Pain and Seduction in Children Flashcards
What are barriers to pain management in children
Fear of side effects, miconseption that babies don’t feel pain, lack of trained healthcare providers, difficulty of assessment
What are the consequences of not adequately treating pain in babies
Long-term changes in the developing nervous system, alteration in later perception and reaction to pain
What is the gold standard for pain, physiological changes
Self report, increase in blood pressure heart rate and oxygen consumption
What is the tool used to asses pain in 3 to 7 year olds
Wong-baker FACES
When self reporting is not possible how can pain be assessed
Physiological changes, behavioral changes, facial expressions, change in cry
What are two different behavioral observation scales
FLACC: full term neonates and no verbal children
NIPS: Premature and full term neonates
What are behavioral AND physicological tools used to assess pain used in infants and nonverbal children
CRIES: 0 to 6 months, PIPP: term and premature infants, NPASS: preterm and term infants(assess pain AND sedation), COMFORT: 0-18 (assess pain AND sedation)
What are the management goals for pain in children
Decrease pain, decrease anxiety, decrease short term and long term effects of exposure to pain
What are the nonpharmacological techniques that should always be used with pharmacological agents
Distraction techniques, allow parents to stay, pacifiers, hypnosis, soft music, breathing techniques, swaddling, decrease light and noise
What nonpharmacological techniques can aid in handling newborn pain
Skin to skin care (Kangaroo care), swaddling, sucrose, pacifier
What happens in a baby brain when giving a pacificer
Releases serotonin leading to modulating the transmission of pain stimuli
How much sucrose should be given and when should it be given to aid in infant pain, when does it lose its effect, when is it useful
1 to 2 ml of 24% sucrose two minutes prior to painful stimuli (heel lance), After 6 months of life/ blood draws, heel sticks and line insertions
What are the options in order to treat mid and moderate pain,moderate to severe
Acetaminophen, NSAIDs, non-opioid analgesics/ opioids
For severe pain which opiods are most commonly used
Morphine, Fentanyl, and Hydromorphone
What is the gold standard for severe pain management, cautions
Morphine/ caution for decreased renal function, must be hemodynamically stable, in neonates doses should be reduced 25 to 50 percent with longer intervals
Which opioid is 100 times more potent than morphine, what is its use in children
Fentanyl, commonly used as continous infusion in PICU/NICU setting in mechanically ventilated patients
Which opioid is 5 to 6 times stronger than morphine, when should it be used
Hydromorphone, good in renal insufficiency (less nausea and itchness than morphine)
What are the options for moderate pain
Acetaminophen plus codeine, Acetaminophen plus hydrocodone, tramadol
Why hydrocodone plus codeine no longer used as frequently anymore, BBW
Variability in the metabolism of codeine (CYP2D6)/ Contraindicated use in ages less than 12 year old and post-tonsillectomy and/or adeindectomy
What is the BBW regarding tramadol
Contraindicated use in ages less than 12 years old, tonsillectomy/adenoidectomy, sleep apnea, obesity, chronic lung disease, people prone to seizures
What is PCA, when is it used, what opioids are associated, who does not use it , lockout interval
Patients self-administer small doses of opioid analgesics IV at frequent intervals, Moderate to sever pain, morphine fentanyl and hydromorphone/ kids less than 6 years, cognitively/physically impaired/ 6 to 10 minutes
What are the side effects of opioids
Respiratory depression (lower the dose or naloxone), nausea (metoclopramide or ondansetron), constipation (docusate or sennosides, pruritus (diphenhydramine), urinary retention(lower dose)
What is the first choice for mild pain
Acetaminophen
What are the NSAIDs that are used for pain in children, benefit when used with opiods
Ibuprofen and Naproxen (tablets and oral suspension), Ketorolac (IV/IM)/ may decrease opioid use by 30%
What are the side effects of NSAIDs, caution
GI bleeding and Nephropathy/ dehydration and hypovolemia, renal and hepatic dysfunction, coagulation disorders, peptic ulcer disease, concomittant use with anticoagulants and nephrotoxic drugs, post operative with a high risk of bleeding`
What are controversies that makes it so patients may or may not use NSAIDs
Tonsillectomy: increased risk of bleed but can be used except Ketorolac, orthopedic surgery: impaired bone healing but also inconclusive so use is limited especially in spinal fusion or limb lengthening
What are the perioperative opioid-strategies that have been used to reduce the use of opioids
IV/PR acetaminophen and NSAIDs, Dexamethasone, low dose ketamine, clonidine an dexmedetomidine, gabapentin and pregablin
Why is it important to control anxiety if a patient is having pain as well
Anxiety enhances pain perception
What are the benefits of sedation in mechanically ventilated patients
Promotes ventilator synchrony, improves oxygenation, prevents inadvertent extubation, alleviates discomfort and anxiety
T/F: Paralyzed patients receiving NMBAs have a mandatory use of sedation
True
What are the assessment for sedation
State behavioral scale (SBS), COMFORT B scale
What medication classes are used for sedation and anxiolysis
BZDs, Alfa 2 agonists,
What are non-pharmacological intervention to reduce anxiety
Reduction of noise and light, skin care, baths, music
What are the BZDs used in children
Midazolam, Lorazepam, Diazepam
What is the alpha 2 adrenoreceptor agonist, clinical applications
Dexmedetomidine/ sedation in the PICU in ventilated and non ventilated patients, procedural sedation, treatment of latrogenic withdrawal
What is the main advantage of dexmedetomidine
Lack of significant respiratory depression, may reduce the requirement for other sedative/analgesic agents, rapid onset and duration of action
What are the common side effects of dexmedetomidine
Bradycardia, hypotension, dry mouth
What sedative drug is contraindicated in kids and why
Propofol is contraindicated for continuous sedation in pediatric patients due to metabolic acidosis and death (PRIS)
What is seen with longer lengths of stay and morbidity along with no responding in pain/anxiolysis, pediatric assessment tools
Delirium/ pCAM-ICU, CAP-D, SOS-PD
What are the risk factors for delirium risk factors
Age less than 2 years, development delay, severity of illness, mechanical ventilation, immobilization, Prolonged ICU stay, Restraints
What medications can be given for delirium
Benzodiazepines, Anticholinergics, steroids
What are ways to prevent delirium
Assess infection, manage hypoxemia and metabolic abnormalitites, minimize sedation, assess for iatrogenic withdrawal, stabilize a daily schedule with normal sleep and wake cycles
