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NRSG 329 > Week 4 - Pain and Palliation > Flashcards

Week 4 - Pain and Palliation Flashcards

1
Q

What is pain?

A

pain is whatever the person says it is existing where ever the person says it does

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2
Q

what are the 3 types of pain?

A
  • somatic/ nociceptive
  • visceral
  • neuropathic
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3
Q

describe somatic/ nociceptive pain

A

injury to body tissue

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4
Q

describe visceral pain, provide examples

A
  • comping from the visceral organs
  • normally referred pain
  • ex. heart, liver, GI
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5
Q

describe neuropathic pain

A

central or peripheral nerve pain

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6
Q

what are the 2 classifications for pain? describe them

A
  1. acute
    - <6 months
    - comes at a quicker onset/ leaves easier
  2. chronic
    - >6 months
    - comes in intense waves
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7
Q

define tolerance

A

physical adaption of the need of medication

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8
Q

define physical dependence

A
  • physical effect
  • withdrawal symptoms
  • ex. caffeine > migraines
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9
Q

define addiction

A
  • Maladaptive behavioural pattern characterized by drug-seeking behaviour
  • intense craving for a drug’s mind altering properties rather than use for intended medical purpose
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10
Q

how does pain over stimulate the endocrine system?

A

increases:
- stress hormone
- metabolic rate
- HR
- water retention

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11
Q

how does pain over stimulate the immune system?

A

impaires immune function

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12
Q

how does pain over stimulate the pulmonary system?

A

decreases flow and volume which leads to retained secretions and atelectasis

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13
Q

how does pain over stimulate the cardiovascular system?

A

increases:
- HR
- cardiac output
- systemic vascular resistance
- BP
- oxygen consumption

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14
Q

how does pain over stimulate the musculoskeletal system?

A
  • decreases muscle function
  • fatigue
  • immobility
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15
Q

what are the assessment principles you need to follow?

A
  • systematic approach
  • evaluate efficiency of all interventions
  • document efficacy of interventions
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16
Q

what do you use QUESTT for?

A

systemic approach to assess pain

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17
Q

what does QUESTT stand for?

A

Q - questioning the child
U - use a pain scale
E - evaluate behaviour
S - secure the parents involvement
T - take into account cause of pain
T - take action

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18
Q

how do we assess pain?

A
  • QUESTT
  • LOWTARP
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19
Q

what does LOWTARP stand for?

A

L - location
O - onset
W - worsening
T - type of pain
A - alleviating/ associated symptoms
R - radiating
P - provoking/ precipitating

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20
Q

experience of pain is affected by what?

A
  • how parents react
  • stage of growth/ development
  • cognitive level
  • emotions (anxiety/ depression)
  • gender
  • culture
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21
Q

what are factors that influence pain in children?

A
  • cognitive factors
  • behavioural factors
  • emotional factors
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22
Q

in regards to factors that influence pain in children, describe cognitive factors

A
  • understanding pain source
  • ability to control what will happen
  • expectations about quality/ strength of pain
  • whether attention is focused on painful event
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23
Q

in regards to factors that influence pain in children, describe behavioural factors

A
  • use of pain control strategy
  • response of parents/ healthcare works
  • whether or not restrained
  • ability to continue usual activities
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24
Q

in regards to factors that influence pain in children, describe emotional factors

A
  • fear
  • anxiety
  • frustration
  • anger
  • depression
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25
Q

what are some examples for objective data for behavioural clues to pain?

A
  • guarding
  • impaired thought process
  • social withdrawal
  • introspection
  • altered time perception
  • moaning
  • crying
  • pacing
  • restless behaviour
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26
Q

what do infants response to pain look like?

A
  • using all facial muscles
  • red in color
  • pull their legs up to the sides
  • may refuse to eat
  • may not cry if in severe pain
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27
Q

what do toddlers response to pain look like?

A
  • crying
  • screaming
  • protest
  • withdraw
  • easy to identify pain but difficult to assess
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28
Q

what do preschoolers response to pain look like?

A
  • cry
  • localize body part
  • anticipate painful procedures
  • body image concerns
  • use more general terms/ not able to accurately differentiate
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29
Q

what do school-aged children’s response to pain look like?

A
  • body image concerns
  • may assume pain is punishment
  • concrete thinkers/ cause and effect
  • all or nothing mentality
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30
Q

what do adolescence response to pain look like?

