Pain assessment and Immunization (Week 5)

Question 1

How is chronic pain defined?

Answer 1

Pain persists for > 3 months, or beyond the expected period of healing

Question 2

What is recurrent pain?

Answer 2

Pain that is episodic. Examples: migraines, sickle cell pain

Question 3

At what age is it appropriate to use the numeric pain scale?

Answer 3

8 years

Question 4

What are examples of behavioural pain assessment tools?

Answer 4

FLACC
CHEOPS
TPPR
PPPRS

Question 5

Which scale do you use to assess pain in unconscious and ventilated children? Explain.

Answer 5

The comfort scale, 8 indicators on a scale of 1-5
- alertness
- calmness/agitation
- respiratory response
- physical movement
- BP
- HR
- muscle tone
- facial tension

Observe for 2 mins, and aff up the scores
- scores of 17-26 = adequate sedation and pain control
- scores 26-40 = inadequate pain control

Question 6

What is the FLACC scale

Answer 6

Face
- 0: no expression or smile
- 1: occasional grimace or frown, withdrawn, disinterested
- 2: frequent to constant frown, clenched jaw

Legs
- 0: normal/relaxed
- 1: uneasy, restless, tense
- 2: kicking, legs drawn up

Activity
- 0: lying quietly, normal position, moves easily
- 1: squirming, shifting back and forth, tense
- 2: arched, rigid or jerking

Cry
- 0: none
- 1: moan or whimpers, occasional complaints
- 2: crying steadily, screams, sobs

Consolability
- 0: content, relaxed
- 1: reassured by touch, hug, or talked to, distractable
- 2: difficult to console or comfort

Question 7

What is the FACES pain scale

Answer 7

6 cartoon faces, the child chooses which face best describes his/her pain

Question 8

Visual analog scale (VAS)

Answer 8

“no hurt” to “biggest hurt” are more appropriate than “least pain sensation to worst intense pain imaginable”

Question 9

What is the adolescent pediatric pain tool?

Answer 9

Assess pain location, intensity, and quality

Question 10

What is the pediatric pain questionnaire

Answer 10

Assess patient and parental perceptions f pain
3 components:
- VACS
- color-coded rating scale
- verbal descriptors

Question 11

CRIES neonatal pain scale

Answer 11

Crying
Requiring O2 increase
Increased VS
Expression
Sleeplessness

Question 12

What are nonpharmacological pain interventions for infants?

Answer 12

Containment
positioning
non-nutritive sucking
kangaroo holding

Question 13

What is CAM?

Answer 13

1. biologically based - food, diet, herbal, vitamins
2. manipulative tx - chiropractic, osteopathy, massage
3. energy based - reiki, magnetic tx
4. mind-body techniques - mental or spiritual healing, hypnosis
5. alternative medical systems - homeopathy, traditional Chinese medicine

Question 14

What is the recommended dose of acetaminophen?

Answer 14

PO 10-15 mg/kg/dose; no more than 5 doses/24hr

Question 15

What is the recommended dose for ibuprofen?

Answer 15

PO 5-10 mg/kg/dose, every 6-8 hrs

note: only for children > 6 months

Question 16

What are adjuvant analgesics for?

Answer 16

Enhances the effects of analgesics
- ex. anxiolytics, sedatives, amnesics
- ex. diazepam, midazolam
- ex. TCA for neuropathic pain
- stool softeners and laxatives for constipation
- steroids for inflammation and bone pain

Question 17

What are common opioids used in epidurals?

Answer 17

Fentanyl, hydromorphone, perservative free morphine

Question 18

What are nursing responsibilities in opioid analgesics?

Answer 18

Prevent opioid-induced respiratory depression
- careful monitoring of sedation level

Check skin around catheter site

Assessment of pain

Question 19

What is Lidocaine? How do you prepare it?

Answer 19

a local anesthetic that can also help stop bleeding.

Causes stinging and burning… reduce this by:
- buffering the lidocaine
- warming the lidocaine to body temp

Question 20

What are S/E of opioids?

