Pain Assessment and Management in Children

Question 1

imperative understand how show and express pain based on age; diff based on age; to correctly treat pain need understand how showing and expressing it and why not forthcoming with pain

Answer 1

Ped nurse:

Question 2

Newborns do not feel pain.
The intensity of a child’s behavioral reaction indicates the intensity of the child’s pain.
Children are truthful when they are asked if they are experiencing pain.
Children learn to adapt to pain and painful procedures.
Children experience more adverse effects of narcotic analgesics than adults do.
Children are more prone to addiction to narcotic analgesics.

Answer 2

False

Question 3

Exposure to pain at an early age has little to no effect on the child.

Answer 3

False
More pain exposed to - long-term sensory issue; SPD long-term

Question 4

Acute vs. Chronic
Factors influencing pain
Nurses understanding
Infant
Toddler
Preschooler
School Age
Adolescent
*** Unmanaged pain may lead to potential long-term physiologic, psychosocial, and behavioral consequences. - take pain management seriously; assess and re-assess often

Answer 4

Pediatric pain

Question 5

React differently with each
Chronic conditions - DM, cystic fibrosis, cancer, sickle cell, chronic ear infections, migraines

Answer 5

Acute vs. Chronic

Question 6

Age/gender
Cognitive level
Temperament
Previous painful experiences
More trauma in past - worse react
Know what happen
Family Culture

Answer 6

Factors influencing pain

Question 7

Take factors into account

Answer 7

Nurses understanding

Question 8

Clench hands
Flail hands, feet, legs, arms
Grimace
Immobilize them

Answer 8

Infant

Question 9

Cries
BIG: Changes in behavior
Not prolong injuries
Not ability explain pain

Answer 9

Toddler

Question 10

Easier explain
Lot better answering questions - formulate questions and know what looking for; direct parents to ask them to ask questions and how feeling

Answer 10

Preschooler

Question 11

Very good at how pain is, where is, what happened
Might hide injury/completely forthcoming because treatment - past friends or culture

Answer 11

School Age

Question 12

Not want show pain on culture or friends
Good at telling us pain
With-hold that - worried about something and what comes next; being tough

Answer 12

Adolescent

Question 13

Old enough to tell how feeling: 4+ yrs
FACES (Wong-Baker): 3 and older; not use reliably until 4; no hurt or lot hurt; not happy/sad
OUCHER: 3-13 years; pics faces and correlates to number
Numerical rating scale (NRS): 8 and up; scale 1-10
Let child pick whatever comfy with - use same one throughout hospitalization

Answer 13

Pain scales - self-reporting

Question 14

Cannot tell us verbally in pain
Neonatal Infant Pain Scale (NIPS)
NPASS
r-FLACC - 2 months-7yrs; cannot communicate with us
Go based on how reacting; face look, legs, activity, cry, consolable, pts on how acting and add them up; higher number more pain
Assess pain every time

Answer 14

Pain scales - behavioral

Question 15

Which pain scale would the nurse use when assessing a 4-year-old client?
1. CRIES
2. FLACC
3. Numerical
4. FACES

Answer 15

Answer: 4

Question 16

Which is the MOST reliable indicator of a 2.5-year-olds pain?
1. Crying and sobbing
2. Changes in behavior
3. Verbal exclamations of pain
4. Changes in pulse and resp rate

Answer 16

Answer: 2

Question 17

Pharmacologic management
Nurse Management
Consequences of untreated pain in infants
Nonpharmacologic management

Answer 17

Pain management

Question 18

Nonopioids
Opioids
Coanalgesic drugs
Choosing the timing of analgesia
Choosing the method of administration
Patient-controlled analgesia
Epidural analgesia
Transmucosal and transdermal analgesia

Answer 18

Pharmacologic management

Question 19

Mild-moderate pain: tylenol, ibuprofen; give acetaminophen: at birth: max amt depending on weight - sometimes in cough med - make sure not OD on that
ibuprofen/motrin - 6 months; cannot clear properly
High fever - can alternate meds; due q6hr; alternate q3hr

Answer 19

Nonopioids

Question 20

Severe pain: fentanyl, morphine, codeine
Worry about constipation and resp depression
Constipation: hard on toddler esp if recently potty trained if have to go in diaper or adolescent to go in bed pan more likely to hold it

Answer 20

Opioids

Question 21

Older ones - can do it
Can do parents - maybe - very educated and involved in care

Answer 21

Patient-controlled analgesia

Question 22

Monitoring side effects
Evaluation and effectiveness of pain regimen; re-evaluate; cause of pain; making worse; what helping it go away; get parents involved and what works at home and helps child at home

Answer 22

Nurse Management

Question 23

Physiologic indicators
Behavioral indicators

Answer 23

Consequences of untreated pain in infants

Question 24

Distraction
Relaxation
Guided imagery
Cutaneous stimulation
Containment and swaddling
Nonnutritive sucking
Kangaroo care

Answer 24

Nonpharmacologic management

Question 25

Toddler best age; can do little in preschool

Answer 25

Distraction

Question 26

School-age; older kids

Answer 26

Relaxation

Question 27

School-age; older kids

Answer 27

Guided imagery

Question 28

School-age; older kids
Helping with deep breathing

Answer 28

Cutaneous stimulation

Question 29

Infants
Used being in utero - like borders and boundaries

Answer 29

Containment and swaddling

Question 30

Pacifier with sugar water - relieves more pain than pain med; calms them down and relaxes them

Answer 30

Nonnutritive sucking

Question 31

Skin to skin

Answer 31

Kangaroo care

Question 32

Painful and invasive procedures
Postoperative pain
Burn pain
Recurrent headaches
Recurrent abdominal pain
Pain associated with sickle cell disease
Cancer pain in children
Pain and sedation in end-of-life care

Answer 32

Common pain states

Question 33

Procedural sedation and analgesia

Answer 33

Painful and invasive procedures

Question 34

Associated with surgery
Combination of medications

Answer 34

Postoperative pain

Question 35

Multiple components
Difficult and challenging to control

Answer 35

Burn pain

Question 36

Tension, dental braces, weakness of eye muscles, sinusitis, epilepsy, sleep apnea, injury

Answer 36

Recurrent headaches

Question 37

Common in children

Answer 37

Recurrent abdominal pain

Question 38

ED visits for opioid treatment

Answer 38

Pain associated with sickle cell disease

Question 39

Most prevalent symptom is pain

Answer 39

Cancer pain in children

Question 40

Comfort can be relief with a combination of opioids and adjuvant analgesics

Answer 40

Pain and sedation in end-of-life care