Vital Signs and Pain

Match the route of temperature measurement to the most appropriate age.

10 years Oral 4 years Axillary 3 months Temporal

The nurse is assessing vital signs for children. Which patient finding would be most concerning?

A 12-year-old patient breathing 30 breaths/min A respiratory rate of 30 is considered tachypnea in a 12-year-old and requires further evaluation.

Pain can be categorized as either acute or chronic. Which example(s) describes chronic pain? Select all that apply.

A child who is receiving chemotherapy for neuroblastoma diagnosed 7 months ago Pain caused by cancer or chemotherapy is considered chronic pain. Pain that is ongoing and lasts longer than 6 months is considered chronic pain. Chronic pain continues even after the injury or illness has completed. A child with recurring headaches and migraines Recurring pain is considered chronic pain. Pain that is ongoing and lasts longer than 6 months is considered chronic pain. Chronic pain continues even after the injury or illness has completed. A teenager suffering from neck pain related to an accident 10 months ago Continued pain from an accident greater than 6 months is considered chronic pain. Chronic pain continues even after the injury or illness has completed.

What is the best way to schedule medication for a 2-year-old child with constant pain?

ATC or around the clock ATC medications are given around the clock to lessen the chance of breakthrough pain.

A nurse is caring for a 4-year-old postoperatively after an open reduction and fixation of his right arm. Which type of pain should the nurse expect the child to have?

Acute pain Acute pain typically last less than 3 months and is sharp and severe when compared to chronic pain. Acute pain goes away once the underlying issue is resolved and the child is returned to normal activity. Postoperative pain is acute pain occurring after a surgery.

Which factor(s) does the nurse need to take into account when selecting a pediatric pain assessment scale? Select all that apply.

Age of the patient Pediatric pain assessment scales are validated based upon the ages and developmental levels of children. Developmental levels Pediatric pain assessment scales are validated based upon the ages and developmental levels of children. Cognitive function Some pediatric pain assessment scales require the child to be cognitively available to choose his or her pain level. Able to verbally communicate Some pediatric pain assessment scales require the child to be able to verbally communicate his or her pain level.

Which applies to the definition of pain?

An unpleasant somatic or visceral sensation Pain is defined as an unpleasant somatic or visceral sensation associated with actual, potential, or perceived tissue damage. Associated with actual, potential, or perceived tissue damage Pain is defined as an unpleasant somatic or visceral sensation associated with actual, potential, or perceived tissue damage. Can be acute or chronic Pain can be categorized as either acute or chronic.

An 8-year-old who has recently learned that she is moving out of state is seeing her primary care provider once again for abdominal pain. The provider has ruled out any physical causes of the pain. Which factor is the most likely cause of the child's pain?

Anxiety Recurrent abdominal pain (RAP) can be caused by several different factors, including both physical and psychosocial causes. The anxiety related to the recent announcement of moving out of state can cause RAP.

The nurse checks the newborn's pulse and records 140 beats/min. Which should be the nurse's next action?

Assess the oxygen saturation A pulse of 140 beats/min is normal in a newborn. The nurse would continue the examination, and assessing the oxygen saturation is the next step in the examination.

A nurse is trying to decide between using a behavioral pain scale and a self-report pain scale for her patient. What is the primary difference between the two categories?

Behavioral scales are based on observation of pain while self-report scales are based on the child's report of pain. Behavioral pain assessments are based upon observation of the child rather than self-report from the child as used by self-report scales.

The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient?

CRIES scale The CRIES scale is used for infants from 32 weeks gestational age to 6 months.

Children are different from adults when it comes to pain medication dosage and administration. Which factor is different between adults and children?

Children metabolize drugs faster than adults. Children metabolize drugs faster than adults and therefore may need different dosages than adults.

Which of the medications listed are considered coanalgesic medications?

Colace Coanalgesic medications are given in conjunction with opioids. Colace is given to help with possible constipation associated with opioid use. Gabapentin Gabapentin is a drug used in conjunction with other pain medications for neuropathic pain. Amitriptyline Amitriptyline is an antidepressant used in conjunction with other pain medications for neuropathic pain, burning, and insomnia.

The nurse is caring for a 7-month-old infant with influenza. The nurse notes an axillary temperature of 103.7° F. Which action should the nurse take first?

Confirm accuracy and notify the health care provider The provider should be notified of abnormal vital signs after the temperature has been verified using another route.

The nurse is caring for a 6-year-old 2 hours post tonsillectomy. Which pediatric pain assessment should the nurse choose to use with the patient?

FLACC scale The FLACC scale is used for ages 2 months to 7 years. Though the child is only 2 hours post-op, using the FLACC scale allows the nurse to assess the child's pain without a verbal response from the child.

