Acute Pain Management in Pediatrics

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Questions and Answers

What is a critical caution when using EMLA prior to a procedure?

It must be combined with NSAIDs for better effectiveness.

It should be kept on for a minimum of 12 hours.

It can be used without any other considerations.

It needs to be removed as soon as possible after the procedure. (correct)

What is the recommended dose of acetaminophen syrup for children post-immunization?

5–10 mg/kg, every 4 hours.

10–15 mg/kg, single dose as needed. (correct)

20–30 mg/kg, every 6 hours.

15–20 mg/kg, single dose.

Why might some institutions refrain from prescribing NSAIDs post-tonsillectomy?

To reduce fever during recovery.

Because of the risk for bleeding from the tonsil bed. (correct)

Due to potential risk of sensitization.

NSAIDs are less effective than opioids for post-operative pain.

What is a common adverse effect experienced by children following routine immunization?

Fever and irritability. Signup and view all the answers

What form of analgesia has been shown to be effective immediately after tonsillectomy?

Infiltrated tramadol. Signup and view all the answers

What is a key consideration when assessing acute pain in infants and neonates?

Their body systems are immature Signup and view all the answers

Which medication is contraindicated for children under 16 years of age?

Aspirin Signup and view all the answers

What is considered the first-line choice for mild to moderate pain in infants and children?

Acetaminophen Signup and view all the answers

Why are topical analgesics recommended for infants undergoing painful skin-piercing procedures?

They penetrate the skin effectively Signup and view all the answers

What potential side effect can occur from using topical analgesics in infants?

Skin blanching Signup and view all the answers

Why is early examination and pain relief important for patients with acute pain?

It prevents the development of chronic pain Signup and view all the answers

What is one of the reasons for the increased potential for drug-induced toxicity in infants?

Reduced rates of hepatic metabolism and renal excretion Signup and view all the answers

What is a common characteristic of shock-associated acute pain in patients?

It can vary in severity Signup and view all the answers

What is the primary reason for determining the client's perception of pain?

To understand what the pain means to the client. Signup and view all the answers

Why is it important to screen pain every time vital signs are evaluated?

Pain can increase the body's stress response. Signup and view all the answers

What vital sign indicates Jack's level of pain, based on his self-report?

9 on the 0-10 scale Signup and view all the answers

Which statement about the management of acute appendicitis pain is NOT true?

The initial pain is always sharp and located at the right lower quadrant. Signup and view all the answers

What is the significance of the elevated ST segment on Jack's ECG?

Indicates acute myocardial infarction Signup and view all the answers

What characterizes the initial pain associated with appendicitis?

Gnawing and aching visceral pain near the umbilicus. Signup and view all the answers

What initial intervention was prescribed for Mrs D upon her arrival at the emergency department?

Oxygen and medication interventions Signup and view all the answers

What measures should be taken to relieve pain in a patient before it becomes severe?

Incorporate both pharmacologic and non-pharmacologic approaches early. Signup and view all the answers

During which phase should nursing care be performed to optimize the effects of analgesics?

During the peak effect of analgesics. Signup and view all the answers

What symptom did Jack exhibit that suggested a significant medical concern?

Vomiting Signup and view all the answers

What does the positive laboratory test for cardiac troponin I indicate for Mrs D?

Potential heart muscle damage Signup and view all the answers

Why is empathic communication important for nurses caring for patients and their families?

It fosters an understanding of the patient's health changes. Signup and view all the answers

What should be done when evaluating the effectiveness of analgesics?

Observe for signs and symptoms of side effects. Signup and view all the answers

Which side effects of opioid medication should be monitored closely in children?

Respiratory depression and sedation. Signup and view all the answers

What characteristic of Jack's pain did he describe?

Aching and gnawing with sharp qualities Signup and view all the answers

What vital sign was documented as the fifth vital sign in Jack's observation?

Pain level Signup and view all the answers

What role do cognitive behavioral activities play in managing a child's recovery?

They help maintain equilibrium and reduce distress. Signup and view all the answers

Why should a proactive approach to laxative use be taken in post-operative PCA for children?

