Pain and Fever Flashcards
Neural Interactions of Pain
- Transduction
- Transmission
- Modulation
- Perception
Transduction
Stimuli at nerve endings sent to spinal cord
Transmission
Impulses sent through sensory nervous system - peripheral and central
Modulation
Alteration of impulses
Perception
Experience of pain
Nociceptive Pain
- Somatic pain - skin/subcutaneous tissues; dull, aching
- Visceral pain - internal organs/poorly localized; deep cramping/sharp squeezing; referred pain
Neuropathic Pain
Injury to peripheral nerves resulting in malfunction of nervous system; shooting or stabbing
How do infants show pain?
nonverbal behaviors
How can 2-3 year olds rate pain?
Can use words but not severity
How can 4 year olds rate pain?
can rate intensity of pain
How can 8 year olds rate pain?
location, intensity, and quality of pain
FLACC
Can be used for children aged 4-19 years with developmental delays
Face, Legs, Arms, Cry, and Consolability
Acute Pain Management for Infants
- Sensorimotor techniques - pacifiers, swaddling, stroking, holding, singing
- 12% sucrose solution
Acute Pain Management for Children/Adolescents
- Cognitive-behavioral: relaxation, controlled breathing, coping statements
- Physical strategies: heat, cold, pressure, massage
- Distraction techniques: guided imagery, videos
Anagesics for Mild to Moderate Pain
Acetaminophen 10-15 mg/kg/dose every 4-6 hours
Oral NSAIDs
- Ibuprofen 4-10 mg/kg/dose every 6-8 hours
- Naproxen 5-7 mg/kg/dose every 8-12 hours (for over 2 years old)
Opioid Agonists
For Moderate to Severe Pain
1. Codeine
2. Hydromorphone
3. Methadone
4. Hydrocodone
5. Oxycodone
6. Morphine
What can be given if muscle spasms are a factor in pain?
Benzodiazepines
Age-Related Differences in Analgesia Response (Neonates/Infants)
- Delayed hepatic enzyme maturation (altered metabolism)
- Decreased plasma protein binding
** Glomerular filtration reduces in neonatal period
Age Related Differences in Analgesia Response (Toddlers/Preschoolers)
Increased renal clearance
Primary Treatment for Pain
NSAIDs, APAP, TCAs
Brain damage does not occur in temperatures below what?
107.6
Non-pharmacologic Measures for Fever
- Adequate hydration
- Reassurance to parents
- Appropriate clothing
- Ambient environment temp around 72F
- 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
Acetaminophen and Ibuprofen for fever (mechanism)
Work by inhibiting prostaglandin synthesis without affecting the baseline body temperature
Fever without Focus
- 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)
Fever of Unknown Origin
- 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
