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NRSG 329- Peds > Week 4- Chronic Illness and Pain > Flashcards

Week 4- Chronic Illness and Pain Flashcards

(75 cards)

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1
Q

What is Pediatric Palliative Care?

A

caring for or comforting children living with progressive, life-threatening illnesses

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2
Q

life threatening illness is

A

illnesses where survival to adulthood is a challenge. In a medical context, “palliative” means to care or to comfort, as opposed to curing

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3
Q

General Principles of Palliative Care for Children

A
  1. Simultaneous care: cure and palliative care, goal to increase QOL
  2. Family centered Approach
    - The child and family are viewed as the unit of care, addressing their collective needs
  3. interdisciplinary team
    collaborates to deliver comprehensive, coordinated palliative care.
  4. Ongoing assessment
    Continuous evaluation of the child and family’s desires and priorities is crucial to guide the care plan.
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4
Q

Psychological QOL

A

Emotions, feelings
Perspective on what it happening
Open communication
Anxiety
Depression/ anger
Enjoyment/leisure
Pain distress
Happiness
Fear
Cognition/attention

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5
Q

Social QOL

A

Live as normal a life as possible
Family/friends
Advocating for advance financial social support
Financial burden
Roles and relationships
Access to resources
Affection/sexual function
Appearance

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6
Q

Spiritual QOL

A

Complex individual
Peace hope positive outlook on life
Religion
Alleviating suffering
Meaning of pain
Transcendence (makes meaning of the experience

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7
Q

Clinical Definition of Pain

A

“ Pain is whatever the person says it is, existing wherever the person says it does.”

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8
Q

Acute Pain

A

Sudden onset less than 3 months, brief episode of pain

Pain associated with a brief episode of tissue injury or inflammation with pain intensity decreasing progressively over days to weeks

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9
Q

Chronic Pain

A

~Persistent or nearly constant for > 3 months
~Is present beyond the expected time of healing

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10
Q

Recurrent Pain

A

~Painful episodes alternating with pain free episodes both acute and chronic

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11
Q

Consequences of Poorly controlled (post-operative) pain:

5

A

Slower recovery & ↑ length of stay (don’t want to get up)
↑ Risk of complications & anxiety
Unplanned re-admissions
Chronic pain (12-80% one year post surgery)
↓Immune function & ↑ tumor growth

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12
Q

Endocrine System Negative Effects of Pain

A

Unmanaged pain triggers elevated stress hormones.

Metabolic rate and heart increase dramatically.

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13
Q

immune system disruption

A

Persistent pain compromise’s immune function.

Defensive mechanisms become significantly weakened.

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14
Q

Pulmonary consequences

A

Pain reduces lung flow and volume. Secretion retention and atelectasis become serious risks.

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15
Q

cardiovascular strain

what can increase

A

Pain elevates heart rate and blood pressure.

Oxygen consumption increases substantially.

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16
Q

Principles of Pain Assessment in Children: QUESTT*

A

Question the child
Use a pain-rating scale
Evaluate behavioral and physiologic changes
Secure parent’s involvement
Take the cause of pain into account
Take action and evaluate results

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17
Q

Assessment of pain requires attention to:

4

A

Location of pain
Quality of pain
Pattern
Intensity

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18
Q

Childs Experience of Pain

A

Children’s pain experience is influenced by a complex interplay of physiological, psychological, and environmental factors.

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19
Q
A
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20
Q

Children’s pain experience is influenced by

A

a complex interplay of physiological, psychological, and environmental factors.

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21
Q

experience of pain affected by

4

A

Stage of growth and development
Cognitive level
Emotions: anxiety and depression?
Culture (coping strategies)

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22
Q

Behavioral Clues to Pain Objective Data

A

Guarding
Impaired thought process
Social withdrawal
Altered time perception
Moaning
Crying
Pacing
Distracting self
Restless behavior
Facial Mask of Pain
Physical signs: diaphoresis
BP/Pulse/RR Change

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23
Q

pain response in infants cues

A
  • furrowed brow
  • tense
  • drawing legs up
  • Cry/scream
  • Look tense
  • facial expression
  • Pulling knees up
  • Poor Consolability
  • Might refuse to eat
  • Grimacing
  • Sleep disturbances
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24
Q

toddler pain responses

A

Cry
Scream
Protest
Say NO lots
Withdraw
Can identify pain but can’t tell you much more
Crawled in bed

