Iv Test #2 Pain

Front 1

pain is subjective; you can't measure pain
- however, pain has physiologic signs: inc HR, inc BP, dec O2 stat, sweating

Back 1

T

Front 2

3 types of pain?

Back 2

1- acute- pain from surgery, trauma - lasts days to weeks
2- chronic- sickle cell disease; 1 mo or more
3- recurrent - migraines

Front 3

pain is the __ vital sign; Since 2001, JCAHO says we have to measure pain & document it, or hosp don't get paid.

Back 3

5th

Front 4

when is pain assessment done:

Back 4

- upon each admission
- w each vital sign assessment
- any change in child's clinical condition

Front 5

there are 4 standardized pain scales used; they are?

Back 5

1- NUMERIC PAIN INTENSITY SCALE; child has to be school age , ie need to order the numbers; can't be used by autistic or retarded child
2- FACES RATING SCALE- used by kids as young as 3; since no child is happy about going to hosp, the "0" pain with happy face is never chosen, so this scale likely results in more pain assessment.
3- NEONATAL INFANT PAIN SCALE; for pts 0-2 mo old and all pts in NICU; has 6 categories: facial exp, cry, breathing pattern, arms, legs, state of arousal w scale from 0-7.
4.FLACC SCALE - for 2 mo to 7 yrs old; 0= no pain; 10= most pain; can also be used with adult pts with cognitive limiitations; measured: face, legs, activity, cry, consolability

Front 6

- neonate?
- infant?

Back 6

infant from birth to 28 days old, ie 1 mo old baby
- birth to 12 mo, when baby is able to assume an erect posture

Front 7

- pain signs in infants (in their face) are?
- very young babies only have tremors when in pain
- at 9-12 mo of age, the older infant can push nurses hand away if it perceives a painful action on the way
- preschoolers have lots of guilt and magical thinking and believe pain is punishment for previous thoughts and actions
- preschoolers (4 yrs old) can describe the location of pain.
- School age: body integrity is very important - don't want anything to be cut off; if they break their leg, they'll ask if we're going to cut the leg off.

Back 7

- brow bulge
- eye squeeze

Front 8

1- Tolerance?
2- Physical dependence?
3- Addiction?
4- Pseudoaddiction syndrome?

Back 8

1- pt needs more med to achieve pain relief; can happen in as little as 2 wks
2- withdrawal symptoms occur when drug is abruptly stopped; drugs must be decreased in increments
3- dysfunctional continuous craving for drug
4- so-called "clock watchers"; goes away with adequate pain control

Front 9

whenever possible, administer pain meds via non-invasive route-- orally or existing IV line

Back 9

T

Front 10

Non-pharmacologic pain management
1- infants (0-12 mo)
2- toddlers (1-3 yrs)
3- preschool (4-5 yrs)
4. school-age (6-10 yrs)
5. adolescent (11-18 yrs)

Back 10

1- rocking, patting, sucking, swaddling, containment(put baby in nest, ie rolling blanket and put baby in middle), kangaroo care ( skin to skin contact with mom)
2. favorite toy, distraction, tell toddler 1 sec before painful procedure
3. role play, stories, books, prepare before event
4. this age likes to know what's going to happen
5. also want to be prepared, like DVDs, guided imagery

Front 11

common mistakes w pain meds?

Back 11

1- underdosing
2- limiting the types of meds used; for ex: a newer therapy is to use neurontin (for phantom pain) & Tegral as pain adjuvant

Front 12

Define optimum dosage of analgesic?

Back 12

dosage that controls pain without severe side effects

Front 13

the pharmacology WHO ladder is to treat:
1- mild pain with___
2. moderate pain with ___
3. severe pain with ___

Back 13

1- nonopoid analgesics: tylenol, toradol (ibuprofen)
2- combine tylenol w nonopoid
3- morphine - gold std

Front 14

if you take oxycodone aka hydrocodone for more than 2 wks, develop tolerance

Back 14

T

Front 15

Morphine is considered gold std; doesn't have "ceiling", but has respiratory issues: for children < 2, if resp are less than 12/min, don't give morphine;
- if already given, what do you do? titrate the drip, call physician
- morphine dosage is generally 50 mg

Back 15

T

Front 16

Morphine sulfate?

Back 16

- narcotic analgesic
- give thru IV or PCA, not to be given fast IV push, rather infuse over 5 min at 0.5 mg/kg
- SE: resp depression, hypotension, N&V, constipation
- common SE is itching - that's why often give children benadryl along w morphine
- INTERVENTIONS: monitor resp rate & depth

Front 17

Chloral Hydrate?
- prototype hypnotic, not an analgesic

Back 17

USE: s/t sedative hypnotic which makes you pass out; largely been replaced by conscious sedation, ie diprivan, propofol
SIDE EFFECTS: N&V, gastric irritation, excitement (paradoxical effect),

Front 18

Versed (Midazolam)?

Back 18

CLASS: benzodiazepine
USE: pre-operative sedation, conscious sedation
SE: apnea, resp depression, hypotension, bradycardia, paradoxical effect
- pt on Versed needs to be transported on cardio-pulmonary monitor

Front 19

what drug is used to reverse respiratory & CNS depression caused by opiate (narcotic) overdose?

Back 19

Narcan (Naloxone)
- antidote for morphine overdose

Front 20

what drug is given as antidote for benzodiazepines?

Back 20

Romazicon (Flumazenil)
- would reverse Valium overdose
- reverses sedative effects of benzo's used in anesthesia or conscious sedation