Ricci 36 Pain

A newborn who is suspected of having leukemia is being prepared for bone marrow aspiration. The newborn's mother asks whether any type of sedation or anesthesia will be used. What statement should the nurse make in response?

"Because this is a painful procedure, your child will receive conscious sedation to alleviate pain." In the past, it was believed infants do not feel pain because of incomplete myelination of peripheral nerves. Evidence-based practice has shown this not to be true as myelination is not necessary for pain perception. A second argument in the past against needing to provide pain relief for infants was that they have no memory. It can be shown, however, physiologic changes occur with pain even in preterm infants, so even with a lack of memory, it is clear pain is experienced. Sedation does not typically involve risk high enough to forgo it before a painful procedure.

The nurse is caring for a client who has sickle cell anemia and is in a sickle cell crisis. The child is hospitalized for treatment of symptoms and pain management during the crisis. The parents tell the nurse that they don't think their child needs any pain medication because he is sleeping a lot. How should the nurse respond?

"I understand why you think your child isn't in pain; sleep is often a way for children to cope with pain." Sleep or play may be a coping strategy for the child in pain, and sleep may reflect exhaustion of the child who is coping with pain; therefore, the nurse and parents should not assume the child is pain free. Stating, "I think your child can determine if they are feeling pain better than you can determine it" is not therapeutic communication and may anger the parents. Telling the parents that the medication must be given as ordered does not address the parent's concern.

The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?

"Pick your favorite Band-Aid and show me which arm to use." Allowing the child options related to the style of the Band-Aid and the extremity to use gives the child some control over the happenings. Offering a pinwheel is a distraction technique. Encouraging the parent to hold the child during the procedure promotes feelings of security. Encouraging the child or parents to ask questions facilitates communication.

A nurse is interviewing the mother of a sleeping 10-year-old girl to assess the level of the child's postoperative pain. Which comment should trigger additional questions and necessitate further teaching?

"She is asleep, so she must not be in pain." Just because the girl is sleeping does not mean she is not in pain. Sleep may be a coping strategy or reflect excessive exhaustion due to coping with pain. An easygoing temperament and the ability to articulate how she feels will be helpful for the nurse to establish a baseline assessment. If the girl had never had surgery before, she is less likely to have previous memories or episodes of prolonged or severe pain.

The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?

"This can be taken with other medications we have at home that didn't require a prescription." The nurse must emphasize that the parents should read closely labels of over-the-counter medications they already have or purchase. Some may contain ibuprofen or other nonsteroidal anti-inflammatory drugs, and if given in conjunction with ibuprofen may lead to overdose. The other statements are correct.

The nurse is caring for a 17-year-old child who was sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the teen indicates the need for further instruction?

"This medication should be taken on an empty stomach." Ibuprofen belongs to a group of medications referred to as non steroidal anti-inflammatory drugs. Side effects of this medication may include nausea, vomiting, bleeding gums and bruising. Taking this medication with foods may help to lessen gastrointestinal upset.

The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching?

"We should start the method after he feels pain." The parents must understand that they should begin the technique or method chosen before the child experiences pain or when he first indicates he is anxious about or beginning to experience pain. The other statements are accurate.

Riley Infant Pain Scale

*Infant* 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.

Infant pain presentation

-Increased heart rate, usually averaging approximately 10 bpm; possibly bradycardia in preterm newborns. -Decreased vagal toneDecreased oxygen saturation. -Palmar or plantar sweating (as measured by skin conductivity testing); not reliable in infants before 37 weeks' gestation.

Physiology of pain

1) Exposure to thermal noxious stimuli results in activation of nociception (*transduction*). (2) Impulses are relayed along the peripheral nerves to the spinal cord through the dorsal horn (*transmission*). (3, 4) This results in the individual feeling the sensation of pain (*perception*). (5) Neurons in the brain stem send signals back down to the dorsal horn, and these fibers release substances such as endorphins, which can inhibit painful impulses in the dorsal horn (*modulation*).