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25
preschooler pain response
Cry, localize body part (however not able to accurately differentiate – use more general terms “stomach”) anticipate painful procedures, body image concerns Pain response may be subdued or child less physical than expected (this age group, when healthy, not capable of sitting or lying for long periods of time
26
School-aged developmental stages and pain response
Body image concerns, may assume pain is punishment (concrete thinkers – cause and effect) “All or nothing”
27
adolescent pain responses | assume pain may feel need to
Assume pain will be treated, can conceptualize pain relief May feel the need to hide pain (“grin and bear it) and hesitate to report if they think everything is being done to relieve it
28
newborn/infant pain assessment tools | 3
CRIES, NIPS, and the Premature Infant Pain Scale assess pain in infants through physiological and behavioral cues
29
toddler pain assessment tools | 3
FLACC, Oucher, and Faces scales which evaluate pain expression and behaviors.
30
preschooler pain assessment tools
Oucher, Faces, FLACC, and body outline tools to capture their self-report and observable pain indicators.
31
school age and adolescent | pain scales
Older children can use Oucher, Faces pain, Visual Analogue, and Numeric scales to self-report their pain intensity.
32
Assessing Readiness for Use of Pain Scales
language skills sequencing ability following directions answering questions
33
FLACC use for
toddler preschooler Face Leg Activity Cry consolability
34
FACES use for | age
3+ toddler preschooler
35
The primary goal of pharmacological interventions is to
manage the patient's current pain while also anticipating and preventing any future pain episodes.
36
opioids gabapentin tylenol Aspirin when to give each
nociceptive neuropathic kids respond very well to this don't give can cause Raye syndrome
37
Codeine Considerations
Codeine has a less predictable effect compared to morphine.
38
considerations with drugs
kids have higher proportion of body water metabolize drugs differently
39
Side effects of opioids which is more common | 4
constipation: common side effect of opioid use, and it's easier to prevent than to treat. Proactive management is key. dysphoria and hallucinations: Opioid-induced dysphoria and hallucinations are often underreported. Decreasing or stopping the opioid can help mitigate these effects. Respiratory Depression: serious concern with opioid use. naloxone should be on hand and nausea and vomiting: the most common side effects of opioid medications.
40
signs of an allergy
Hives, Itching, Wheals, Sneezing, Asthma
41
uses of Topical Anesthetics
can effectively reduce pain from certain procedures such as venipuncture, lumbar puncture, circumcision, and IV insertion.
42
how long for topical anesthetic to become fully effective
30-60 mins
43
acetaminophen risk assessment
Identify children at risk for liver toxicity. Monitor for persistent nausea, vomiting, prolonged fasting, or anorexia.
44
dosage monitoring acetaminophen | reason
Prevent unintentional overdosing. Track PRN doses carefully, especially in vulnerable patients
45
follow up evaluation acetaminophen
Reassess patient after 48-72 hours. Look for signs of improvement or adverse effects.
46
common NSAIDS
advil ibuprofen naproxen
47
ketorolac usage | 2
Administer for breakthrough pain and post-operative care. Monitor closely for potential side effects.
48
NSAIDs precautions
Monitor for gastrointestinal and renal effects in prolonged use.
49
Non pharm techniques for techniques for pain management | 3
Toys and activities: age appropriate, reduce focus on pain audio visual aids: music, videos, tv shows, create a comforting environment peer interaction: normalize hospital experience
50
advanced non pharm techniques | 3
self-exercises: teach positive thinking and thought stopping techniques. Guide older children in creating empowering mental statements. Guided imagery: Help patients visualize a safe, calm place. This can reduce anxiety and pain perception. Relaxation Techniques: instruct on comfortable position and just released breathing. Minimize external stimuli to enhance effectiveness.
51
what is type 1 diabetes
autoimmune disease that affects the pancreas. The immune system mistakenly attacks and destroys insulin producing cells called beta cells
52
DKA management
three bag system (dextrose, saline, insulin) keep hydrated
53
insulin insufficiency causes
