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Pediatrics > Pain (PowerPoint & Book) > Flashcards

Pain (PowerPoint & Book) Flashcards

1
Q

pain is

A

whatever the patient experiencing it says it is

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2
Q

its not about how much their pain is its about

A

how we manage and asssess

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3
Q

the main issue with pain meds is

A

intervals between pain meds

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4
Q

treat pain

A

early

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5
Q

gate control theory

A

distracting to prevent pain response to go to brain

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6
Q

why do we not do Motrin or aspirin

A

due to bleeding risk

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7
Q

expose to pain meds like IV substance abuse determines

A

tolerance and dose needed

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8
Q

why might children not complain of pain

A

may not know how to say
scary to mom and dad
needles
we assume or know they are in pain
past issues with pain

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9
Q

what influences pain response

A

culture

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10
Q

unrelieved pain can result in

A

psychological trauma

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11
Q

if we have unrelieved pain post op what does that do

A

lead to shallow breathing which leads to atelectasis and pneumonia

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12
Q

pain receptors are dveloped at

A

birth

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13
Q

sucrose does what

A

nonpharm mean for pain relief
activates opioid receptors

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14
Q

signs of pain in infant of less than 6 mo

A

grimacing
poor feeding

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15
Q

signs of pain in infant greater than 6 mo

A

crying, irritability, restlessness

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16
Q

toddlers sign of pain

A

aggressive
physical resistance

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17
Q

school age signs of pain
7-9

A

rigid
still
emotional withdrawl
fighting/super emotional

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18
Q

school age signs of pain
10-12

A

bravery
regress

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19
Q

adol signs of pain

A

controlled behavioral response
- depends on culture
distraction or deny pain
- want to be seen as an adult

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20
Q

what patients struggler with faces or oucher scale

A

intelleucal disability (autism)
- difficulty with facial recognition

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21
Q

numeric can be used what age range and above

A

school age

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22
Q

poker chip scale

A

use for intellectual disability
EX: you have 10 poker chips and tell me how much pain you are in with the chips

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23
Q

how to assess pain location

A

ask
point on doll
draw picture

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24
Q

self report pain need what

A

understand direction or follow direction

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25
Q

don’t call shots a

A

poke

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26
Q

NIPS

A

neonatal

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27
Q

FLACC

A

faces
legs
arms
cry
consolbility

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28
Q

questions to ask

A

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

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29
Q

QUESTT

A

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

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30
Q

What works quicker IV or PO

A

IV

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31
Q

if PO meds work longer what does this mean

A

need to stay ontop of pain medications

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32
Q

PCA age range

A

6 and up

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33
Q

codine cannot be used when

A

tonsillectomy and adeniodectomy
- deep sleep and apenic episodes

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34
Q

what is reversal of opioids

A

narcan

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35
Q

EMLA used for

A

shots that sting

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36
Q

EMLA causes what

A

tissue swelling

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37
Q

EMLA application. time

A

45-60

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38
Q

what do we do for IM that prevent seepage

A

Z track

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39
Q

nonpharm

A

distraction
guided imagery
relaxation
breathing
hypnosis
sucrose
heat and cold
electroanalegisa
acupunture
CBT
pet
aroma
massage
therapeutic

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40
Q

why do we need to asses cognitive and developmental status

A

so you know appropriate scale and words/methods

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41
Q

always evaluate effective of pain relief, why

A

do they need something more for pain

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42
Q

acute pain

A

sudden, short duration
associated with single event

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43
Q

chronic pain

A

lasting longer than 3 months
prolonged disease
may be nociceptive or neuropathic

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44
Q

nocieceptive pain

A

normal process of pain caused by tissue injury or damage
- transduction, transmission, perception, modulation

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45
Q

neuropathic pain

A

abnormal processing of pain stimuli by the peripheral or CNS
- primary lesion or dysfuction

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46
Q

if pain is untreated or poorly treated

A

neurons become hyper excited which sensitizes the CNS, this leads to pain memory and permeant alteraitons

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47
Q

every infant and child perceives pain but what is different based on how they develop

A

undersaynading
repsonse
memory

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48
Q

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.

A

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).

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49
Q

MYTH
Infants are incapable of expressing pain.

