Chapter 30- Peds

Positive self-talk

teach child positive statements to say when in pain--> "I will be feeling better soon" or "When I go home, I will feel better, and we will eat ice cream"

Adolescent response to pain

• Less vocal with less physical resistance • More verbal in expressions, such as "It hurts" or "You're hurting me" • Displays increased muscle tension and body control

guided imagery

"feel the cool breezes" "see the beautiful colors" have child write down or record script combine relaxation and rhythmic breathing

thought stopping

-identify positive facts about the painful event. -Identify reassuring information -condense positive and reassuring facts into a set of brief statements and have child memorize them

Older infant response to pain:

-uses crying -shows a localized body response with deliberate withdrawal from what is causing the pain -reveals expression of pain or anger -demonstrates a physical struggle, especially pushing away from what is causing pain

Young child response to pain:

-uses crying and screaming -uses verbal expressions such as "Ow" -thrashing of arms and legs to combat pain -Clings to parent/nurse -Requests physical comfort like hugs

A child with appendicitis has been treated with preemptive analgesia before undergoing appendectomy. What would be the benefits of this treatment to the child? Select all that apply: A. It decreases postoperative pain. B. It increases the need for analgesics. C. It reduces the length of the patient's hospital stay. D. It improves the success of surgery. E. It decreases the risk of neuropathic pain.

A. C. Preemptive analgesia is a treatment in which local or regional anesthetics and analgesics are administered to the child before a surgery such as appendectomy. It helps reduce postoperative pain and shortens hospital stays. It reduces the need for analgesics by reducing pain in children. Preemptive analgesia does not affect the success of the surgery. Preemptive analgesia has no effect on neuropathic pain, which is seen mostly in patients with cancer.

Who is the FLACC scale used for?

2 months-7 yrs

Which nursing action should be implemented to provide effective pain relief in an 11-year-old child with severe pain? A. using a 0-10 numerical scale for assessment B. encouraging the use of traditional pain-relieving methods C. avoiding the use of pain questionnaires for assessment D. avoiding administering morphine (Avinza) to child

A. Common metric systems such as a 0-10 numerical scale are used to assess pain in children. It helps the nurse determine the severity of pain and thus provide effective treatment. Traditional methods may not provide immediate pain relief and may cause drug interactions. Therefore, a customized treatment plan is needed. Pain assessment questionnaires should be used to assess the pain. Morphine (Avinza) can be administered for pain relief to a child with severe pain.

The nurse is caring for a 2-year-old child who returns to the hospital floor after undergoing an operation. Which nonverbal action implies that the child is in pain? Select all that apply. A. Loud crying B. Drowsiness C. Confused look D. Furrowed brow E. Puckering of lips

A. D. E. Crying is the most common manifestation of underlying pain. The child can have furrowed brow, puckered lips, clenched teeth, and turning down of mouth as outward signs of pain. Drowsiness and confused looks are not common body signs to express pain.

After administering an injection, the nurse provides containment by covering the infant with a blanket roll. What are the probable reasons for this nursing intervention? Select all that apply. A. To decrease stress B. To keep the child awake C. To increase the heart rate D. To make the child feel warm E. To make the infant feel secure

A. E. Containment is a nonpharmacological approach that helps the child feel secure and reduces stress. It can help the infant settle down and stop crying. This therapy is not performed to keep the child awake, and in fact it can help the child sleep. Containment is intended to reduce or maintain the heart beat, not increase it.

The nurse is caring for a child after a heelstick procedure. What is the best measure to reduce the child's pain and discomfort after the procedure? A. Switching off all the lights in the child's room B. Swaddling the child after the procedure is finished C. Leaving the child alone and allowing relaxation time D. Playing music in the room and dimming the lights

B. It has been proven that children who get physical contact while in pain are more comforted. Swaddling is the most appropriate technique to comfort a child. Switching off the lights, leaving the child alone in the room, or playing music will not comfort the child. The child may feel frightened and distressed if such measures are taken.

A child who is on opioid therapy has come for a follow-up visit to a pain clinic. After assessment, the health care provider adds methylphenidate (Methylin) to the child's regimen. What could be the reason for adding this drug? The child had: A. pruritus. B. experienced sedation. C. dysphonia. D. respiratory depression.

B. Pruritus, sedation, dysphoria, and respiratory depression are side effects of opioid therapy. Methylphenidate (Methylin) is given as an adjuvant drug to reduce the sedation caused by opioids. Hydroxyzine (Hypam) is used to treat pruritus. Haloperidol (Haldol) is used to treat dysphoria. Naloxone (Narcan) is used to treat respiratory depression.

