Pain Assessment Flashcards
Peds Assessment Triangle: Appearance
looking for:
- abnormal tone
- decreased interactiveness
- decreased consolability
- abnormal look/gaze
- abnormal speech and cry
Peds Assessment triangle: Circulation to skin
- pallor/ pale
- mottling
- cyanosis
Peds Assessment triangle: Work of breathing
- abnormal sounds
- abnormal position
- retractions
- flaring
- apnea/ gasping
Pediatric Early Warning Score (PEWS)
- 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
The rothman index
- score is based of VS, labs, nursing assessments
- HIGH SCORE = BETTER
- tells how likely a kid is going home
Barriers to pain management
- 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
Cultural considerations for pain management
- pain expression depends on racial and ethnic groups
- Amish: stoic
- may express to family membranes but not healthcare
- pain is a sign of weakness
Neonatal pain considerations
- 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
Infant pain response 0-12 months
- memory of pain starts about 6 months
-chin quivering, facial grimace, poor feeding, reflex withdrawal, cries, disturbed sleep
Toddler 1-3 years old
- doesnt understand, fearful
- resist w/entire body, move away from pain
- aggressive behavior, disturbed sleep, cries
- cannot describe intensity or type
Preschooler pain response 3-6 years old
- relates pain to injury, active physical resistance
- easily frustrated
- can identify location and intensity , may deny pain
School age pain response 6-12 years old
- understands pain and disease
- passive resistance: tries to hold still and be brave
- can describe intensity, location, psychologic pain
Adolescent pain response 12-18 years old
- sophisticated and complex understanding of pain
- qualitative and quantitative pain
Consequences of unrelieved pain
- Resp: shallow breathing, tachycardia
- Neuro: not sleeping
- Metabolic: increase metabolism, sweating
- Immune: decrease immune
- Gastro: GI upset, doesnt eat
- Pain: increase pain sensitivity + decrease pain threshold
Neonatal Infant Pain scale (NIPS)
- Assess for procedural pain up to 6 weeks old
- 5 indicators:
- facial expression
- cry quality
- breathing pattern
- arm and leg positioning
- state of arousal
- total score 7
N- PASS Pain Scale
- Used for infants and neonates
- Pain and sedation scoring
- 5 indicators
- crying, irritability
- behavior/ state
- facial expression
- extremities/ tone
- vital signs
- Total score out of 10
FLACC Pain Scale ( face, legs, activity, cry, consolability )
- 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
Faces and numeric pain scale
- Use faces for children > age 3
- Numeric for children > age 8
total score out of 10
Acetaminophen
- used for pain and fever
- 10mg/kg/dose
- assess liver function
- antidote: acetylcycteine
- reassess: PO: 45-60 min
IV: 10-20 min
NSAID: Ibuprofen
-used for pain, inflammation, fever
- monitor kidney function ( ibuprofen, advil, motrin )
- ketorolac: risk of bleeeding complications
-** USED OVER 6 MONTHS OLD **
OPIODS: morphine, hydromorphone
- adverse effect: resp. depression
- antidote: Naloxone, narcan
- ** NO CODEINE UNDE AGE 18 ( metabolizes to morphine and can lead to overdose )
EMLA
- used on intact skin, IV starts
- apply 30-60 min prior to procedure
LET
- lidocaine, epinephrine, tetracaine
- used for laceration repair (open skin )
- apply 30 min prior to procedure
SEDATION: ketamine, propofol, inhaled nitrous oxide, benzodiazepines
Nursing: education, medicate as ordered, monitor VS and LOS during procedure
