pain management Flashcards
atraumatic care
- Atraumatic care is the use of interventions that minimize or eliminate physical and psychological distress.
- Pain is managed by atraumatic, nonpharmacological, and pharmacological interventions.
Influential factors that can have a positive or negative effect on pain perception
Age Development stage Chronic or acute disease Prior experiences with pain Personality Family dynamics Culture Socioeconomic status
signs of pain young infant
- Loud cry
- Rigid body or thrashing
- Local reflex withdrawal from pain stimulus
- Expressions of pain (eyes tightly closed, mouth open in a squarish shape, eyebrows lowered and drawn together)
- Lack of association between stimulus and pain
older infant pain signs
- Loud cry
- Deliberate withdrawal from pain
- Facial expression of pain
toddlers pain signs
- Loud cry or screaming
- Verbal expressions of pain
- Thrashing of extremities
- Attempt to push away or avoid stimulus
- Noncooperation
- Clinging to a significant person
- Behaviors occur in anticipation of painful stimulus
- Requests physical comfort
school age child pain
- Stalling behavior
- Muscular rigidity
- Any behaviors of the toddler, but less intense in the anticipatory phase and more intense with painful stimulus
adolescent pain signs
- More verbal expressions of pain with less protest
- Muscle tension with body control
self report age
4 and up
nursing care related to pain
- Reassess the child’s pain level frequently.
- Use nonpharmacological, pharmacological, or both approaches to manage pain.
- Ask parent or caregiver to reassess the child’s pain level.
- Assess the child for adverse reactions to pain medications.
- Assess the child’s physical functioning following pain management intervention.
- Assess for negative effects or distress the child might experience related to pain, such as anxiety, withdrawal, sleep disruption, fear, depression, or unhappiness.
atraumatic care related to pain
- Use a treatment room for painful procedures.
- Avoid procedures in “safe places,” such as the play room or the child’s bed.
- Use developmentally appropriate terminology when explaining procedures.
- Offer choices to the child.
- Allow parents to stay with the child during painful procedures.
- Use play therapy to explain procedures, allowing the child to perform the procedure on a doll or toy
pharmacologic approach to pain
1st step
2nd step
drug of choice
- The WHO recommends a two-step approach for pharmacological management of pain in children.
- For children above 3 months of age with mild pain, the first step is to administer a nonopioid.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for mild pain.
- The second step is to administer a strong opioid.
- Morphine is the drug of choice.
- Optimal dosage of medications control pain without causing severe adverse effects.
- Select the least traumatic route for medication administration.
what is acceptable for mild pain
tynoal
nsaids
moderate to severe pain
opioids
- morphone, oxycodone, fentanyl
treating pain peripherally and centrally
combinding nonopioid and opoid
- greater analgesia and fewer adverse effects
FLACC
face legs activity cry
2 moths to 7 years
0-10
Faces
3 and older
numeric pain scale
5 years and older
medication routes
- IM injections are not recommended for pain control in children.
- Intranasal medications are not recommended for children younger than 18 years.
- Rectal medications have variable absorption rates, and children dislike them.
- Intradermal medications are used for skin anesthesia prior to procedures.
Nonpharmacological Measures for Pain Control: distraction
- use play, radio, a computer game, or a movie.
- Tell jokes or a story to the child.
Nonpharmacological Measures for Pain Control: relaxation
- Hold or rock the infant or young child.
- Assist older children into a comfortable position.
- Assist with breathing techniques.
- Positive self-talk: Have the child say positive things during a procedure or painful episode.
- Behavioral contracting
Use stickers or tokens as rewards. - Give time limits for the child to cooperate.
- Reinforce cooperation with a reward.
Guided imagery
● Assist the child in an imaginary experience.
● Have the child describe the details.
Nonpharmacological Measures for Pain Control: containment
- Swaddle the infant.
- Place rolled blankets around the child.
- Maintain proper positioning.
Nonpharmacological Measures for Pain Control: nonnutritive sucking
- Offer pacifier with sucrose before, during, and after painful procedures.
- Offer nonnutritive sucking during episodes of pain.
Nonpharmacological Measures for Pain Control: completementary and alternative med
- Offer foods, vitamins, or supplements.
- Offer massage or chiropractic options.
- Review energy-based treatments such as magnets.
- Discuss mind-body techniques such as hypnosis, homeopathy, or naturopathy.
