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Pediatric Nursing > Pediatric Pain Management > Flashcards

Pediatric Pain Management Flashcards

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1
Q

What is pain?

A

pain is whatever the patient says it is and exists whenever the patient says it does
Pain in kids is multi-dimensional, subjective, physiological and behavioral

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2
Q

Eland & Anderson 1977

A

similar surgical procedures- traumatic amputations, malignant neck mass, repair of ASD
25 children- 24 pain meds
18 adults- 671 pain meds
13/25 kids received no pain meds

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3
Q

Perry & Heidrich, 1982

A

Burn Unit
surveyed nurses medicating prior to tanking
6 nurses would not pre-medicate an adult
24 nurse would not medicate a child

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4
Q

Beyer, DeGood, Ashley, & Russell, 1983

A

compared 50 adults/50 children matched for diagnosis - cardiac surgery
70% of the total analgesics were given to the adults
12 infants/toddlers received no analgesics

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5
Q

Broome, et al 1996

A

27% insititions did not use self report tools
IMs given “sometime often” 48%
DPT- “Sometimes-often” 50%
Effectiveness of pain control significantly better for school age & adolescents than younger kids
96% major obstacles- knowledge deficit, attitudes, stated skills, lack of resources

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6
Q

Rieman & Gordon 2007

A 
295 pediatric RNs
8 Shriners hospitals
Peds pain assessment and management
Mean score was 74%
More experienced nurses scored higher
Nurses who belonged to a professional organization scored higher
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7
Q

What is the first myth?

A

Nervous system of the neonate is too immature to feel pain

pain receptors are fully developed & functional at birth
complete myelinization is not necessary for pain perception

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8
Q

What is the second myth?

A

children, infants in particular dont feel pain

“Whatever is painful in the adult is painful in the infant & child until proven otherwise”
Wongs Golden Rule
1993

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9
Q

What is the third myth?

A

children cant tell you where they hurt

even infants show signs of pain in facial expressions, posture, cry, & body movements
young children can point to where they hurt and effectively use pictorial pain assessment tools
older children can tell in words and drawings where they hurt

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10
Q

what is the fourth myth?

A

children who do not report pain or request medication for pain, are not in pain

children are egocentric & believe that others know how they feel
they perceive adults to be the “care providers”. if they needed it you would provide it

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11
Q

What is the fifth myth?

A

children cry during procedures because they do not like to be restrained

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12
Q

What is the sixth myth?

A

narcotics cause respiratory depression in children

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13
Q

What is the seventh myth?

A

pain will have no lasting effect on children- they wont remember it anyway

recent research indicates that memory for pain & behavioral changes may begin as early as the neonatal period
may change the way an individual perceives/copes with pain

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14
Q

What is the eighth myth?

A

narcotic pain meds administered to children increase the risk of addiction particularly in adolescents

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15
Q

Sucrose

A
  • Painful procedures infants birth- 6 months: venipuncture, heel stick, LPs/circs
  • 24-28% sucrose
  • Dripped on anterior third of tongue- absorbed by receptors- not swallowed
  • pacifier dipping
  • 1cc 2 min prior to procedure
  • another cc during procedure
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16
Q

Aspirin

A
  • analgesic/ anti-pyretic/ anti-inflammatory/ antiplatelet

- restricted to selected used in pediatrics (risk of Reyes Syndrome)- Rhematic Fever, Kawasakis Disease

17
Q

Acetaminophen

A

analgesic/antipyretic

-Dose: 10-15mg/kg every 4-6 hours not to exceed 5 doses in 24 hrs

18
Q

Ibuprophen (motrin)

A

analgesic/ anti-inflammatory/ antipyretic/ anti-platelet

-dose 10mg/kg every 6-8 hours

19
Q

Ketorolac (toradol)

A
  • NSAID Analgesic- IV, IM, or oral
  • 0.5-1.0 mg/kg
  • short term use- 5 days
  • side effects: acute renal failure, elevation liver enzymes, prolonged bleeding time. Dose lower with renal dysfunction
  • black box warning
20
Q

Narcotics- Opiates

A
  • MS, Fentanyl (100 x more potent than MS), Dilaudid, Codeine
  • Mu receptors
  • No ceiling on analgesic effect
  • Narcan antagonist
  • Common side effects- respiratory depression, hypotension, constipation, euphoria, histamine release- itching
21
Q

