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PEDs Exam 2 > Pain > Flashcards

Pain Flashcards

1
Q

What age group typically sees their pain as a punishment, and it is important we reassure this age group that the illness/injury is not their fault.

A

preschool: guilt vs initiative

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2
Q

What are some physical and behavioral changes that we need to keep track of when assessing pain?

A

Restlessness, VS changes, grimacing, mood change, pain thresholds vary

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3
Q

What are 2 behavioral measures and scales used to assess pain in infants, toddlers and children who are nonverbal–not used in acute care settings.

A 
CRIES
-crying
-requires SpO2 >95%
-increased vital signs
-expression
-sleeplessness
(0-2 scale)
NIPS
-facial expression
-cry
-breathing pattern
-arms
-legs
-state of arousal
-HR
-O2 Sat
(a score greater than 3 indicates pain)
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4
Q

What self report scale is used in ages 4-8 years old?

A

FACES

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5
Q

What self report scale is used by older children?

A

numeric scale

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6
Q

-Types of Pain-

Acute pain and example?

A

last less than 2 weeks

Example: post operative

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7
Q

-Types of Pain-

Chronic pain and example?

A

at least 3 months- can be constant or transient

Example: back injury

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8
Q

-Types of Pain-

Recurrent pain and example?

A

episodic, comes along more frequently

example: migraine, sickle cell pain

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9
Q

-Managing Pain-

mild to moderate?

A

acetaminophen (0-6 months would ONLY get this medication) or NSAIDs

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10
Q

-Managing Pain-

moderate to severe?

A

opioids- this is based on the disease and the child.

For severe pain- it would be IV pain meds

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11
Q

what is a med that is used for conscious sedation, especially when a pt needs stitches?

A

Midazolam

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12
Q

Acute, continuous pain is best managed with a _____ dose scheduling and around the clock medications- teach parents and patients to give medication at a lower pain level.

A

fixed

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13
Q

PRN orders are typically used for what types of pain?

A

breakthrough pain or activity pain

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14
Q

Dressing changes should be done during a drugs ____ time.

A

peak

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15
Q

What are the peak times for nonopioids, PO opioids, and IV opioids?

A

Nonopioid: 2 hours
PO opioid: 45-60 minutes
IV opioid: 15-30 minutes

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16
Q

Children older than ___ months metabolize more rapidly and may require higher doses of meds.

A

6

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17
Q

NO _____ for children ever because it will convert to morphine in the ____ and puts the child at risk for toxic levels of morphine.

A
  • codeine

- liver

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18
Q

When a child is given hydrocodone with acetaminophen, we need to be very aware of the amount of _________ the child is getting because this is a huge risk for accidental ________.

A
  • acetaminophen

- poisoning

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19
Q

-Physical Dependence-

Tolerance?

A

dose needs to be increased to achieve desired effect–Two options: increase dose or decrease the amount of time between doses

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20
Q

-Physical Dependence-

Addiction?

A

characteristics pattern of some type of opioid use, may have a loss of control over use, preoccupation with obtaining the drug

21
Q

-Physical Dependence-

Ceiling effect?

A

the dose goes beyond with no relief- need to increase the dose to help the pain which increases the adverse effects and increases the risk for addiction

22
Q

Common side effects of NSAIDs?

A

N/V, dyspepsia, epigastric pain, diarrhea, constipation, gastric ulcers and bleeding

23
Q

True or False: NSAIDs can be taken on an empty stomach.

A

false-need to take with food r/t GI bleeds

24
Q

What are some common side effects of opioids?

A

constipation, sedation, N/V, pruritus, respiratory depression, dysphoria, confusion, hallucinations, urinary retention

25
Q

If a pt experiences constipation while taking opioids, what is a management intervention that can be provided?

A

stool softeners, increase fluids, increase activity if tolerated, maybe bowel regime

26
Q

If a pt experiences sedative effects while taking opioids, what is a management intervention that can be provided?

A

if severe, need to change the dose

27
Q

If a pt experiences nausea/vomiting while taking opioids, what is a management intervention that can be provided?

A

ondansetron

28
Q

If a pt experiences pruritus while taking opioids, what is a management intervention that can be provided?

A

diphenhydramine

29
Q

If a pt experiences respiratory depression while taking opioids, what is a management intervention that can be provided?

A

have NARCAN available

30
Q

If a pt experiences dysphoria, confusion, and/or hallucinations while taking opioids, what is a management intervention that can be provided?

A

change meds

31
Q

If a pt experiences urinary retention while taking opioids, what is a management intervention that can be provided?

A

oxybution

32
Q

At what age can a child begin using a patient controlled analgesia (PCA) pump?

A

5 years old

33
Q

What medication is typically used in a patient controlled analgesia (PCA) pump?

A

morphine

34
Q

What are some side effects to watch for if a child is using a patient controlled analgesia (PCA) pump?

A

Respiratory rate should be checked every 2 hours
oxygen saturation monitoring
Naloxone should be an order in the med profile.
Itching: we can use diphenhydramine
Constipation: stool softeners, increased fiber, increased fluids and laxatives.

35
Q

What are some common opioids that are used for epidural pain control?

A

Fentanyl, hydromorphone, preservative-free morphine

36
Q

What are some local anesthetic meds?

A

bupivacaine or ropivacaine

37
Q

Which medication is given for its “calming” effect

A

Clonidine

38
Q

What 3 ways are epidural pain control medications are administered?

A
  • single or intermittent bolus
  • continuous infusion
  • patient-controlled epidural analgesia (PCEA)
39
Q

What are some types of nursing care done for epidural analgesia?

A
  • Careful monitoring for respiratory depression
  • Record the ENTRY MARK at the beginning AND the end of the shift
  • Skin care around insertion site
  • Treat itching with diphenhydramine or naloxone infusion
  • These patients are followed by a pain team.
40
Q

Before administering lidocaine, it needs to be warmed to what temp?

A

body temp

41
Q

What are some side effects to be aware of when administering lidocaine?

A

stinging and burning on injection

42
Q

Nonpharmacologic pain management in neonates?

A
  • 24% sucrose water
  • Swaddling
  • Keeping parents close by and involved.
43
Q

Nonpharmacologic interventions for pain for older children?

A

Breathing techniques, distraction (reading, games, etc.), guided imagery, relaxation, music, massage, heat/cold therapy and hypnosis
*School age: show on a doll

44
Q

What are 4 common types of cultural barriers to pain treatment?

A

-Inadequate assessment of pain
-Concern about side effects and dependence
((Maybe they saw a family member go through addiction, etc.))
-Reluctance to report pain and take pain medications
((Maybe they do not like the taste, fiance, location, etc.))
-Lack of adherence to treatment plan

45
Q

What is the gold standard medication used for appendectomy?

A

Piperacillin Sodium-Tazobactam

46
Q

What syndrome are we most concerned about when giving vancomycin?

A

Red man syndrome

47
Q

When do we need to draw troughs on vancomycin?

A

before the 4th dose is given

48
Q

What other medications are commonly administered in the pediatric world?

A
  • TPN/intralipids
  • acetaminophen
  • ibuprofen
  • Ketorolac
  • ampicillin
  • gentamicin
  • acyclovir
49
Q

What place do we round to when calculating a safe dose for PEDs pts?

A

100th place

PEDs Exam 2 (4 decks)

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