Poker Chip Tool

4 red poker chips are used explain as "pieces of hurt", do not give a zero option for hurt; child will say "I don't have any" if they are not hurting ask "how many pieces of hurt do you have right now?" 1 = little hurt, 2 = little more hurt, 3 = more yet, 4 = most hurt you could have. *3-18yrs*

A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified?

A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified? Parents can increase or decrease the child's ability to handle a situation. Showing disapproval about crying and expecting the boy to be brave may intensify the pain experience and be beyond the child's coping capabilities. Reacting to the child's pain in an accepting manner and offering comfort measures helps the child cope.

Visual analog scale

A pain rating scale using a straight line; the left end of the line represents no pain, the right end represents the worst pain, and patients mark the place on the line that best represents the severity of their pain, *5yrs or older*

Pharmacokinetics

Absorption, distribution, metabolism, and excretion

The nurse is caring for a pediatric client experiencing mild to moderate pain related to a recent bone marrow biopsy procedure. The child is receiving chemotherapy treatments for a cancer diagnosis. The child has several prn pain medication options on the medication administration record. Which medication should the nurse administer?

Acetaminophen Acetaminophen is a relatively safe medication use to treat mild to moderate pain, and it does not have the same GI or antiplatelet effects of NSAIDs (such as naproxen); therefore, it would be the best choice since this child is receiving chemotherapy treatments for cancer. Morphine and Fentanyl are opioid analgesics used for moderate to severe pain.

A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is:

Acute referred pain Acute pain means sharp pain, as is the case in this scenario. It generally occurs abruptly after an injury. The pain of a pin prink is an example. Chronic pain is pain that lasts for a prolonged period or beyond the time span anticipated for healing. Referred pain is pain that is perceived at a site distant from its point of origin. In this case, the typical ice cream "brain freeze" is a headache that results from the contact of the cold ice cream with the digestive tract.

Factors influencing a child's perception of pain include

Age and gender, cognitive level, temperament, previous pain experiences, and family and cultural background, all of which *cannot be changed.*

The nurse is caring for a burn client with orders for oral ibuprofen and morphine PRN to control pain. Which nursing interaction is the most beneficial for the nurse to implement for pain management?

Alternate these medications around the clock to diminish peaks and valleys in pain control. Pain is best managed by a proactive, preemptive approach. Anticipating and treating pain is much more effective and humane than trying to manage pain once it is present. PRN administration of pain medication tends to propagate a pain cycle with peaks (side effects like sedation) and troughs (pain) of drug action. If pain is present or anticipated for most of the day, medications must be scheduled and administered around the clock (ATC), with additional doses of analgesics available for prompt relief of breakthrough pain.

Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important?

Assessing vital signs frequently, because they can become depressed Moderate sedation is a medically controlled state of depressed consciousness that allows the protective reflexes to be maintained. The depressed state can be cuased by many medications: midazolam, ketamine, propofol, etc. Children often pass through their intended level of consciousness to a deeper level. It is imperitive that the child be continuously monitored, the person administering the drugs be skillfully trained in pediatric advanced life support, and there be emergency equipment and drugs available at all times during the procedure. The child would be positioned necessary for the procedure to be carried out.

Pain Observation Scale for Young Children

Behavioral assessment tool designed for use in children between *1 and 4 years* of age. 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.

Toddler pain presentation

Can react to painless procedures as intensely as painful ones, with intense emotional upset and physical resistance or aggression. They may bite, hit, scream, or kick.

School age pain presentation

Can usually communicate the type, location, and severity of pain. Children older than the age of 8 years can use specific words, such as "sharp as a knife," "burning," or "pulling" to describe their pain. However, they may deny pain in an attempt to appear brave or to avoid further pain related to a procedure or intervention.

FACES pain scale

Child as young as 3 can use. Six cartoon faces range smile- cry. Child chooses face that best describes how they feel. *3-8yrs*

Oucher pain scale

Children 3-12 years of age with culturally specific photographs showing different levels of pain and discomfort.

The nurse is caring for a 12-year-old in sickle-cell crisis. The nurse determines that the child is very tense and might benefit from relaxation techniques. Which is the best approach for the nurse to take when implementing this pain reduction technique?