The nurse is caring for a 9-year-old child with asthma. Where should the nurse place the pulse oximeter to monitor the child's oxygen saturation?

Finger The nurse would use the finger to assess the oxygen saturation of a 9-year-old child.

Complementary and alternative medications (CAM) are gaining popularity among parents of ill children. Which of the interventions listed are considered part of the CAM process?

Herbal supplements Biologically based medications, including foods, special diets, herbal or plant preparations, vitamins, and other supplements, are considered complementary and alternative medications. Chiropractic treatments Manipulative treatments such as chiropractic, osteopathy, and massage are complementary and alternative medications. Acupuncture Acupuncture is a traditional Chinese medicine used in CAM therapies. Reiki Reiki is an energy-based CAM therapy used to heal the body's bioelectric fields.

Studies have shown that untreated pain at certain times in a child's life can lead to negative effects on child development. Which of the effects can result from untreated pain in a child? Select all that apply.

Hypertension Untreated pain can lead to an increase in several vital signs, including increased heart rate and hypertension. Decrease in growth and development Untreated pain in children can lead to a decrease in growth and development. Decreased immune function Untreated pain in children can lead to a decrease in immune function.

Why is it important for the pediatric nurse to assess the intensity of a child's pain?

In order to give the correct pain medication Children are typically prescribed two types of pain medication, one for mild to moderate pain and one for moderate to severe pain. The pediatric nurse needs to understand the intensity of the pain so that they can administer the correct pain medication.

Which route of administration is preferred if immediate analgesia is needed

Intravenous (IV) bolus IV bolus is the preferred route for severe pain due to its rapid onset.

The nurse is caring for an 11-month-old infant who has been diagnosed with human immunodeficiency virus (HIV). When the nurse is obtaining vital signs for the child, which actions are appropriate? Select all that apply.

Observe for signs of respiratory distress. While the child is at rest, the nurse should observe for signs of respiratory distress while obtain the vitals. Measure apical heart rate for 60 seconds. Measuring apical heart rate is an important part of the assessment of a patient younger than 2 years. Use a manual cuff to measure blood pressure. Using a manual cuff while auscultating is important for obtaining an accurate blood pressure reading in a child.

Recurrent pain is a unique type of pain. Which factor(s) makes recurrent pain different?

Recurrent pain may be categorized as acute or chronic pain. Depending on the length of time of the recurrent pain, it can be categorized as either acute or chronic. Common types are headaches or abdominal pain. The most common types of recurrent pain in pediatrics are headaches and abdominal pain. It can be caused by physical, psychosocial, or both factors. Recurrent abdominal pain can be caused by several different factors, including both physical and psychosocial causes. Keeping a diary of possible contributing factors can help with diagnosis. Children can use a headache diary to keep track of possible contributing reasons for the headache.

The World Health Organization (WHO) has certain principles that should be followed for pharmacological pain management. Which statement(s) is part of the WHO principles?

Using a two-step strategy The WHO states that the principles for pharmacological pain management should include using a two-step strategy, dosing at regular intervals, using the appropriate route of administration; and adapting treatment to the individual child. The two-step strategy allows for pain medication for all pain, mild to severe. Dosing at regular intervals The WHO states that the principles for pharmacological pain management should include using a two-step strategy, dosing at regular intervals, using the appropriate route of administration; and adapting treatment to the individual child. Regularly scheduled intervals are preferred over only using PRN dosing. Adapting treatment to the individual child The WHO states that the principles for pharmacological pain management should include using a two-step strategy, dosing at regular intervals, using the appropriate route of administration; and adapting treatment to the individual child. Adapting the treatment to each child, allows flexibility for the child and his or her diagnosis Using the appropriate route of administration The WHO states that the principles for pharmacological pain management should include using a two-step strategy, dosing at regular intervals, using the appropriate route of administration; and adapting treatment to the individual child. The route of administration should be chosen based on the child's pain level and diagnosis.

The nurse is taking care of a 10-year-old child admitted to the unit for a flare-up of sickle cell disease. The child is alert, oriented, cognitively a 10-year-old, and able to verbalize the pain. Which pediatric pain assessment scale(s) is appropriate to use with this child?

Wong-Baker FACES scale The child is cognitively appropriate and can verbalize pain; therefore, this scale is acceptable to use. Visual analog scale (VAS) This is an appropriate scale for this child based on age and cognitive level. This scale can be used for children as young as 4 years old but typically for 7 years and older. Numeric scale This is an appropriate scale for this child based on age and cognitive level. The numeric scale can be used for children as young as 5 years of age.