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Module 5 > Non Pharmacologic And Pharmacologic Pain Intervention > Flashcards

Non Pharmacologic And Pharmacologic Pain Intervention Flashcards

1
Q

What is the single most powerful non pharmacological method of pain relief to children

A

Parents

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2
Q

Non Pharma logical interventions

A

Reduce perception of pain
Provide sense of control (a traumatic)
Decrease anxiety
Nuances the effectiveness of analgesics
Learn the intervention prior to need

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3
Q

Non pharmacological categories

A

Sensory
Cognitive behavioral and relaxation
Imagery

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4
Q

Sensory technique

A

Used to alter the perception of pain by stimulating ones senses
Sight smell taste feeling hearing

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5
Q

Tactile stimulation of cutaneous fibers

A

May be completed with perceived painful sensations

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6
Q

Distraction stimulation

A

May refocus attention away from pain

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7
Q

Ex of tactile stimulation

A

Rubbing stroking patting hugging hand holding
Squeezing a soft object
Vibrating devices
Alternating of heat and cold
Applying transcutaneous electrical nerve stimulation TENS

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8
Q

Cold vibration devices

A

Buzzy bee

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9
Q

Buzzy bee

A

Uses cold and vibration
Natural gate control pain relief by confusing the body’s own nerves dulling or eliminating sharp pain
“Use between the brain and the pain “

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10
Q

How can you distract infants and young children

A

Objects that move or change shape or color (pin wheel kaleidoscopes , videos, magic wands)
Pop up books , seek and find books
Puppets
Rocking
Non nutritive sucking
Music and or singing
Play therapy
Art therapy

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11
Q

Distraction for older children and adolescents

A

Electronic activities such as video games or televisions
Books/reading
Music and or singing
Art therapy
Aromatherapy

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12
Q

Cognitive behaviorist relaxation techniques

A

Bubble blowing
Counting (backwards or in patterns or groups)
Deep breathing
Progressive muscle relaxation

Biofeedback
Mindfulness based stress reduction (MSBR)

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13
Q

Guided imagery

A

A trip, pain switch magic glove
Hypnosis
Story telling and pretending

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14
Q

How can guided imagery be done

A

In person w clinician or there are several recordings available

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15
Q

Taking a trip

A

Ask the child where they would like to go , tell them to close their eyes and you guide them to it

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16
Q

Pain switch

A

Ask child to visualize his or her pain as a light or electrical current and then to describe a switch that can be used to turn off the pain

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17
Q

Magic gloves

A

Used 3-12 yrs of age

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18
Q

Additional non pharm therapies

A

Yoga
Thai chi
PT
Massage
Acupuncture
Energy therapies
Aromatherapy

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19
Q

Non opioids

A

Used in conjunction with opioids require less opioid usage
Mild to moderate pain
Targets the PNS
Ceiling effect

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20
Q

Benefits of using non opioids in conjunction with opioids

A

Pain control is better achieved through this combination method
Pt will experience few adverse side effects from opioids

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21
Q

most common non opioids

A

Acetaminophen (Tylenol)
IV acetaminophen (Ofirmev)
Ibuprofen (Motrin , advil)

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22
Q

Opioids

A

Moderate to severe pain
Targets CNS (resp depression)
No ceiling effect

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23
Q

Most effective opioids

A

Morphine sulfate (morphine)
Fentanyl citrate ( sublimate)
Hydro morphine hydrochloride (dilaudid)

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24
Q

Fentanyl citrate (sublimaze)

A

100x more potent than morphine

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25
Q

Hydromorphone hydrocholoride (dilaudid)

A

6x more potent than morphine

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26
Q

Methadone

A

Methadone may be used to wean them from opoids and to treat severe or chronic pain

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27
Q

Other opoids

A

Oxycodone /OxyContin
Hydrocodone combine with acetaminophen or ibuprofen

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28
Q

Oxycodone /OxyContin

A

“Contin” extend and release

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29
Q

Hydrocodone combined w acetaminophen or ib profen

A

Norco
Lortab
Vicodin
Vicoprofen

30
Q

Gabapentin (neurontin )

A

Anticonvulsants -

Neuro pain

31
Q

ketorolac (toradol)

A

NSAIDS-

Anti-inflammatory for use before or after medical procedures / surgery

32
Q

tofranil)

A

Tricyclic antidepressants
Neuro pain

Amitriptyline, imipramine (

33
Q

Midazolam (versed)

A

Sedatives
Relaxation or sedation prior to medical procedures / surgery

34
Q

Coanalgesic adjuvant therapies

A

Used in addition with opoids /non opoids for better pain control

35
Q

Skeletal muscle relaxants

A

Baclofen (lioresal)
Helps with spasm , spasticity

36
Q

Anti anxiety medication

A

Lorazepam (ativan)
Muscle relaxant or to to lessen anxiety before medical procedures / surgery

37
Q

Corticosteroids

A

Methylprednisolone (solumedrol)
Reduce pain and inflammation

38
Q

Placebos

A

Not recommended
Considered unjustified and unethical
Raise serious ethical and legal questions

Ex. Mom wants to use saline instead morphine

39
Q

Oral

A

Preferred route if tolerating po intake
Longer duration and least invasive
Liquid
Pill
Lollipop form

40
Q

Range orders with morphine to an infant who hasn’t took it before

A

Start small dose monitor resp, and wait up to 30 min if they are still in significant pain then administer the other.

