Week 4 - Pain and Palliation Flashcards
(89 cards)
1
Q
What is pain?
A
pain is whatever the person says it is existing where ever the person says it does
2
Q
what are the 3 types of pain?
A
- somatic/ nociceptive
- visceral
- neuropathic
3
Q
describe somatic/ nociceptive pain
A
injury to body tissue
4
Q
describe visceral pain, provide examples
A
- comping from the visceral organs
- normally referred pain
- ex. heart, liver, GI
5
Q
describe neuropathic pain
A
central or peripheral nerve pain
6
Q
what are the 2 classifications for pain? describe them
A
- acute
- <6 months
- comes at a quicker onset/ leaves easier - chronic
- >6 months
- comes in intense waves
7
Q
define tolerance
A
physical adaption of the need of medication
8
Q
define physical dependence
A
- physical effect
- withdrawal symptoms
- ex. caffeine > migraines
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
10
Q
how does pain over stimulate the endocrine system?
A
increases:
- stress hormone
- metabolic rate
- HR
- water retention
11
Q
how does pain over stimulate the immune system?
A
impaires immune function
12
Q
how does pain over stimulate the pulmonary system?
A
decreases flow and volume which leads to retained secretions and atelectasis
13
Q
how does pain over stimulate the cardiovascular system?
A
increases:
- HR
- cardiac output
- systemic vascular resistance
- BP
- oxygen consumption
14
Q
how does pain over stimulate the musculoskeletal system?
A
- decreases muscle function
- fatigue
- immobility
15
Q
what are the assessment principles you need to follow?
A
- systematic approach
- evaluate efficiency of all interventions
- document efficacy of interventions
16
Q
what do you use QUESTT for?
A
systemic approach to assess pain
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
18
Q
how do we assess pain?
A
- QUESTT
- LOWTARP
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
20
Q
experience of pain is affected by what?
A
- how parents react
- stage of growth/ development
- cognitive level
- emotions (anxiety/ depression)
- gender
- culture
21
Q
what are factors that influence pain in children?
A
- cognitive factors
- behavioural factors
- emotional factors
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
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
24
Q
in regards to factors that influence pain in children, describe emotional factors
A
- fear
- anxiety
- frustration
- anger
- depression
25
what are some examples for objective data for behavioural clues to pain?
- guarding
- impaired thought process
- social withdrawal
- introspection
- altered time perception
- moaning
- crying
- pacing
- restless behaviour
26
what do infants response to pain look like?
- 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
27
what do toddlers response to pain look like?
- crying
- screaming
- protest
- withdraw
- easy to identify pain but difficult to assess
28
what do preschoolers response to pain look like?
- cry
- localize body part
- anticipate painful procedures
- body image concerns
- use more general terms/ not able to accurately differentiate
29
what do school-aged children's response to pain look like?
- body image concerns
- may assume pain is punishment
- concrete thinkers/ cause and effect
- all or nothing mentality
30
what do adolescence response to pain look like?
- 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
31
what pain assessment tools would you use for newborn/ infants?
- CRIES
- NIPS
- premature infant pain scale
32
what pain assessment tools would you use for toddlers?
- FLACC
- oucher
- faces pain-relating scale
33
what pain assessment tools would you use for preschooler?
- oucher
- faces pain-relating scale
- FLACC
- body outline
34
what pain assessment tools would you use for school age?
- oucher
- faces pain-relating scale
- word graphic
35
what pain assessment tools would you use for adolescents?
- oucher
- faces pain-relating scale
- numeric
36
what is the most common pain assessment tool that is used for adolescents?
numeric
37
what does NIPS stand for?
N - neonatal
I - infant
P - pain
S - scale
38
what is included in the NIPS scale?
- facial expression
- cry
- breathing patterns
- arm movements
- leg movements
- state of arousal
39
What does FLACC stand for?
F - face
L - legs
A - activity
C - cry
C - consolability
40
in order to effectively use a pain scale, the child must have an understanding of what?
- a little and a lot of pain
- be able to communicate about it
41
how do you assess language skills?
able to:
- use words in sequence
- follow simple directions
- answer simple questions
42
what is the most common side effect we will see from opioids on a paediatric floor?
nausea and vomiting
43
what are some side effects we will see as a result of opioids?
- allergy (rare)
- itch (histamine release)
- constipation
- dysphoria/ hallucinations
- respiratory distress
44
what is the most common reason we give opioids in peds?
post operatively
45
in regards to side effects we might see from opioids describe what allergies might look like and what we would do
- hives/ rash
- wheezing
- SOB
- stop opioids
- call physician
46
in regards to side effects we might see from opioids describe what itch/ histamine release might look like and what we would do
- itching
- sneezing
- asthma exacerbation
- continue opioid/ treatment
- go to PO
- antihistamine
47
in regards to side effects we might see from opioids describe how you would treat constipaiton
- docusate
- bisacodyl
- lactulose
48
in regards to side effects we might see from opioids describe what dyysphoria/ hallucinations might look like and what we would do
- poorly reported
- decrease or stop opiates as tolerated
49
in regards to side effects we might see from opioids describe what respiratory depression might look like and what we would do
- naloxone
- follow protocol
50
what are the most common medications we give in peds?
