Pain (PowerPoint & Book) Flashcards
pain is
whatever the patient experiencing it says it is
its not about how much their pain is its about
how we manage and asssess
the main issue with pain meds is
intervals between pain meds
treat pain
early
gate control theory
distracting to prevent pain response to go to brain
why do we not do Motrin or aspirin
due to bleeding risk
expose to pain meds like IV substance abuse determines
tolerance and dose needed
why might children not complain of pain
may not know how to say
scary to mom and dad
needles
we assume or know they are in pain
past issues with pain
what influences pain response
culture
unrelieved pain can result in
psychological trauma
if we have unrelieved pain post op what does that do
lead to shallow breathing which leads to atelectasis and pneumonia
pain receptors are dveloped at
birth
sucrose does what
nonpharm mean for pain relief
activates opioid receptors
signs of pain in infant of less than 6 mo
grimacing
poor feeding
signs of pain in infant greater than 6 mo
crying, irritability, restlessness
toddlers sign of pain
aggressive
physical resistance
school age signs of pain
7-9
rigid
still
emotional withdrawl
fighting/super emotional
school age signs of pain
10-12
bravery
regress
adol signs of pain
controlled behavioral response
- depends on culture
distraction or deny pain
- want to be seen as an adult
what patients struggler with faces or oucher scale
intelleucal disability (autism)
- difficulty with facial recognition
numeric can be used what age range and above
school age
poker chip scale
use for intellectual disability
EX: you have 10 poker chips and tell me how much pain you are in with the chips
how to assess pain location
ask
point on doll
draw picture
self report pain need what
understand direction or follow direction
don’t call shots a
poke
NIPS
neonatal
FLACC
faces
legs
arms
cry
consolbility
questions to ask
what is the cause
what can they do
what can’t they do
- help understand this is temporary
- parents response
- manage pain at home
- parent preference for pain management
- how does pt cope
QUESTT
question the chi;d
use a pain rating scale
evaluate behvaioral and physiologic changes
secure parents involvement
take the cause of pain into account
take action and evaluate response
What works quicker IV or PO
IV
if PO meds work longer what does this mean
need to stay ontop of pain medications
PCA age range
6 and up
codine cannot be used when
tonsillectomy and adeniodectomy
- deep sleep and apenic episodes
what is reversal of opioids
narcan
EMLA used for
shots that sting
EMLA causes what
tissue swelling
EMLA application. time
45-60
what do we do for IM that prevent seepage
Z track
nonpharm
distraction
guided imagery
relaxation
breathing
hypnosis
sucrose
heat and cold
electroanalegisa
acupunture
CBT
pet
aroma
massage
therapeutic
why do we need to asses cognitive and developmental status
so you know appropriate scale and words/methods
always evaluate effective of pain relief, why
do they need something more for pain
acute pain
sudden, short duration
associated with single event
chronic pain
lasting longer than 3 months
prolonged disease
may be nociceptive or neuropathic
nocieceptive pain
normal process of pain caused by tissue injury or damage
- transduction, transmission, perception, modulation
neuropathic pain
abnormal processing of pain stimuli by the peripheral or CNS
- primary lesion or dysfuction
if pain is untreated or poorly treated
neurons become hyper excited which sensitizes the CNS, this leads to pain memory and permeant alteraitons
every infant and child perceives pain but what is different based on how they develop
undersaynading
repsonse
memory
MYTH
newborns and infants are ncapable of feeling pain. Children do not feel pain with the same intensity as adults because a child’s nervous system is immature.
The anatomic, physiologic, and neurochemical structures for pain transmission are well developed at birth, even in preterm infants (Huether, 2014, p. 495). Children feel a similar amount of pain as adults postoperatively (Tobias, 2014a).
MYTH
Infants are incapable of expressing pain.
Infants express pain with both behavioral and physiologic cues that can be assessed.
MYTH
Infants and children have no memory of pain.
Children remember painful episodes, fear procedures that cause pain, and may have increased pain responses during future pro- cedures (Fein, Zempsky, Cravero, et al., 2012).
MYTH
Parents exaggerate or aggravate their child’s pain
Parents know their child and are able to identify behaviors associ- ated with pain.
MYTH
Children are not in pain if they can be distracted or if they are sleeping.
Children use distraction to cope with pain, but they soon become exhausted when coping with pain and fall asleep.
MYTH
Repeated experience with pain teaches the child to be more toler- ant of pain and cope with it better.
Children who have more experience with pain respond more vig- orously to pain. Experience with pain teaches how severe the pain can become.
MYTH
Children recover more quickly than adults from painful experi- ences such as surgery.
Children heal quickly from surgery, but they have the same amount of tissue injury and pain from surgery as an adult.