Close the door to the client's room, dim the lights, and close the curtains before beginning. Dimming the lights and closing the door to sounds, bright light, and distractions in the hall are good ways to begin a relaxation exercise. The television should be off during this technique so it will not be a distraction. Parents do not need to leave the room as this may cause increased anxiety for the child. Deep and slow breathing are relaxation techniques, not quick breathing.

Situational factors influencing a child's perception of pain involve

Cognitive, and emotional aspects and *can be changed.*

A 4-year-old child is scheduled for an MRI. The child's parent is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have?

Conscious sedation Conscious sedation refers to a state of depressed consciousness, usually obtained through IV analgesia therapy. The technique allows a child to be both pain free and sedated for a procedure. The child is monitored throughtout the process by a nurse. PCA is a pump that delivers pain medication and allows the client to receive medication via continuous infusion or bolus dose. General anesthesia means the client loses all reflexes. This is not necessary for an MRI and it would have to be administered and monitored via an anesthesiologist. An IM injection is painful and frightenes the child. It is not necessary when oral and IV medications can be used.

***The nurse is caring for a 7-year-old postoperative child who is reporting an 8 out of 10 on a pain intensity scale. The child's parent is requesting pain medication. The child received ibuprofen 3 hours ago. What is the correct nursing action?

Contact the health care provider and request an opioid pain medication. The nurse must advocate for the child. Advocacy may involve convincing a parent that opioids are appropriate for the situation or consulting with the prescriber regarding an ineffective medication regimen. Explaining to the parnet that the child cannot receive any more pain medication is ineffective and does not advocate for the child in pain. Turning on the television is not a bad idea. However, it is not the priority. It is not appropriate to apologize. The nurse can do something. Contacting the health care provider to request more medication is in the nurse's power.

CRIES pain scale

Crying- characteristic of pain Requires O2 for SaO2 ,95% Increased Vital signs Expression Sleepless *Neonates (0-6 months)*

Chronic pain

Defined as pain that continues past the expected point of healing for injured tissue. It provides no protective function. It may be continuous or intermittent, with and without periods of exacerbation or remission.

Acute pain

Defined as pain that is associated with a rapid onset of varying intensity. It usually indicates tissue damage and resolves with healing of the injury.

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

Neuromodulators

Endogenous opioid chemical regulators that appear to have analgesic activity and alter pain perception.

FLACC pain scale

F: Faces. L: Legs. A: Activity. C: Cry C: Consolability *6 months to 7 years of age*

***The nurse is assessing the pain level of a child who is 4 years old. When choosing a pain scale, the nurse demonstrates understanding of cognitive levels when choosing these scales as best for this child. Select all that apply.

FACES Pain Rating Scale Oucher Pain Rating Scale Poker Chip Tool The FACES, Oucher, and Poker Chip Tool pain rating scales are self-reporting tools that can be used for children 4 years of age. The FACES and Oucher scales use faces to help the child express their pain level, and the Poker Chip Tool helps the child by use the chips as "pieces of hurt" to express their pain. Visual analog and numeric scales involve a horizontal or vertical line with marked endpoints. The visual analog scale can be used in children 8 years or older but some studies report effectiveness in children 5 to 7 years of age. The numeric scale can be used with children 8 years or older.

The nurse is preparing to assess the pain of a developmentally and cognitively delayed 8-year-old. Which pain rating scales should the nurse choose?

FACES pain rating scale The nurse should select the pain assessment tool that is appropriate for the child's cognitive abilities. The FACES pain rating scale is designed for use with children ages 3 and up. A child with limited reading skills or vocabulary may have difficulty with some of the words listed to describe pain on the word graphic scale. Some of the concepts might be too difficult on the visual analog and numerical scales for a developmentally disabled child. The base age for the Adolescent pediatric pain tool is 8 years, but its use would likely be inappropriate for an 8-year-old with cognitive delays.

The nurse is completing a CRIES Scale for an child who had surgery a few hours ago. Which elements will be included in the assessment? Select all that apply.

