues (beyond expected healing time). Younger pts and pts with poor pain management are more at risk for developing this pain.

Question 11

LMNOPQRST in pain

Answer 11

location, mechanism of pain (causes), neuropathic (type), onset, palliative/proactive, quality, region, severity, timing

Question 12

Describe NIPS scale

Answer 12

Used on infants up to 2m. Uses observable data. Highest pain is 7/7 intensity

Question 13

Describe FLACC scale

Answer 13

• Age range is 2m-7yrs.
• Also used for cognitive impaired pts. and those who cant speak
• uses observable data
• Stands for Face, legs, activity, cry, consolability. All rated out of 2
• overall 0-10 intensity rating

Question 14

Describe Revised FACES scale

Answer 14

• Show faces to pt that show comfort expressions.
• More realistic than modified FACES or Wong-Baker tool.
• Depicts less emotion and more discomfort
• 0-10 intensity scale

Question 15

Describe Modified FACES scale

Answer 15

• Show faces to pt that show comfort lvl.

- Problem is that kids may confuse discomfort expressions for emotional expressions

Question 16

Describe the WHO pain ladder

Answer 16

A 3 step ladder that explains what medications to give based on pain scores.

• If pain score is 1-3 (mild pain), we give non-opioid (Tylenol or ibuprofen) with or with or without adjuvant
• If pain is 4-6 (moderate pain), we give weak opioids with or without non-opioids or adjuvant
• If pain is 7-10 (severe pain), we give strong opioids, with or without non-opioids or adjuvant

Question 17

What is multimodal analgesia

Answer 17

Using multiple analgesics at smaller doses to maximize pain control and minimized drug-induced adverse effects

Question 18

What are the 3 p’s to pain relief

Answer 18

Pharmacology, physiotherapy, psychology

Question 19

What is ATC medication scheduling

Answer 19

“Around the clock” which means scheduled dosing. It is considered when pt is in pain for more than 12hr is in the day. It keeps pain level stable

Question 20

Cons of PRN medication scheduling

Answer 20

Patient will have reoccurring breakthrough pains when their analgesia blood levels are low. So medication adm will have to be ASAP after request

Question 21

What is the non-pharm support framework/ladder

Answer 21

1. Mild to mod pain involves physical therapy
2. mod to severe pain involves behavioral therapy
3. severe pain involves Cognitive therapy

Question 22

What patient teaching about pain management can you give to a post-op pt

Answer 22

• give pain pamph;et at discharge
• Encourage them to take Tylenol +/- NSAID for the first 48-72 hrs post-op
• Teach them when to uses their opioids. when pain reaches 4/10 or 30 min before activity (if oral)
• ## Tell them that good pain control = faster recovery