Pain Assessment In Neonates Infants And Children Flashcards
Pain
Is whatever the experiencing person says it is , existing when he says it does
Always believe the pt
True or false neonates do not feel pain with teh same intensity as adults because a child nervous system is immature
False
Nociception
The process by which pain becomes conscious
Ex premature infant demonstrates severe stress response to painful stimuli
Why is it important to relief pain in and infants?
It can permanently change their nervous system and may prime them for having chronic pain
T or f
Repeated experience w pain teaches the chid to be more tolerant of pain and cope with it better
False
Does a chid or an adult tolerate pain better?
An adult does.
A children’s tolerance to pain actually increases with age.
Do children get accustomed to painful procedures?
Negative ghost rider
Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures
Ex of a chid demonstrating increased behavioral response to pain with a repeated procedure
A chid with a chronic illness an hospitalized frequently. After repeated lumbar spine the child becomes more resistant each time
Why wouldn’t a child tell you that they are hurt
Nonverbal
To avoid injections
Constant/chronic pain
They believe others know how they feel
Culture(pain seen as weakness)
Gender (boys wont admit)
What are ways a nonverbal kid can tel you they are in pain
Pointing at the site of where it hurts or using appropriate pain scale
Why would It look like a child is not in pain
Developmental level
The way they cope
Temperament
Activity level
Intensity of reaction to pain
Physical dependence
Withdrawal symptoms when chronic use of an opioid is discontinued or an opioid antagonist (naloxone or narcan) is give
It may require gradually reducing the dose over several days
Withdrawal
A collection of symptoms both behavioral and physiologic that occurs when opiates or sedatives that have been administered for seven days or more are abruptly decreased or discontinued
Manifestations of withdrawal :behavioral
Anxiety, agitation, insomnia, tremors
CNS symptoms of withdrawal
Irritability
GI dysfunction of withdrawal
N&V diarrhea or feeding intolerance
Autonomic dysfunction of withdrawal
Tachypnea tachycardia fever sweating and hypertension
Drug tolerance
Need for larger dose of opioid to maintain original effect or more frequent doses
May occur when children have been taking opioids or sedatives for several days (5-7)
What can a child’s tolerance increase other than the drug
The side effects like respiration depression
Sedation
Nausea
Narcotic addiction behavioral and voluntary
Compulsive drug seek behavior
Not for medical reasons like pain relief
Best way to assess pain
Self report and if they can score it on a pain scale
Nonspecific ways nonverbal vocalize pain
Cry scream groan
2nd best indicator of pain
Behavioral
Facial expression
Posture
Activity
Behavioral state
Response to intervention
Behavioral state
Sleep wake cycle. Are they sleeping more than usual?
Third way to assess pain
Physiologic
Vital signs o2
Hormonal changes
Sweating
Palmar (sweating)
Last way to assess pain
Pain stimuli /history (sickle cell always in pain)
Temperament
Age,sex
Culture
Significant other input
QUESTT
Question the pt
Use pain rating scale
Evaluate behavior and physiologic signs
Secure family’s involvement
Take cause of pain into acct
Take action and assess effectiveness
Verbal indications of pain
May speak “i dont feel good”
May deny pain due to fear of injections
Use a variety of words boo boo or Owie, ouch
Other languages “ay ay”
Question parents
