86
Quantitative data supported the proposed qualitative model demonstrating lower peer attachment and hopefulness scores for more isolated adolescents. Future recommendations included study replication and verification of the proposed Friendship Sharing model.
References 1. Hinds PS: An investigation of the relationship between adolescent hopefulness, caring behaviors of nurses, and adolescent healthcare outcomes. Diss Abstr Int 46:2623-B (University Microfilms No. 8522813), 1985 2. Armsden GC, Greenberg MT: The inventory of parent and peer attachment Individual differences and their relationship to psychological well-being in adolescence. J Youth Adolesc 16:427-453, 1987
Intravenous Midazolam Versus Fentanyl as Premedication for Painful Procedures in Pediatric Oncology Patients Kathy Conner, RN, MN, CPN, OCN, Eric Sandler, MD, Christine Weyman, MD, Kathleen Reilly, PharmD, Nancy Dickson, RN, OCN, and Jan Luzins, RN Many children with cancer must undergo frequent painful procedures, such as bone marrow aspirations and lumbar punctures, for the diagnosis and treatment of their disease. These repeated procedures usually result in anxiety and pain for patients and their families. In an attempt to decrease the anxiety and pain experienced with procedures, many institutions have tried various medications for sedation and/or pain relief purposes before procedures. Patients have experienced various degrees of relief and are often sedated for hours postprocedure. To help resolve these problems, two short-acting drugs were compared in a double-blinded crossover study. The study drugs included fentanyl, a narcotic analgesic, and midazolam, a benzodiazepine. The purpose of the study was to determine the efficacy and safety of these two drugs as premedications for painful procedures in pediatric oncology patients. . Patients between the ages of 3 and 21 years with a diagnosis of leukemia or lymphoma participated in the study. Safety measures were followed as mandated by the American Academy of Pediatrics for conscious sedation. All patients randomly received either fentanyl or midazolam for their first procedure on study with the other drug given at the next procedure. After two procedures on study, patients could select their drug of choice for subsequent procedures. Fentanyi was given at a maximum dose of 4 J.1g1kg and midazolam was given at 0.2 mg/kg to a maximum of 8 mg. Drugs were administered over 10 minutes and titrated to level of sedation and/or slurring of speech. Assessment of procedures was done using a visual analog scale, parent questionnaire, vital signs, and the Observational Scale of Behavioral Distress. For the 25 evaluable patients on study, 100% preferred study drugs to any previous sedation. The drug of choice for 18 patients (72% ) was midazolam while 7 patients (28% ) preferred fentanyl Minimal From Division of Pediatric Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL © 1991 by Association of Pediatric Oncology Nurses.
Downloaded from jpo.sagepub.com at UNIV NEBRASKA LIBRARIES on April 10, 2015
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side effects included transient hypotension, transient 02 desaturation, itching, rashes, headaches, and vomiting. Of those reporting preprocedural anxiety, 56% of the patients and 62% of the parents had a decrease in anxiety during the study. Negative behavioral symptoms decreased in 47% of the patients. Visual analog scores improved in 60% of patients and 80% of parents when patients received their drug of choice. Observational scale scores were not found to correlate significantly with the preferred study drug. Total amnesia of procedures occurred in 35% of the procedures using fentanyl
and 91 % of the procedures done with midazolam. In conclusion, the authors report that anxiety and pain experienced during treatment procedures is a major problem in the pediatric oncology population. Both fentanyl and midazolam are effective in relieving this pain and anxiety, with midazolam preferred by the majority of patients. Side effects of these drugs were found to be mild and tolerable, and both drugs were determined to be safe as used in the
outpatient setting.
of Ethyl Chloride Anesthetic Spray Before Invasive Procedures Performed on Pediatric Oncology Patients
The
Use
Susan C. Zappa, RN, CPN,
Stacey B. Nabors, RN, BSN,
and
Carol Wise, RN, CPN The purpose of using an anesthetic spray before invasive procedures performed on pediatric oncology patients was to determine if this measure would help to minimize fear, emotional trauma, and pain during cancer treatments. Ethyl chloride spray was chosen because it provides immediate anesthetic results. It is noninvasive, inexpensive, and easily obtained. This technique can be accomplished by one nurse, and it is not time consuming. Additionally, the spray bottle is not prone to ’
mechanical failure. Before invasive procedures such as accessing ports, lumbar punctures, or bone marrow aspirates, ethyl chloride was sprayed for 3 to 5 seconds directty on cleansed skin. Because the anesthetic action lasts no more than a few seconds, the needle stick must be performed immediately on the patient Staff observed that pediatric cancer patients often become anxious, agitated, combative, and uncooperative due to fear of pain during invasive procedures. It was not the actual administration of medicines that caused this reaction, but the fear of the needle stick itself. Increased education and implementation of coping mechanisms were often not enough to allay this fear. The tangible solution of using ethyl chloride provided an improved method of alleviating this distress. A questionnaire evaluating perceptions of both patients and parents, as well as staff observations of a decrease in anxiety and agitation, demonstrated the usefulness of this clinical practice. With the choice to use the &dquo;cold spray&dquo; or not, the patient felt a sense of control and involvement in his or her treatment. Decreasing the amount of pain the patient experienced increased cooperation, lessened
From Hematology-Oncology Clinic, Cook-Fort Worth Children’s Medical 1991 by Association of Pediatric Oncology Nurses.
