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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.
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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.
A cancer patient is experiencing neuropathic cancer pain. Which prescription should the nurse expect to be ordered to control anxiety?
- A. Lorazepam (Ativan)
- B. Gabapentin (Neurontin)
- C. Hydromorphone (Dilaudid)
- D. Morphine sulfate (MS Contin)
Correct Answer: B
Rationale: Anticonvulsants (gabapentin, carbamazepine) have demonstrated effectiveness in neuropathic cancer pain. Ativan is an antianxiety agent, and Dilaudid and MS Contin are opioid analgesics.
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.
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 planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan to ensure maximum effect?
- A. 15 minutes until maximum effect
- B. 30 minutes until maximum effect
- C. 1 hour until maximum effect
- D. 1 1/2 hours until maximum effect
Correct Answer: C
Rationale: Nonsteroidal antiinflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hour for effect, so timing is crucial.