Pain: maternal and child health Flashcards
pain is both hurtful and _____ (mentally) to kids
confusing
preschoolers and young kids lack a sense of ___ which makes it difficult to explain to them when their pain will go away
time
what age can a kid indicate where thyre feeling pain by pointing
3
what ages cn rate their pain on a scale of 1-10
older s age and ados
why might a kid be reluctant to admit pain
how can you address this
fear of getting shot as Tx
advocate for oral analgesia, PC analgesia, intermittent IV
is there much chance of kids getting narcotic dependent
no. little risk
T or F resp depression is more likely in kids than adults
\F. makes it sound like theyre equal
how can you assess whether an nalgesic was effective for kid
nonverbal cues
vitals
childs statements
where do pain impulses join CNS fibres
dorsal horn of spinal cord
somatic pain=
eg
pain that originates from deep body structures eg muscles or bones
eg sprained ankle
pain that arises from mucous membranes is an example of
describe this type of pain
cutaneous pain
pain that arises from superficial structures such as skin and mucous membranes
pain that arises from internal organs=
visceral pain
eg appendicitis
pain threshold in kids is most influnced by
genetics
pain tolerance is most affected by
cultural influences
gate control theory of pain: how an gating mechanisms be stimulated
cutaneous stim
distraction
anxiety reduction
pain in the presence of anxiety in kids affects pain how
child perceives it more quickly
how can you assist in providing good pain assessment. who and how do you educate
parents may refrain from telling you kids in pain bcause they think ur expert
HCW may rely on parents
kids may not know pain can be taken care of and not report
to prevent this, tell everyone how pain willbe assessed, everyones role and whats avail for pain relief helps ensure these misunderstandings dont occur
what is the chief mark in -infants- that pain is present
they cant be comforted completely
which type of infant has most difficulty in making distress response
preterm neonate
why is pain diff to assess in toddlers and preschoolers
(not much specifically on preschoolers) 3 items
-diff because they lack vocab
-use their words
-diff comparing pain to past pain as lack experience
-
-
considerations for pain in
preschoolers-4 items
- egocentric, think adults know already
- may think pain is punishment
- may be diff to comfort as they dont have perception of time (its only for minute)
- may regress
preschooler. another way to eval if analgesia is working
if they resume their normal behaviour after (info from parents)
why might preadolescents have difficulty describing their pain
they think concretely cant conceive that sharp means both knife and quality of pain in abdomen
are school age kids old enough to control pain through nonpharm measures eg distraction
yes
when might a kid be ready to use numerical pain scale
middle school
how can you eval if kids ready to use scale (that goes r to L or numeric)
give triangles arrange sm to lg
t or f kids in pain cant sleep
f they may sleep to distract hemselves or be exhausted by the pain
how could you adjust a pain scale for a kid if theyre having diff
turn it bottom to top
use sale of 1-5
with adolescents whats doubly important to assess and why (of pt in pain(
they may try to be stoic
assess body motions eg clenching, tensing, rapid breathing
CRIES scale. meant for
stands for
(crying, requires 02, expression, sleeplessness) neonates
cries scale score of _ or more means most likley
in pain
how is each it scored
4+
0-2
who cant use cries scale
intubate or paralyzed
comfort behaviour scale used for
v young infants
pain mgmt based on gate control theory
let kid know you want to take away pain (use positive approach
- admin meds before intense to prevent pain
- never give JUST an analgesic. make kid comfy etc by backrubs or straightening the sheets
- ask kid what they thinkd be helpful
- help them talk abt pain to reduce fear
- relieve anxiety and maybe use relaxation
- offer emotional support
- validate eg its ok to cry not be a big girl. dont shame
substitution of meaning=
good for
guided imagery is distraction technique to help a kid place another meaning on a painful procedure
eg the needle is a rocket ship ask the kid to elaborate eg what color is the ship, does it have stripes
-good for chronic pain and quick procedures
is severe headache a concern with epidural analgesia
no. the epidural needle doesnt enter CSF
what must a distraction activity require
is a video game an example
requires: concentration. simple distractions like video games allow pain to break through
gives the kid feeling of control
is thought stopping summarized as dont think about it
no. it allows the thoughts and the child transforms or changes them into more positive ones
whats the secret to success for thought stopping
use the technique every time the disturbing anxious thoughts appear
what age group is biofeedback for
ados. younger cant conc
biofeedbak=
biofeedback is based on the theory that people an regulate interneural events eg heart rate and pain in response to a stimulus
TENS=
transcutaneous eletrical nerve stimulation. apply sm electrodes to dermatomes that supply the body portion where pains experienced. when kid sense paint hey push a button on the box which delivers a current
tens, given for acute or chronic pain
both
tens not recommended if:
incontinent or has wound thats likely to cause electrodes to get wet
when can you apply heat after__
24hrs after injury
what type of nalgesic measure shoud be avoided
IM
intranasal admin
attractive as easy to admin for parents and well absorbed
is severe headache a concern with epidural analgesia
no. the epidural needle doesnt enter CSF
method of analgesia for pts in acute pain
IV
topical anesthetic considerations
cover it in young kids so they dont wipe it off or eat t
takes 30min-hr to take effect
can be applied at home before clinic
number one reason for poisoning in small kids
acetaminophen
how old are pts when they can use PCA
5-6yrs old
conscious sedation=
state fo depressed consciousness usually obtained through IV analgesia
allows kid to be pain free nd sedated for a procedure
protective reflexes are left intact
