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Unpleasant sensation, occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorders
PAIN
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The experience of pain is ____ to each individual (many factors influence the experience)
unique
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Pain is what:
the experiencing person says it is
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Measurements of pain in children:
Self Report (gold standard)
Behavioral (crying, facial expressions, body movements)
Physiological (HR, BP, RR, O2)
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Age of which child does not express anticipatory fear
<6months
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Age of which a child begins to develop fear of painful experience and withdraw when pain is anticipated
6-18 months
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Age at which child expresses pain with words such as "hurt" or "boo-boo"
18-24 months
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Age at which child begins to localize pain and identify external causes
3 years
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Age at which the child improves understanding of pain and has the ability to localize and cooperate
5-7 years
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Stage at which child is able to qualify/quantify pain and develop cognitive coping strategies that may help diminish pain
Adolescence
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ABCs of Pain Management:
- A-assessment (multidimensional)
- B- believe the child has pain
- C- communication is clear, concise, pt focused
- D- do something/intervene
- E- evaluate effectiveness of interventions
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Treatment Goals of Pain in the child
- Minimize physical pain and discomfort
- Alleviate anxiety
- Prevent potentially deleterious physiologic responses due to pain
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Methods of Non-Pharm Pain Treatment
- Distraction
- Relaxation
- Guided imagery
- Positive Self-Talk
- Communication
- Psychological Treatment
- Biofeedback
- Transcutaneous electrical nerve stimulation
- Acupuncture
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Ways to Reduce Minor Procedural Pain
- EMLA cream
- Vicous Lidocaine
- LET (lidocaine, epinephrine, tetracaine)
- TAC (tetracaine, adrenaline, cocaine)
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Apply EMLA cream (Eutectic mixture of local anesthetic) ____ min before procedure by placing cream on site and covering with dressing
60-90 minutes
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Oral syrup used for oral trauma or stomatitis
Vicous Lidocaine
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Apply LET get (lidocaine, epi, tetracaine) ___ min before procedure
20-30 minutes
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TAC is used for ____ such as lacerations, and takes about ___ minutes to start working
non intact skin; 10 minutes
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Pharmocologic Pain Management is:
not always reliable as sole indicator of pain)
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Routes of Pain Meds:
- Oral
- Transdermal
- Intramuscular
- Intravenous
- Patient-Controlled Analgesia (PCA)
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Pain med NOT used in peds because of the high incidence of adverse reactions
Topical DEMEROL
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EMLA should be used in children > ____ month
1 month
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Do's/Don'ts of EMLA
Do not rub into skin
Apply to intact skin an hour before procedure and cover with occlusive bandage
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Apply TAC (tetracaine, epi, cocaine) to ___ skin
Non-intact skin (lacerations)
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Do's/Don'ts of LET (lidocaine, epinephrine, tetracaine)
- Do NOT use on mucus membranes
- Use for lacerations
- Do NOT leave on >10-30min
Less expensive and does not contain controlled substance
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Biophysical interventions for Pain
- Sucking
- Swaddling
- Holding
- Rocking
- Positioning
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Need for larger dose of opioid to maintain original effect of medicine
Drug Tolerance
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Withdrawal symptoms when chronic use of opioid is discontinued or opioid antagonist (Narcan) is given
Physical Dependence
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Behavioral and Voluntary pattern of Narcotic Addiction:
Characterized by compulsive drug-seeking behavior
Leading to overwhelming involvement with procurement and use of opioid NOT for medical reasons such as pain relief
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"Do's" of Pain Management
Treat pain as medical emergency
Use age-appropriate assessment methods
Use the same assessment method over time to compare adequacy of management
Combine opioids and nonopioids as prescribed
Adhere to around-the-clock administration schedule
Use nonpharmacologic interventions as appropriate
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Do NOTS of Pain Management
Forget that s/s are different in chronic pain and acute pain
Withhold opioids for a child in pain because of fear of addiction or respiratory depressions
Give IM injections
Administer Meperidine (Demerol) (especially for long term use)
Forget that breakthrough pain may occur even with around the clock drug admin.
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Wong-Baker Faces Pain rating scale can be used in children as young as:
3 years
(0-5)
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FLACC Scale (0-2)
- Face
- Legs
- Activity
- Cry
- Consolability
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Golden Rule of Pain
- pain is what the person says it is
- (what is painful to an adult is painful to an infant unless prove otherwise)
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By ________years of age, the ability to discriminate degrees of pain in facile expressions appears to be reasonably established
3
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By ______ to _____ years of age, most children are able to use the 0 to 10 numeric rating scale that is currently used by adolescents and adults?
7-10
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What are the 3 types of measures for pain?
- Behavior
- Physiologic
- Self Report
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List at least four non-pharmacologic techniques that reduce pain perception in children
- Distraction
- Relaxation
- Guided imagery
- Positive self-talk
- Thought stopping
- Behavioral contracting
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TRUE or FALSE:
Infants and children can become psychologically dependent on or addicted to pain medication
- False. Infants and children do not have the
- cognitive ability to make the cause-effect association and therefore cannot
- become addicted
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