MYTH
Children tell you if they are in pain. They do not need medication unless they appear to be in pain.
Children may be too young to express pain or afraid to tell anyone other than a parent about the pain. The child may fear treatment for pain will be worse than the pain itself.
MYTH
Children without obvious physical reasons for pain are not likely to have pain.
The cause of pain cannot always be determined. The feeling of pain is subjective and should be accepted.
MYTH
Children run the risk of becoming addicted to pain medication when used for pain management.
Children may develop physical dependence and tolerance after prolonged use of opioids for a serious injury, but addiction is uncommon (Galinkin, Koh, & Committee on Drugs and Section on Anesthesiology and Pain Management, 2014).
response to pain is influenced by
memory, temperament, ability to control what will happen, use of pain coping mechanism, emotions
pain may be expressed by
anger
anxiety
feeding problems
slepe disturbances
why might children not complain of pain
cannot give a description
need to be brave
assume nurse knows
afraid it will hurt more than pain
stoic response with diminished expression of pain
Irish, Japanese, Russian, Amish, and Appalachian
0-6 mo
understanding
Has no understanding of pain; is responsive to parental anxiety
0-6 mo
- behavioral
Generalized body movements, chin quivering, facial grimacing, poor feeding
0-6 mo verbal
cries
6-12 understanding
Has a pain memory; responsive to parental anxiety
6-12 behavioral
Reflex withdrawal to stimulus, facial grimacing, disturbed sleep, irritability, restlessness
6-12 verbal
cries
1-3 understanding
Lacks understanding of what causes pain and why it might be experienced
1-3 yr old behavioral
Demonstrates fear of painful situ- ations; may resist with entire body or localized withdrawal; aggressive behavior, disturbed sleep
1-3 yr old verbal
Cries or wails, cannot describe intensity or type of pain
Uses common words for pain such as owie and boo-boo
3-6 yr old understand
Pain is a hurt
Does not relate pain to illness;
may relate pain to an injury
Often believes pain is punish- ment or someone else is respon- sible for the pain
Unable to understand why a painful procedure will help them feel better
3-6 yr old behavioral
Active physical resistance, directed aggressive behavior, strikes out physically and verbally when hurt, easily frustrated
3-6 verbal
Has the language skills to express pain on a sensory level
Can identify location and intensity of pain, may deny pain, may believe their pain is obvious to others
7-9 school age (concrete) understanding
Understands simple relationships between pain and disease
Understands the need for painful procedures to monitor or treat disease
May associate pain with feeling bad or angry
May recognize psychologic pain related to grief and hurt feelings
7-9 school age (concrete) behavior
Passive resistance, clenches fists, holds body rigidly still, suffers emotional withdrawal, engages in plea bargaining
7-9 school age (concrete) verbal
Can specify location and intensity of pain; can describe physical characteristics of pain in relation to body parts
10-12 school age (transitional piaget) understanding
Better understanding of the rela- tionship between an event and pain
Has a more complex awareness of physical and psychologic pain, such as moral dilemmas and mental pain
10-12 school age (transitional piaget) behavioral
May pretend comfort to project bravery, may regress with stress and anxiety
10-12 school age (transitional piaget) verbal
Able to describe intensity and loca- tion with more characteristics, able to describe psychologic pain
adol understanding
Has a capacity for sophisticated and complex understanding of the causes of physical and men- tal pain
Recognizes that pain has both qualitative and quantitative characteristics
Can relate to the pain experi- enced by others
adol bejavioral
Wants to behave in a socially acceptable manner, shows a con- trolled behavioral response
May immerse self in an activity as a pain distraction
May not complain about pain if given cues that nurses and other healthcare providers believe it should be tolerated
adol verbal
More sophisticated descriptions as experience is gained; may think nurses are in tune with their thoughts, so they do not need to tell the nurse about their pain
responses to pain
- respiratory
Rapid shallow breathing Inadequate lung expansion Inadequate cough
which leads to
Alkalosis
Decreased oxygen saturation, atelectasis Retention of secretions, pneumonia
responses to pain
- neurologic
Increased sympathetic nervous system activity and release of catecholamines
which leads to
Tachycardia, elevated blood pressure, vasoconstriction, and decreased tissue oxygenation
Increased intracranial pressure, change in sleep patterns, irritability
responses to pain
- metabolic
Increased metabolic rate with stress response, increased release of hormones, suppressed release of insulin
which leads to
Increased fluid and electrolyte losses Altered nutritional intake, hyperglycemia
responses to pain
- immune system changes
Depressed immune and inflammatory responses
which leads to
Increased risk of infection, delayed wound healing
