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pain. Flashcards

1
Q

describe pain

A
  • every child has own perception of pain
  • unpleasant sensory and emotional experience associated with actual or potential tissue damage
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2
Q

management of pain involves…

A
  • age appropriate assessment of pain
  • selecting and implementing an appropriate method to relieve pain
  • evaluating effectivness of intervention
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3
Q

describe acute pain

A
  • sudden, shrt duration caused by a single event
  • can also be an exacerbation of a chronic condition
  • examples include surgery/injury and sickle cell crisis
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4
Q

describe chronic pain

A
  • lasting longer than 3 months, persistent
  • lasts beyond the normal healing time
  • can be disruptive to daily function
  • affects entire CNS -> increased responsiveness to both painful and painless stimuli
  • examples include juvenile idiopathic arthritis, cancer, neuropathic pain (abnormal processing of pain by peripheral or CNS)
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5
Q

a child’s response to pain can be influenced by…

A
  • maturation of nervous system
  • developmental stage
  • cognitive level
  • temperment
  • family/culture
  • situational factors
  • previous pain experience

these things may increase or decrease the intensity of the pain perceived

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6
Q

true or bullshit

neonates and infants do not feel pain

A

bullshit

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7
Q

true or bullshit

children do no feel pain with the same intensity as adults

A

bullshit

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8
Q

true or bullshit

infants are incapable of expressing pain

A

bullshit

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9
Q

true or bullshit

infants and children remember pain

A

true

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10
Q

true or bullshit

parents may exaggerate their child’s pain

A

bullshit

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11
Q

true or bullshit

children are not in pain if they can be distracted or are sleeping

A

bullshit

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12
Q

true or bullshit

repeated experience with pain teaches the child to be more tolerant of pain and cope better

A

bullshit

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13
Q

true or bullshit

children do not recover more quickly than adults from painful experiences such as surgery

A

true

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14
Q

true or bullshit

children wont tell if they are in pain and need medication even if they do not appear to be in pain

A

true

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15
Q

true or bullshit

children without obvious physical reasons for pain are not likely in pain

A

bullshit

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16
Q

true or bullshit

children are at risk for addiction

A

bullshit

can have physical dependence but not really addiction

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17
Q

true or bullshit

culture does not affect pain response in children

A

bullshit

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18
Q

what are some common pain states that children may experience?

A
  • painful and invasive procedures: procedrual sedation and analgesia
  • post op pain: associated with surgery, controlled with a combo of meds
  • burn pain: multiple compenents, difficult and challenging to control
  • recurrent headaches: tension, dental braces, weakness of eye muscles, sinusitis, epilepsy, sleep apnea, injury
  • recurrent abdominal pain: common in children
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19
Q

what are some respiratory consequences of unrelieved pain

A
  • shallow breathing
  • inadequate lung expansion
  • poor cough
  • potential for pneumonia
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20
Q

what are some neurologic consequences of unrelieved pain

A
  • increases SNS activity and release of catecholamines
  • tachycardia
  • hypertension
  • change in sleep (more or less)
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21
Q

what are some metabolic consequences of unrelieved pain

A
  • increased metabolic rate = perspiration
  • increased cortisol and blood glucose
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22
Q

what are some immune consequences of unrelieved pain

A
  • depression of immune system and anti inflammatory response
  • causes increased risk of infection/delayed wound healing
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23
Q

what are some GI consequences of unrelieved pain

A
  • delayed return of GI function
  • anorexia, poor nutritional intake
  • ileus
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24
Q

what are some pain consequences of unrelieved pain

A

altered resposne to pain

25
Q

what is the goal of assessing pain in children

A

provide accurate information about location of pain and its effects on the child

26
Q

what should you ask parents about their child’s pain

A

ask them about “typical” pain responses of the child

27
Q

what indicators are measured by pain assessment tools?

A
  • behavior measures
  • self reporting of pain
28
Q

do pain assessment tools use vital signs as indicators of pain?

