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Module 5 > Pain Assessment In Neonates Infants And Children > Flashcards

Pain Assessment In Neonates Infants And Children Flashcards

1
Q

Pain

A

Is whatever the experiencing person says it is , existing when he says it does

Always believe the pt

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2
Q

True or false neonates do not feel pain with teh same intensity as adults because a child nervous system is immature

A

False

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3
Q

Nociception

A

The process by which pain becomes conscious

Ex premature infant demonstrates severe stress response to painful stimuli

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4
Q

Why is it important to relief pain in and infants?

A

It can permanently change their nervous system and may prime them for having chronic pain

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5
Q

T or f
Repeated experience w pain teaches the chid to be more tolerant of pain and cope with it better

A

False

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6
Q

Does a chid or an adult tolerate pain better?

A

An adult does.
A children’s tolerance to pain actually increases with age.

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7
Q

Do children get accustomed to painful procedures?

A

Negative ghost rider
Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures

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8
Q

Ex of a chid demonstrating increased behavioral response to pain with a repeated procedure

A

A chid with a chronic illness an hospitalized frequently. After repeated lumbar spine the child becomes more resistant each time

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9
Q

Why wouldn’t a child tell you that they are hurt

A

Nonverbal
To avoid injections
Constant/chronic pain
They believe others know how they feel
Culture(pain seen as weakness)
Gender (boys wont admit)

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10
Q

What are ways a nonverbal kid can tel you they are in pain

A

Pointing at the site of where it hurts or using appropriate pain scale

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11
Q

Why would It look like a child is not in pain

A

Developmental level
The way they cope
Temperament
Activity level
Intensity of reaction to pain

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12
Q

Physical dependence

A

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

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13
Q

Withdrawal

A

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

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14
Q

Manifestations of withdrawal :behavioral

A

Anxiety, agitation, insomnia, tremors

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15
Q

CNS symptoms of withdrawal

A

Irritability

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16
Q

GI dysfunction of withdrawal

A

N&V diarrhea or feeding intolerance

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17
Q

Autonomic dysfunction of withdrawal

A

Tachypnea tachycardia fever sweating and hypertension

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18
Q

Drug tolerance

A

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)

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19
Q

What can a child’s tolerance increase other than the drug

A

The side effects like respiration depression
Sedation
Nausea

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20
Q

Narcotic addiction behavioral and voluntary

A

Compulsive drug seek behavior
Not for medical reasons like pain relief

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21
Q

Best way to assess pain

A

Self report and if they can score it on a pain scale

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22
Q

Nonspecific ways nonverbal vocalize pain

A

Cry scream groan

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23
Q

2nd best indicator of pain

A

Behavioral
Facial expression
Posture
Activity
Behavioral state
Response to intervention

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24
Q

Behavioral state

A

Sleep wake cycle. Are they sleeping more than usual?

