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NU 374 > Vital Signs, Pain Assessment and Communication with Pediatrics > Flashcards

Vital Signs, Pain Assessment and Communication with Pediatrics Flashcards

1
Q

first step in assessing pain

A

understanding their previous experience with pain

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2
Q

the assessment tool used for pain severity is dependent on the child’s __

A
  • age
  • cognitive development
  • ability to communicate
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3
Q

older school age children typically report the severity of their pain on what scale?

A

(numeric) 0-10 scale
- 0 is no pain, 5 is moderate pain, 10 is worst pain possible

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4
Q

what is the verbal pain scale?

A

mild, moderate, severe

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5
Q

what is the wong-baker faces pain rating scale?

A

uses 6 faces, each representing a different level of pain
- smiling face = no pain
- crying face = worst pain
- child points to the face that depicts their pain
- used as young as 3 years old (often used in older preschoolers)

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6
Q

the most reliable indicator of pain

A

patient’s own report

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7
Q

what observable behaviors may be indicative of pain in a person that cannot verbally express their pain?

A
  • irritability
  • restlessness
  • moaning
  • grimacing
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8
Q

premature infant pain profile (PIPP)

A

a scoring system for preterm infants that uses
- facial expressions
- behaviors
- vital signs
to determine pain levels

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9
Q

FLACC scale

A

Facial expression
Leg movement
Activity
Cry
Consolability
- measures pain in infants and children
- used with patients with CI up to age 19
- scores 0-10

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10
Q

comfort scale

A

measures distress in unconscious & ventilated infants, children, and adolescents using indicators such as
- blood pressure
- muscle tone
- facial tension

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11
Q

pain characteristics

A
  • achy vs. sharp
  • what makes pain better/worse
  • how pain keeps from usual activities
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12
Q

pain characteristic information is gathered by the nurse from who?

A
  • depending on the patient’s age/cognitive ability, either the patient or their caregivers
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13
Q

nursing care to pediatric patients experiencing pain includes

A
  • pharmacologic
  • non-pharmacologic
    *has to be appropriate for patient’s age and developmental stage
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14
Q

pharmacologic interventions to pain

A
  • Mild-Moderate pain: non-opioids (acetaminophen, NSAIDs)
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15
Q

when administering pharmacologic interventions, the nurse must do what before and after? why?

A

assess for pain before and after
- measures the effectiveness of the intervention

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16
Q

what do you have to monitor when giving your pedi patient opioids?

A
  • constipation
  • pruritus
  • nausea
  • vomiting
  • sedation
  • respiratory depression
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17
Q

non-pharmacologic interventions are used to ___

A
  • help decrease pain perception
  • decrease feelings of anxiety and fear
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18
Q

pain is

A

a feeling of discomfort and an emotional experience
- common in all age groups

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19
Q

optimal pain management is achieved when the nurse

A
  • completes age-appropriate pain assessments
  • self report scales
  • objective measures
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20
Q

effective management of pain in children is

A

tailored to the individual
- includes pharmacologic and non-pharmacologic interventions

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21
Q

respiratory rate in infants and young children should be counted for how long? why?

A
  • 1 full minute
  • young children and infants have irregular breathing patterns
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22
Q

the ___ child, the ___ the respiratory rate will be

A

younger children have higher RR

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23
Q

assessing heart rate for children <2 years old

A

auscultate apical heart rate for 1 minute
- stethoscope directly on patient’s chest where the apex of the heart is

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24
Q

at what age can you start palpating the radial pulse to determine heart rate?

A

age 2

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25
Q

the ___ child, the ___ the heart rate will be

A

younger children have higher heart rates

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26
Q

temperature in children can be measured using what routes?

A
  • temporal: >3 months
  • axillary: <3 months
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27
Q

in children, where do we want the SpO2 level to be?

A

> 92%
- some exceptions (ie cardiac patient with congenital heart defect)

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28
Q

blood pressure should be taken when?

A

when the child is calm
- to prevent a falsely high reading

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29
Q

blood pressure cuff placement

A
  • on an upper extremity
  • make sure it is the appropriate size for the patient
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30
Q

if the BP cuff is too small, how will the reading be affected?

A

inappropriately high BP reading

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31
Q

if the BP cuff is too large, how will the reading be affected?

A

inappropriately low BP reading

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32
Q

how can you determine if the patient’s BP is normal? (hint: equation)

A

SBP = 70 + (age in years x 2)

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33
Q

blood pressure increases with increasing ___ and ____

A

height and weight
- larger child will have a slightly higher BP than a smaller child

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34
Q

what is the last vital sign to change in a really sick child?