Facial expression Vital signs Sleeping activities The CRIES scale assesses neonatal discomfort related behaviors in the postoperative period. The elements assessed include crying, oxygen required to maintain saturation above 95%, increased vital signs, expression, and sleeplessness. Activity and positions are reflected in the FLACC scale.

Pain threshold

Fibers lead to the perception of diffuse, dull, burning, or aching pain. The point at which the person first feels the lowest intensity of the painful stimulus is termed

The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond?

Give the mother the FACES pain rating scale to use with her son. Different pain rating scales are appropriate for different developmental levels. Children often regress when in pain, so a simpler tool such as the FACES scale may be needed. It is also helpful to enlist the assistance of the parent. Expecting the child to select a chip is developmentally inappropriate when the child shows signs of regression. The child wouldn't understand the phrase "word-graphic scale," and this scale or the visual analog scale is more complex than this 4-year-old can handle.

***The nurse is working with a 5-year-old boy who must receive repeated intravenous injections as part of his treatment. He hates the injections, however, and is frightened whenever he sees the syringe and needle. In an attempt to overcome this fear, the nurse holds the syringe up for him to see and tells him, "This looks kind of like a space rocket, don't you think? Here comes the space rocket—it needs to refuel." Which pain management technique is the nurse using here?

Imagery Imagery involves the use of the imagination to create a mental image. This mental image usually is a positive, pleasurable image, but it need not be real. As an example, a child could imagine a venipuncture needle as a silver rocket ship probing the moon or a submarine diving under the water to escape a torpedo just in time. Thought stopping is a technique in which children learn to stop anxious thoughts by substituting a positive or relaxing thought in its place. Hypnosis involves the child entering a trance-like state to effectively avoid sensing pain. Biofeedback is based on the theory people can regulate internal events such as heart rate and pain response in response to a stimulus. A biofeedback apparatus is used to measure muscle tone or the child's ability to relax.

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiological effects?

Impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression Unrelieved acute pain can lead to impaired mobility; anorexia, causing poor nutritional intake; delayed wound healing; anxiety and irritability; somatic symptoms; sleep disturbances; avoidance; developmental regression; and increased parental distress. Constipation, nausea, vomiting, nocturnal enuresis, and migraine headaches are not effects of acute pain.

Adolescent pain presentation

May be concerned primarily about body image and fear losing control over their behavior. This may result in denial or refusal of medications. Their mood and what they think is expected of them will also affect their response to pain.

Preschooler pain presentation

May become quiet or try to withdraw and hide in response to actual or perceived pain. For example, the child may say he or she needs to go to the bathroom or needs to get something from another room. Because of their magical type of thinking, preschoolers may believe pain is a punishment for misbehaving or having bad thoughts.

Pharmcodynamics

Mechanism of action, including adverse effects

Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects?

Morphine A ceiling effect is when a dosage of a pain medication is frequently increased but smaller and smaller gains are made to reduce the pain. The severity of the side effects also increase as the dosage is increased. Mixed-agonist-antagonists have a ceiling effect. Pure opioid agonists (morphine, hydromorphone, fentanyl) do not have a ceiling effect. They can be given in initial dosages and as needed without having to increase the dose to gain pain relief. Acetominophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and aspirin have ceiling effects. Each of them have recommended dosages not to be exceeded every 24 hours.

Adolescent Pediatric Pain Tool

Multidimensional pain instrument for children and adolescents that is used to assess three dimensions of pain: Location Intensity Quality *8-17yrs*

NIPS pain scale

N - Neonatal I - Infant P - Pain S - Scale - similar to CRIES INCLUDES - facial expression - arm movement - cry - leg movement - respiration - arousal

Transduction

Nocireceptor activation.

Superficial somatic pain

Often called cutaneous pain, involves stimulation of nociceptors in the skin, subcutaneous tissue, or mucous membranes. Typically the pain is well localized and described as a sharp, pricking, or burning sensation.

