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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
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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
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Goals of Rating Pain
- 1. Identify Characteristics
- 2. Establish Baseline
- 3. Evaluate Pain Status
- 4. Effects of Intervention
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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)
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Behavior Measurements of Pain
- Face
- Crying (duration, pitch)
- Behavioral Changes
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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
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CRIES
- C: crying
- R: regulation of O2
- I: increased vital signs
- E: expression, facial
- S: sleeplessness
Same scoring as FLACC
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FACES
Best to save until the kids is 5 or 6
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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)
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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
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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
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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
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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
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Reevaluate pain every ____ min.
30-60
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