To prevent the potential constipating effects of opioid medication. Signup and view all the answers

How did Mrs D's daughter contribute to her care in the emergency department?

By providing her full medical and biosychosocial history Signup and view all the answers

What is a primary cause of acute abdominal pain in adolescents and adults?

Inflammation of abdominal organs. Signup and view all the answers

What is shock primarily associated with?

Inadequate blood supply, depriving cells of oxygen and nutrients. Signup and view all the answers

How does the autonomic sympathetic nervous system relate to the causes of pain during shock?

It activates the inflammatory response. Signup and view all the answers

Which condition is NOT associated with the causes of acute abdominal pain?

Chronic gastrointestinal disorder. Signup and view all the answers

What might cause visceral obstruction leading to acute abdominal pain?

Cancer invading the intestine. Signup and view all the answers

Study Notes

Learning Objectives

Biopsychosocial pain assessment is crucial for managing acute pain.
Post-operative tonsillectomy pain is severe; pre-operative education for parents and children is essential.
Shock-associated acute pain has specific components that need understanding.
Early evaluation and management of pain in patients is necessary.

Acute Pain in Pediatric Populations

Special consideration is required for infants and neonates due to underdeveloped body systems.
Risk of drug-induced toxicity is higher due to decreased hepatic metabolism and renal excretion.
Aspirin is contraindicated for children under 16 years; overdose of non-opioid medications can lead to liver failure.
Acetaminophen and NSAIDs are first-line options for mild to moderate pain in infants and children.

Procedural Pain Management in Infants

Topical analgesics like EMLA cream and 2.5% lidocaine are recommended for frequent skin-piercing procedures in infants, unless allergic to amide anesthetics.
EMLA cream has a lower melting point, enhancing skin penetration and maintaining safe serum levels.
Side effects may include blistering, skin blanching, and eruptions.
Careful monitoring is required for drug interactions and proper timing of application.

Procedural Pain Management in Children

Routine immunizations may cause fever, irritability, and minor reactions.
Acetaminophen syrup (10–15 mg/kg) can be used as needed post-immunization to manage symptoms.

Post-Operative Tonsillectomy Pain Management

High risks of nausea, vomiting, and potentially severe bleeding require careful pain management.
NSAIDs may not be prescribed by some facilities due to bleeding risks.
Effective pain relief is critical to prevent sensitization, alleviate distress, and promote recovery.
Infiltrated tramadol is effective for immediate post-operative pain, with NSAIDs given based on age and weight.

Patient-Controlled Analgesia (PCA) for Children

All opioids can cause constipation; preventative measures including laxatives are essential.
Nurses must monitor vital signs, pain management effectiveness, and potential adverse effects.

Acute Abdominal Pain Causes

Acute abdominal pain in adults and adolescents typically results from tissue damage, organ inflammation, vascular issues, or visceral obstruction.

Acute Pain and Shock

All acute pain can be linked to shock, a syndrome where cells lack adequate blood supply, depriving them of oxygen.
Pain is linked to the inflammatory response activated by autonomic nervous system responses.
Pain perceptions should be gauged through patient communication and should be assessed during vital sign evaluations.

Nursing Practices for Acute Pain and Shock

Elevated temperature can contribute to stress responses; understanding patient anxiety is essential.
Clear, empathetic communication with both patients and families is crucial for managing anxiety and confusion.

Acute Appendicitis and Pain Management

Appendicitis can often lead to misdiagnosis and litigation due to its symptoms.
Initial pain is vague and poorly localized, with progression leading to sharper, more localized pain.
Current understanding recognizes that pain management does not delay diagnosis.

Clinical Examples

Immediate nursing care for suspected acute coronary syndrome focuses on urgent interventions.
For cases of acute pain, comprehensive monitoring of vital signs including pain levels (5th vital sign) is essential for effective evaluation and response.

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Description

This quiz explores the crucial aspects of acute pain management in pediatric populations, including biopsychosocial assessments and post-operative care for tonsillectomy. It also covers the unique considerations for infants and neonates, such as risks of drug-induced toxicity and appropriate pain relief options. Understanding procedural pain management, including the use of topical analgesics, is also emphasized.