Assessment of Sedation
– Sedation
is scored in addition to pain for each behavioral and physiological criteria to
assess the infant’s response to stimuli – Sedation
does not need to be assessed/scored with every pain assessment/score – Sedation
is scored from 0 ®
-2 for each behavioral and physiological criteria, then summed and noted as a
negative score (0 ®
-10) ¬ A
score of 0 is given if the infant’s response to stimuli is normal for their
gestational age –
Desired levels of sedation vary according
to the situation ¬ “Deep
sedation” ®
score of ¬ “Light
sedation” ®
score of ¬ Deep
sedation is not recommended unless an infant is receiving ventilatory support,
related to the high potential for apnea and hypoventilation – A
negative score without the administration of opioids/ sedatives may indicate: ¬ The
premature infant’s response to prolonged or persistent pain/stress ¬ Neurologic
depression, sepsis, or other pathology – Pain
assessment is the fifth vital sign – assessment for pain should be included in
every vital sign assessment – Pain
is scored from 0 ®
+2 for each behavioral and physiological criteria, then summed ¬ Points
are added to the premature infant’s pain score based on their gestational age
to compensate for their limited ability to behaviorally or physiologically
communicate pain ¬ Total
pain score is documented as a positive number (0 ®
+10) – Treatment/interventions
are indicated for scores > 3 ¬ Interventions
for known pain/painful stimuli are indicated before the score reaches 3 – The
goal of pain treatment/intervention is a score £
3 – More
frequent pain assessment indications: ¬ Indwelling
tubes or lines which may cause pain, especially with movement (e.g. chest
tubes) ®
at least every 2-4 hours ¬ Receiving
analgesics and/or sedatives ®
at least every 2-4 hours ¬ 30-60
minutes after an analgesic is given for pain behaviors to assess response to
medication ¬ Post-operative ® at least every 2 hours for 24-48 hours, then every 4 hours until off medications Pavulon/Paralysis
– It
is impossible to behaviorally evaluate a paralyzed infant for pain – Increases
in heart rate and blood pressure may be the only indicator of a need for more
analgesia – Analgesics
should be administered continuously by drip or around-the-clock dosing ¬
Higher, more frequent doses may be required
if the infant is post-op, has a chest tube, or other pathology (such as NEC)
that would normally cause pain |
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