A patient who is on opioid therapy reports having no pain relief from the previously prescribed dosage. The primary health care provider increases the dosage. What is the reason for increasing the dosage? The patient has symptoms of opioid: A. addiction. B. tolerance. C. dependence. D. withdrawal.

B. If the patient reports having no pain relief for the prescribed dosage of opioids, it indicates that the patient has developed opioid tolerance. In this condition the dosage may be increased to provide effective pain relief to the patient. If the patient feels the need to administer the drugs without cause (pain), then the patient has opioid addiction or opioid dependence. Depression, lacrimation, irritability, and anorexia are symptoms of opioid withdrawal.

The nurse is caring for a postoperative child. On assessment, the child rated the level of pain as 8. Which drug should be administered to manage the child's pain? A. Tolmetin (Tolectin) B. Fentanyl (Sublimaze) C. Naproxen (Naprosyn) D. Acetaminophen (Tylenol)

B. Opioid medications are found to be effective in managing postoperative pain. Fentanyl is an opioid drug effective both as an anesthetic during surgery and as a sedative in pain management. Tolmetin, naproxen, and acetaminophen are nonopioid sedatives for pain management. They are used for managing pain in mild to moderate conditions and not used for managing severe pain such as postoperative pain.

An important consideration when using the FACES pain rating scale with children is: A. that children color the face with the color they choose to best describe their pain. B. the scale can be used with most children, including those as young as 3 years old. C. the scale is not appropriate for use with adolescents. D. the scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

B. The FACES scale has been validated for children as young as 3 years old to rate pain. The child points to the face that best describes the pain being experienced. The scale is useful for all ages above 3 years, including adults. The scale does not have a means of assessing physiologic data.

A mother reports that her baby is teething and is very uncomfortable. What measures should the nurse suggest to the mother to relieve the baby's discomfort? Select all that apply. A. Administer morphine (Avinza) B. Use frozen teething rings C. Give the child a hard cracker or bread D. Use anesthetic gels available for teething E. Rub some wine on the child's gums and cheeks

B. C. D. A child can be very uncomfortable and irritable during teething. The best intervention is the application of anesthetic gels that are available in the market for teething. The discomfort can also be reduced with the use of frozen rings and bread or hard crackers that the child can chew on. Morphine is prescribed by health care practitioners in cases of severe pain and is not recommended for teething. It is inappropriate to rub wine on the child's gums.

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of opioid side effects, which actions should the nurse include in the patient's plan of care to prevent constipation? Select all that apply: A. Instruct the child to remain supine while in bed B. Administer docusate sodium (Colace). C. Encourage fluid intake. D. Encourage the child to eat fruit. E. Administer diphenhydramine (Benadryl).

B. C. D. Administration of Colace, a stool softener, can help prevent constipation . Increased fluid and fruit intake (high fiber content) can help prevent constipation. Increased activity helps stimulate peristalsis. Diphenhydramine does not increase peristalsis or prevent constipation

Which assessment scales rate pain using the straight line method? Select all that apply. A. Face, Legs, Activity, Cry, Consolability (FLACC) scale B. Numeric scale C. Color tool scale D. Visual analog scale E. Word-graphic rating scale

B. D. E. The numeric scale is a pain assessment method that uses a straight line with divisions marked as scores, with one end written as "No Pain" and the other as "Worst Pain." The child is asked to point at the divisions, and the pain is scored accordingly. The visual analog scale also uses a straight line where the divisions are marked as scores. One end of the scale is marked "No Pain" and other as "Worst Pain." The word-graphic rating scale uses descriptive words marked on the line to denote varying intensities of pain. The FLACC scale involves observing and rating the behavioral patterns of the child. The color tool scale uses markers for a child to create his or her own scale by representing the pain experienced using different colors.

A patient with severe pain was prescribed pentazocine (Talwin). After few weeks the patient tells the nurse that she has severe sweating, tears, a runny nose, and nasal irritation. What is the most likely reason for the patient to have these symptoms? Drug: A. Overdose B. Addiction C. Withdrawal

C. Pentazocine is a mixed opioid agonist and antagonist. Sudden discontinuation of the medication causes withdrawal symptoms. The symptoms of opioid withdrawal are severe sweating, tears (lacrimation), and rhinorrhea, which is characterized by runny nose and nasal irritation. The symptoms of drug overdose (opioid overdose) are sedation, respiratory depression, nausea, and vomiting. Drug addiction (opioid addiction) and drug dependence (opioid dependence) are characterized by strong desire or sense of compulsion to take the drug, suicidal ideation, and depression.

