(SYNOPTIC) Neonates + Paediatrics Flashcards
How do we assess pain in children?
Self-report (if child is able)
Behavioural indicators
Physiological indicators
How should pain be assessed when they are unable to tell you verbally, i.e. a neonate?
Facial Expression?
0 - relaxed
1 - grimace
Crying?
0 - no
1 - whimper
2 - vigorous crying
Arms?
0 - relaxed
1 - flexed/ extended
Legs?
0 - relaxed
1 - flexed/ extended
Posture?
0 - relaxed
1 - flexed/ extended
State of arousal?
0 - asleep/ awake
1 - restless
Heart rate?
0 - baseline
1 - increase by 10-40BPM
2 - increase by ≥40BPM
Respiratory rate?
0 - baseline
1 - alteration in breathing
When observing pain of a neonate, and having allocated a score, how are the scores interpreted?
1-3: Nurse-controlled measure
- non-nutritive sucking
- repositioning
4-7: Consider sucrose/ alternative pain relief + nurse-controlled measures
8-10: Review with medical team
- discuss alternative prescription for pain relief
What is FLACC, with regard to pain?
Pain assessment score
Face Legs Activity Crying Consolability
What are some behavioural indicators of pain?
- Irritability
- Unusual quietness or lethargy
- Restlessness
- Sobbing, screaming or whimpering
- Increased clinging
- Loss of appetite
- Laying ‘scared stiff’
What are some physiological indicators of pain?
- heart rate
- respiratory rate
- blood oxygen
- blood pressure
Treatment for mild pain
Paracetamol
Treatment for mild to moderate pain
Paracetamol + NSAID
Treatment for moderate pain
Paracetamol + NSAID + codeine?? look at codeine cards
Treatment for severe and very pain
Paracetamol + NSAID + morphine
For what patient age group is codeine considered suitable?
Patients older than 12
For what patient age group is codeine contraindicated?
All children under 18yrs who undergo removal of tonsils/ adenoids
For the purpose of sleep apnoea
What do you do in suspected asthma?
Diagnosis and assessment
What do you do in diagnosed asthma?
- assess symptoms
- measure lung function
- check inhaler technique and adherence
- adjust dose appropriately (up or down)
- update self-management plan
What is the management of suspected asthma in neonates and paediatrics?
Initiation of treatment with very low-> low dose ICS
What is the management ladder of diagnosed asthma in neonates and paediatrics?
(1) Regular preventer
(2) Initial add-on therapy
- VERY low dose ICS
- ≥5 add LABA/ LTRA
- <5 add LTRA
(3) Additional controller therapies:
- Consider increasing ICS to low dose
- ≥5 add LABA/ LTRA
- no response to LABA: consider stopping
(4) Refer for specialist care
When would you consider moving up the ladder?
If using 3 doses or more a week
If child is at 5 and still have symptoms what would we do?
Objective tests
- FeNO
- Spirometry
- Bronchodilator reversibility
Monitor peak flow for 2-4 weeks if there is diagnostic uncertainty
FeNO
35ppb or more
Spirometry
FEV1/FVC ratio < 70%
What is LTRA treatment?
Leukotriene receptor antagonist therapy
What dose of beclometasone dipropionate is considered to be a very low dose for use in children?
50 microgram
2 puffs
BD
What dose of beclometasone dipropionate is considered to be a low dose for use in children?
100 micrograms
2 puffs
BD
What dose of beclometasone dipropionate is considered to be a medium dose for use in children?
200 micrograms
2 puffs
BD
