Pain management in peds Flashcards
What are pain cues in newborn?
High pitched shrill cry
Thrashing and tremors
Increase in BP, HR, RR
Decrease in O2 Sat
Facial expression (Eyes tightly closed, brows lowered and drawn together, wrinkled forehead)
What does FLACC stand for? Used for?
F=Face
L=Legs
A=Activity
C=Cry
C=Consolability
—-Pain scale for newborns or nonverbal kids—
—Sort of like APGAR (except high score is bad and low score is good). Given 0, 1, 2 points. The higher the score the worse the markers are for pain.—
What are some non-pharm pain interventions for NB?
Quiet <40 decibels
Dim lights
Holding, touching, vibrations, rocking
Kangaroo care
Sucking on pacifier or nursing
Sweet ease
Swaddling
Why are IM injections for pain meds used as last resort in kids?
Fear of pain and upset
Muscle not absorbent enough to provide consistent flow of med
Short duration
What are some topical anesthetics used in peds?
Lidocaine-prilocaine 5% (EMLA)
Amethocaine 4% (Ametop)
Vapocoolant spray (works fast)
J-Tip (device to deliver lidocaine into skin)
Drug of choice for fever in kids.
Tylenol
Caution for Tylenol administration.
Must monitor total amount received over 24 hours closely because
Tylenol is mixed in with opioid meds to increase effectiveness.
Can cause hepatic damage in overdose.
What is max dosage of Tylenol in peds?
No more than 6 doses in 24 hours.
—90 mg/kg/daily–
What is dosage of Tylenol?
10-15 mg/kg/dose q 4-6 hours
(q 6-8 hours in neonates)
What are absolute contraindications for Tylenol?
thrombocytopenia
—Platelets too low–
Anemia
Hepatic disease
How old must a child be for NSAID use?
> 6 months old
What is dose of ibuprofen?
8-10 mg/kg/dose q 6-8 hours
What is an IV administered NSAID?
Toradol (ketorolac)
Dose is 0.5 mg/kg
Not given to children less than 6 months old.
What are the most common side effects of opioid administration?
Sedation-resolves after 1-3 days
Pruritus-resolves after 1-3 days
N/V-resolves after 1-3 days
Urinary retention-resolves after 1-3 days
Cough suppression
Constipation
Respiratory depression
Which opioid is unsafe for children?
Codeine
–Because some kids metabolize it too fast and OD–
Which is preferred opioid for children?
Morphine
Which opioid of 5 times more potent than morphine?
Dilaudid
Which opioid is 100 times more potent than morphine?
Fentanyl
Which opioid is metabolized the most slowly? What is its most common side effect?
Methadone and Nausea
Prolonged duration of action
Comes in liquid form too
Which opioid is given only for post-op shivering and rigors in kids?
Demerol (meperidine)
Do opioids have dose limits?
No-The max dose is the dose that causes unacceptable side effects.
Unique to every person.
What is preferred route for pain meds in children?
Oral or IV
–As soon as possible, we change from IV admin to oral–
Hydrocodone is usually mixed with…
Acetaminophen or
Ibuprofen
Dosage for morphine.
PO=0.2—0.5 mg/kg/dose q 4-6 hours
IV= 0.05—0.1 mg/kg/dose q 2-4 hours
What is Dilaudid’s generic name?
Hydromorphone
What is fentanyl patch called?
Duragesic
–used for chronic pain–
