pain assessment and management (1) Flashcards
what is abnormal processing of pain by the peripheral or central nervous system
neuropathic pain
what kind of stuff treats neuropathic pain?
Acupuncture, massage, medication
what is normal pain called
Noicioceptive pain
at what age gestation can children feel pain?
25 weeks, the full third trimester
can neonates an infants feel pain?
Yes
Do children feel pain with the same intensity as adults?
Yes
Are infants incapable of expressing pain?
No
Can infants and children remember pain?
Yes
Are children still in pain if they are distracted or sleeping?
They can be
Do repeated experiences with pain teach children to be more tolerant of it and cope better?
No
Do children recover more quickly from adults from painful experiences such as surgery?
No
are children at risk for addiction?
No
Does culture affect pain response in children?
Yes
What are respiratory consequences of unrelieved pain in children?
- Shallow breathing
- Inadequate lung expansion
- poor cough
what are neurologic consequences of unrelieved pain?
- Increased SNS activity and release of catecholamines
- Tachycardia, hypertension, change in sleep
Metabolic consequences of unrelieved pain?
- Increased metabolic rate, sweating
- increased cortisol and blood glucose
what are immune consequences of unrelief pain?
- Depression of immune and anti-inflammatory response
- causes increased risk of injection or delayed wound healing
GI consequences of unrelieved pain?
- Delayed return of GI function
- Anorexia, poor nutritional intake
- ileus, bowel obstruction
which indicators are measured by pain assessment tools?
1. Tachycardia
2. Tachypnea
3. behavior measures
4. self reporting of pain
5. hypertension
6. Flushing and pallor
7. Perspiration
8. decreased oxygen saturation
Only 3 and 4
What pain skills used for infants, young children, and those with developmental delays
FLACC
What does FLACC stand for
faces, legs, activity, cry, consolability
describe the faces scale
- 0-5 scale
- point to face that corresponds to #
what ages is the faces scale used for?
as young as 3
describe the oucher scale
- series of 6 photos of faces
- 0-10 scale
what ages is the oucher scale used for?
3-12
describe visual analog or numerical scale
- 0= no pain, 10= worst pain
what ages are the visual analog or numerical scale used for?
9 years to adult
what behaviors indicate pain?
- crying
- restlessness or agitation
- hyperalertness or vigilance
- sleep disturbances
- irritability
what 3 kinds of drugs are ued for pediatric pain management?
- opioids
- NSAIDS
- nonnarcotic analgesics
examples of opioids used for pain in kids
morphine, dilaudid
what kind of opioids can’t be used in kids
demerol (meperidine) or codeine
which NSAIDs are used for peds pain?
toradol, ibuprofen
which nonnarcotic analgesic is used for pain?
tylenol
max dose of opioids for newborns?
0.1 mg/kg/dose
max dose of opioids for 3 month old?
2 mg/dose
max dose of opioids for 6 year old?
4 mg/dose
max dose of opioids for 12 year old?
8 mg/dose
max dose of opioids for adolescents?
10 mg/dose
side effects of opioids?
- resp depression
- sedation
- constipation
- pruritis
- nausea
- vomiting
- urinary retention
what orders would combat the side effects of opioids?
- antiemetics
- use low doses of opioids and non-opioids together
- stool soft/laxatives
- antihistamine (itching)
- catheter
what drug reverses opioid effects?
naloxone
what are signs of respiratory depression?
- sleepiness
- small pupils
- shallow breathing
what is the cycle of consequences of long-term (1-2 weeks) opioid use in peds
physical dependence -> tolerance -> withdrawal -> (repeat)
what is the weight based dosing of acetaminophen
10-15 mg/kg/dose
what is the max dosing of acetaminophen q4-6h, q6-8h, and daily
- q4-6h= 325-650 mg
- q6-8h= 1000 mg
- daily= 4g
weight based dosing for ibuprofen
5-10 mg/kg/dose
q4-6h dose for ibuprofen?
200-400 mg
weight based dosing of ketorolac (and max)
0.5 mg/kg (up to 15 mg)
q6h dosing of ketorolac
15-30 mg q6h
what organ is damaged in acetaminophen overdose, and what is the antidote?
liver, acetylcysteine
what are side effects of ibuprofen and ketorolac?
increased risk for GI irritation, ulceration, and bleeding
which med administration method is most commonly avoided in peds?
IM (pain/stress)
what are the 2 kinds of PCA pump med administration?
Basal (constant level)
Demand (smaller dose on demand)
what is emla cream made of?
mixture of lidocaine 2.5%, and prilocaine 2.5%
what consitions cause chronic pain in children?
- juvenile idiopathic arthritis
- cancer
- headaches
- recurrent abdominal pain
- sickle cell disease
- HIV
when is procedural sedation used?
for painful diagnostic and therapeutic procedures
what kind of procedures require procedural sedation?
chest tube insertion, arterial puncture, burn debridement, laceration repair, bone marrow aspiration, fracture reduction
moderate vs. deep sedation?
moderate= maintain refelxes / respond
deep= can’t maintain airway or refelxes
what are the goals of procedural sedation?
- prevent or releive pain & anxiety
- ease of doing procedure
- prevent complications
