Procedural pain management in neonates, infants and children
More than one answer may be correct. Select all that apply
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Procedural pain includes the pain associated with:
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a)
Lumbar puncture
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b)
Burn dressing change
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c)
Appendicectomy
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d)
Ocular examination in neonates
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e)
Urinary catheterisation.
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a)
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Non-pharmacological strategies with strongest evidence for efficacy in children include:
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a)
Hypnosis
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b)
Music
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c)
Massage
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d)
Distraction
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e)
Cognitive behavioural intervention.
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a)
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For neonates which of the following statements are true?
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a)
Sucrose cannot be used in preterm neonates
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b)
Breast feeding should be encouraged where possible during painful procedures
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c)
Sucrose is more effective than morphine for reducing pain from heel lance procedures
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d)
Rocking, stroking and sensory stimulation are effective for pain relief
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e)
Hypnosis is an effective strategy for pain relief in neonates.
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a)
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Characteristics of analgesic agents include:
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a)
EMLA is superior to Ametop for pain associated with venepuncture and IV cannulation
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b)
Paracetamol and NSAIDs are effective pharmacological agents for procedural pain management
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c)
Morphine reaches peak pain relieving effectiveness 10 minutes after oral administration
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d)
Ketamine causes more respiratory depression than morphine
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e)
Nitrous oxide can be safely used with head injuries
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f)
Fentanyl has a faster onset and shorter duration of action than morphine.
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a)
Acute pain in the emergency department
More than one answer may be correct. Select all that apply
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Management of acute pain in the ED:
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a)
6–7% of patients present with a fractured neck of femur
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b)
In the UK, College of Emergency Medicine (CEM) guidelines exist regarding the management of pain in the elderly
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c)
CEM guidelines are based on the PEMI study from North America
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d)
The annual rise in ED attendances in the UK is 6–7%
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e)
Around 20 million people attend the ED in the UK each year.
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a)
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The Joint Commission on Accreditation of Healthcare Organisations (JCAHCO) in the USA:
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a)
conducts national audit across the USA on the management of acute pain
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b)
first made recommendations on the management of acute pain in 2004
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c)
makes recommendations of the type of analgesia to be delivered in the ED
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d)
makes recommendations on pain assessment on admission and discharge in the ED
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e)
drew up further revisions of the standards on timelines and the adequacy of analgesia following the PEMI study.
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a)
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The College of Emergency Medicine in collaboration with the Care Quality Commission:
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a)
runs national audits on the management of pain in children presenting to the ED aged 5 to 10 with long bone fractures
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b)
report that only 70% of audit data is complete
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c)
report that the most recent audit return on the management of fractured neck of femur identified that only 62% of patients received pain relief within 60 minutes
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d)
demonstrate in the most recent audit return on the management of fractured neck of femur that 72% of patients had appropriate analgesia administered
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e)
work on improving care of patients with fractured neck of femur to dovetail with the National Service Framework.
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a)
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The new Department of Health clinical quality indicators for emergency departments are as follows:
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a)
The four-hour waiting time standard was launched in 2006
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b)
Six new clinical quality indicators have been launched
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c)
The new indicators include the rate of unplanned returns
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d)
The CEM audit on the management of pain in children has been incorporated into the narrative indicator
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e)
The CEM audit on the management of pain in the elderly has not been incorporated into the new indictors.
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a)
Pain assessment with cognitively impaired older people in the acute hospital setting
More than one answer may be correct. Select all that apply.
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Healthcare professionals remain reluctant to assess pain in cognitively impaired older people because:
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a)
it is not a priority
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b)
there are no appropriate pain assessment tools
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c)
the evidence for the most effective pain scale is contradictory
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d)
it offers unique challenges
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e)
it is not possible to assess pain in this patient group.
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a)
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For those patients with cognitive impairment it is necessary to:
-
a)
manage challenging behaviours with antipsychotic drugs
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b)
communicate effectively with families and carers
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c)
commence using a behavioural pain assessment tool as soon as possible
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d)
apply the appropriate pain assessment tool in relation to the individual's cognitive ability
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e)
reassess patient behaviours following pharmacological and non-pharmacological interventions.
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a)
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The Abbey Pain Scale is:
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a)
the perfect pain tool for severely cognitively impaired older people
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b)
one of the few pain scales that take into account six behavioural measures
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c)
best used as a single measure of pain
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d)
helpful in contributing to an overall plan of care for older people
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e)
concerned with measuring the probability that a person is experiencing pain.
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a)
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Algoplus® pain-behaviour scale:
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a)
demonstrated good psychometric properties in a wide range of clinical settings
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b)
has variable inter-rater reliability
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c)
has high sensitivity to a change in pain
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d)
requires further testing in clinical settings
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e)
offers the best approach to measure pain in acute settings.
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a)
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Evidence suggests that sustainable pain assessment practices may be achieved by:
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a)
education programmes alone
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b)
implementing a new approach
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c)
considering the context and culture of a ward
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d)
leadership and role modelling of best practice
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e)
ensuring healthcare professionals have an understanding.
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a)
Chronic post surgical pain
More than one answer may be correct. Select all that apply.
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What is the estimated prevalence of severe, disabling, chronic, postoperative pain one year after inguinal hernia repair?
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a)
40%
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b)
25%
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c)
15%
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d)
5%
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a)
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Which of the following factors are not thought to contribute to the development of chronic postsurgical pain?
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a)
Younger age
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b)
Intraoperative nerve handling
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c)
Work-related factors
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d)
Severity of acute pain
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a)
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Which of the following is not a criterion for the definition of post-surgical chronic pain?
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a)
The pain must develop after a surgical procedure
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b)
Nerve trauma must have been identified intra-operatively
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c)
Other causes for the pain have been excluded
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d)
The possibility that the pain is from a pre-existing condition has been excluded.
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a)
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What percentage of patients attending specialist pain clinics attributed their chronic pain to previous surgery?
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a)
5%
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b)
16%
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c)
22%
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d)
33%
-
a)