A

blood pressure

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35
Q

if a pedi patient has an abnormal HR and RR, but normal BP, this could be indicative of ___

A

could still be a sign for potential clinical decline

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36
Q

infant (0-12 months): normal heart rate

A

75-130

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37
Q

infant (0-12 months): normal respirations

A

25-35

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38
Q

infant (0-12 months): normal blood pressure

A

systolic: 65-100
diastolic: 45-65

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39
Q

toddler (1-3 years): normal heart rate

A

65-100

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40
Q

toddler (1-3 years): normal respirations

A

25-35

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41
Q

toddler (1-3 years): normal blood pressure

A

systolic: 90-105
diastolic: 50-65

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42
Q

preschooler (3-6 years): normal heart rate

A

65-100

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43
Q

preschooler (3-6 years): normal respirations

A

25-30

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44
Q

preschooler (3-6 years): normal blood pressure

A

systolic: 95-110
diastolic: 55-70

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45
Q

school-age (6-12 years): normal heart rate

A

58-90

46
Q

school-age (6-12 years): normal respirations

A

20-25

47
Q

school-age (6-12 years): normal blood pressure

A

systolic: 100-115
diastolic: 60-75

48
Q

adolescent (12-18 years): normal heart rate

A

50-90

49
Q

adolescent (12-18 years): normal respirations

A

15-20

50
Q

adolescent (12-18 years): normal blood pressure

A

systolic: 110-125
diastolic: 70-85

51
Q

temperature range: rectal

A

97.9-100.4F
36.6-38C

52
Q

temperature: oral

A

95.9-99.5F
35.5-37.5C

53
Q

temperature: axillary

A

94.5-99.1F
34.7-37.3C

54
Q

temperature: tympanic

A

96.4-100.4F
35.8-38C

55
Q

temperature: temporal

A

97.9-100.4F
36.6-38C

56
Q

hypotensive systolic BP in infants (1-12 months)

A

<70mm Hg

57
Q

hypotensive systolic BP in children 1-10 years (5th BP percentile)

A

<70mm Hg + (age in years x 2) mm Hg

58
Q

hypotensive systolic BP in children >10 years

A

<90mm Hg

59
Q

at what age do we begin measuring BP?

A

3 years old

59
Q

oral temp should be refrained from use on children under ___

A

<5 years old

59
Q

rectal temp should be refrained if the child has

A
  • diarrhea
  • chemo
  • recent rectal surgery
60
Q

how is the tympanic temperature taken differently by age group?

A

<3 years pull pinna down and back
>3 years pull pinna up and back

61
Q

heart rate is measured at the apical site for children

A

< 2 years

62
Q

heart rate is measured at the radial site for children

A

> 2 years
- measure for 30 sec x 2
- confirm with other side- should be equal

63
Q

when auscultating the apical HR, place the stethoscope diaphragm

A
  • at 4th ICS L MCL (mid-clavicular line) for children < 7 years
  • at 5th ICS L MCL for children > 7 years
64
Q

S1 should be loudest at __

A

the apex of the heart

65
Q

apnea is defined as

A

absence of breath for > 20 seconds

66
Q

periodic breathing is

A

the absence of breath for 10-20 sec in infants
- normal

67
Q

diaphragmatic breathing vs thoracic breathing

A

d: < 7 years
t: > 7 years

68
Q

communication guidelines: infants

A

-smile
-use a soft voice
-make eye contact
-use animated facial expressions
-use tactile stimulation (rocking, holding, cuddling)
-talk out loud (as if you are talking to yourself)
-look for subtle and obvious non-verbal signs of communication (hands over face, batting ear, gagging self with fingers)

69
Q

communication guidelines: toddlers

A

-get down to the child’s level for eye contact (squatting, crouching next to them)
-smile
-use a gentle, cheerful voice
-allow tactile manipulation of equipment and environment (when appropriate)
-offer simple choices when possible (blue vs. red shirt)
-use play/games to explain or prepare the child for the procedure
-allow the child to assist with simple and safe aspects of care (helping to move a piece of equipment or open a package)
-use direct and concrete child-friendly terms: “you’re tubie is getting a drink” (IV fluid, peg tube), “I’m giving your arm a
hug” (blood pressure cuff), “getting rid of the bugs” (alcohol swab), etc.
-look for obvious non-verbal signs of communication (pushing objects away, hiding, covering mouth)

70
Q

communication guidelines: preschoolers

A

-use the techniques listed under toddlers and add:
-allow the child to participate in care if interested
-use of play and/ or role-playing to explain or prepare for the procedure
-encourage the child to use their words
-offer simple explanations if the child asks why questions

71
Q

communication guidelines: school-aged

A

-allow the child to participate in care if interested
-allow choices whenever possible
-offer explanations and reasons in simple terms to answer who, what, when, why, how questions
-make eye contact
-use praise and rewards when applicable
-offer reassurance if the child is concerned about the integrity of the body being affected by care
-allow the child to decide if the parent(s) or legal guardians should be present