Without enough insulin, the body cannot effectively use glucose for energy. This leads to high blood sugar levels.
54
Insulin plays a role in regulating
Insulin plays a role in regulating the metabolism of carbohydrates, fats, and proteins.
55
More Type 1 diabetes diagnoses occur
during winter months exact reason is not entirely understood
56
viral triggers | diabetes
Illness or infection often precede Type 1 diabetes diagnosis. Viral infections can trigger the autoimmune response that leads to the disease.
57
family history with T1DM
A family history of Type 1 diabetes increases the risk of developing the disease.
58
presenting symptoms of T1D | 4
hyperglycemia: hallmark glucosuria: excess glucose spills into urine as kidneys struggle to reabsorb it polydipsia: compensate for fluid loss by increasing thirst polyphagia: constantly craves energy despite consuming food due to the inability to use glucose
59
diagnostic tests for T1D | 3
blood glucose levels: Elevated blood glucose levels, particularly fasting blood glucose, are a primary indicator of diabetes. urine analysis: Urine testing reveals presence of glucose (glucosuria) and potentially ketones (ketonuria), suggesting impaired glucose metabolism. Glucose tolerance test: This test assesses insulin response to glucose load; low insulin levels in the face of high glucose indicate a potential for type 1 diabetes.
60
glycosylated hemoglobin
reflects average glucose levels over the preceding 2-3 months. Regular A1C monitoring is essential for assessing long-term glycemic control and adjusting treatment plans as needed.
61
target BG under 6 6-12 13-18
6-12 4-10 4-7
62
Diabetic ketoacidosis (DKA) is a
serious complication of diabetes that occurs when the body doesn’t have enough insulin- “diabetic coma”
63
symptoms of DKA | 5
- altered consciousness - electrolyte imbalance - dehydration - dysrhythmias - shock complete vascular collapse
64
initial warning signs of DKA | 4
- thirst - frequent urination with high ketone levels - very dry mouth - spiked blood sugar
65
Management of Severe DKA | 3
1. Resuscitation Address immediate life threats, including dehydration and electrolyte imbalances 2. Acid-base, Glucose, and Electrolyte Correction Restore blood pH, glucose, and electrolyte levels within a safe range. 3. Transition to Daily Routine Gradually transition to regular diabetes management strategies.
66
Importance of Exercise | 4
Regular physical activity helps control blood sugar levels and improves overall health Exercise helps the body use insulin more effectively. It can help reduce the amount of insulin needed for blood sugar control. Exercise is vital for normal growth and development in children.
67
Management During Exercise
Eat a snack before exercising. Exercise lasting less than 1 hour usually requires a small snack / complex carbohydrate or protein. Longer exercising may require more frequent snacks / complex carbohydrates or a protein. Insulin adjustment may be needed if hypoglycemia occurs during the activity. Check blood glucose after activity and before bedtime to prevent night time hypoglycemia
68
T2D is cuaseed by
resistance to insulin as well as the inability of the pancreas to keep up with the increase demand of insulin Insulin resistance + chronic hyperglycemia
69
characteristics 85% of children are _____ at diagnosis Age of onset is ___________ have an especially high rate of type 2 diabetes Strong _______
obese. BMI >30 (normal 15-17) middle to late puberty around 13 years Minority populations family history
70
reflects hyperinsulinemia
Acanthosis nigricans: hyper-pigmentation and thickening of the skin into velvety irregular folds in the neck and flexural areas type 2
71
Type 2 Diabetes care
Glucose monitoring Insulin replacement therapy Oral hypoglycemic medications Other therapies
72
age for numeric pain scale
8 and older
73
Three factors that can influence an individual's perception and experience of pain
Age: cry or talk Past experiences: Children who have had traumatic medical experiences may exhibit heightened sensitivity to pain Culture: express of suppress
74
Among female children and adolescents, the first sign of type 1 diabetes may be:
genital candidiasis
75
The benefits of using an insulin pump include
- By continuously providing insulin they eliminate the need for injections of insulin - They simplify management of blood sugar and often improve A1C - They enable exercise without compensatory carbohydrate consumption - weight gain

NRSG 329- Peds (6 decks)

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