PIP pain scale

P - Premature I - Infant P - Pain P - Profile - similar to CRIES INCLUDES - eye squeeze - nasolabial furrow - heart rate - oxygen saturation - brow furrow Each parameter is scored as 0, 1, 2, or 3. The score is then totaled and the maximum score that can be achieved is 21. The higher the total score, the more intense the pain.

5th vital sign?

Pain

Neuropathic pain

Pain due to malfunctioning of the peripheral or central nervous system. It may be continuous or intermittent and is commonly described as burning, tingling, shooting, squeezing, or spasm- like pain.

Visceral pain

Pain that develops within organs such as the heart, lungs, gastrointestinal tract, pancreas, liver, gallbladder, kidneys, or bladder. It is often produced by disease.

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta?

Pulses weaker in lower extremities compared to upper extremities With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased sytemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot.

***The nurse is about to assess pain in the child and will use the QUESTT acronym as a guide to objective and subjective data collection. This acronym stands for what? Select all that apply.

Question the child and Take action are accurate. The other descriptors for the acronym are not. The corrected meaning follows: Use a reliable pain scale, Evaluate the child's behavioral and physiologic changes and determine the effectiveness of the intervention, Secure parental involvement, and Take cause of the pain into account when intervening.

Somatic pain

Refers to pain that develops in the tissues. It can be further divided into two groups—superficial and deep.

Nociceptive pain

Reflects pain due to noxious stimuli that damages normal tissues or has the potential to do so if the pain is prolonged

The nurse is caring for a child who has received postoperative epidural analgesia. Which nursing assessment is priority?

Respiratory depression Respiratory depression, although rare when epidural analgesia is used, is always a possibility. However, when it does occur it usually occurs gradually over a period of several hours after the medication is initiated. This allows adequate time for early detection and prompt intervention. The nurse should also monitor for pruritus, urinary retention, and nausea and vomiting but the priority is to monitor for respiratory depression.

***The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for?

Respiratory depression, constipation, and pruritis Nausea and vomiting, pruritis, sedation, respiratory sedation, constipation, and urinary retention are common side effects of opioid medications. Hypotension, hypertension, diarrhea, and disorientation are not common side effects of opioid medication.

The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for?

Respiratory depression, constipation, and pruritis Nausea and vomiting, pruritis, sedation, respiratory sedation, constipation, and urinary retention are common side effects of opioid medications. Hypotension, hypertension, diarrhea, and disorientation are not common side effects of opioid medication.

Nociceptors

Sensory receptors that enable the perception of pain in response to potentially harmful stimuli.

What are some negative effects that chronic pain can have on the pediatric population?

Sleep disturbances, exhaustion, irritability, mood disturbances, and depression Chronic pain is defined as pain that continues past the expected point of healing for the injured tissue. This pain has many effects as the child continues in pain. These effects may include sleep disturbances, exhaustion, irritability, mood disturbances, and depression. Heart rate, respiratory rate and blood pressure increases are seen more with acute pain. Children in any type of pain have a decreased appetite instead of increased.

A young child is in the emergency department with swelling and pain in the right ankle. The client states that while playing soccer, the client somehow twisted the ankle, and could not walk off the field. The health care provider tells the client that it is a sprain. Which type of pain is this client experiencing?

Somatic

The nurse teaches a preschooler to use a FACES pain rating scale prior to surgery. At that time, the preschooler points to the smiling face. Following surgery when the nurse suspects the child has pain, the preschooler points again to the smiling face. How would the nurse interpret this response?

The child is using the scale to predict what he or she would like, not what the child has. Preschoolers use "magical thinking," or believe that what they wish will come true. They may use pain scales, therefore, to "wish" for a smiling face, rather than for rating their pain. Preschoolers also may not report pain, thinking it is something to be expected. If the child does not report pain then the nurse should also assess the child's features: Is the child grimmacing, crying, or being totally still? The nurse can also ask the parent if this is how the parent would describe the child when in pain. Pain is subjective so the nurse would not be reporting the pain falsely.

The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?

The child's nonverbal behaviors may indicate the presence of discomfort. Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain.

