Non Pharmacologic And Pharmacologic Pain Intervention Flashcards
What is the single most powerful non pharmacological method of pain relief to children
Parents
Non Pharma logical interventions
Reduce perception of pain
Provide sense of control (a traumatic)
Decrease anxiety
Nuances the effectiveness of analgesics
Learn the intervention prior to need
Non pharmacological categories
Sensory
Cognitive behavioral and relaxation
Imagery
Sensory technique
Used to alter the perception of pain by stimulating ones senses
Sight smell taste feeling hearing
Tactile stimulation of cutaneous fibers
May be completed with perceived painful sensations
Distraction stimulation
May refocus attention away from pain
Ex of tactile stimulation
Rubbing stroking patting hugging hand holding
Squeezing a soft object
Vibrating devices
Alternating of heat and cold
Applying transcutaneous electrical nerve stimulation TENS
Cold vibration devices
Buzzy bee
Buzzy bee
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 “
How can you distract infants and young children
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
Distraction for older children and adolescents
Electronic activities such as video games or televisions
Books/reading
Music and or singing
Art therapy
Aromatherapy
Cognitive behaviorist relaxation techniques
Bubble blowing
Counting (backwards or in patterns or groups)
Deep breathing
Progressive muscle relaxation
Biofeedback
Mindfulness based stress reduction (MSBR)
Guided imagery
A trip, pain switch magic glove
Hypnosis
Story telling and pretending
How can guided imagery be done
In person w clinician or there are several recordings available
Taking a trip
Ask the child where they would like to go , tell them to close their eyes and you guide them to it
Pain switch
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
Magic gloves
Used 3-12 yrs of age
Additional non pharm therapies
Yoga
Thai chi
PT
Massage
Acupuncture
Energy therapies
Aromatherapy
Non opioids
Used in conjunction with opioids require less opioid usage
Mild to moderate pain
Targets the PNS
Ceiling effect
Benefits of using non opioids in conjunction with opioids
Pain control is better achieved through this combination method
Pt will experience few adverse side effects from opioids
most common non opioids
Acetaminophen (Tylenol)
IV acetaminophen (Ofirmev)
Ibuprofen (Motrin , advil)
Opioids
Moderate to severe pain
Targets CNS (resp depression)
No ceiling effect
Most effective opioids
Morphine sulfate (morphine)
Fentanyl citrate ( sublimate)
Hydro morphine hydrochloride (dilaudid)
Fentanyl citrate (sublimaze)
100x more potent than morphine
Hydromorphone hydrocholoride (dilaudid)
6x more potent than morphine
Methadone
Methadone may be used to wean them from opoids and to treat severe or chronic pain
Other opoids
Oxycodone /OxyContin
Hydrocodone combine with acetaminophen or ibuprofen
Oxycodone /OxyContin
“Contin” extend and release
Hydrocodone combined w acetaminophen or ib profen
Norco
Lortab
Vicodin
Vicoprofen
Gabapentin (neurontin )
Anticonvulsants -
Neuro pain
ketorolac (toradol)
NSAIDS-
Anti-inflammatory for use before or after medical procedures / surgery
tofranil)
Tricyclic antidepressants
Neuro pain
Amitriptyline, imipramine (
Midazolam (versed)
Sedatives
Relaxation or sedation prior to medical procedures / surgery
Coanalgesic adjuvant therapies
Used in addition with opoids /non opoids for better pain control
Skeletal muscle relaxants
Baclofen (lioresal)
Helps with spasm , spasticity
Anti anxiety medication
Lorazepam (ativan)
Muscle relaxant or to to lessen anxiety before medical procedures / surgery
Corticosteroids
Methylprednisolone (solumedrol)
Reduce pain and inflammation
Placebos
Not recommended
Considered unjustified and unethical
Raise serious ethical and legal questions
Ex. Mom wants to use saline instead morphine
Oral
Preferred route if tolerating po intake
Longer duration and least invasive
Liquid
Pill
Lollipop form
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
What is important to consider when administering pill form
Don’t assume they can swallow a pill based on age
lolipop form
Transmucosal
Fentanyl oralet (actiq)
Tetracaine lollipop
Tetracaine lollipop
Great for post op t&a
If you only need pain relief in the area and not systemic
Intravenous IV
Bolus (IVP)
Continuous
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”
Can parents and nurses administer PCA pump
Yes depends on hospital guidelines
Family controlled analgesia
Nurse activated analgesia
IM route
Not recommended for pain
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)
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
Inhalation
Used for procedures
Anesthetics -nitrous oxide
Partial or complete analgesia for painful procedures
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
JTIP .25 ml
Need free jet injection
Special purpose das use for xylocaine (lidocaine)
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
LMX4
4% lidocaine cream
Apply 30 min before procedure duration is 60 min.
Lidocaine Tetracaine
Transdermal patches
Synergy , s - Caine
Apply 20-30 min
Do not apply on broken skin
Administer before painful procedure
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
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
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
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 ***
Be careful with adrenaline why?
Don’t put it on tips of noses, penis , tips of fingers
It will cause vasoconstriction
Scheduled pain med
Ideal , best practice
Break through pain
PRN meds
Respiratory depression
Most serious adverse effect
Rare
Occurs w first dose
If respirations are depressed
Assess sedation
Stop or reduce infusion if continuous
Stimulate pt
Administer o2
Support resp
If resp depression occurs and they are unarousable or apneic
We administer narcan ( naloxone)
Since narcan fades faster than opoids
We may have to re administer if respiratory depression happens again
Respiratory depression due to benzodiazepines can be reversed with ?
Flumazenil (romazicon)
Two medications administered for Nausea and vomiting
Administer
Ondasteron (zofran)
Promethazine (phenergan)
These symptoms usually subside after 2 days of opioid admin
Constipation
Prevention is more effective than treatment
Administer stool softener or laxative
Increase fluid intake
Increase fiber
Increased physical activity
Purities
Five diphenhydramine (Benadryl)
Ondasetron (zofran)
For opioid and epidural Pruritis
What did hospice do to wake pt up?
Ritalin or adderall
Therapeutic response
“ i am putting the medicine in this tube and you’ll start feeling less hurt”