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25
Third way to assess pain
Physiologic Vital signs o2 Hormonal changes Sweating Palmar (sweating)
26
Last way to assess pain
Pain stimuli /history (sickle cell always in pain) Temperament Age,sex Culture Significant other input
27
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
28
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
29
How can we have child locate pain
Marking body parts on human figure drawing Point the area with one finger on self doll stuffed animal
30
Three categories of pain intensity scales each measuring different parameters
Subjective Behavioral Multidimensional
31
Subjective
Asking pt to score for you
32
Behavioral
Based on pt behavior
33
Multidimensional
Typically the scales that are used in the nicu Measuring more than one thing
34
Subjective pain scales
Wong baker faces Ouches scale Word graphic scale Numeric rating scale
35
Wong baker faces pain rating scale
6 drawn faces Continuum from smiling to tearful For children as young as 3 Explain how to use And do not compare child’s face with those on the pain scale
36
Oucher pain scale
Six photographs of child’s face from no hurt to biggest hurt you could ever have Difference races Children 3-13
37
Word graphic rating scale
Use descriptive words to denote varying intensities of pain Explain each word no pain to worst possible pain Starting at age 4 to 17
38
Numeric scale
In order to utilize the numeric pain scale they must be able to count an have a number concept and under stand concepts More or less Higher or lower Number order “What is bigger 5 or 8”
39
What ages is numeric scale used
Age 5 and older but really when they have an understanding the numeric scales can be at around 7-8
40
Behavioral pain scales
Flacc Revised flacc Modified flacc
41
FLACC
Face legs activity cry consolability May be used for 2 mo to 7 yr Observe 1 to 5 min during routine care Add scores from 5 categories for total score Great for infants up to 3 years
42
Flacc “face “ 0 1 2
0 No particular expression or smile 1 occasional grimace or frown withdraw disinterest 2 frequent to constant quivering chin , clenched jaw
43
Legs flacc 0 1 2
0 normal position or relaxed 1 uneasy restless tense 2 frequent to constant quivering chin, clenched jaw
44
Activity flacc 0 1 2
0 lying quietly normal position moves easy 1 squirming shifting back and forth , tense 2 arched, rigid or jerking
45
Cry flacc 0 1 2
0 no cry (awake or asleep ) 1 moans or whimpers, occasionally complaint 2 crying steadily screams or sobs frequent complaint
46
Consalibility flacc 0 1 2
0 content relaxed 1 reassured by occasional touching, hugging, talk to , distractable 2 difficult to console or comfort
47
Revised flacc
For children with cognitive impairment
48
Modified flacc scale
Mechanically ventilated pt
49
Multidimensional rating scales
N-pass Nips Pipp Cries
50
NPASS
23-40 wk gestation Combines assessment of pain agitation and sedation For procedural and prolonged pain
51
NIPS neonatal infant pain scale
Children less than 1 226-40 wk gestation Composed of 6 indicators and each behavioral indicator is score w 0 1 except for cry which is 0,1,2 Observed for 1 min
52
PIPP
0 - 6 indicates minimal or no pain 7-12 indicates slight to moderate pain Greater than 12 indicates severe pain Total score 0-21 25-40 weeks (hesi says 28-40) For procedural and post op pain
53
Cries
10 pint scale Used for neonates greater than or equal to 32-40wks of gestation (32-60 wks) For post op pain Consist of 5 physiologic and behavioral indicators which are rated on a 3 point scale
54
Signs of pain in infants and children vocalized
Crying often w apneic spells Whimpering groaning moaning
55
State changes possible signs of pain in infants and children
Chang in sleep wake cycle Changes in activity level Agitation or listlessness
56
Bodily movement signs of pain in infants and children
Limb withdrawal , swiping or thrashing Rigidity Flaccidity Clenching of fist
57
Facial expression signs of pain in infants
Most reliable signs Eyes tightly closed or opened Mouth opened , squarish Furrowing or bulging of brow Quivering of chin and tongue Deepened nasolabial fold
58
Infant -pain
Loud inconsolable crying Facial expression of pain Decreased appetite
59
Infant pain
Loud inconsolable crying Facial expression of pain Decreased apetitie
60
young children pain
Kind crying or screaming Using words such as ouch or it hurts Thrashing of extremities Clinging to parent Restless and irritable Lack of cooperation
61
School age child
Stalling Muscular rigidity Restlessness Sleep disturbances
62
Adolescent pain
Withdrawn Decreased activity Increased muscle tension
63
Behaviors that indicate location of pain
Pulling ears Rolling head side to side King on side w legs flexed on abdomen Limping Refusing to move a body part
64
Physiological pain in neonatal
Increase HR RR BP Shallow respirations Vagal nerve tone (shrill cry) Pallor or flushing Diaphoreses palmar swearing O2 sat Increased muscle tone EEG changes
65
Indications of acute pain physiological fight or flight
Dilated pupils Increased perspiration Increase rate force of hr Increased rate / depth of resp Increase bp Decreased urine output Decreased peristalsis of gi tract Increased bMR
66
Do we prioritize physiologic for pain
Negative ghost rider it should be used adjuncts to self report
67
Acute pain
Activates body’s fight or flight stress response
68
Chronic pain
When pain persist body begins to adapt and there is a decrease in the sympathetic responses Stress response is absent or diminished
69
What is the only reason to assess pain
To take action to relief it
70
Iv analgesics
Assess after 5- 15 min
71
Po analgesics
30-60 min

Module 5 (39 decks)

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