Pain (Peds)

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Pain (Peds)
2012-02-24 15:50:08

Pain (Peds)
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  1. Why is pain medication under treated by parents and health care providers?
    • Worry about side effects such as respiratory distress, addiction, and too much sleeping
    • Unable to verbalize pain med needs
    • Most common real side effect: Constipation
  2. Pain can be worse for kids because...
    • Cannot anticipate actions with pain
    • Cannot explain where, when, or how
    • Cannot understand the cause
    • Cannot unsterstand time
    • Cannot understnd why people (especially parents) don't protect them
  3. Goals of Rating Pain
    • 1. Identify Characteristics
    • 2. Establish Baseline
    • 3. Evaluate Pain Status
    • 4. Effects of Intervention
  4. Physiologic Measurements of Pain
    • Ox Sats
    • Palmar Sweating
    • Heart Rate (really only for adults; for infants usually goes up and down anyways)
    • Blood Pressure (sometimes lower in newborns, but usually elevated)
    • Metabolic Changes: glucose (b/c infants use sugar so much faster than adults)
  5. Behavior Measurements of Pain
    • Face
    • Crying (duration, pitch)
    • Behavioral Changes
  6. FLACC
    • F: face; most consistent indicator; esp between eyebrows (tightly closed eyes, open lip and stretched mouth with taut tongue)
    • L: legs (not relaxed)
    • A: activity (restless; cannot find a comfortable position)
    • C: cry (duration, pitch, does it go away?)
    • C: consolable (anxiety and fear can effect the rating; can you relax the child if you hold them?)

    • 0 Nothing
    • 1 Mild
    • 2 A lot going on

    Pain intervention: 3 or more
  7. CRIES
    • C: crying
    • R: regulation of O2
    • I: increased vital signs
    • E: expression, facial
    • S: sleeplessness

    Same scoring as FLACC
  8. FACES
    Best to save until the kids is 5 or 6
  9. Drug Administration (Right Drug)
    • Sedative (make them fall asleep or stay still) vs. Opiate (only treat pain) vs. Sleeping Aids (usually are not ordered for peds) vs. Anti-depressives (nerve receptors for pain and depression are in the same place in your brain)
    • Be cautious when giving infants sedatives; makes them unable to communicate
    • Avoid Demerol - 48 hours or less (not processed well in the kidneys; after 48 hours they can have seizures or psychosis (confusion, etc)) ....morphine is a better alternative
    • Don't necessarily need a big surgery for pain meds (ex. ear infection)
  10. Drug Administration (Right Dosage)
    • Increase dose of same med when given by mouth vs IV
    • Never assume that it is right without checking it yourself
    • Give more PO meds
  11. Drug Administration (Right Route)
    • PCA pumps: kids dont always know how to work them (give to at least 6 or 7 year olds; if not using it right, suggest continuous low dose, once they get better can get rid of continous and just have boosters)
    • Don't give PO meds until able to tolerate food/fluid
    • Before D/C a PCA: make sure they can eat and tolerate food and PO pain meds, otherwise if they cannot take PO meds then they will be in pain b/c nothing in the system
  12. Drug Administration (Right Time)
    • Morphine Max Time: 2 hours
    • Nurse needs to anticipate pain and premeditate compliancy (getting up, waking up, having difficulty sleeping, before painful procedure)
    • EMLA or Spray before injections
  13. Alternative to Medications
    • Holding, repositioning, touching
    • Distraction and Guided Imagery, Hypnosis
    • Music
    • Heat and cold applications
    • Pacifiers, orogustatory stimulation
    • Company; especially parents
    • Parents help and should be involved in pain assessment
  14. Five S's
    • Swaddle
    • Side
    • Swish
    • Sway
    • Suck

    Then usually Sleep
  15. Reevaluate pain every ____ min.