Pain Peds

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Pain Peds
2015-02-24 21:55:37
Pain Peds

Pain Peds
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  1. Unpleasant sensation, occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorders
  2. The experience of pain is ____ to each individual (many factors influence the experience)
  3. Pain is what:
    the experiencing person says it is
  4. Measurements of pain in children:
    Self Report (gold standard)

    Behavioral (crying, facial expressions, body movements)

    Physiological (HR, BP, RR, O2)
  5. Age of which child does not express anticipatory fear
  6. Age of which a child begins to develop fear of painful experience and withdraw when pain is anticipated
    6-18 months
  7. Age at which child expresses pain with words such as "hurt" or "boo-boo"
    18-24 months
  8. Age at which child begins to localize pain and identify external causes
    3 years
  9. Age at which the child improves understanding of pain and has the ability to localize and cooperate
    5-7 years
  10. Stage at which child is able to qualify/quantify pain and develop cognitive coping strategies that may help diminish pain
  11. 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
  12. Treatment Goals of Pain in the child
    • Minimize physical pain and discomfort
    • Alleviate anxiety
    • Prevent potentially deleterious physiologic responses due to pain
  13. Methods of Non-Pharm Pain Treatment
    • Distraction
    • Relaxation
    • Guided imagery
    • Positive Self-Talk

    • Communication
    • Psychological Treatment
    • Biofeedback
    • Transcutaneous electrical nerve stimulation
    • Acupuncture
  14. Ways to Reduce Minor Procedural Pain
    • EMLA cream
    • Vicous Lidocaine
    • LET (lidocaine, epinephrine, tetracaine)
    • TAC (tetracaine, adrenaline, cocaine)
  15. Apply EMLA cream (Eutectic mixture of local anesthetic) ____ min before procedure by placing cream on site and covering with dressing
    60-90 minutes
  16. Oral syrup used for oral trauma or stomatitis
    Vicous Lidocaine
  17. Apply LET get (lidocaine, epi, tetracaine) ___ min before procedure
    20-30 minutes
  18. TAC is used for ____ such as lacerations, and takes about ___ minutes to start working
    non intact skin; 10 minutes
  19. Pharmocologic Pain Management is:
    not always reliable as sole indicator of pain)
  20. Routes of Pain Meds:
    • Oral
    • Transdermal
    • Intramuscular
    • Intravenous
    • Patient-Controlled Analgesia (PCA)
  21. Pain med NOT used in peds because of the high incidence of adverse reactions
    Topical DEMEROL
  22. EMLA should be used in children > ____ month
    1 month
  23. Do's/Don'ts of EMLA
    Do not rub into skin

    Apply to intact skin an hour before procedure and cover with occlusive bandage
  24. Apply TAC (tetracaine, epi, cocaine) to ___ skin
    Non-intact skin (lacerations)
  25. 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
  26. Biophysical interventions for Pain
    • Sucking
    • Swaddling
    • Holding
    • Rocking
    • Positioning
  27. Need for larger dose of opioid to maintain original effect of medicine
    Drug Tolerance
  28. Withdrawal symptoms when chronic use of opioid is discontinued or opioid antagonist (Narcan) is given
    Physical Dependence
  29. 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
  30. "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
  31. 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.
  32. Wong-Baker Faces Pain rating scale can be used in children as young as:
    3 years

  33. FLACC Scale (0-2)
    • Face
    • Legs
    • Activity
    • Cry
    • Consolability
  34. 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)
  35. By ________years of age, the ability to discriminate degrees of pain in facile expressions appears to be reasonably established
  36. 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?
  37. What are the 3 types of measures for pain?
    • Behavior
    • Physiologic
    • Self Report
  38. List at least four non-pharmacologic techniques that reduce pain perception in children
    • Distraction
    • Relaxation
    • Guided imagery
    • Positive self-talk
    • Thought stopping
    • Behavioral contracting
  39. 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