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Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period?
- A. Codeine sulfate (Codeine)
- B. Morphine (Roxanol)
- C. Methadone (Dolophine)
- D. Meperidine (Demerol)
Correct Answer: B
Rationale: The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.
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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 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.
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.
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 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include?
- A. The child will continue to sleep and be pain free.
- B. Parents cannot administer additional medication with the button.
- C. The pump can deliver baseline and bolus dosages.
- D. There is a high risk of overdose, so monitoring is done every 15 minutes.
Correct Answer: C
Rationale: The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.