Pain Management Flashcards
Influential Factors
Influential factors that can have a positive or negative effect on pain perception. Age. Developmental age. Chronic or acute disease. Prior experiences with pain. Personality. Family dynamics. Culture. Socioeconomic status.
Young Infant Developmental Characteristics
Loud cry.
Rigid body or thrashing.
Local reflex withdrawal from pain stimulus.
Expression of pain (eyes tightly closed, mouth open in a squarish shape, eyebrows lowered and drawn together).
Lack of association between stimulus and pain.
Older Infant Developmental Characteristics
Loud cry.
Deliberate withdrawal from pain.
Facial expression of pain.
Toddler Developmental Characteristics
Loud cry or screaming. Verbal expressions of pain. Thrashing of extremities. Attempt to push away or avoid stimulus. Noncooperation. Clinging to a significant person. Behaviors occur in anticipation of painful stimulus. Requests physical comfort.
School aged child Developmental Characteristics
Stalling behavior.
Muscular rigidity.
Any behaviors of the toddler, but less intense in the anticipatory phase and more intense with painful stimulus.
Adolescent Developmental Characteristics
More verbal expression of pain with less protest.
Muscle tension with body control.
Pain Intensity
Assessment includes behavioral measures, multidimensional, and self-report.
Self-report is used for children 4 years or older. Children under 4 are unable to accurately report their pain.
Multiple tools have been developed and researched as reliable.
A nurse should choose an appropriate pain tool that will adequately assess the infant or child’s pain.
Include the parent or caregiver in rating the child’s pain.
Assess the location, quality, and severity of pain.
Nursing Care of Pain
Reassess the child’s pain level frequently.
Use non pharmacological, pharmacological, or both approaches to manage pain.
Ask the parent of caressive to reassess the child’s pain level.
Ask the parent or caregiver their satisfaction of the pain management.
Assess the child for adverse reactions to pain medications.
Review lab results.
Assess the child’s physical functioning following pain management interventions.
Assess for negative effects of distress the child might experience related to pain, such as anxiety, withdrawal, sleep disruption, fear, depression, or unhappiness.
Atraumatic Measures
Use treatment room for painful procedures.
Avoid procedures in “safe places”, such as the play room or the child’s bed.
Use developmentally appropriate terminology when explaining procedures.
Offer choices to the child.
Allow parents to stay with the child during painful procedures.
Use play therapy to explain procedures, allowing the child to perform the procedure on a doll or toy.
Pharmacological Measures
WHO recommends a two step approach for pharmacological management of pain for children:
For children above 3 months of age with mild pain, the first step is to administer a nonopioid. NSAIDs are frequently used for mild pain.
The second step for children who have moderate to severe pain is to administer a strong opioid. Morphine is the drug of choice.
Optimal dosage of medications control pain without causing adverse effects.
Select the least traumatic route for medication administration.
Give medications routinely, versus PRN. to manage pain the tis expected to last for an extended period of time.
Combine adjunctive medications (steroids, antidepressants, sedatives, anti anxiety medications, muscle relaxants, anticovulsants) with other analgesics.
Use nonopioid and opioid medications:
Acetaminophen and NSAIDs are acceptable for mild to moderate pain.
Opioids are acceptable for moderate to severe pain. Medications used include morphine sulfate, oxycodone, and fentanyl.
Combining a nonopiod and an opioid medication treats pain peripherally and centrally. This offers greater analgesia with fewer adverse effects (respiratory depression, constipation, and nausea)
IM injections are not recommended for pain control in children.
IN medications are not recommended for children younger than 18 years old.
Rectal medications have variable absorption rates, and children dislike them.
Intradermal medication are used for skin anesthesia prior to procedures.
Oral
Route is preferred due to convenience, cost, and ability to maintain steady blood levels.
Take 1-2 hours to reach peak analgesic effects. Oral medications are not suited for children experiencing pain that requires rapid relief or pain that is fluctuating in nature.
Lidocaine and Prilocaine
Available in gel or cream.
Used for any procedure in which the skill will be punctured 60 minutes prior to a superficial puncture and 2.5 hours prior to a deep puncture.
Place an occlusive freezing over the cream after application.
Prior to procedure, remove the dressing and clean the skin. Indication of an adequate response is reddened or blanched skin.
Demonstrate to the child that the skin is not sensitive by tapping or scratching lightly.
Instruct parents to apply medication at home prior to the procedure.
Fentanyl
Topical/transdermal route:
Used for children older than 12 years of age.
Use to provide continuous pain control. Onset of 12-24 hours and a duration of 72 hours.
Use an immediate-release opioid for breakthrough pain.
Treat respiratory depression with naloxone.
IV Bolus
Rapid pain control in approx 5 minutes.
Use for mediations such as morphine, hydromorphone.
Continuous: provides steady blood levels.
Patient Controlled Analgesia (PCA)
Self-administration of pain medication.
Can be basal, bolus, or combination.
Has lockouts to precent overdosing.