The nurse is assessing pain in a child with cerebral palsy using the Riley Infant Pain Scale (RIPS). The nurse documents that the child has severe pain and gives a rating of 1 according to the RIPS. What behavior did the nurse find in the child? The child is: A. thrashing his arms. B. jerking during sleep. C. restless and frowning. D. clenching his teeth.

C. The RIPS is used to assess pain in children with cerebral palsy. The rating is based on changes in the child's behavior due to pain. If the child is restless and is frowning or grimacing, the nurse should assign a rating of 1. If the child is thrashing his arms, jerking during sleep, and screaming loudly when touched, then the nurse should assign a rating of 3. If the child is clenching his teeth or cries when touched, then the nurse should assign a rating of 2

The nurse is starting an intravenous (IV) line on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that: A. children tolerate pain better than adults. B. children become accustomed to painful procedures. C. children often lie about experiencing pain. D. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

D. Children with chronic illnesses are more likely to identify invasive procedures as stressful compared with children with acute illnesses. There are no data to support the theory that children tolerate pain better than adults. The child has increasing difficulty with numerous and repeated painful procedures rather than becoming accustomed to them. Pain is whatever the experiencing person defines it to be.

The nurse is assessing a child who is on opioid therapy for pain. Which adverse effect should the nurse be aware of in the patient? A. Brain death B. Kidney failure C. Hepatic failure D. Respiratory depression

D. Respiratory depression is the most common side effect of opioid therapy. Opioid therapy does not cause brain death. Opioids can cause urinary retention, but they do not cause kidney damage because they do not impair renal function. Opioids do not impair liver function, so they do not cause hepatic failure.

The nurse assesses a Spanish-speaking child who is undergoing chemotherapy to determine the intensity, quality, and type of pain. Which scale might the nurse be using? A. Bieri scale B. Oucher Pain Scale C. numeric rating scale D. Adolescent Pediatric Pain Tool

D. The Adolescent Pediatric Pain Tool is a multidimensional scale where intensity, quality, and type of pain are assessed; it is available in a Spanish version. The Bieri scale is a face scale where pain is assessed with faces. It does not assess the intensity, quality, and type of pain. The Oucher Pain Scale was developed to assess pain intensity in children who do not communicate in English and is designed to avoid cultural influences in pain management. The numeric rating scale uses numeric ratings on a line from 0 to 10 to measure pain intensity.

The nurse is assessing the behavior of a child with pain using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The nurse notes that the child is restless and maintains a disinterested face. However, the child is consolable by hugging. What score does the nurse give the child based on FLACC scale? A. 0 B. 1 C. 2 D. 3

D. The FLACC pain assessment tool is used to assess pain. Using this scale, the nurse notes each behaviors and rates them. The variables include face, leg, activity, cry, and consolability. The child has a disinterested face, is restless, and is consoled by hugging. The nurse rates each behavior as 1, and the sum yields a score of 3. If the child has no facial expression or has a smiling face with a normal sleep pattern, then the score is 0. A score of 1 is given for variables such as grimacing, restlessness, squirming, moaning, and distractibility. Variables such as constant frowning, kicking, jerking, steady crying, and difficulty being consoled are assigned a score of 2

A 1-year-old child is suffering from minor pain after a fall. Using a behavioral pain assessment scale, the nurse rates the child's pain at 2 on a 0 -10 pain scale. Which medication should the nurse question in the prescription? A. Codeine sulfate (Codeine) B. Acetaminophen (Tylenol) C. Morphine (Avinza) D. Oxycodone with aspirin (Percodan)

D. The most appropriate medications for minor pain (< 3 on the pain scale) are nonsteroidal antiinflammatory drugs and morphine. Percodan contains aspirin, which is contraindicated in young children because it may cause Reye's syndrome. Drugs such as codeine, acetaminophen, and morphine can be safely prescribed in the children because these drugs do not contain aspirin.

What does FLACC stand for?

Face, Legs, Activity, Cry, Consolability

Who is the Wong Baker scale typically used for?

For children as young as 3 y.o

New Born and Young infant response to pain:

Uses crying, shows facial appearance of pain, rigidity, thrashing

Who is the Numeric Scale typically used with?

children as young as 5 and can count to 10 and have concept of numbers

school-age child response to pain:

demonstrates behaviors of the young child, especially during the actual procedure -exhibits time-wasting behavior such as "Wait a minute!" -Displays muscle muscular rigidity, such as clenched fists