Pain Assessment

Question 1

Peds Assessment Triangle: Appearance

Answer 1

looking for:
- abnormal tone
- decreased interactiveness
- decreased consolability
- abnormal look/gaze
- abnormal speech and cry

Question 2

Peds Assessment triangle: Circulation to skin

Answer 2

• pallor/ pale
• mottling
• cyanosis

Question 3

Peds Assessment triangle: Work of breathing

Answer 3

• abnormal sounds
• abnormal position
• retractions
• flaring
• apnea/ gasping

Question 4

Pediatric Early Warning Score (PEWS)

Answer 4

• score is based on the most severe finding in each category
• Categories: behavior, cardiovascular, respiratory
• HIGH NUMBER = BAD
• persistent post-op vomiting and every 15 minute nebulizers adds 2 points

Question 5

The rothman index

Answer 5

• score is based of VS, labs, nursing assessments
• HIGH SCORE = BETTER
• tells how likely a kid is going home

Question 6

Barriers to pain management

Answer 6

• myth: children dont feel pain
• lack of pain assessment + reassessment
• “there are no untoward consequences of children’s pain”
• lack of understanding + knowledge of how to measure and treat

Question 7

Cultural considerations for pain management

Answer 7

• pain expression depends on racial and ethnic groups
• Amish: stoic
• may express to family membranes but not healthcare
• pain is a sign of weakness

Question 8

Neonatal pain considerations

Answer 8

• can feel pain at 25 wks
• frequent procedures can alter the way pain is processed, can create hypersensitivity and lead to chronic pain procedures
• sometimes too fatigued to show pain behavior

Question 9

Infant pain response 0-12 months

Answer 9

• memory of pain starts about 6 months
  -chin quivering, facial grimace, poor feeding, reflex withdrawal, cries, disturbed sleep

Question 10

Toddler 1-3 years old

Answer 10

• doesnt understand, fearful
• resist w/entire body, move away from pain
• aggressive behavior, disturbed sleep, cries
• cannot describe intensity or type

Question 11

Preschooler pain response 3-6 years old

Answer 11

• relates pain to injury, active physical resistance
• easily frustrated
• can identify location and intensity , may deny pain

Question 12

School age pain response 6-12 years old

Answer 12

• understands pain and disease
• passive resistance: tries to hold still and be brave
• can describe intensity, location, psychologic pain

Question 13

Adolescent pain response 12-18 years old

Answer 13

• sophisticated and complex understanding of pain
• qualitative and quantitative pain

Question 14

Consequences of unrelieved pain

Answer 14

1. Resp: shallow breathing, tachycardia
2. Neuro: not sleeping
3. Metabolic: increase metabolism, sweating
4. Immune: decrease immune
5. Gastro: GI upset, doesnt eat
6. Pain: increase pain sensitivity + decrease pain threshold

Question 15

Neonatal Infant Pain scale (NIPS)

Answer 15

• Assess for procedural pain up to 6 weeks old
• 5 indicators:
  
  1. facial expression
  2. cry quality
  3. breathing pattern
  4. arm and leg positioning
  5. state of arousal
• total score 7

Question 16

N- PASS Pain Scale

Answer 16

• Used for infants and neonates
• Pain and sedation scoring
• 5 indicators
  
  1. crying, irritability
  2. behavior/ state
  3. facial expression
  4. extremities/ tone
  5. vital signs
• Total score out of 10

Question 17

FLACC Pain Scale ( face, legs, activity, cry, consolability )

Answer 17

• used for ages > 3 months
• behavioral pain scale - non verbal
• 5 indicators ( face legs, activities, cry, consolability )
• observe patient for 2-5 mins
• total score out of 10

Question 18

Faces and numeric pain scale

Answer 18

• Use faces for children > age 3
• Numeric for children > age 8
  total score out of 10

Question 19

Acetaminophen

Answer 19

• used for pain and fever
• 10mg/kg/dose
• assess liver function
• antidote: acetylcycteine
• reassess: PO: 45-60 min
  IV: 10-20 min

Question 20

NSAID: Ibuprofen

Answer 20

-used for pain, inflammation, fever
- monitor kidney function ( ibuprofen, advil, motrin )
- ketorolac: risk of bleeeding complications
-** USED OVER 6 MONTHS OLD **

Question 21

OPIODS: morphine, hydromorphone

Answer 21

• adverse effect: resp. depression
• antidote: Naloxone, narcan
• ** NO CODEINE UNDE AGE 18 ( metabolizes to morphine and can lead to overdose )

Question 22

EMLA

Answer 22

• used on intact skin, IV starts
• apply 30-60 min prior to procedure

Question 23

LET

Answer 23

• lidocaine, epinephrine, tetracaine
• used for laceration repair (open skin )
• apply 30 min prior to procedure

Question 24

SEDATION: ketamine, propofol, inhaled nitrous oxide, benzodiazepines

Answer 24

Nursing: education, medicate as ordered, monitor VS and LOS during procedure

Question 25

non pharmacologic pain management

Answer 25

• distraction, cutaneous stim.- massage, sucrose “sweeties”, swaddling, heat/cold, positioning

Question 26

S/sx of chronic pain

Answer 26

BP, HR, RR are not elevated like acute pain