Nokea
The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurses response should be based on which characteristic about preterm infants pain?
- A. They may react to painful stimuli but are unable to remember the pain experience.
- B. They perceive and react to pain in much the same manner as children and adults.
- C. They do not have the cortical and subcortical centers that are needed for pain perception.
- D. They lack neurochemical systems associated with pain transmission and modulation.
Correct Answer: B
Rationale: Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.
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Which nonpharmacologic intervention appears to be effective in decreasing neonatal procedural pain?
- A. Tactile stimulation
- B. Commercial warm packs
- C. Doing procedure during infant sleep
- D. Oral sucrose and nonnutritive sucking
Correct Answer: D
Rationale: Nonnutritive sucking attenuates behavioral, physiologic, and hormonal responses to pain. The addition of sucrose has been demonstrated to have calming and pain-relieving effects for neonates. Tactile stimulation has a variable effect on response to procedural pain. No evidence supports commercial warm packs as a pain control measure. With resulting increased blood flow to the area, pain may be greater. The infant should not be disturbed during the sleep cycle. It makes it more difficult for the infant to begin organization of sleep and awake cycles.
The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route?
- A. Less expensive than oral medications
- B. Produces a first-pass effect through the liver
- C. Does not need to be administered frequently
- D. Provides most rapid onset of effect, usually in about 5 minutes
Correct Answer: D
Rationale: The advantage of pain medication by the IV bolus route is that it provides the most rapid onset of effect, usually in about 5 minutes. IV medications are more expensive than oral medications, and the IV route bypasses the first-pass effect through the liver. Pain control with IV bolus medication needs to be repeated hourly for continuous pain control.
A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which?
- A. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure.
- B. Use a combination of fentanyl and midazolam for conscious sedation.
- C. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure.
- D. Apply a transdermal fentanyl (Duragesic) patch immediately before the procedure.
Correct Answer: B
Rationale: A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.
The nurse is teaching the parents of a child with recurrent headaches methods to modify behavior patterns that increase the risk of headache. Which statement by the parents indicates understanding the teaching?
- A. We will allow the child to miss school if a headache occurs.
- B. We will respond matter-of-factly to requests for special attention.
- C. We will be sure to give much attention to our child when a headache occurs.
- D. We will be sure our child doesnt have to perform at a band concert if a headache occurs.
Correct Answer: B
Rationale: To modify behavior patterns that increase the risk of headache or reinforce headache activity, the nurse instructs the parents to avoid giving excessive attention to their childs headache and to respond matter-of-factly to pain behavior and requests for special attention. Parents learn to assess whether the child is avoiding school or social performance demands because of headache.
A preterm infant has just been admitted to the neonatal intensive care unit. The infants parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurses explanation be?
- A. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli.
- B. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief.
- C. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences.
- D. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.
Correct Answer: D
Rationale: Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response. The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response. Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates.