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NUR 425 week 2 monday Pain and Conscious Sedation in Children ppt

Terms in this set (66)

procedural conscious sedation (moderate sedation)
-retains the ability to maintain airway
-responds appropriately to physical stimulation and verbal commands
goals of procedural conscious sedation
-improve client comfort and tolerance of the procedure
-alleviate client anxiety associated with the procedure
objectives of procedural conscious sedation
-maintain consciousness
-minimal variations in vitals
-increased pain threshold
-tolerance of the procedure
-diminished recall (anterograde amnesia)
-rapid, safe return of client to baseline status
how do we know that the child is sedated
-visible relaxation
-slurred speech
-client report of relaxation when questioned
-arousable sleep
procedural conscious sedation requires preparation of NPO
true
clear liquids minimum fasting period
2 hours
breast milk minimum fasting period
4 hours
infant formula minimum fasting period
6 hours
nonhuman milk minimum fasting period
6 hours
meal minimum fasting period
8 hours
during sedation the nurses primary role is to
monitor the child
the goal of monitoring the patient during sedation is
early detection and correction of adverse effects
support the client during sedation by
providing emotional support
aspects of monitoring the client during sedation
-continuous IV access maintained
-monitor cardiac rhythm, respiratory rate and effort, blood pressure
-sedation level assessment
-level of consciousness
-pain level
-oxygen saturation
-CO2 monitoring
-suction
administration of sedation is done by
-the licensed independent practitioner
-most medications should be administered slowly to avoid respiratory depression
care of client during sedation acronym

SOAPME
suction
oxygen
airway
pharmacy (reversal drug)
monitor
equipment
sedation assessment tool
modified aldrete recovery score
sedation assessment tool
Moderate Aldrete Recovery Score aspects
respiration
O2 saturation
consciousness
circulation
activity
sedation medications
midazolam (versed)
fentanyl (sublimaze)
propofol (diprivan)
ketamine (ketalar)
midazolam (versed)
onset: 30 sec-1min
peak: 3-5 min
duration: 15-80 min
side effects: respiratory depression, agitation
reversal agent for midazolam (versed)
fumazenil (romazicon)

Half-life - approximately 1 hour
May be followed by period of re-obtundation (may require extended observation & additional dosing)
Side effect: nausea & vomiting, dizziness, agitation/anxiety
fentanyl (sublimaze)
onset: 1 min
peak: 1-3 min
duration: 30-60 min
side effects: resp depression, hypotension, nausea, vomiting, euphoria
what happens if fentanyl (sublimaze) is given too rapidly
can cause chest wall muscle rigidity
reversal agent for fentanyl (sublimaze)
naloxone (narcan)

Half-life:less than duration of fentanyl
Prolonged observation: necessary
Repeat doses may also be required usually after 20 minutes
Side effect: dependent on the administration (should be administered over 2-3 minutes)
propofol (diprivan)
onset: 30 seconds
peak: 1 min
duration: 3-10 min
side effects: resp depression, hypotension, bradycardia, involuntary body movements
reversal agent for propofol (diprivan)
NO REVERSAL AGENT FOR PROPOFOL (DIPRIVAN)
who can administer propofol (diprivan)
only physicians

there is no reversal agent and this is a transition medication not a long term sedative
ketamine (ketalar)
onset: less than 5 min
peak: 15-30 min
duration: 45-120 min
side effects: resp depression with rapid administration, hypertension, vomiting, increased oral secretions, post procedure confusion state or hallucinations
ketamine (ketalar) is pretreated with
benzodiazapam for the post procedure confusion state or hallucinations
reversal agent for ketamine (ketalar)
NO REVERSAL AGENT FOR KETAMINE (KETALAR)
contraindications for ketamine (ketalar)
infants less than 3 months of age
Pain Assessment and Management in Children
...
infant responses to pain
-body response (general-localized)
-loud crying
-facial expression
-physical resistance
young child response to pain
-loud crying
-verbal expression
-thrashing arms and legs
-lack of cooperation
-clings to parents/nurses
-behaviors begin in anticipation of pain

(this age cannot tell you where it hurts)
school age response to pain
-same as young child during the painful episode but less so in anticipation
-stalling behaviors to avoid pain
-muscular rigidity
adolescent response to pain
-less vocal and motor response to pain
-more verbal expression
-increased muscle tension and body control
behavioral pain scales for children
-FLACC
-Children's Hospital of Eastern Ontario Pain Scale (CHEOPS)
behavioral pain scales (FLACC and CHEOPS) are used for what age group
3 years and younger
self reporting pain scale for children
-Wong Baker FACES
-Oucher
-Bieri Scale
-Numeric Scale
-Visual Analog Scale (VAS)
FLACC behavioral pain scale for children
face, legs, activity, cry, consolability
CHEOPS behavioral pain scale for children
crying, facial expression, verbalization, activity of torso, touching, response of lower limbs
Wong Baker, Bieri Pain Scale, and Oucher Pain Scale are used for what age group

(faces scales)
3-5 years old
Numeric Pain Scale and Visual Analog Scale (VAS) are used for what age group
5 years and older
pain management
-shouldn't be delayed
-nonpharm and pharm methods should be used in conjunction
-nonpharm methods should be used with no pain or short term pain
-medication combination is beneficial based on time of effectiveness
if there is no pain or short term pain what method of pain management should be used
nonpharmacological pain management
non-pharmacological pain management interventions
-parent presence
-comfort measures (music, sucrose solution/pacifier)
-cutaneous stimulation
-distraction
-environment (dim lights, decrease noise, limit visitors, favorite toys, blankets, pictures)
-suggestion
-progressive muscle relaxation
-guided imagery
-hypnosis
cut off age for sucrose pacifiers
6 months
cutaneous stimulation for infants
swaddling, nesting, kangaroo care
cutaneous stimulation for all ages
massage, touch
distraction 2-6 years
stories, bubbles, counting, deep breathing
distraction 6 years and older
video games, TV, rhythmic breathing
suggestion 6-10 years
magic glove, patch, hat, or blanket
progressive muscle relaxation 6 years and older
music
guided imagery 6 years and older
favorite place, superhero, special event
hypnosis age of use
6 years and older
topical pain medications
-eutectic mixture of local anesthetics (EMLA)
-topical vapocoolant spray
-Jtip needle free injection system
-buzzy topical stimulant
eutectic mixture of local anesthetics (EMLA)
reduce pain from dermatologic procedures (venous access, LP, immunizations etc)

effective: 30-60 min
topical vapocoolant spray
applied directly to the skin without open lesions

effective in: 15 sec
Jtip needle free injection system
no needles, pressurized gas propels medication through the skin and into SQ

effective: immediately
buzzy topical stimulant
combination of cold and vibrations

effective: immediately
Kahoot Questions
...
at what stage will children begin to identify the location and intensity of their pain
preschool
the nurse is assisting with a conscious sedation for a child undergoing a procedure. which of medication will be available for the reversal of Midazolam (Versed)?
Flumazenil (Romazicon)
the nurse is assessing the child after receiving a medication for sedation. which of the following would the nurse immediately notify the health care professional

a. visible agitation
b. slurred speech
c. child stated "i feel good"
d. easily awakened with sedation
A. visible agitation
the nurse is planning to draw labs from a 4 month old infant. which of the following techniques would be the best method to reduce pain during the procedure

a. read a story
b. blow bubbles
c. provide a sucrose pacifier
d. play a disney video
C. provide a sucrose pacifier
a nurse is caring for an 18 month old child. which pain scale would be most appropriate to use
FLACC pain scale
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