pain. Flashcards
describe pain
- every child has own perception of pain
- unpleasant sensory and emotional experience associated with actual or potential tissue damage
management of pain involves…
- age appropriate assessment of pain
- selecting and implementing an appropriate method to relieve pain
- evaluating effectivness of intervention
describe acute pain
- sudden, shrt duration caused by a single event
- can also be an exacerbation of a chronic condition
- examples include surgery/injury and sickle cell crisis
describe chronic pain
- lasting longer than 3 months, persistent
- lasts beyond the normal healing time
- can be disruptive to daily function
- affects entire CNS -> increased responsiveness to both painful and painless stimuli
- examples include juvenile idiopathic arthritis, cancer, neuropathic pain (abnormal processing of pain by peripheral or CNS)
a child’s response to pain can be influenced by…
- maturation of nervous system
- developmental stage
- cognitive level
- temperment
- family/culture
- situational factors
- previous pain experience
these things may increase or decrease the intensity of the pain perceived
true or bullshit
neonates and infants do not feel pain
bullshit
true or bullshit
children do no feel pain with the same intensity as adults
bullshit
true or bullshit
infants are incapable of expressing pain
bullshit
true or bullshit
infants and children remember pain
true
true or bullshit
parents may exaggerate their child’s pain
bullshit
true or bullshit
children are not in pain if they can be distracted or are sleeping
bullshit
true or bullshit
repeated experience with pain teaches the child to be more tolerant of pain and cope better
bullshit
true or bullshit
children do not recover more quickly than adults from painful experiences such as surgery
true
true or bullshit
children wont tell if they are in pain and need medication even if they do not appear to be in pain
true
true or bullshit
children without obvious physical reasons for pain are not likely in pain
bullshit
true or bullshit
children are at risk for addiction
bullshit
can have physical dependence but not really addiction
true or bullshit
culture does not affect pain response in children
bullshit
what are some common pain states that children may experience?
- painful and invasive procedures: procedrual sedation and analgesia
- post op pain: associated with surgery, controlled with a combo of meds
- burn pain: multiple compenents, difficult and challenging to control
- recurrent headaches: tension, dental braces, weakness of eye muscles, sinusitis, epilepsy, sleep apnea, injury
- recurrent abdominal pain: common in children
what are some respiratory consequences of unrelieved pain
- shallow breathing
- inadequate lung expansion
- poor cough
- potential for pneumonia
what are some neurologic consequences of unrelieved pain
- increases SNS activity and release of catecholamines
- tachycardia
- hypertension
- change in sleep (more or less)
what are some metabolic consequences of unrelieved pain
- increased metabolic rate = perspiration
- increased cortisol and blood glucose
what are some immune consequences of unrelieved pain
- depression of immune system and anti inflammatory response
- causes increased risk of infection/delayed wound healing
what are some GI consequences of unrelieved pain
- delayed return of GI function
- anorexia, poor nutritional intake
- ileus
what are some pain consequences of unrelieved pain
altered resposne to pain
what is the goal of assessing pain in children
provide accurate information about location of pain and its effects on the child
what should you ask parents about their child’s pain
ask them about “typical” pain responses of the child
what indicators are measured by pain assessment tools?
- behavior measures
- self reporting of pain
do pain assessment tools use vital signs as indicators of pain?