Answer 20

Resp depression
constipation
pruritis
N+V
Sedation
Tolerance
Physical dependence

Question 21

How do we reduce the risk of physical dependence on opioids?

Answer 21

Gradually taper off the medication
- 1/2 dose q6h for 2 days
- reduce by 25% q2 days until a total daily dose of 0.6 mg/kg/day of morphine is reached
- after 2 days on this dose, discontinue

OR

Oral methadone - using 1/4 equinanalgesic dose

Question 22

What is the “windup phenomenon”?

Answer 22

Decreased pain threshold + chronic pain

Sometimes, non-noxious stimuli are perceived as noxious and cause pain;

Overtime a small amount of pain stimuli will trigger an episode and make them feel very severe episode of pain -> can turn into a chronic phenomenon

Question 23

What is the sedative drug of choice?

Answer 23

Ketamine - analgesic, sedative, and amnesic

Question 24

What are the signs of red flag headaches in children?

Answer 24

Neck stiffness –> concerned for meningitis

Headache occurred after an injury –> concern for increased ICP

Persistent vomiting w/ significant neurological changes

Question 25

What type of bowel obstruction does green bile-colored vomit indicate?

Answer 25

lower obstruction, malrotation of bowels

Question 26

What does milky-coloured vomit in a 3-week-old baby indicate?

Answer 26

upper GI obstruction, malnutrition, breathing issues, pyloric stenosis

Question 27

Diphtheria: Agent, transmission, clinical manifestations, treatment, precautions

Answer 27

agent: corynebacterium diphtheria
transmission: direct contact

clinical manifestations: upper-resp tract symptoms, bulls neck, white or grey mucous membranes, white patches on back of throat, fever, cough

tx: antibiotics, bed rest
precautions: droplet

Question 28

Varicella/chicken pox: Agent, transmission, clinical manifestations, treatment, precautions

Answer 28

agent: varicella-zoster virus
transmission: direct + resp secretions

clinical manifestations:
- prodromal: slight fever, malaise
- pruritic rash beings a macule, vesicle then erupts
- rash is centripetal (affects extremities and face)

tx: supportive care
precautions: standard + airborne
- if oozing: contact added

Question 29

Erythema infectiosum: Agent, transmission, clinical manifestations, treatment, precautions

Answer 29

agent: human herpesvirus type 6
transmission: droplet, contact

clinical manifestations:
- persistent fever for 3-7 days
- slapped cheek appearance
- mild URI symptoms

tx: supportive care
precautions: standard

Question 30

Measles (Rubeola): Agent, transmission, clinical manifestations, treatment, precautions

Answer 30

agent: viral
transmission: highly contagious, direct contact

clinical manifestations:
- prodromal: fever, malaise, cough, coryza, conjunctivitis
- koplik spots on mucosa
- rash that appears on day 3-4 of illness

tx: IgG (IM)
precautions: airborn

Question 31

Rubella (german measles): Agent, transmission, clinical manifestations, treatment, precautions

Answer 31

agent: rubella virus
transmission: direct contact

clinical manifestations
- low grade fever
- headache
- malaise
- sore throat
- Rash

tx: supportive care
precautions: droplet

Question 32

Pertussis (whooping cough): Agent, transmission, clinical manifestations, treatment, precautions

Answer 32

agent: bordetella pertussis
transmission: direct contact from droplets

clinical manifestations:
- catarrhal stage: URI symptoms, apnea and cyanosis in babies
- paroxysmal stage: short, rapid cough followed by high-pitched crowing sound, “whoop” or coughing fit lasting up to 10 weeks
- cough can last 12 weeks

tx: antibiotics, supportive care, suctioning, humidity, hydration
precautions: droplet

Question 33

Scarlet fever: Agent, transmission, clinical manifestations, treatment, precautions