- acetaminophen
- NSAID's
51
what are some examples for acetaminophen?
- tylenol
- paracetamol
52
what is a possible problem of acetaminophen ?
liver toxicity
53
if children are at risk for liver toxicity due to much acetaminophen what would this look like?
- persistent nausea and vomiting
- prolonged fasting
- anorexia
54
what are examples of NSAIDs?
- advil
- ibuprofen
- naproxen
- ketorolac
55
what is the only parenteral NSAID?
ketorolac
56
what is ketorolac used for?
breakthrough pain and post op
57
what are the most common side effects of NSAIDs?
- upset stomach
- stomach ulcers
58
what are the different non-pharmacological pain management options?
- preparation
- distraction
- self exercises
- relaxation
59
in regards to the different non-pharmacological pain management options, which age groups are most appropriate for preparation?
- preschool
- school aged
- adolescent (limited to toddlers)
60
in regards to the different non-pharmacological pain management options, which age groups are most appropriate for distraction?
- all age groups specifically acute pain
61
in regards to the different non-pharmacological pain management options, which age groups are most appropriate for self exercise?
older children
62
in regards to the different non-pharmacological pain management options, which age groups are most appropriate for relaxation?
- school aged or adolescent
- useful for chronic pain
63
what does paediatric palliative care refer to?
caring for or comforting children living with progressive life threatening illnesses
64
describe life threatening illnesses
conditions where survival to adulthood is a challenge
65
in regards to quality of life, as nurses one of our most important jobs is to ensure what?
quality of life is maintained in our palliative patients
66
what is included in quality of life specifically for physical aspects
- functional ability
- strength/ fatigue
- sleep/ nausea
- appetite
- constipation
- pain
67
when values of the patient differ from values of the parents what do you do?
- put the child's values first and manage their pain then educate the parents
- always listen to the child first
68
what is included in quality of life specifically for psychological aspects
- anxiety
- depression
- enjoyment/ leisure
- pain distress
- happiness
- fear
- cognition/ attention
69
what is included in quality of life specifically for social aspects
- financial burden
- caregiver burden
- roles & relationships
- affection/ sexual function
- appearance
70
what is included in quality of life specifically for spiritual aspects
- hope
- suffering
- meaning of pain
- religion
- transcendence
71
what does transcendence mean?
moving past the experience and making meaning out of it
72
what does the role of the nurse with a dying child include?
- 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
what does anticipatory grief mean?
- see early on and then later before death
- grieving the loss that hasn't happened yet
74
what does acute grief mean?
- 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
how do infants conceptualize death?
no concept of death
76
how do toddlers conceptualize death?
- don't understand death as a permanent condition
- effected by emotions surrounding family
77
how do preschoolers conceptualize death?
- temporary and reversible
- form of punishment
- feeling of guilt/ shame
78
how do school ages conceptualize death?
- 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
how do adolescence conceptualize death?
- good understanding of death
- feeling of immortality
- diagnosis can impact self esteem/ identity
80
can palliative care occur simultaneously with curative care?
yes
81
what are the general principles of palliative care for children?
- child/ family viewed as unit of care
- interdisciplinary team approach
- ongoing assessment/ clarification of desires/ priorities important
- quality of life is subjective
82
what are goals for intensive care?
- fight death
- cure
- prolong life at all costs
83
what are goals for palliative care?
- promote physical, psychological, spiritual, social comfort
- promote acceptance of death as an outcome
84
what is the most common mode of death in the paediatric intensive care unit?
limitation or withdrawal of life sustaining therapy
85
what are different types of life sustaining therapies that could potentially be stopped?
- mechanical ventilation
- vasoactive infusions
- renal replacement therapies
- invasive catheters
- extracorporeal membrane oxygenation
- antibiotics
- IV fluids
- feeds
86
what are some factors contributing to the PARENTS decisions to forgo life sustaining treatments?
- quality of life
- likelihood of improvement
- pain/ discomfort
- unlikely to survive hospitalization
- information the staff provided
- religious/ spiritual beliefs
- Childs appearance/ behaviour
87
what are some factors contributing to the PARENTS decisions to forgo life sustaining treatments?
- 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
what are some factors contributing to the CLINICIANS decisions to forgo life sustaining treatments?
-no benefit
- excessive burden
- no relational benefit
- diagonsis
- acute vs. chronic disease
- perceived benefit
- prognosis
- family preference
- probability of survival
- functional status
89
the ideal decision making process begins where?
early during ICU admission with multidisciplinary meeting