72
Q

communication guidelines: adolescents

A

-“give undivided attention” (Hockenberry, Wilson, & Rodgers, 2019, p. 85).
-“be courteous, calm, honest, and open-minded” (Hockenberry, et al., 2019, p. 85).
-do your best not to overreact (Hockenberry, et al., 2019).
-avoid judging, criticizing, or offering opinions (Hockenberry, et al., 2019).
-allow choices when appropriate
-respect privacy (i.e., ask parents to leave the room if child desires)
-encourage participation in care
-use understandable language
-use active listening re: concerns/opinions
-respect autonomy but make expectations clear and be firm in approach when appropriate
-expect to ask several questions to construct one detailed answer

73
Q

communication guidelines: transgender

A

-respect privacy
-use preferred pronouns
-use their preferred name
-use active listening re: concerns/opinions
-assess for verbal and non-verbal signs and symptoms of loneliness and depression during conversations and care
-convey a non-judgmental and caring approach

74
Q

communication guidelines: cognitively impaired

A

-use a soft voice
-use understandable language/terms
-be clear and direct with explanations
-may be hypersensitive to light, noise, taste or smell; maintain decreased environmental stimulation
-announce any tactile stimulation before implementing (I’m going to touch your hand now,)
-use non-verbal language to communicate if preferred (sign language, picture board)
-encourage socially acceptable behaviors (waving hello or goodbye, saying hello, using manners)
-encourage the child to participate in dialogue if possible, using verbal and non-verbal methods

75
Q

types of pain assessment tools

A
  • behavioral (observational)
  • self-report rating scales
  • multidimensional
    **whichever is used must be used consistently by all staff
76
Q

pain should be assessed via behavioral observation for what age group?

A

infants to age 4 years

77
Q

pain should be assessed using self-reporting scales for children of what age?

A

4+ years

78
Q

NIPS stands for

A

neonatal infant pain scale

79
Q

NIPS is

A
  • behavioral scale
  • used for birth-1 month old
  • pain scores range from 0-7 (0-2 points per indicator)
  • 6 indicators
80
Q

6 indicators of NIPS

A
  • facial expression
  • cry
  • breathing
  • apnea
  • legs
  • alertness
81
Q

NIPS total score: 0-2

A

none to mild pain

82
Q

NIPS total score: 3-4

A

mild to moderate pain

83
Q

NIPS total score: >4

A

severe pain

84
Q

(NIPS) if the pain is rated a 4, what happens?

A

non-pharmacologic intervention with reassessment in 30 minutes

85
Q

(NIPS) if pain is rated >4, what happens?

A

non-pharmacological intervention, possibly pharmacologic intervention with reassessment in 30 minutes

86
Q

can FLACC scale be used with children with CI?

A

yes up until age 19

87
Q

wong-baker scale: face 1

A

score: 0
no pain/no hurt

88
Q

wong-baker scale: face 2

A

score: 2
hurts little bit

89
Q

wong-baker scale: face 3

A

score: 4
hurts little more

90
Q

wong-baker scale: face 4

A

score: 6
hurts even more

91
Q

wong-baker scale: face 5

A

score: 8
hurts a whole lot

92
Q

wong-baker scale: face 6

A

score: 10
hurts worst

93
Q

which pain scale is culturally sensitive?

A

the wong-baker scale
- faces scale has facial expressions that are culturally sensitive Caucasian, Chinese, and African American

94
Q

numeric pain rating scales are used for children

A
  • 8 years and up
  • can count and has number sense
95
Q

pain assessment tool goals: NIPS (ideal score)

A

<3

96
Q

pain assessment tool goals: FLACC (ideal score)

A

<4

97
Q

pain assessment tool goals: numeric (ideal score)

A

<4

98
Q

what should you do with every pain assessment?

A

vital signs

99
Q

pain in children with communication or CI is assessed via the

A

NCCPC-r: non-communicating children’s pain checklist-revised
- score of 7 or higher is indicative of pain

or
PICIC: pain indictor for communicatively impaired children

100
Q

NCCPC-r categories of assessment

A
  • vocal
  • social
  • facial
  • body and limbs
  • physiological
  • eating/sleeping

*score 0 (not at all) - 3 (very often) or NA

101
Q

how would you assess chronic or reoccurring pain in a pedi?

A
  • pediatric pain tool
  • adolescent pediatric pain tool
102
Q

the pediatric pain tool and the adolescent pediatric pain tool should be used when:

A
  • difficult to isolate pain symptoms from other symptoms
  • difficult to localize pain
  • rating pain does not always accurately convey to others how they really feel
  • need a tool that assess pain and functional disability
103
Q

general observational/behavioral s/sx of pain

A
  • crying
  • guarding
  • decreased sleep
  • not eating
  • eyes shut
  • squeezing facial features
  • withdrawn
104
Q

general physiologic s/sx of pain

A

increased
- HR
- RR
- BP
- temp
*think increased Vitals

105
Q

FLACC total score: 0

A

no pain

106
Q

FLACC total score: 1-3

A

mild pain

107
Q

FLACC total score: 4-6

A

moderate pain

108
Q

FLACC total score: >7

A

severe pain

NU 374 (18 decks)

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