NIPS and NPASS

Adventures to

NPASS

Neonatal Oasis Island

Understanding the new NICU pain Scale

Use it with caution

Proper assessment of pain is essential to allow for safe and compassionate care of the infant in the NICU. Currently, our NICU uses NIPS. Neontal Infant Pain Scale (NIPS) addresses acute pain but may not adequately measure chronic pain.

Introduction

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Compare NIPS and NPASS

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NIPS vs NPASS

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When compared to NIPS, what gestational age does NPASS capture?

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Neonates 28-40 weeks

Neonates 23-40 weeks

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Assessing Pain Using NPASS

Logs

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With each assessment, the patient will receive a score from 0-2 for each of the 5 assessment criteria. 0: Normal or No Pain 1: Mild Pain 2: Moderate/Severe Pain The patient's pain score will be from 0-10. Pain assessment can be completed at rest or with stimuli. Pain assessments should be completed: -Pre, during, and post any painful procedures -Care assessments

Scoring Pain using NPASS

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Pain Assessment Criteria Scale

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Baby Geo was born at 37 weeks and admitted to the NICU for respiratory distress. Geo has a history of being on CPAP and IV fluids, both were discontinued yesterday. Now, Geo continues to work on PO feeding with the support of a NG tube. At shift report, Geo appears to be sleeping with baseline HR at 140 and stable O2 saturations on room air.

Meet Baby Geo

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An hour later, you hear Geo crying. You enter his bay to help console him. His HR is 162 and O2 saturation is undetecable due to kicking and arching. Geo's cry is high pitched and he is inconsolable despite intervention. Based on this information and your assessment, what is baby Geo's pain/agitation score using NPASS?

A. 9

B. 6

C. 10

Click the magnifying glass to view the NPASS criteria

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Assessing Sedation Using NPASS

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While on a sedation drip, the patient will receive a score from -2 to 0 for each of the 5 assessment criteria. 0: Normal or No sedation -1: Mild sedation -2: Moderate/Severe sedation The patient's sedation score will be from -10 to 0. Unlike pain, sedation should be evaluated with stimuli. Like pain assessments, sedation assessments should be completed: -Pre, during, and post any painful procedure -Care assessments

Evaluating Sedation using NPASS

While pain will be assessed every time using NPASS, the sedation score will only be assessed when a patient is on a sedation drip.

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Sedation Assessment Criteria Scale

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Baby Kate was born at 37 weeks and admitted to the NICU for respiratory distress. Kate is currently on a ventilator with a PICC line for access. Currently, Kate is on a morphine drip for sedation. Her baseline HR is 130. Prior to daily rounds, the neo asks you to evaluate baby Kate's sedation. Per the MAR, the goal NPASS score for the morphine is -2 or greater.

Meet Baby Kate

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You enter Kate's bay for her cares and assessment. At rest, Kate appears to be relaxed and asleep. During her cares, Kate responds to stimuli with slight spontaneous movement of her upper extremities. Although intubated, she tries to cry and has small facial grimace. Kate's HR remains at her baseline throughout cares.

Based on the describtion and your assessment, what is baby Kate's sedation score using NPASS?

A. -1

B. 2

Click the magnifying glass to view the NPASS criteria

C. -4

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Per the MAR, the goal NPASS score for Kate's morphine drip is -2 or greater.

Based on your assessment and NPASS score, you suggest to the Neo Kate's morphine drip should be:

B. Decreased

A. Increased

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Evaluating Pain and Sedation Using NPASS

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Baby Leo was born at 36 weeks and admitted to the NICU for respiratory distress and pneumothorax. Leo has a chest tube placed to suction and is on 2L high flow nasal cannula. Leo currently has a PIV for a morphine drip for pain associated with the chest tube. His baseline HR is 140.During rounds, the plan is change the CT to water seal with the hopes to pull the CT later in the shift. Since the plan is to allow Leo to breastfeed after being stable on 2L HFNC without a CT, the neo is wants to wean his drip while keeping Leo comfortable.

Meet Baby Leo

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Leo tolerated the change and the neo has decided to remove the CT. Prior to the removal, you assess Leo's sedation and pain using NPASS. Leo appears relaxed and asleep at rest. He arouses mimially, spontanously moves away from the stimuli, and lets out small cry. His tone and grasp reflex is found to be normal. HR remains within baseline.

What is Leo's baseline NPASS score prior to removing the chest tube (Pre-procedure)?

A. -3

B. 0

C. -1

Click the magnifying glass to view the NPASS criteria

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Click the magnifying glass to view the NPASS criteria

During the CT removal, you assess his pain during the procedure. Leo is irritable, cries, and fingers clench as the neo pulls out the CT. His brows furrows intermittently and he is restless and squirmy after the procedure. Leo is able to be consoled easily with containment. His HR increases to 150 and O2 remains stable throughout the procedure.

What is Leo's NPASS pain and sedation score during the CT removal?

A. 1

B. 4

C. 0

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NPASS and Prematurity

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When compared to NIPS, NPASS provides an evaluation of a broader population and considers pain associated with being born premature. NPASS adds points to the total score for based on the corrected gestational age; Add +1 if 32-35 weeks gestation/corrected ageAdd +2 if 28-31 weeks gestation/corrected ageAdd +3 if <28 weeks gestation/corrected age

Prematurity

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Baby Mia was born at 26 weeks and admitted to the NICU prematurity. She has a history of intubation and surfactant. Mia now remains on BCPAP until she is corrected to 32 weeks. She is currently corrected to 29 weeks. She has a PICC for access and is receiving TPN and lipids. Her baseline HR is 160. At change of shift bedside report, baby Mia appears to be sleeping between cares and comfortable in her isolette.

Meet Baby Mia

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Click the magnifying glass to view the NPASS criteria

You are called to Mia's bedside by her mom. Although Mia looks relaxed and no signs of stress, her mom is concerned she is uncomfortable. Mia is awake and has moments of restlessness. Since she is awake, you complete her cares slightly early and reposition Mia. She drifts off to sleep after cares.

Based on description and assessment, what would Mia's NPASS score be?

A. 1

B. 3

C. -2

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