A
  • assume pain will be treated
  • can conceptualize pain relief
  • may hide pain/ hesitate to report if they think everything is being done to relieve it
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31
Q

what pain assessment tools would you use for newborn/ infants?

A
  • CRIES
  • NIPS
  • premature infant pain scale
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32
Q

what pain assessment tools would you use for toddlers?

A
  • FLACC
  • oucher
  • faces pain-relating scale
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33
Q

what pain assessment tools would you use for preschooler?

A
  • oucher
  • faces pain-relating scale
  • FLACC
  • body outline
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34
Q

what pain assessment tools would you use for school age?

A
  • oucher
  • faces pain-relating scale
  • word graphic
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35
Q

what pain assessment tools would you use for adolescents?

A
  • oucher
  • faces pain-relating scale
  • numeric
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36
Q

what is the most common pain assessment tool that is used for adolescents?

A

numeric

37
Q

what does NIPS stand for?

A

N - neonatal
I - infant
P - pain
S - scale

38
Q

what is included in the NIPS scale?

A
  • facial expression
  • cry
  • breathing patterns
  • arm movements
  • leg movements
  • state of arousal
39
Q

What does FLACC stand for?

A

F - face
L - legs
A - activity
C - cry
C - consolability

40
Q

in order to effectively use a pain scale, the child must have an understanding of what?

A
  • a little and a lot of pain
  • be able to communicate about it
41
Q

how do you assess language skills?

A

able to:
- use words in sequence
- follow simple directions
- answer simple questions

42
Q

what is the most common side effect we will see from opioids on a paediatric floor?

A

nausea and vomiting

43
Q

what are some side effects we will see as a result of opioids?

A
  • allergy (rare)
  • itch (histamine release)
  • constipation
  • dysphoria/ hallucinations
  • respiratory distress
44
Q

what is the most common reason we give opioids in peds?

A

post operatively

45
Q

in regards to side effects we might see from opioids describe what allergies might look like and what we would do

A
  • hives/ rash
  • wheezing
  • SOB
  • stop opioids
  • call physician
46
Q

in regards to side effects we might see from opioids describe what itch/ histamine release might look like and what we would do

A
  • itching
  • sneezing
  • asthma exacerbation
  • continue opioid/ treatment
  • go to PO
  • antihistamine
47
Q

in regards to side effects we might see from opioids describe how you would treat constipaiton

A
  • docusate
  • bisacodyl
  • lactulose
48
Q

in regards to side effects we might see from opioids describe what dyysphoria/ hallucinations might look like and what we would do

A
  • poorly reported
  • decrease or stop opiates as tolerated
49
Q

in regards to side effects we might see from opioids describe what respiratory depression might look like and what we would do

A
  • naloxone
  • follow protocol
50
Q

what are the most common medications we give in peds?

A
  • acetaminophen
  • NSAID’s
51
Q

what are some examples for acetaminophen?

A
  • tylenol
  • paracetamol
52
Q

what is a possible problem of acetaminophen ?

A

liver toxicity

53
Q

if children are at risk for liver toxicity due to much acetaminophen what would this look like?

A
  • persistent nausea and vomiting
  • prolonged fasting
  • anorexia
54
Q

what are examples of NSAIDs?

A
  • advil
  • ibuprofen
  • naproxen
  • ketorolac
55
Q

what is the only parenteral NSAID?

A

ketorolac

56
Q

what is ketorolac used for?

A

breakthrough pain and post op

57
Q

what are the most common side effects of NSAIDs?

A
  • upset stomach
  • stomach ulcers
58
Q

what are the different non-pharmacological pain management options?

A
  • preparation
  • distraction
  • self exercises
  • relaxation
59
Q

in regards to the different non-pharmacological pain management options, which age groups are most appropriate for preparation?

A
  • preschool
  • school aged
  • adolescent (limited to toddlers)
60
Q

in regards to the different non-pharmacological pain management options, which age groups are most appropriate for distraction?

A
  • all age groups specifically acute pain
61
Q

in regards to the different non-pharmacological pain management options, which age groups are most appropriate for self exercise?

A

older children

62
Q

in regards to the different non-pharmacological pain management options, which age groups are most appropriate for relaxation?

A
  • school aged or adolescent
  • useful for chronic pain
63
Q

what does paediatric palliative care refer to?