nope
what are some behaviors indicating pain
- crying
- restlessness or agitation
- hyper-alertness or vigilance
- sleep disturbances
- irritability, cant be comforted
describe using pain rating scales
- select: select a scal suitable for the child’s developmental age and preferences
- teach: teach the child to use scale before pain is expected (preop)
- use: use the same scale with child each time pain is assessed
- ask: ask child about acceptable or functional pain level
- reassess: reassess c/o pain within one hour
name and describe some pain scales for preterm and neonates
- NIPS: evaluates procedural pain
- CRIES: evaluates post op pain in ICU
- PIPP: evaluates procedural pain, used for infants between 28-40wks gestation
these rely on nurses observation
what pain scale is used for infants and young children and describe it
FLACC
- faces, legs, activity, cry, consolability
- also used for developmental delay
- for acute pain state
- used when unable to self report pain
what are some important things to consider when using the FLACC scale
- pain levels should be assessed prior to hands on care
- dont use if they are able to self report
name some pain scales for children to adults
- FACES
- oucher
- visual analogue or numerical scale
describe FACES
- 0-5, point to face that corresponds to number
- as young as 3yrs
describe oucher
- series of six photos of faces
- 0-10 scale
- 3-12yrs
describe visual analogue or numerical scale
0 = no pain
10 = worst pain
for 9yrs to adult
name some drugs used for pain management
- opioids like morphine, dilaudid
- NO demoral (meperidine) or codeine
- NSAIDS like toradol and ibuprofen
- nonnarcotic analgesics like tylenol
what drugs are used for mild to moderate pain
non opioid like tylenol and NSAIDS
what drugs are used for moderate to severe pain
opioids like morphine sulfate and dilaudid
what are some side effects associated with opioids
- resp depression and sedation
- constipation
- pruritis
- nausea, vomiting
- urinary retention
what orders would you expect to see to combat the side effects of opioids?
- antiemetics
- stool softeners
- antihistamines
what drug is used to reverse opioid adverse effects?
naloxone
what signs may alert you to the development of opioid related repiratory depression?
- sleepiness, difficult to arouse
- small/pinpoint pupils
- very shallow breathing
frequent cardio/resp monitoring is essential, actually visualizing the patient is wayyy mor accurate than vital monitors
what are some consequences of long term opioid use
- physical dependence
- tolerance
- withdrawal
whats a side effect of acetaminophen
liver damage with overdose
what drug is used to reverse the adverse effects of acetaminophen?
acetylcysteine
whats a side effect of ibuprofen and ketorolac
increase risk of GI irritation, ulceration, and bleeding
what are some different routes for pain management meds
- IV: intermittent or continuous
- oral
- rectal
- IM
- PCA: demand/basal infusion, 5 yrs and older
- epidural
describe using PCA for pain management
- basal/demand
- gives child control and overall better pain management
- child has to be old enough and cognitively able to understand it
what are some complementary nonpharmacologic therapies for pain management
- distraction, guided imagery, relaxation techniques
- breathing techniques
- cutaneous stimulation
- “sweeties” up to 12mo
- heat and cold
- acupuncture
can be used alone or with pharm
what are you assessing in nursing management of pain
- pain scale at least every 4 hours
- IV sites
- PCA/epidural pumps set correctly
- side effects of meds
- effectiveness of pain meds
whats included in the nursing management of pain
increase
- increase comfort during painful procedures
- topical or local anesthetics
- heat/cold
teach
- teach use of complementary therapies
- both parents and child
listen
- listen to parents
- pain rating and what works for the child
what may be used for pain management during a procedure
- vapocoolant sprays
- EMLA cream: mixture of lidocaine and prilocaine
- other topical anesthetics
describe an individulaized treatment plan for a child with chronic pain
- improve function and comfort
- includes meds, bowel program, exercise, PT, complementary therapies
can chronic pain in kiddos lead to prejudice?
yep
descibe procedural sedation
- used for painful diagnostic and therapeutic procedures
- chest tube insertion, arterial puncture, burn debridement, laceration repair, bone marrow aspiration, fracture reduction
- moderate or deep
what is the goal of procedural sedation
- prevent or relieve pain and anxiety
- ease of doing procedure
- prevent complications
describe nursing management of procedural sedation
educate parents
- fasting prior to procedure and for some time after
- may have adverse effects
- watch closely afterwards and dont leave em alone near bodies of water
premedicate
- prevent procedure related pain and anxiety
- pain meds should always be used with sedation
monitor child
- during procedure
- visual confirmation of resp status