***The nurse is caring for a 12-year-old postoperative spinal rod placement client with scoliosis. Which factors might intensify the child's postoperative pain experience?

The client had a painful experience with an appendectomy at age 10. Negative painful past experiences can intensify a child's response to pain. Temperament has not been shown to influence the actual intensity of the pain experience, but it does seem to influence children's expression of pain behaviors. Age does not intensify the pain experience. Discussion of pain control methods can alleviate stress and therefore decrease the pain experience.

***The nurse is caring for a term infant suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures and the newborn?

The newborn's pain pathway components are developed enough at birth to experience pain. Neuroanatomical and neuroendocrine components of the pain pathway are sufficiently developed in the neonate to allow the transmission and perception of pain. While infants may not remember painful experiences as distinct actual events, the functional structures for long-term memory, specifically, the integrity of the limbic system and diencephalons, are well developed in newborns. These early painful experiences may be stored as procedural memory, not accessible to conscious recall. Ample evidence indicates that both term and preterm neonates have the capacity to experience and remember pain much like older children and adults do. Newborns should receive analgesia for painful procedures.

When assessing a wound for proper anesthetic effect, which finding would indicate the wound would be ready for suturing?

The nurse can visualize a blanching effect When assessing readiness of an anesthetic agent, the nuse should assess for a change in the skin color. This is either blaching or rednessess. A blue or darkened color would not indicate the effectiveness of the local anesthetic and may indicate a complication which should be assessed. If the wound requires suturing, fresh bleeding may continue to occur even though the surrounding skin is anesthesitized. A local anesthetic will control pain, not bleeding.

***A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education?

This is caused by an opening that usually closes by 1 week of age. A PDA is caused by an opening that usually closes by 1 week of age called the ductus arteriosus. The defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

After receiving a pain medication for 7 days, the client has begin to request pain medication more frequently. What inference about this occurrence is most credible?

Tolerance to the medication is beginning to take effect. Drug tolerance occurs when increasing doses are required to manage the pain. Physical dependence can occur after as few as 5 days of continuous use of the drug; symptoms of withdrawal begin if it is suddenly stopped. There are no signals that addiction is of concern for this client.

The sensation of pain involves a sequence of physiologic events:

Transduction, transmission, perception, and modulation.

True/False Infants, including preterm infants, experience pain.

True.

A 5-year-old arrives at the emergency department and reports abdominal pain. After performing an assessment and laboratory work, the health care provider diagnoses appendicitis. The nurse knows that this child is experiencing which type of pain?

Visceral Visceral pain involves sensations that arise from internal organs, such as the intestines. The pain of appendicitis is visceral pain. Appendicits would produce acute pain, not chronic. Acute pain arises at the time of injury. Chronic pain lasts past the time in which the injury should have healed. Somatic pain is pain that develops within the tissues. Cutaneous pain is a superficial somatic pain that arises in the skin and mucus membranes.

***The nurse is caring for a client who has been diagnosed with a tumor in the small intestine that is pressing on the liver. Which type of pain does the nurse anticipate the client will complain of?

Visceral Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.

The nurse is preparing to administer a dose of ketorolac to a 15-year-old adolescent. How should the nurse administer the medication to reduce the potential for gastrointestinal upset?

With meals Ketorolac is a non-steroidal anti-infmammatory drug (NSAID). It is associated with gastrointestinal upset. To reduce this side effect the nurse may administer the medication with food.

The nurse is providing postsurgical care for a 5-year-old. The nurse knows to avoid which question when assessing the child's pain level?

Would you say that the pain you are feeling is sharp or dull? A preschooler may have difficulty distinguishing between the types of pain such as if the pain is sharp or dull. It also limits the information being obtained by the nurse. They can, however, tell someone where it hurts and can use various tools such as the FACES scale (cartoon faces) or the OUCHER scale (photograph and corresponding numbers) to rate their pain.

Deep somatic pain

typically involves the muscles, tendons, joints, fasciae, and bones. It can be localized or diffuse and is usually described as dull, aching, or cramping. Deep somatic pain may be due to strain from overuse or direct injury, ischemia, and inflammation.