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PEDS EXAM #1
Pain Management
| Question | Answer |
|---|---|
| Acute Pain | Rapid onset, varying intensity, usually indicates tissue damage and resolves with the healing of the injury. |
| Chronic Pain | Pain that continues past the expected point of healing for injured tissue. Provides no protective function. May be continuous or intermittent. Often interferes with sleep and ADLs. |
| Nociceptive Pain | Pain due to noxious stimuli that damages normal tissues or has the potential to do so if pain is prolonged. Can be described as sharp, burning, dull, aching, cramping, deep aching, or sharp stabbing |
| Neuropathic Pain | Pain due to malfunctioning of the peripheral or central nervous system. May be continuous or intermittent, often described as burning, tingling, shooting, squeezing, or spasm-like. |
| Nociceptive Pain Examples | chemical burns, sunburn, cuts, appendicitis, and bladder distention |
| Neuropathic Pain Examples | post traumatic and post-surgical peripheral nerve injuries, pain after spinal cord injury, metabolic neuropathies, phantom limb pain after amputation, and post-stroke pain |
| Somatic Pain | Refers to pain that develops in the tissues. Can be superficial or deep |
| Superficial Somatic Pain | Often called cutaneous pain, involves the stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes. Typically is well localized and described as sharp, pricking, or burning sensations. Often tenderness is present |
| Superficial Somatic Pain Examples | External Mechanical, chemical, or thermal injuries, or skin disorders. |
| Deep Somatic Pain | Typically involves the muscles, tendons, joints, fasciae, and bones. Can be localized or diffuse, and is usually described as a dull, aching, or cramping. Tenderness and reflex spasm may be present. They also may exhibit SNS activation such as tachycardia, hypertension, tachypnea, diaphoresis, pallor, and pupillary dilation |
| Deep Somatic Pain Examples | Strain from overuse, or direct injury, ischemia, and inflammation. |
| Visceral Pain | Pain that develops within organs such as the heart, lungs, GI tract, pancreas, liver, gallbladder, kidneys, or bladder. Often produced by a disease. Usually diffuse and poorly localized, and is described as deep ache or sharp stabbing sensation that may be referred to other areas. Tenderness, nausea, vomiting, and diaphoresis may be present |
| Visceral Pain Examples | Detention of an organ, organ muscular spasm, contraction, pulling, ischemia, or inflammation. |
| Factors affecting pain | Age, Gender, Cognitive Level, Temperament, Previous Pain Experiences, and Family/Cultural Backgrounds. |
| QUEST | An excellent way to remember the key principles of pain assessment. It includes: Question the child. Use a reliable and valid pain scale. Evaluate the child's behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention. The child's behavior and motor activity may include irritability and protection as well as withdrawal of the affected painful area. Secure the parent's involvement. Take the cause of pain into account when intervening. Take action. |
| FACES | Is a self-report tool that is typically used in children 3 to 8 years of age. Consists of six illustrations of faces arranged horizontally with expressions ranging from smiling (indicating no hurt) to crying with frowning (indicating hurts worst). Under each face is a short description such as “hurts little bit” and a number. Then, the nurse asks the child to select the facial expression. The nurse then documents the number corresponding to the word description and face. |
| OUCHER Pain Scale | Uses facial expressions to indicate increasing degrees of hurt. However, instead of illustrations, six photographs are usedAfter explaining the photos and numeric scale, the child is asked to point to the number that best describes his or her level of pain. This scale is useful for self-reporting of pain in children between 3 and 12 years of age |
| Poker Child Tool | Also known as the pieces of hurt tool, that uses four red poker chips to quantify the child's level of pain. Chips are arranged in a horizontal line on a surface in front of the child. Starting with the chip closest to the child's left side, the nurse points to the chip and explains that the first chip means a little hurt. Then, the nurse asks the child how many “pieces of hurt” Useful for assessing pain in preschool-age children and can be used in children 3 to 18 years of age |
| Visual Analogs Scale | Involve a horizontal or vertical line with marked endpoints. The endpoints are identified as no pain and worst pain. The nurse explains the scale to the child. The child makes a line that best describes the level of pain. The nurse then measures the distance from the “no pain” endpoint to the child's mark and records this as the pain score. Can be used in children 5 years or older |
| Numerical Scale | Typically has endpoints of 0 and 10, reflecting no pain and worst pain, respectively. The nurse asks the child to pick the number that best describes his or her level of pain. Can be used with children 8 years or older |
