1. Pain and Fever
7/11/05

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

3. 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

4. Faces Scale

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

6. 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

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

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

9. Fever

10. 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

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

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

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

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