Then you start 3 hours from the last dose

41
Q

What is important to consider when administering pill form

A

Don’t assume they can swallow a pill based on age

42
Q

lolipop form

A

Transmucosal
Fentanyl oralet (actiq)
Tetracaine lollipop

43
Q

Tetracaine lollipop

A

Great for post op t&a
If you only need pain relief in the area and not systemic

44
Q

Intravenous IV

A

Bolus (IVP)
Continuous

45
Q

PCA

A

Self admin
By 5-6years of age
If they understand cause and effect]
Typically used in hospice
“If i push this the pain goes away”

46
Q

Can parents and nurses administer PCA pump

A

Yes depends on hospital guidelines

Family controlled analgesia
Nurse activated analgesia

47
Q

IM route

A

Not recommended for pain

48
Q

Rectal route

A

Not recommended , but last option
Traumatic
Absorption affected by stool
Many drugs can be compounded into rectal suppositories(if we do not have a choice)

49
Q

Intradermal route

A

Used primarily for skin anesthesia
Local anesthetics (lidocaine)/ which may be buffered with sodium bicarbonate

Lumbar punctures , bone marrow , aspirations , arterial punctures , skin biopsies

50
Q

Inhalation

A

Used for procedures
Anesthetics -nitrous oxide
Partial or complete analgesia for painful procedures

51
Q

Transdermal

A

Fentanyl (duragesic)
12 and older
Continuous pain control
Used on skin
Onset isnt till 12 - 24 hr

Duration is 72 hrs

Not for acute pain relief

52
Q

JTIP .25 ml

A

Need free jet injection
Special purpose das use for xylocaine (lidocaine)

53
Q

EMLA

A

Apply 1-2 1/2 hr before painful event
Vasoconstricts
2 1/2 hr for deep IM
Non emergent matters
Not used in ED but can use on floor.
Parents can get prescription

54
Q

LMX4

A

4% lidocaine cream
Apply 30 min before procedure duration is 60 min.

55
Q

Lidocaine Tetracaine

A

Transdermal patches
Synergy , s - Caine
Apply 20-30 min
Do not apply on broken skin
Administer before painful procedure

56
Q

Pain ease (ethyl chloride)

A

Vapocoolebt refrigerant spray
Used on intact , minor open wounds and intact mucous membranes
For need procedures and minor surgical procedures
No vasoconstriction

57
Q

Refrigerant sprays

A

Works within seconds to freeze numb skin up to 1 minute
Available from pharmacy (dose not require a physician order)
Ask a pediatrician for use in 4 yrs and younger

58
Q

What are refrigerant sprays used for

A

Immunizations
Iv starts
Joint injections
Blood draws
Incision and drainage of small abscess
Foreign body removal
Suturing and suture removal

59
Q

LAT

A

Lidocaine- adrenaline Tetracaine
Gel or liquid (gel preferred)
Anesthesia occurs in 10 - 15 min
Adrenaline is not used on end arterioles because of vasoconstriction
Primarily for suturing
Ex if kid falls off bar stool slits chin open this is perfect

NON intact skin ***

60
Q

Be careful with adrenaline why?

A

Don’t put it on tips of noses, penis , tips of fingers

It will cause vasoconstriction

61
Q

Scheduled pain med

A

Ideal , best practice

62
Q

Break through pain

A

PRN meds

63
Q

Respiratory depression

A

Most serious adverse effect
Rare
Occurs w first dose

64
Q

If respirations are depressed

A

Assess sedation
Stop or reduce infusion if continuous
Stimulate pt
Administer o2
Support resp

65
Q

If resp depression occurs and they are unarousable or apneic

A

We administer narcan ( naloxone)

66
Q

Since narcan fades faster than opoids

A

We may have to re administer if respiratory depression happens again

67
Q

Respiratory depression due to benzodiazepines can be reversed with ?

A

Flumazenil (romazicon)

68
Q

Two medications administered for Nausea and vomiting

A

Administer
Ondasteron (zofran)
Promethazine (phenergan)

These symptoms usually subside after 2 days of opioid admin

69
Q

Constipation

A

Prevention is more effective than treatment
Administer stool softener or laxative
Increase fluid intake
Increase fiber
Increased physical activity

70
Q

Purities

A

Five diphenhydramine (Benadryl)
Ondasetron (zofran)

For opioid and epidural Pruritis

71
Q

What did hospice do to wake pt up?

A

Ritalin or adderall

72
Q

Therapeutic response

A

“ i am putting the medicine in this tube and you’ll start feeling less hurt”

Module 5 (39 decks)

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