part 4

Question 1

Pain in neonates (less than 4 weeks) is difficult to assess. What should the pain assessment for this category be based on and what are some tools?

Answer 1

• based on physiological and behavioral responses
• Assessment tools:
• CRIES neonatal pain scale
• premature infant pain profile (PIPP)
• neonatal pain, agitation, and sedation scale (NPASS)

Question 2

What are some responses to pain from an older infant?

Answer 2

• withdrawal from painful stimuli
• loud crying
• facial grimacing
• physical resistance

Question 3

What are some responses to pain from a young child(12 months to 5 years)?

Answer 3

• loud screaming and crying
• verbalizing “ow”, “ouch”, “it hurts”
• thrashing
• attempts to push away the stimulus

Question 4

What are some responses to pain from a school-age child (6-11)?

Answer 4

• stalling behavior “wait a minute”
• muscle rigidity
• may use behaviors of a young child

Question 5

What are some responses to pain from an adolescent (12-18)?

Answer 5

• LESS VOCAL PROTEST
• LESS MOTOR ACTIVITY
• increased muscle tension and body control
• more verbalizations

Question 6

Who is at a greater risk for undertreatment of pain?

Answer 6

children with communication and cognitive impairment

Question 7

Who is a great source of information and what are the pain measurement tools for a child with communication and cognitive impairments?

Answer 7

• primary caregiver is important source of information
• Assessment tools:
• noncommunicating children’s pain checklist
• pain indicator for communicatively impaired children (PICIC)

Question 8

What are the important components of an assessment f of a child with chronic illness and complex pain?

Answer 8

• trusting relationship with the child and family
• onset of pain
• pain duration or pattern
• effectiveness of current treatment
• factors aggravating or relieving pain
• concurrent symptoms and complications

Question 9

What are some nonpharmacological ways to help children manage pain?

Answer 9

• distraction
• relaxation
• guided imagery
• cutaneous stimulation
• sucrose
• heat/cold
• music

Question 10

What are the five classes of complementary and alternative medicine treatments to help children manage pain?

Answer 10

• biologically based: foods, herbal/plant based, vitamins/supps
• manipulative: chiropractic, massage
• energy based: reiki, bioelectrical or magnetic treatment
• mind-body technique: mental healing, expressive treatment
• alternative: homeopathy, traditional chinese medicine

Question 11

What is the 2 step approach for pharmacological pain management in children?

Answer 11

Step 1:
-older than 3 months with mild pain administer a nonopioid like NSAID, acetaminophen, ibuprofen, naprosyn
-administer strong opioid for moderate to severe pain
Step 2:
-morphine or can consider other opioids (codiene, hydrocodone)