Pediatric Palliative Care Flashcards
Use of Faces pain scale revised (FPS-R)
Age: 4-12 yo self reported by child
Quick to use
Pieces of hurt tool/poker chip tool
Age: 3-12 yo (less reliable for 3-4yo)
Self reported by kid
concrete ordinal rating scale
Visual analogue scale
Age: above 8 yo
self reported by child
Sensitive to change, correlates with parents ratings of kids pain
Con: more recall bias, high degree of abstraction
The oucher photographic scale
Age: 3-12 yo
color photo of childs face with different pain expressions
Numerical rating scale (NRS)
Age: older than 8yo
scale of 1-10
Opioid differences in neonates (<3mo)
Immature liver fxn–> slower metabolism
Decreased clearance by kidneys
High ratio of body water:fat –> increases volume of distribution–> increase duration of action
Lower levels of albumin and glycoprotein–> increase ratio of unbound (active):bound (inactive) drug–> increase effect of each dose
Reduced ventilatory response to low O2 and high CO2–> inadequate gas exchange
CRIES
Age: Pain scale for neonates
Crying (no, high pitched, inconsolable)
Requires O2 for sat >95%
Increased vital signs
Expression (grimace)
Sleepless
FLACC pain assessment
When do kids develop pain specific language
17-23mo
What age do kids add descriptive language to pain specific language
30mo
What age can kids explain the intensity of pain
4-6yo
What age can kids localize pain and discuss causation?
7-11yo
Duration and peak of hydromorphone
Duration: 4h
Peak:
- PO 45-60min
- SC 15-30 min
- IV 5-15min
Duration and peak of fentanyl
Duration 30-60min
Peak:
- SC 15-30min
- IV 5-15min
Rate to titrate opioids
Mild-mod pain -> 25-50%
Mod to severe-> 50-100%