response to pain
- GI
Decreased gastric acid secretions and intestinal motility
which leads to
Impaired gastrointestinal functioning, nausea, poor nutritional intake, ileus
pain scale for nonverbal
NIPS
FLACC
NIPS
preterm and full term up to 6 weeks after birth for procedural pain
- facial expression, cry, quality, breathing patterns, arms, legs position, state of arousal
FLACC
acute pain for infants and young children following surgery
used until able to report pain with another scale
older than what can localize pain if given an outline of the front and back of the body
3yr
intellectual disability
-FLACC post op pain
what is the best method for assessing pain
self report tool
to us pain scales the child must understand
concept of little and a lot of pain
children 2-3 or less
understand concept of more or less
give them 3 choices
4-5 years olf
differentiate larger and small numbers
can self report
FACES
6 faces
3 years up
oucher scale
6 pictures
poker chips
quantity acute pain
school age and adol have better number conceptions
numeric pain scale
0-10
s/s of pain
achycardia, tachypnea, hypertension, pupil dilation, pallor, increased perspiration, and increased secretion of stress hormones such as the catechol- amines and cortisol
children and adol may demonstrate what kinds of signs
Short attention span (child is easily distracted)
* Posturing (guarding a painful joint by avoiding movement), remaining immobile, or protecting the painful area
* Drawing up knees, flexing limbs, massaging affected area
* Lethargy, remaining quiet, or withdrawal
* Sleep disturbances
* Depression and/or aggressive behavior, especially for those who fear that the discomfort will worsen
NSAIDS
inburophen
bone, infalam and connective tissue issues
opioids
seere pain
morphine
common opioid side effects
sedation, nausea, vom- iting, constipation, urinary retention, and itching
major life treating complications is
respiratory depression
s/s of rest depression
sleepiness, small pupils, and shallow breathing, changed LOC
resp depresison is more likely to occur when
sleeping
- monitor respiratory rate
dependence
physiological adapatiation
withdrawl
physical signs and symptoms that occur when a sedative or pain drug is stopped suddenly
tolderance
adaptation to an opioid dosage that results in a shorter duration of drug effec- tiveness over time. An increasing dosage is needed to produce the same level of pain relief.
prevent withdrawal
taper 2-4 weeks
delays in analgesia administration increase the chances of
breakthrough pain
age for PCA
6 but can be 5
child needs to be able to do what for PCA
self report pain and understand pushing the button will give them meds to relieve pain
who can push PCA pump button
PATIENT ONLY
distraction
involves engaging a child in a pleasant activity to help focus attention on something other than pain and the anxi- ety
children in severe pain cannot be
distracted
guided imagery
cognitive behavioral process that encourages the child to relax
relaxation techniques do what
reduce muscle tension
breathing techniques
Rhythmic deep breaths can be used with distraction or muscle relaxation during a painful procedure or as a mechanism to reduce stress.
hypnosis
Hypnosis is an altered state of awareness facilitating height- ened concentration, decreased awareness of external stimuli, increased relaxation, and increased suggestibility.
sucrose works by
The sweet taste is believed to activate the endogenous opioid pathways, leading to the release of endog- enous opioids
electroanalgesia
delivers small amounts of electrical stimulation to the skin by electrodes. This electronic stimulation is stronger than the pain impulses and is thought to interfere with the transmission of pain impulses from the peripheral nerves to the spinal cord and brain.
NSAIDS may mask
fever
be careful with NSAIDS in
GI issues
why do kids sleep after pain med
This sleep is not a side effect of the drug or a sign of an overdose, but the result of pain relief. Pain interrupts sleep, and once pain is relieved, the child can sleep comfortably.
EMLA (eutectic mixture of local anesthetics) cream, an emul- sion of 2.5% lidocaine and 2.5% prilocaine, is effective if applied 60 minutes before a needlestick, venipuncture, or circumcision procedure on intact skin in infants and children (Barnes, 2014). The depth of penetration deepens if left on longer.
at home pain management
around clock for 1-2 days
bevahior changes with chronic pain
fatigue
inactivity
posturing
difficulty concentration and sleeping
withdrawal from activity
mood disturbances
children with chronic pain should learn
cognitive behavioral therapy which helps reduce stress and cope with pain
sedation
medically controlled state of depressed consciousness (light to deep) used for painful diagnostic and therapeutic procedures.
moderate sedation
Moderate sedation (formerly called conscious sedation) occurs with lower doses of sedatives and enables the child to maintain protective reflexes independently, continuously maintain a patent airway, and respond to tac- tile and verbal stimuli
deep sedation
Deep sedation is a controlled state of depressed consciousness or unconsciousness in which protec- tive airway reflexes are lost.