| Adolescent Pediatric Pain Tool | A multidimensional self-report type of tool useful for older children, usually between 8 and 17 years of age. Involves three aspects of assessment. First assessment, the child identifies the location of the pain on two pictures, front and back views of the body by coloring the area. Then the nurse instructs the child to identify the severity of pain. Lastly the child is asked to circle or point to the words that describe their pain |
| Premature Infant Pain Profile (PIPP) | An assessment tool that is useful for measuring pain in term or preterm neonates. It looks at behavioral indicators, such as facial expressions, and physiologic changes such as changes in heart rate and oxygen saturation, and takes into account gestational age. |
| Neonatal Infant Pain Scale (NIPS) | A behavioral assessment tool that is useful for measuring pain in pre- and full-term neonates. Six parameters are measured: facial expression, cry, breathing patterns, arms, legs, and state of arousal. Each parameter except for cry is scored as 0 or 1. cry is scored as 0, 1, or 2. The scores are then totaled and the maximum score that can be achieved is 7. A higher score indicates increased pain. |
| Riley Infant Pain Scale (RIPS) | A behavioral assessment tool useful for infants who lack verbal ability. Measures six parameters: facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Each parameter is scored as 0, 1, 2, or 3. The score is then totaled and the maximum score that can be achieved is 18. The higher the total score, the more intense the pain. |
| Pain Observation Scale for Young Children (POCIS) | A behavioral assessment tool designed for use in children between 1 and 4 years of age. This tool measures seven parameters: facial expression, cry, breathing, torso, arms and fingers, legs and toes, and state of arousal. Each parameter is scored as 0 or 1. The maximum score achievable is 7. The higher the score, the greater the pain being experienced by the child. |
| CRIES Scale for Neonatal Postoperative Pain Assessment | A behavioral assessment tool that also includes measures of physiologic parameters. Developed to quantify postoperative pain in the newborn, or to monitor the infant's progress over time during recovery Assesses five parameters: cry, oxygen required for saturation levels less than 95%, increased vital signs, facial expression, and sleeplessness. Each parameter is scored as 0, 1, or 2 and then totaled. As with other assessment tools, the higher the score, the greater the infant's pain. |
| r-FLACC Behavioral Scale for Pain in Nonverbal Young Children & Children with Cognitive Impairment | It has been demonstrated to be a reliable tool for children from age 6 months to 7 years of age. This tool measures five parameters: facial expression, legs, activity, cry, and consolability. Observe the child with the legs and body uncovered. If the child is awake, observe him or her for 1 to 2 minutes |
| Nonpharmacological Pain Management | Aim to assist children in coping with pain and to give them a sense of mastery or control over the situation. These strategies may be categorized as: behavioral-cognitive, or biophysical. |
| Behavioral-Cognitive Pain Management | Having the child focus on a specific area or aspect, rather than the pain. For example: relaxation, distraction, imagery, biofeedback, thought stopping, and positive self-talk |
| Biophysical Pain Management | Focuses on interfering with the transmission of pain impulses reaching the brain. Examples include heat and cold applications, massage, and pressure |
| Nonopioid Analgesics | used to treat mild to moderate pain include acetaminophen and NSAIDs such as ibuprofen, ketorolac, naproxen, and, less commonly, indomethacin, diclofenac, and piroxicam. |
| Opioid Analgesics | Morphine. The drug to which all other opioids are compared and is usually the drug of choice for severe pain |
| Local Anesthetics | are commonly used to provide analgesia for procedures. They are effective in providing successful pain relief with only minimal risk of systemic adverse effects. The first choice for the most effective, painless local anesthesia is EMLA (eutectic mixture of local anesthetics [lidocaine and prilocaine]). It achieves anesthesia to a depth of 2 to 4 mm, so it reduces pain of phlebotomy, venous cannulation, and intramuscular injections up to 24 hours after injection. |
| Epidural Analgesia | involves the insertion of a catheter into the epidural space through which drugs can be administered as bolus injections (a one-time bolus or on an intermittent schedule), as a continuous infusion, or as PCA. Usually an opioid, such as morphine, fentanyl, or hydromorphone, is given in conjunction with a long-acting local anesthetic, such as bupivacaine. |
| Moderate Sedation | is a medically controlled state of depressed consciousness that allows protective reflexes to be maintained so the child has the ability to maintain a patent airway and respond to physical or verbal stimulation. |
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