Answer 33

agent: group A Beta-hemolytic streptococci
transmission: direct from droplets

clinical manifestation
- prodromal: abrupt high fever, halitosis
- enanthema: tonsils large, edematous covered w/ exudate
- strawberry tongue
- exanthema: sandpaper rash

tx: penicillin and supportive care
precautions: droplet until 24 hr of Abx

Question 34

Influenza: Agent, transmission, clinical manifestations, treatment, precautions

Answer 34

agent: influenza virus
transmission: direct
clinical manifestations:
- abrupt fever
- URI symptoms
- malaise, anorexia

tx:prevention, antiviral tx if detected early, supportive care
precautions: droplet

Question 35

Respiratory syncytial virus: Agent, transmission, clinical manifestations, treatment, precautions

Answer 35

agent: RSV
transmission: contact

manifestations:
- cough
- runny nose
- fever
- wheezing

tx: supportive care
precaution: contact

Question 36

Pneumococcal disease : Agent, transmission, clinical manifestations, treatment, precautions

Answer 36

agent: streptococcal pneumococci
transmission: direct

clinical manifestations:
- pneumonia
- otitis media
- sinusitis
- localized infections

tx: prevention, abx, supportive care
precautions: droplet

Question 37

Stomatitis

Answer 37

swelling and redness of the lining of your mouth. It can cause painful sores that can make it hard for you to eat, drink, or swallow

Goals: relieve pain (NSAIDs) + topical anesthetics

Question 38

Scabies : Agent, transmission, clinical manifestations, treatment, precautions

Answer 38

agent: sacroptes scabiei
transmission: prolonged close contact where mites burrow into the epidermis and deposits eggs

clinical manifestations
- intense pruritus
- excoriation and burrows
- discrete inflammation between finger webs, neck folds, groin

tx:
- permethrin 5% cream
- cleaning all clothing and linen w. high heat
- supportive care for pruritus

impetigo can occur as a secondary infection

Question 39

Pediculosis capitis: Agent, transmission, clinical manifestations, treatment, precautions

Answer 39

agent: pediculus humanus capitis
transmission: prolonged close contact (head lice)

manifestations:
- intense pruritus of the scalp
- nits attached to hair shaft

Tx
- pediculicide and removal of nits
- permethrin 1% cream, repeat in a week, treat affected family
- education and support
- advocacy and support for school attendance

Question 40

bedbugs: Agent, transmission, clinical manifestations, treatment, precautions

Answer 40

agent: cimex lectularius
transmission: contact

manifestations:
- intense pruritis, inflammation
- may progress to cellulitis/folliculitis
- may trigger asthma exacerbation

tx:
- identification and eradication of bedbugs
- topical steroids
- cleaning linens and clothes
- supportive care for pruritus for 2-3 weeks

Question 41

Lyme disease: Agent, transmission, clinical manifestations, treatment, precautions

Answer 41

agent: spirochete Borrelia burgdorferi
transmission: infected deer tick bite

clinical manifestations:
- stage 1: “bullseye” rash, fever, malaise
- stage 2: rash on hands and feet, fever, fatigue, lymphadenopathy, cough
- stage 3: systemic involvement (2-12 months)

Tx:
- Doxycycline > 8 years
- amox < 8 years

Question 42

When are children vaccinated against diphtheria, tetanus, pertussis, polio, and Hemophilus influenza type b?

Answer 42

2, 4, 6, and 18 months

Question 43

When is the Rot-1 virus given, what is it for?

Answer 43

Given at 2 and 4 months
- against rotavirus

Question 44

When is Pneumococcal conjugate (Pneu-C-13) vaccine given, and what’s it for?

Answer 44

2, 4 and 12 months

Protects against pneumococcal infections:
- pneumonia
- bacteremia
- meningitis

Question 45

When is the Meningococcal conjugate (Men-C-C) vaccine given

Answer 45

12 months

Question 46

When is the MMR vaccine given? What does it protect against?

Answer 46

12 months, 4 -6 years (2nd dose: MMR+V)

3 in 1 vaccine - measles, mumps, and rubella

Question 47

When is varicella (var) vaccine given?

Answer 47

15 months

Question 48

At what age is the Hep B vaccine given?

Answer 48

Grade 7

Question 49

At what age is the HPV vaccine given?

Answer 49

grade 7