A

nope

29
Q

what are some behaviors indicating pain

A
  • crying
  • restlessness or agitation
  • hyper-alertness or vigilance
  • sleep disturbances
  • irritability, cant be comforted
30
Q

describe using pain rating scales

A
  • select: select a scal suitable for the child’s developmental age and preferences
  • teach: teach the child to use scale before pain is expected (preop)
  • use: use the same scale with child each time pain is assessed
  • ask: ask child about acceptable or functional pain level
  • reassess: reassess c/o pain within one hour
31
Q

name and describe some pain scales for preterm and neonates

A
  • NIPS: evaluates procedural pain
  • CRIES: evaluates post op pain in ICU
  • PIPP: evaluates procedural pain, used for infants between 28-40wks gestation

these rely on nurses observation

32
Q

what pain scale is used for infants and young children and describe it

A

FLACC

  • faces, legs, activity, cry, consolability
  • also used for developmental delay
  • for acute pain state
  • used when unable to self report pain
33
Q

what are some important things to consider when using the FLACC scale

A
  • pain levels should be assessed prior to hands on care
  • dont use if they are able to self report
34
Q

name some pain scales for children to adults

A
  • FACES
  • oucher
  • visual analogue or numerical scale
35
Q

describe FACES

A
  • 0-5, point to face that corresponds to number
  • as young as 3yrs
36
Q

describe oucher

A
  • series of six photos of faces
  • 0-10 scale
  • 3-12yrs
37
Q

describe visual analogue or numerical scale

A

0 = no pain
10 = worst pain

for 9yrs to adult

38
Q

name some drugs used for pain management

A
  • opioids like morphine, dilaudid
  • NO demoral (meperidine) or codeine
  • NSAIDS like toradol and ibuprofen
  • nonnarcotic analgesics like tylenol
39
Q

what drugs are used for mild to moderate pain

A

non opioid like tylenol and NSAIDS

40
Q

what drugs are used for moderate to severe pain

A

opioids like morphine sulfate and dilaudid

41
Q

what are some side effects associated with opioids

A
  • resp depression and sedation
  • constipation
  • pruritis
  • nausea, vomiting
  • urinary retention
42
Q

what orders would you expect to see to combat the side effects of opioids?

A
  • antiemetics
  • stool softeners
  • antihistamines
43
Q

what drug is used to reverse opioid adverse effects?

A

naloxone

44
Q

what signs may alert you to the development of opioid related repiratory depression?

A
  • sleepiness, difficult to arouse
  • small/pinpoint pupils
  • very shallow breathing

frequent cardio/resp monitoring is essential, actually visualizing the patient is wayyy mor accurate than vital monitors

45
Q

what are some consequences of long term opioid use

A
  • physical dependence
  • tolerance
  • withdrawal
46
Q

whats a side effect of acetaminophen

A

liver damage with overdose

47
Q

what drug is used to reverse the adverse effects of acetaminophen?

A

acetylcysteine

48
Q

whats a side effect of ibuprofen and ketorolac

A

increase risk of GI irritation, ulceration, and bleeding

49
Q

what are some different routes for pain management meds

A
  • IV: intermittent or continuous
  • oral
  • rectal
  • IM
  • PCA: demand/basal infusion, 5 yrs and older
  • epidural
50
Q

describe using PCA for pain management

A
  • basal/demand
  • gives child control and overall better pain management
  • child has to be old enough and cognitively able to understand it
51
Q

what are some complementary nonpharmacologic therapies for pain management

A
  • distraction, guided imagery, relaxation techniques
  • breathing techniques
  • cutaneous stimulation
  • “sweeties” up to 12mo
  • heat and cold
  • acupuncture

can be used alone or with pharm

52
Q

what are you assessing in nursing management of pain

A
  • pain scale at least every 4 hours
  • IV sites
  • PCA/epidural pumps set correctly
  • side effects of meds
  • effectiveness of pain meds
53
Q

whats included in the nursing management of pain

A

increase
- increase comfort during painful procedures
- topical or local anesthetics
- heat/cold

teach
- teach use of complementary therapies
- both parents and child

listen
- listen to parents
- pain rating and what works for the child

54
Q

what may be used for pain management during a procedure

A
  • vapocoolant sprays
  • EMLA cream: mixture of lidocaine and prilocaine
  • other topical anesthetics
55
Q

describe an individulaized treatment plan for a child with chronic pain

A
  • improve function and comfort
  • includes meds, bowel program, exercise, PT, complementary therapies
56
Q

can chronic pain in kiddos lead to prejudice?

A

yep

57
Q

descibe procedural sedation

A
  • used for painful diagnostic and therapeutic procedures
  • chest tube insertion, arterial puncture, burn debridement, laceration repair, bone marrow aspiration, fracture reduction
  • moderate or deep
58
Q

what is the goal of procedural sedation

A
  • prevent or relieve pain and anxiety
  • ease of doing procedure
  • prevent complications
59
Q

describe nursing management of procedural sedation

A

educate parents
- fasting prior to procedure and for some time after
- may have adverse effects
- watch closely afterwards and dont leave em alone near bodies of water

premedicate
- prevent procedure related pain and anxiety
- pain meds should always be used with sedation

monitor child
- during procedure
- visual confirmation of resp status

peds (15 decks)

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