A

caring for or comforting children living with progressive life threatening illnesses

64
Q

describe life threatening illnesses

A

conditions where survival to adulthood is a challenge

65
Q

in regards to quality of life, as nurses one of our most important jobs is to ensure what?

A

quality of life is maintained in our palliative patients

66
Q

what is included in quality of life specifically for physical aspects

A
  • functional ability
  • strength/ fatigue
  • sleep/ nausea
  • appetite
  • constipation
  • pain
67
Q

when values of the patient differ from values of the parents what do you do?

A
  • put the child’s values first and manage their pain then educate the parents
  • always listen to the child first
68
Q

what is included in quality of life specifically for psychological aspects

A
  • anxiety
  • depression
  • enjoyment/ leisure
  • pain distress
  • happiness
  • fear
  • cognition/ attention
69
Q

what is included in quality of life specifically for social aspects

A
  • financial burden
  • caregiver burden
  • roles & relationships
  • affection/ sexual function
  • appearance
70
Q

what is included in quality of life specifically for spiritual aspects

A
  • hope
  • suffering
  • meaning of pain
  • religion
  • transcendence
71
Q

what does transcendence mean?

A

moving past the experience and making meaning out of it

72
Q

what does the role of the nurse with a dying child include?

A
  • grieving
  • palliative care
  • location of death
  • assisting family with end off life decision making
  • allowing natural death
  • involving dying child in the decision making process
  • organ or tissue donation
  • caring for the nurse caring for the child
73
Q

what does anticipatory grief mean?

A
  • see early on and then later before death
  • grieving the loss that hasn’t happened yet
74
Q

what does acute grief mean?

A
  • intense yearning or longing for the person who died
  • intrusive or preoccupying thoughts or images of the deceased person
  • a sense of loss of meaning or purpose in a life without the deceased
75
Q

how do infants conceptualize death?

A

no concept of death

76
Q

how do toddlers conceptualize death?

A
  • don’t understand death as a permanent condition
  • effected by emotions surrounding family
77
Q

how do preschoolers conceptualize death?

A
  • temporary and reversible
  • form of punishment
  • feeling of guilt/ shame
78
Q

how do school ages conceptualize death?

A
  • can think about it but have a difficult time relating it to themselves
  • think they can escape it
  • curiosity/ uncertainty for life after death
79
Q

how do adolescence conceptualize death?

A
  • good understanding of death
  • feeling of immortality
  • diagnosis can impact self esteem/ identity
80
Q

can palliative care occur simultaneously with curative care?

A

yes

81
Q

what are the general principles of palliative care for children?

A
  • child/ family viewed as unit of care
  • interdisciplinary team approach
  • ongoing assessment/ clarification of desires/ priorities important
  • quality of life is subjective
82
Q

what are goals for intensive care?

A
  • fight death
  • cure
  • prolong life at all costs
83
Q

what are goals for palliative care?

A
  • promote physical, psychological, spiritual, social comfort
  • promote acceptance of death as an outcome
84
Q

what is the most common mode of death in the paediatric intensive care unit?

A

limitation or withdrawal of life sustaining therapy

85
Q

what are different types of life sustaining therapies that could potentially be stopped?

A
  • mechanical ventilation
  • vasoactive infusions
  • renal replacement therapies
  • invasive catheters
  • extracorporeal membrane oxygenation
  • antibiotics
  • IV fluids
  • feeds
86
Q

what are some factors contributing to the PARENTS decisions to forgo life sustaining treatments?

A
  • quality of life
  • likelihood of improvement
  • pain/ discomfort
  • unlikely to survive hospitalization
  • information the staff provided
  • religious/ spiritual beliefs
  • Childs appearance/ behaviour
87
Q

what are some factors contributing to the PARENTS decisions to forgo life sustaining treatments?

A
  • quality of life
  • likelihood of improvement
  • pain/ discomfort
  • unlikely to survive hospitalization
  • information the staff provided
  • religious/ spiritual beliefs
  • Childs appearance/ behaviourwhat are some factors contributing to the PARENTS decisions to forgo life sustaining treatments?
88
Q

what are some factors contributing to the CLINICIANS decisions to forgo life sustaining treatments?

A

-no benefit
- excessive burden
- no relational benefit
- diagonsis
- acute vs. chronic disease
- perceived benefit
- prognosis
- family preference
- probability of survival
- functional status

89
Q

the ideal decision making process begins where?

A

early during ICU admission with multidisciplinary meeting

NRSG 329 (5 decks)

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