Center, Fort Worth, TX. ©
Downloaded from jpo.sagepub.com at UNIV NEBRASKA LIBRARIES on April 10, 2015
Quantitative data supported the proposed qualitative model demonstrating lower peer attachment and hopefulness scores for more isolated adolescents. Future recommendations included study replication and verification of the proposed Friendship Sharing model.
References 1. Hinds PS: An investigation of the relationship between adolescent hopefulness, caring behaviors of nurses, and adolescent healthcare outcomes. Diss Abstr Int 46:2623-B (University Microfilms No. 8522813), 1985 2. Armsden GC, Greenberg MT: The inventory of parent and peer attachment Individual differences and their relationship to psychological well-being in adolescence. J Youth Adolesc 16:427-453, 1987
Intravenous Midazolam Versus Fentanyl as Premedication for Painful Procedures in Pediatric Oncology Patients Kathy Conner, RN, MN, CPN, OCN, Eric Sandler, MD, Christine Weyman, MD, Kathleen Reilly, PharmD, Nancy Dickson, RN, OCN, and Jan Luzins, RN Many children with cancer must undergo frequent painful procedures, such as bone marrow aspirations and lumbar punctures, for the diagnosis and treatment of their disease. These repeated procedures usually result in anxiety and pain for patients and their families. In an attempt to decrease the anxiety and pain experienced with procedures, many institutions have tried various medications for sedation and/or pain relief purposes before procedures. Patients have experienced various degrees of relief and are often sedated for hours postprocedure. To help resolve these problems, two short-acting drugs were compared in a double-blinded crossover study. The study drugs included fentanyl, a narcotic analgesic, and midazolam, a benzodiazepine. The purpose of the study was to determine the efficacy and safety of these two drugs as premedications for painful procedures in pediatric oncology patients. . Patients between the ages of 3 and 21 years with a diagnosis of leukemia or lymphoma participated in the study. Safety measures were followed as mandated by the American Academy of Pediatrics for conscious sedation. All patients randomly received either fentanyl or midazolam for their first procedure on study with the other drug given at the next procedure. After two procedures on study, patients could select their drug of choice for subsequent procedures. Fentanyi was given at a maximum dose of 4 J.1g1kg and midazolam was given at 0.2 mg/kg to a maximum of 8 mg. Drugs were administered over 10 minutes and titrated to level of sedation and/or slurring of speech. Assessment of procedures was done using a visual analog scale, parent questionnaire, vital signs, and the Observational Scale of Behavioral Distress. For the 25 evaluable patients on study, 100% preferred study drugs to any previous sedation. The drug of choice for 18 patients (72% ) was midazolam while 7 patients (28% ) preferred fentanyl Minimal From Division of Pediatric Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL © 1991 by Association of Pediatric Oncology Nurses.
Downloaded from jpo.sagepub.com at UNIV NEBRASKA LIBRARIES on April 10, 2015
87
side effects included transient hypotension, transient 02 desaturation, itching, rashes, headaches, and vomiting. Of those reporting preprocedural anxiety, 56% of the patients and 62% of the parents had a decrease in anxiety during the study. Negative behavioral symptoms decreased in 47% of the patients. Visual analog scores improved in 60% of patients and 80% of parents when patients received their drug of choice. Observational scale scores were not found to correlate significantly with the preferred study drug. Total amnesia of procedures occurred in 35% of the procedures using fentanyl
and 91 % of the procedures done with midazolam. In conclusion, the authors report that anxiety and pain experienced during treatment procedures is a major problem in the pediatric oncology population. Both fentanyl and midazolam are effective in relieving this pain and anxiety, with midazolam preferred by the majority of patients. Side effects of these drugs were found to be mild and tolerable, and both drugs were determined to be safe as used in the
outpatient setting.
of Ethyl Chloride Anesthetic Spray Before Invasive Procedures Performed on Pediatric Oncology Patients
The
Use
Susan C. Zappa, RN, CPN,
Stacey B. Nabors, RN, BSN,
and
Carol Wise, RN, CPN The purpose of using an anesthetic spray before invasive procedures performed on pediatric oncology patients was to determine if this measure would help to minimize fear, emotional trauma, and pain during cancer treatments. Ethyl chloride spray was chosen because it provides immediate anesthetic results. It is noninvasive, inexpensive, and easily obtained. This technique can be accomplished by one nurse, and it is not time consuming. Additionally, the spray bottle is not prone to ’
mechanical failure. Before invasive procedures such as accessing ports, lumbar punctures, or bone marrow aspirates, ethyl chloride was sprayed for 3 to 5 seconds directty on cleansed skin. Because the anesthetic action lasts no more than a few seconds, the needle stick must be performed immediately on the patient Staff observed that pediatric cancer patients often become anxious, agitated, combative, and uncooperative due to fear of pain during invasive procedures. It was not the actual administration of medicines that caused this reaction, but the fear of the needle stick itself. Increased education and implementation of coping mechanisms were often not enough to allay this fear. The tangible solution of using ethyl chloride provided an improved method of alleviating this distress. A questionnaire evaluating perceptions of both patients and parents, as well as staff observations of a decrease in anxiety and agitation, demonstrated the usefulness of this clinical practice. With the choice to use the &dquo;cold spray&dquo; or not, the patient felt a sense of control and involvement in his or her treatment. Decreasing the amount of pain the patient experienced increased cooperation, lessened
From Hematology-Oncology Clinic, Cook-Fort Worth Children’s Medical 1991 by Association of Pediatric Oncology Nurses.
Center, Fort Worth, TX. ©
Downloaded from jpo.sagepub.com at UNIV NEBRASKA LIBRARIES on April 10, 2015
