Pain Assessment and Management in Children Flashcards
imperative understand how show and express pain based on age; diff based on age; to correctly treat pain need understand how showing and expressing it and why not forthcoming with pain
Ped nurse:
Newborns do not feel pain.
The intensity of a child’s behavioral reaction indicates the intensity of the child’s pain.
Children are truthful when they are asked if they are experiencing pain.
Children learn to adapt to pain and painful procedures.
Children experience more adverse effects of narcotic analgesics than adults do.
Children are more prone to addiction to narcotic analgesics.
False
Exposure to pain at an early age has little to no effect on the child.
False
More pain exposed to - long-term sensory issue; SPD long-term
Acute vs. Chronic
Factors influencing pain
Nurses understanding
Infant
Toddler
Preschooler
School Age
Adolescent
*** Unmanaged pain may lead to potential long-term physiologic, psychosocial, and behavioral consequences. - take pain management seriously; assess and re-assess often
Pediatric pain
React differently with each
Chronic conditions - DM, cystic fibrosis, cancer, sickle cell, chronic ear infections, migraines
Acute vs. Chronic
Age/gender
Cognitive level
Temperament
Previous painful experiences
More trauma in past - worse react
Know what happen
Family Culture
Factors influencing pain
Take factors into account
Nurses understanding
Clench hands
Flail hands, feet, legs, arms
Grimace
Immobilize them
Infant
Cries
BIG: Changes in behavior
Not prolong injuries
Not ability explain pain
Toddler
Easier explain
Lot better answering questions - formulate questions and know what looking for; direct parents to ask them to ask questions and how feeling
Preschooler
Very good at how pain is, where is, what happened
Might hide injury/completely forthcoming because treatment - past friends or culture
School Age
Not want show pain on culture or friends
Good at telling us pain
With-hold that - worried about something and what comes next; being tough
Adolescent
Old enough to tell how feeling: 4+ yrs
FACES (Wong-Baker): 3 and older; not use reliably until 4; no hurt or lot hurt; not happy/sad
OUCHER: 3-13 years; pics faces and correlates to number
Numerical rating scale (NRS): 8 and up; scale 1-10
Let child pick whatever comfy with - use same one throughout hospitalization
Pain scales - self-reporting
Cannot tell us verbally in pain
Neonatal Infant Pain Scale (NIPS)
NPASS
r-FLACC - 2 months-7yrs; cannot communicate with us
Go based on how reacting; face look, legs, activity, cry, consolable, pts on how acting and add them up; higher number more pain
Assess pain every time
Pain scales - behavioral
Which pain scale would the nurse use when assessing a 4-year-old client?
1. CRIES
2. FLACC
3. Numerical
4. FACES
Answer: 4
Which is the MOST reliable indicator of a 2.5-year-olds pain?
1. Crying and sobbing
2. Changes in behavior
3. Verbal exclamations of pain
4. Changes in pulse and resp rate
Answer: 2
Pharmacologic management
Nurse Management
Consequences of untreated pain in infants
Nonpharmacologic management
Pain management
Nonopioids
Opioids
Coanalgesic drugs
Choosing the timing of analgesia
Choosing the method of administration
Patient-controlled analgesia
Epidural analgesia
Transmucosal and transdermal analgesia
Pharmacologic management
Mild-moderate pain: tylenol, ibuprofen; give acetaminophen: at birth: max amt depending on weight - sometimes in cough med - make sure not OD on that
ibuprofen/motrin - 6 months; cannot clear properly
High fever - can alternate meds; due q6hr; alternate q3hr
Nonopioids
Severe pain: fentanyl, morphine, codeine
Worry about constipation and resp depression
Constipation: hard on toddler esp if recently potty trained if have to go in diaper or adolescent to go in bed pan more likely to hold it
Opioids
Older ones - can do it
Can do parents - maybe - very educated and involved in care
Patient-controlled analgesia
Monitoring side effects
Evaluation and effectiveness of pain regimen; re-evaluate; cause of pain; making worse; what helping it go away; get parents involved and what works at home and helps child at home
Nurse Management
Physiologic indicators
Behavioral indicators
Consequences of untreated pain in infants
Distraction
Relaxation
Guided imagery
Cutaneous stimulation
Containment and swaddling
Nonnutritive sucking
Kangaroo care
Nonpharmacologic management
Toddler best age; can do little in preschool
Distraction
School-age; older kids
Relaxation
School-age; older kids
Guided imagery
School-age; older kids
Helping with deep breathing
Cutaneous stimulation
Infants
Used being in utero - like borders and boundaries
Containment and swaddling
Pacifier with sugar water - relieves more pain than pain med; calms them down and relaxes them
Nonnutritive sucking
Skin to skin
Kangaroo care
Painful and invasive procedures
Postoperative pain
Burn pain
Recurrent headaches
Recurrent abdominal pain
Pain associated with sickle cell disease
Cancer pain in children
Pain and sedation in end-of-life care
Common pain states
Procedural sedation and analgesia
Painful and invasive procedures
Associated with surgery
Combination of medications
Postoperative pain
Multiple components
Difficult and challenging to control
Burn pain
Tension, dental braces, weakness of eye muscles, sinusitis, epilepsy, sleep apnea, injury
Recurrent headaches
Common in children
Recurrent abdominal pain
ED visits for opioid treatment
Pain associated with sickle cell disease
Most prevalent symptom is pain
Cancer pain in children
Comfort can be relief with a combination of opioids and adjuvant analgesics
Pain and sedation in end-of-life care