A

Infants express pain with both behavioral and physiologic cues that can be assessed.

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50
Q

MYTH
Infants and children have no memory of pain.

A

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).

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51
Q

MYTH
Parents exaggerate or aggravate their child’s pain

A

Parents know their child and are able to identify behaviors associ- ated with pain.

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52
Q

MYTH
Children are not in pain if they can be distracted or if they are sleeping.

A

Children use distraction to cope with pain, but they soon become exhausted when coping with pain and fall asleep.

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53
Q

MYTH
Repeated experience with pain teaches the child to be more toler- ant of pain and cope with it better.

A

Children who have more experience with pain respond more vig- orously to pain. Experience with pain teaches how severe the pain can become.

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54
Q

MYTH
Children recover more quickly than adults from painful experi- ences such as surgery.

A

Children heal quickly from surgery, but they have the same amount of tissue injury and pain from surgery as an adult.

55
Q

MYTH
Children tell you if they are in pain. They do not need medication unless they appear to be in pain.

A

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.

56
Q

MYTH
Children without obvious physical reasons for pain are not likely to have pain.

A

The cause of pain cannot always be determined. The feeling of pain is subjective and should be accepted.

57
Q

MYTH
Children run the risk of becoming addicted to pain medication when used for pain management.

A

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).

58
Q

response to pain is influenced by

A

memory, temperament, ability to control what will happen, use of pain coping mechanism, emotions

59
Q

pain may be expressed by

A

anger
anxiety
feeding problems
slepe disturbances

60
Q

why might children not complain of pain

A

cannot give a description
need to be brave
assume nurse knows
afraid it will hurt more than pain

61
Q

stoic response with diminished expression of pain

A

Irish, Japanese, Russian, Amish, and Appalachian

62
Q

0-6 mo
understanding

A

Has no understanding of pain; is responsive to parental anxiety

63
Q

0-6 mo
- behavioral

A

Generalized body movements, chin quivering, facial grimacing, poor feeding

64
Q

0-6 mo verbal

A

cries

65
Q

6-12 understanding

A

Has a pain memory; responsive to parental anxiety

66
Q

6-12 behavioral

A

Reflex withdrawal to stimulus, facial grimacing, disturbed sleep, irritability, restlessness

67
Q

6-12 verbal

A

cries

68
Q

1-3 understanding

A

Lacks understanding of what causes pain and why it might be experienced

69
Q

1-3 yr old behavioral

A

Demonstrates fear of painful situ- ations; may resist with entire body or localized withdrawal; aggressive behavior, disturbed sleep

70
Q

1-3 yr old verbal

A

Cries or wails, cannot describe intensity or type of pain
Uses common words for pain such as owie and boo-boo

71
Q

3-6 yr old understand

A

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

72
Q

3-6 yr old behavioral

A

Active physical resistance, directed aggressive behavior, strikes out physically and verbally when hurt, easily frustrated

73
Q

3-6 verbal

A

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

74
Q

7-9 school age (concrete) understanding

A

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

75
Q

7-9 school age (concrete) behavior

A

Passive resistance, clenches fists, holds body rigidly still, suffers emotional withdrawal, engages in plea bargaining

76
Q

7-9 school age (concrete) verbal

A

Can specify location and intensity of pain; can describe physical characteristics of pain in relation to body parts

77
Q

10-12 school age (transitional piaget) understanding

A

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

78
Q

10-12 school age (transitional piaget) behavioral

A

May pretend comfort to project bravery, may regress with stress and anxiety

79
Q

10-12 school age (transitional piaget) verbal

A

Able to describe intensity and loca- tion with more characteristics, able to describe psychologic pain

80
Q

adol understanding

A

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

81
Q

adol bejavioral

A

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

82
Q

adol verbal

A

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

83
Q

responses to pain
- respiratory

A

Rapid shallow breathing Inadequate lung expansion Inadequate cough

which leads to
Alkalosis
Decreased oxygen saturation, atelectasis Retention of secretions, pneumonia