Morphine Opiate Analgesic

A
  • analgesic effect, sedation, some immobility
  • IV loading dose- 0.05-0.1 mg/kg slowly
  • dilute in peds- titrate to effect
  • peak for respiratory depression 20 minutes
  • causes histamine release– itching, flushing, rash/hives
  • Respiratory depression; hypotension
  • antidote- nalaxone
22
Q

Fentanyl Opiate Analgesic

A
  • analgesia, sedation, some immobility
  • 100 times more potent than morphine
  • oralet, IM, IV
  • 1-2micrograms/kg to begin-titrate to effect
  • rapid IV onset- 1-5 minutes;
  • duration- 1/2-1 hour
  • antidote- nalaxone
  • give slowly-may cause skeletal muscle or chest wall rigidity
23
Q

Hydromorphone (Dilaudid)

A
  • can be given PO, IM, IV, R
  • about 7 x more potent than MS
  • IV onset almost immediate
  • Half life= 2.5 hrs
  • Dosage- .015 mg/kg every 4-6 hrs
24
Q

Reversal Agent- Nalaxone/Narcan (opiates)

A
  • displaces opioid drugs at the opioid receptor site
  • what do you want to reverse
  • give IV slowly until desired response
  • Onset- 2 minutes, may repeat every 2-3 minutes
  • duration 15-60 minutes- beware- re sedation
25
Q

Benzodiazepines Biazepam (Valium)

A
  • induces sedation, antianxiety, some immobility, some amnestic properties, great muscle relaxant, no analgesia
  • requires ability to support airway
  • respiratory depression/apnea
  • painful IM or IV
  • doesnt mix well with other drugs/fluids
  • re sedation effects with oral med 6-8 hours
26
Q

Benzodiazepines Midazolam (Versed)

A
  • midazolam (versed)
  • immobility +sedation +amnesia +antianxiolytic
  • unpredictable as primary agent particularly in young children- usually secondary agent
  • often requires cardiac monitoring
  • variety of routes
  • IV- burns (10-15 min)
  • Requires ability to support airway
  • Antidote- Flumazenil
27
Q

Reversal Agent- Flumazenil (Romazicon) (Benzodiazepines)

A
  • Reverses induced sedation and amnesia. May not effectively reverse hypoventilation
  • Rapid onset; Duration < 1 hour
  • Painful IV; give slowly 1/2-1 minute
  • may cause seizures
28
Q

Coanalesics- Tricyclic antidepressants (TCAs)

A
  • neuropathic pain shingles
  • Lower doses avoid some common TCA SEs-sedation, dry mouth, urinary retention
  • Beward the overdose
29
Q

Coanalgesics Gabapentin (Neurontin)

A
  • Gabapentin (Neurontin) anticonvulsant- good for neuropathic pain-primarily affects C fibers
  • Gluccocorticoids- reduce edema in tumor and nerve tissue, bone mets
  • 5% Lidocaine patches-postherpetic neuraligia- on 12 hrs off 12 hrs
30
Q

EMLA LMX4 Synera (topical)

A

EMLA- lidocaine/prilocaine combination 45-60 min application, Rx required, patch or cream

  • LMx4- 4% Lidocaine- 15 min application, over the counter, cream transparent drsg.
  • Synera- Lidocaine (70)/Tetracaine (70) patch
  • some blanching of skin
  • contraindications: methemoglobinemia (EMLA), allergy to lidocaine
31
Q

Topical Anesthetics TAC/LAT (LET)

A
  • tetracaine/adrenaline/cocaine
  • Lidocaine/adrenaline/tetracaine
  • apply to wound with gauze
  • 15-20 minute onset
  • Do not use on mucous membranes
  • No adrenaline on end arterioles
32
Q

J Tip Compressed Gas Driven Syringe

A
  • Needle Free
  • Med Delivered under pressure from compressed gas (Co2)
  • Buffered (Sodium Bicarb) Lidocaine
  • Delivers SQ 5-8 mm in 2 seconds
  • Advantages- no needle, short wait time, no vasoconstriction/blanching
33
Q

Tissue Adhesives Histoacryl Blue/Cyanoacrylate

A
  • minor laceration repair
  • relatively painless
  • Decreased time of repair
  • Negates need for follow-up
  • Cosmetic- as good as if not better

Pediatric Nursing (4 decks)

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