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Pain and Fever Fall 2012 (1)

Child who refused to drink any fluids child who is

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Child who refused to drink any fluids Child who is very sleep, irritable, or difficult to wake Child who is vomiting and cannot keep down fluids
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Fever: Treatment Nonpharmacologic Therapy Adequate fluid intake Body sponging with tepid water Wearing light clothing Removing blankets Stay in room temperature
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Treatment of Fever Pharmacologic Therapy APAP NSAIDs (Ibuprofen) ASA Antipyretics MOA: Inhibition of PGE2 synthesis, decreasing the feedback between the thermoregulatory neurons and the hypothalamus, reducing the hypothalamic set point
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Treatment of Fever Acetaminophen – 2 hours to peak effect Ibuprofen – 2 hours to peak effect Only approved for 6 months and older Do NOT use for >3 days without physician involvement Dosing – same as PAIN treatment
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Musculoskeletal Injuries and Disorders
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Pathophysiology Somatic pain arising from the muscles, bones, joints, and connective tissues Peripheral nociceptors transmit signals to CNS Ischemic muscle pain Decreased blood flow due to intramuscular pressure Quickly fades with rest Pain lasting longer mediated by: Histamine, acetylcholine, serotonin, bradykinin, adenosine, and potassium
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Pathophysiology Inflammatory response Erythema, edema, tenderness at the affected site Mediated by histamine, bradykinin, serotonin, leukotrienes, prostaglandins
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Musculoskeletal Disorders Myalgia Tendonitis Bursitis Strains/sprains Osteoarthritis
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Musculoskeletal Disorders: Clinical Presentation Myalgia Dull, constant ache and weakness in muscle Tendonitis Warmth, swelling, erythema Mild-to-severe pain occurring after use Loss of range of motion
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Musculoskeletal Disorders: Clinical Presentation Bursitis Warmth, edema, erythema Constant pain that worsens with movement or application of external pressure Bursae within joints, usually knee, shoulder, or big toe Strain/Sprain Swelling, bruising Severe pain worsened by movement/joint use
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Musculoskeletal Disorders: Clinical Presentation Osteoarthritis Dull pain in weight-bearing joints, knees, hip, low back, and/or hands Often relieved by rest
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Treatment Treatment goals Decrease severity and duration of pain Restore function of affected area Prevent re-injury and disability Prevent acute pain from becoming chronic pain
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Treatment Exclusions for self-treatment Moderate-severe pain Pain lasting >2 weeks Pain continuing for >7 days with treatment Increased intensity or change in character of pain Pelvic or abdominal pain (except dysmenorrhea) Nausea, vomiting, fever, or sign of infection Visual deformity (suspected fracture) 3rd trimester of pregnancy <2 years of age
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Treatment: Nonpharmacologic Warming-up and stretching prior to physical activity Hydration RICE therapy (rest, ice, compression, elevation) Heat therapy for noninflammatory pain
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