84
Q

responses to pain
- neurologic

A

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

85
Q

responses to pain
- metabolic

A

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

86
Q

responses to pain
- immune system changes

A

Depressed immune and inflammatory responses

which leads to
Increased risk of infection, delayed wound healing

87
Q

response to pain
- GI

A

Decreased gastric acid secretions and intestinal motility

which leads to
Impaired gastrointestinal functioning, nausea, poor nutritional intake, ileus

88
Q

pain scale for nonverbal

A

NIPS
FLACC

89
Q

NIPS

A

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

90
Q

FLACC

A

acute pain for infants and young children following surgery

used until able to report pain with another scale

91
Q

older than what can localize pain if given an outline of the front and back of the body

A

3yr

92
Q

intellectual disability

A

-FLACC post op pain

93
Q

what is the best method for assessing pain

A

self report tool

94
Q

to us pain scales the child must understand

A

concept of little and a lot of pain

95
Q

children 2-3 or less

A

understand concept of more or less
give them 3 choices

96
Q

4-5 years olf

A

differentiate larger and small numbers
can self report

97
Q

FACES

A

6 faces
3 years up

98
Q

oucher scale

A

6 pictures

99
Q

poker chips

A

quantity acute pain
school age and adol have better number conceptions

100
Q

numeric pain scale

A

0-10

101
Q

s/s of pain

A

achycardia, tachypnea, hypertension, pupil dilation, pallor, increased perspiration, and increased secretion of stress hormones such as the catechol- amines and cortisol

102
Q

children and adol may demonstrate what kinds of signs

A

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

103
Q

NSAIDS

A

inburophen
bone, infalam and connective tissue issues

104
Q

opioids

A

seere pain
morphine

105
Q

common opioid side effects

A

sedation, nausea, vom- iting, constipation, urinary retention, and itching

106
Q

major life treating complications is

A

respiratory depression

107
Q

s/s of rest depression

A

sleepiness, small pupils, and shallow breathing, changed LOC

108
Q

resp depresison is more likely to occur when

A

sleeping
- monitor respiratory rate

109
Q

dependence

A

physiological adapatiation

110
Q

withdrawl

A

physical signs and symptoms that occur when a sedative or pain drug is stopped suddenly

111
Q

tolderance

A

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.

112
Q

prevent withdrawal

A

taper 2-4 weeks

113
Q

delays in analgesia administration increase the chances of

A

breakthrough pain

114
Q

age for PCA

A

6 but can be 5

115
Q

child needs to be able to do what for PCA

A

self report pain and understand pushing the button will give them meds to relieve pain

116
Q

who can push PCA pump button

A

PATIENT ONLY

117
Q

distraction

A

involves engaging a child in a pleasant activity to help focus attention on something other than pain and the anxi- ety

118
Q

children in severe pain cannot be

A

distracted

119
Q

guided imagery

A

cognitive behavioral process that encourages the child to relax

120
Q

relaxation techniques do what

A

reduce muscle tension

121
Q

breathing techniques

A

Rhythmic deep breaths can be used with distraction or muscle relaxation during a painful procedure or as a mechanism to reduce stress.

122
Q

hypnosis

A

Hypnosis is an altered state of awareness facilitating height- ened concentration, decreased awareness of external stimuli, increased relaxation, and increased suggestibility.

123
Q

sucrose works by

A

The sweet taste is believed to activate the endogenous opioid pathways, leading to the release of endog- enous opioids

124
Q

electroanalgesia

A

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.

125
Q

NSAIDS may mask

A

fever

126
Q

be careful with NSAIDS in

A

GI issues

127
Q

why do kids sleep after pain med

A

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.

128
Q

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.

A
129
Q

at home pain management

A

around clock for 1-2 days

130
Q

bevahior changes with chronic pain

A

fatigue
inactivity
posturing
difficulty concentration and sleeping
withdrawal from activity
mood disturbances

131
Q

children with chronic pain should learn

A

cognitive behavioral therapy which helps reduce stress and cope with pain

132
Q

sedation

A

medically controlled state of depressed consciousness (light to deep) used for painful diagnostic and therapeutic procedures.

133
Q

moderate sedation

A

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

134
Q

deep sedation

A

Deep sedation is a controlled state of depressed consciousness or unconsciousness in which protec- tive airway reflexes are lost.

Pediatrics (51 decks)

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