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Peds - Growth and Development > Pain assessment and Immunization (Week 5) > Flashcards

Pain assessment and Immunization (Week 5) Flashcards

1
Q

How is chronic pain defined?

A

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

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2
Q

What is recurrent pain?

A

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

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3
Q

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

A

8 years

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4
Q

What are examples of behavioural pain assessment tools?

A

FLACC
CHEOPS
TPPR
PPPRS

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5
Q

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

A

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

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6
Q

What is the FLACC scale

A

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- 1: occasional grimace or frown, withdrawn, disinterested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

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7
Q

What is the FACES pain scale

A

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

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8
Q

Visual analog scale (VAS)

A

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

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9
Q

What is the adolescent pediatric pain tool?

A

Assess pain location, intensity, and quality

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10
Q

What is the pediatric pain questionnaire

A

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

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11
Q

CRIES neonatal pain scale

A

Crying
Requiring O2 increase
Increased VS
Expression
Sleeplessness

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12
Q

What are nonpharmacological pain interventions for infants?

A

Containment
positioning
non-nutritive sucking
kangaroo holding

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13
Q

What is CAM?

A
  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
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14
Q

What is the recommended dose of acetaminophen?

A

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

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15
Q

What is the recommended dose for ibuprofen?

A

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

note: only for children > 6 months

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16
Q

What are adjuvant analgesics for?

A

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

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17
Q

What are common opioids used in epidurals?

A

Fentanyl, hydromorphone, perservative free morphine

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18
Q

What are nursing responsibilities in opioid analgesics?

A

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

Check skin around catheter site

Assessment of pain

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19
Q

What is Lidocaine? How do you prepare it?

A

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

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20
Q

What are S/E of opioids?

A

Resp depression
constipation
pruritis
N+V
Sedation
Tolerance
Physical dependence

21
Q

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

A

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

22
Q

What is the “windup phenomenon”?

A

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

23
Q

What is the sedative drug of choice?

A

Ketamine - analgesic, sedative, and amnesic

24
Q

What are the signs of red flag headaches in children?

A

Neck stiffness –> concerned for meningitis

Headache occurred after an injury –> concern for increased ICP

Persistent vomiting w/ significant neurological changes

25
What type of bowel obstruction does green bile-colored vomit indicate?
lower obstruction, malrotation of bowels
26
What does milky-coloured vomit in a 3-week-old baby indicate?
upper GI obstruction, malnutrition, breathing issues, pyloric stenosis
27
Diphtheria: Agent, transmission, clinical manifestations, treatment, precautions
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
28
Varicella/chicken pox: Agent, transmission, clinical manifestations, treatment, precautions
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
29
Erythema infectiosum: Agent, transmission, clinical manifestations, treatment, precautions
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
30
Measles (Rubeola): Agent, transmission, clinical manifestations, treatment, precautions
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
31
Rubella (german measles): Agent, transmission, clinical manifestations, treatment, precautions
agent: rubella virus transmission: direct contact clinical manifestations - low grade fever - headache - malaise - sore throat - Rash tx: supportive care precautions: droplet
32
Pertussis (whooping cough): Agent, transmission, clinical manifestations, treatment, precautions
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
33
Scarlet fever: Agent, transmission, clinical manifestations, treatment, precautions
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
34
Influenza: Agent, transmission, clinical manifestations, treatment, precautions
agent: influenza virus transmission: direct clinical manifestations: - abrupt fever - URI symptoms - malaise, anorexia tx:prevention, antiviral tx if detected early, supportive care precautions: droplet
35
Respiratory syncytial virus: Agent, transmission, clinical manifestations, treatment, precautions
agent: RSV transmission: contact manifestations: - cough - runny nose - fever - wheezing tx: supportive care precaution: contact
36
Pneumococcal disease : Agent, transmission, clinical manifestations, treatment, precautions
agent: streptococcal pneumococci transmission: direct clinical manifestations: - pneumonia - otitis media - sinusitis - localized infections tx: prevention, abx, supportive care precautions: droplet
37
Stomatitis
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
38
Scabies : Agent, transmission, clinical manifestations, treatment, precautions
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
39
Pediculosis capitis: Agent, transmission, clinical manifestations, treatment, precautions
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
40
bedbugs: Agent, transmission, clinical manifestations, treatment, precautions
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
41
Lyme disease: Agent, transmission, clinical manifestations, treatment, precautions
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
42
When are children vaccinated against diphtheria, tetanus, pertussis, polio, and Hemophilus influenza type b?
2, 4, 6, and 18 months
43
When is the Rot-1 virus given, what is it for?
Given at 2 and 4 months - against rotavirus
44
When is Pneumococcal conjugate (Pneu-C-13) vaccine given, and what's it for?
2, 4 and 12 months Protects against pneumococcal infections: - pneumonia - bacteremia - meningitis
45
When is the Meningococcal conjugate (Men-C-C) vaccine given
12 months
46
When is the MMR vaccine given? What does it protect against?
12 months, 4 -6 years (2nd dose: MMR+V) 3 in 1 vaccine - measles, mumps, and rubella
47
When is varicella (var) vaccine given?
15 months
48
At what age is the Hep B vaccine given?
Grade 7
49
At what age is the HPV vaccine given?
grade 7

Peds - Growth and Development (7 decks)

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