Pain and Fever 7/11/05

Golden Rule Whatever is painful for adults is painful for children until proven otherwise.

Assessing pain Behavioral changes Physiologic changes Box 21-2 on pg.643 Facial expression (eyes brows, mouth Cry Pushing away, thrashing Physiologic changes Acute pain Pulse, BP, sweating

Faces Scale

Neonatal Pain Scale NIPS Pain Assessment Tools Used for infants < 1 year of age. Score greater than 3 means pain. NIPS

Emla cream Topical anesthetic (lidocaine & prilocaine) Application 60 minutes before the procedure (deeper pain extend to 3hours) Onset, depth, duration depends on the duration of the application applied to skin under an occlusive dressing Use liberal amounts

Emla Cream Penetrates skin down to fat Used with caution from 1 to 12 months of age

Other local pain meds. LMX4 – 15 minutes prior Numby stuff

Fever

Fever Management Fever Hyperthermia Body’s set-point higher Temp > 100 F Response to infection Hyperthermia Body exceeds its own set-point Outside environment to high Body can not adjust

Pharmacologic Interventions - Fever To change the set-point NO ASA – Reyes Syndrome Use Tylenol or ibuprofen Retake temp. in 30 min.

Environmental to Reduce Fever One hour post antipyretic Air circulation Cool moist compresses to forehead Reduce clothing Reduce room temp.

Interventions - Hyperthermia Cool tepid bath Cool moist sponging Cooling blanket ? Prevent shivering Stop intervention if shivering.

Febrile Seizures Usually 3 mo. to 5 years of age Can be recurring May treat with anticonvulsant medication if recurring. Tonic– Clonic seizures