Pain & Care of Chronically Ill Child
Name 3 pediatric pain scales
FLACC, CRIES, FACES, Number, Word
What is the most common scoring system used to describe the level of consciousness of a person?
Glasgow Coma Scale
After a 4 day history of diarrhea, a parent says their 6 month old infant no longer produces tears when they cry. What is the likely cause?
Dehydration
A 4 y/o with a recent diagnosis of UTI is readmitted with flank pain. What is the likely cause?
Pyelonephritis
When a child sits forward with hands over their knees, it can be an indicator of severe respiratory distress. This position is referred to as...
tripod position
A 4 m/o is diagnosed with hearing impairment. What might be some clinical manifestations that eluded to this diagnosis?
No startle response; not cooing or babbling.
A small sac-like structure filled with meninges and spinal fluid often found on the low back.
Meningocele
Drooling, fever, tripod positioning, croaking sound on inspiration are consistent with what croup syndrome?
Acute epiglottitis
A genetic issue resulting in missing nerves in the large intestine muscle cells, causing decreased motility through the large intestine resulting in blockages and potential toxic megacolon.
What is Hirschsprung's disease?
An 8 m/o with Tetralogy of Fallot becomes irritated, upset, and inconsolable. They start turning blue around the mouth and in the fingers and toes. What interventions do you perform?
Knees to chest
Try to calm baby
Supplemental oxygen
IV fluids
What would be a nursing educational point to a parent who tells you "my baby doesn't need any lidocaine cream, they don't feel pain like we do," when their 4 y/o child is about to get an IV placed?
Children feel pain just like adults do.
Repeated painful experiences do not make children tougher.
Children can remember painful stimuli.
Lumbar puncture (meningitis)
A 15 y/o pt has a central line for chemotherapy. They come in with a fever of 102.1 F. What are two interventions you expect to do immediately?
A patient is admitted who is diabetic. It is time for a glucose check. The patient tells you that they have a glucometer and an insulin pump. Only one is approved to be used in the hospital, which one?
What is the insulin pump?
In the hospital environment, the standard treatment for asthma typically includes ____________ and ____________.
oxygen and albuterol nebulizer
Justin is an 8 yo male who just had surgery and has a morphine PCA pump with basal rate and prn dose set. Mother states she feels Justin is having pain and asks if she can push the PCA button for him to deliver a prn dose? The correct response is..
No
Only the child can push the PCA button for a prn pain dosing, not family.
Increased intracranial pressure
What is the classic s/s of pyloric stenosis?
Non-bilious, projectile vomiting 30-60minutes after feeds
What is the hourly rate of IV maintenance fluid for a 32 kg patient?
1st 10 kg- (4 ml/hr x kg)
2nd 10 kg (2 ml/hr x kg)
For anything over 20 kg (1 ml/hr x kg)
40 + 20 + 12 ml/hr = 72 ml/hr
A patient with sickle cell anemia is experiencing increased pain in joints, visual disturbances, and swelling of hands. What is happening?
a vaso-occlusive crisis
You are caring for a 16 y/o pt who has a terminal disease and just signed on to hospice. What information is important to remember when communicating with a child in this developmental stage.
Value time with peers more than parents.
Just beginning to learn about themselves, major events (driving, dating, dances, graduation, work).
Increased body perception.
A 2 y/o is 1-month status post ventriculoperitoneal shunt placement and presents with fever of 101.7 F. Why are you concerned and how do you expect to intervene?
1-2 months after VP shunt placement is greatest risk for infection. Septicemia, bacterial endocarditis, meningitis.
Aggressive antibiotics, possible shunt removal.
Increased WBC, infection, bleeding and bruising, fatigue, bone pain, and decreased RBC and platelets are signs and symptoms of what childhood cancer?
Leukemia
Can also present with low grade fever
A 4 months old, former 34 week premie, presents with an ostomy that does not look normal. "It appears to have grown overnight" states the mom. What has happened? When does it become worrisome?
What is a prolapsed stoma.
Becomes worrisome if stoma turns blue, pale or black, stops draining and becomes painful
A 4 month old is admitted after a new seizure. What interventions do you expect will be ordered?
Head CT
MRI
EEG
LP