Pain and Fever

Question 1

Neural Interactions of Pain

Answer 1

1. Transduction
2. Transmission
3. Modulation
4. Perception

Question 2

Transduction

Answer 2

Stimuli at nerve endings sent to spinal cord

Question 3

Transmission

Answer 3

Impulses sent through sensory nervous system - peripheral and central

Question 4

Modulation

Answer 4

Alteration of impulses

Question 5

Perception

Answer 5

Experience of pain

Question 6

Nociceptive Pain

Answer 6

1. Somatic pain - skin/subcutaneous tissues; dull, aching
2. Visceral pain - internal organs/poorly localized; deep cramping/sharp squeezing; referred pain

Question 7

Neuropathic Pain

Answer 7

Injury to peripheral nerves resulting in malfunction of nervous system; shooting or stabbing

Question 8

How do infants show pain?

Answer 8

nonverbal behaviors

Question 9

How can 2-3 year olds rate pain?

Answer 9

Can use words but not severity

Question 10

How can 4 year olds rate pain?

Answer 10

can rate intensity of pain

Question 11

How can 8 year olds rate pain?

Answer 11

location, intensity, and quality of pain

Question 12

FLACC

Answer 12

Can be used for children aged 4-19 years with developmental delays
Face, Legs, Arms, Cry, and Consolability

Question 13

Acute Pain Management for Infants

Answer 13

1. Sensorimotor techniques - pacifiers, swaddling, stroking, holding, singing
2. 12% sucrose solution

Question 14

Acute Pain Management for Children/Adolescents

Answer 14

1. Cognitive-behavioral: relaxation, controlled breathing, coping statements
2. Physical strategies: heat, cold, pressure, massage
3. Distraction techniques: guided imagery, videos

Question 15

Anagesics for Mild to Moderate Pain

Answer 15

Acetaminophen 10-15 mg/kg/dose every 4-6 hours

Question 16

Oral NSAIDs

Answer 16

1. Ibuprofen 4-10 mg/kg/dose every 6-8 hours
2. Naproxen 5-7 mg/kg/dose every 8-12 hours (for over 2 years old)

Question 17

Opioid Agonists

Answer 17

For Moderate to Severe Pain
1. Codeine
2. Hydromorphone
3. Methadone
4. Hydrocodone
5. Oxycodone
6. Morphine

Question 18

What can be given if muscle spasms are a factor in pain?

Answer 18

Benzodiazepines

Question 19

Age-Related Differences in Analgesia Response (Neonates/Infants)

Answer 19

• Delayed hepatic enzyme maturation (altered metabolism)
• Decreased plasma protein binding
  ** Glomerular filtration reduces in neonatal period

Question 20

Age Related Differences in Analgesia Response (Toddlers/Preschoolers)

Answer 20

Increased renal clearance

Question 21

Primary Treatment for Pain

Answer 21

NSAIDs, APAP, TCAs

Question 22

Brain damage does not occur in temperatures below what?

Answer 22

107.6

Question 23

Non-pharmacologic Measures for Fever

Answer 23

1. Adequate hydration
2. Reassurance to parents
3. Appropriate clothing
4. Ambient environment temp around 72F
5. Tepid water baths for temp greater than 104F
   **Sponging should be discontinued if the child starts to shiver; ice-baths and alcohol sponging should not be done

Question 24

Acetaminophen and Ibuprofen for fever (mechanism)

Answer 24

Work by inhibiting prostaglandin synthesis without affecting the baseline body temperature

Question 25

Fever without Focus

Answer 25

• in a child under 24 months of age
• etiology is not apparent after careful H&P
• the younger the infant, the greater the concern for serious bacterial infection (SBI) or invasive viral infection (IVI)

Question 26

Fever of Unknown Origin

Answer 26

• temp greater than 101F
• on several occasions, or more than 3 weeks duration
• with failure to reach a diagnosis despite 1 week of intense investigation