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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
Hydromorphone hydrocholoride (dilaudid)
6x more potent than morphine
26
Methadone
Methadone may be used to wean them from opoids and to treat severe or chronic pain
27
Other opoids
Oxycodone /OxyContin Hydrocodone combine with acetaminophen or ibuprofen
28
Oxycodone /OxyContin
“Contin” extend and release
29
Hydrocodone combined w acetaminophen or ib profen
Norco Lortab Vicodin Vicoprofen
30
Gabapentin (neurontin )
Anticonvulsants - Neuro pain
31
ketorolac (toradol)
NSAIDS- Anti-inflammatory for use before or after medical procedures / surgery
32
tofranil)
Tricyclic antidepressants Neuro pain Amitriptyline, imipramine (
33
Midazolam (versed)
Sedatives Relaxation or sedation prior to medical procedures / surgery
34
Coanalgesic adjuvant therapies
Used in addition with opoids /non opoids for better pain control
35
Skeletal muscle relaxants
Baclofen (lioresal) Helps with spasm , spasticity
36
Anti anxiety medication
Lorazepam (ativan) Muscle relaxant or to to lessen anxiety before medical procedures / surgery
37
Corticosteroids
Methylprednisolone (solumedrol) Reduce pain and inflammation
38
Placebos
Not recommended Considered unjustified and unethical Raise serious ethical and legal questions Ex. Mom wants to use saline instead morphine
39
Oral
Preferred route if tolerating po intake Longer duration and least invasive Liquid Pill Lollipop form
40
Range orders with morphine to an infant who hasn’t took it before
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
What is important to consider when administering pill form
Don’t assume they can swallow a pill based on age
42
lolipop form
Transmucosal Fentanyl oralet (actiq) Tetracaine lollipop
43
Tetracaine lollipop
Great for post op t&a If you only need pain relief in the area and not systemic
44
Intravenous IV
Bolus (IVP) Continuous
45
PCA
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
Can parents and nurses administer PCA pump
Yes depends on hospital guidelines Family controlled analgesia Nurse activated analgesia
47
IM route
Not recommended for pain
48
Rectal route
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
Intradermal route
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
Inhalation
Used for procedures Anesthetics -nitrous oxide Partial or complete analgesia for painful procedures
51
Transdermal
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
JTIP .25 ml
Need free jet injection Special purpose das use for xylocaine (lidocaine)
53
EMLA
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
LMX4
4% lidocaine cream Apply 30 min before procedure duration is 60 min.
55
Lidocaine Tetracaine
Transdermal patches Synergy , s - Caine Apply 20-30 min Do not apply on broken skin Administer before painful procedure
56
Pain ease (ethyl chloride)
Vapocoolebt refrigerant spray Used on intact , minor open wounds and intact mucous membranes For need procedures and minor surgical procedures No vasoconstriction
57
Refrigerant sprays
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
What are refrigerant sprays used for
Immunizations Iv starts Joint injections Blood draws Incision and drainage of small abscess Foreign body removal Suturing and suture removal
59
LAT
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
Be careful with adrenaline why?
Don’t put it on tips of noses, penis , tips of fingers It will cause vasoconstriction
61
Scheduled pain med
Ideal , best practice
62
Break through pain
PRN meds
63
Respiratory depression
Most serious adverse effect Rare Occurs w first dose
64
If respirations are depressed
Assess sedation Stop or reduce infusion if continuous Stimulate pt Administer o2 Support resp
65
If resp depression occurs and they are unarousable or apneic
We administer narcan ( naloxone)
66
Since narcan fades faster than opoids
We may have to re administer if respiratory depression happens again
67
Respiratory depression due to benzodiazepines can be reversed with ?
Flumazenil (romazicon)
68
Two medications administered for Nausea and vomiting
Administer Ondasteron (zofran) Promethazine (phenergan) These symptoms usually subside after 2 days of opioid admin
69
Constipation
Prevention is more effective than treatment Administer stool softener or laxative Increase fluid intake Increase fiber Increased physical activity
70
Purities
Five diphenhydramine (Benadryl) Ondasetron (zofran) For opioid and epidural Pruritis
71
What did hospice do to wake pt up?
Ritalin or adderall
72
Therapeutic response
“ i am putting the medicine in this tube and you’ll start feeling less hurt”

Module 5 (39 decks)

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