Pain Exam

Question 1

What are the factors influencing the perception of pain in children?

Answer 1

1. Cognitive factors
2. Behavioral factors
3. Emotional factors

Question 2

What are the cognitive factors that influence the perception of pain in children?

Answer 2

1. Child’s understanding of course of pain
2. Child’s ability to control what happened that resulted in pain
3. Child’s expectations regarding the pain — our response to pain can alter their perception

Question 3

What are the behavioral factors that influence the perception of pain in children?

Answer 3

1. Child’s actions
2. Response of parents and others to the child’s pain
3. Use of restraints — illegal with children
4. Implications of the pain/injury to the child’s life

Question 4

What are the emotional factors that influence the perception of pain in children?

Answer 4

Child’s ability to understand and cope with the pain

Question 5

What does the assessment pain of depend on?

Answer 5

Age and cognitive ability of the child

Question 6

What assessment do you use on infants, pre verbal, or non verbal children?

Answer 6

Neonatal/infant pain scale — for under 1 year old
Face, legs, activity, cry, and consolability behavior pain scale — for 2 months to 8 years
RFLACC — for 4-19 year olds

Question 7

What assessments can you use for toddlers, preschoolers, and older children that are VERBAL?

Answer 7

Visual analogue scale — for 5 year olds and up
Wong-Baker Faces pain scale — for 3-18 year olds
Face pain scale — for 5-12 year olds
CHEOPS (children’s hospital of eastern Ontario pain scale) — for 1-7 year olds

Question 8

What is the reliability and validity of the Wong-Baker FACES pain scale?

Answer 8

Construct and content validity when used to assess acute pain in ER of 3-6.5 year old children

Question 9

What is the reliability and validity of the Neonatal/infant pain scale (NIPS)?

Answer 9

Has construct and concurrent validity
Interrater reliability is 0.9-0.995
It is valid and practical

Question 10

What is the reliability and validity of the rFLACC?

Answer 10

Good interrater reliability and validity

Question 11

What is the reliability and validity of the CHEOPS?

Answer 11

Concurrent validity with the VAS
Interrater reliability 0.9-0.995

Question 12

What is a global assessment of pain in children?

Answer 12

QUEST PRINCIPLES OF PAIN ASSESSMENT

Question 13

What does QUESTT stand for?

Answer 13

Q — Question the child
U — Use pain rating scales
E — Evaluate behavior and physiologic changes
S — Secure parent’s involvement
T — Take cause of pain into account
T — Take action and evaluate results
document everything

Question 14

What are some considerations you should take when doing a pain assessment for children with neurological impairments?

Answer 14

1. Impact of the therapeutic environment
2. Therapist response
3. Ability to express pain

Question 15

What are the signs of distress/pain in a neonate?

Answer 15

Facial expression
Body movements
Crying
Changes in heart rate, RR, BP, SAO2, vagal tone
Palmar sweating
Plasma cortisol or catecholamine levels

Question 16

What are the signs of distress/pain in a infant?

Answer 16

Stress signs include startles like widening of eyes
Hiccups
Gasping
Tremors
Twitching
Yawning
Sneezing

Question 17

What are the signs of distress/pain in a toddler under 2 years old?

Answer 17

— Feeding difficulties
— Irritability, increased crying, grunting, breath holding, crying that can’t be comforted
— Facial expressions like furrowed brow, wrinkled forehead, closed eyes, or angry appearance
— Sleep changes like waking often or sleeping more or less than usual
— Body movements like making fists, guarding a part of the body, kicking, clinging to whoever holds him or her, not moving.

Question 18

What are the signs of distress/pain in a child 2 years old and up?

Answer 18

Acting our behaviors like defiant speech and actions
Anger problems
Stomachaches or headaches
Decreased appetite
Inability to control emotions, nightmares, clinginess, whining.