Pediatric Pain Assessment

Question 1

Pediatric Pain

Answer 1

• Acute vs. Chronic
• Factors influencing pain
  > age/gender
  > cognitive lvl
  > temperament
  > previous pain experiences
  > family culture
• Unmanaged pain may lead to potential long-term physiologic, psychosocial, & behavioral consequences

Question 2

Pediatric Pain - Infant

Answer 2

• Crying
• Very tense limbs
• VS

Question 3

Pediatric Pain - Toddler

Answer 3

• Crying
• Change in behavior
  > not as much playing

Question 4

Pediatric Pain - Preschooler

Answer 4

• More verbal
• Can explain pain very basic
• Might be more conservative

Question 5

Pediatric Pain - School Age

Answer 5

Verbal report

Question 6

Pediatric Pain - Adolescent

Answer 6

• Verbal
• Might try to hide pain

Question 7

Pain Scales - Self Reporting

Answer 7

• FACES (Wong-Baker): 3 and older
• OUCHER: 3-13yrs
• Numerical rating scale (NRS): 8 and up

Question 8

Pain Scales - Behavorial

Answer 8

• Neonatal Infant Pain Scale (NIPS)
• NPASS
• r-FLACC
  > for non-verbal or brain injuries

Question 9

FLACC Scale

Answer 9

• Face
  > 0: no expression or smile
  > 1: occasional grimace or frown, withdrawn, disinterested
  > 2: frequent to constant frown, clenched jaw, quivering chin
• Legs
  > 0: normal position or relaxed
  > 1: uneasy, restless, tense
  > 2: kicking, or legs drawn up
• Activity
  > 0: lying quietly, normal position, moves easily
  > 1: squirming, shifting back & forth, tense
  > 2: arched, rigid, or jerking
• Cry
  > 0: no crying (awake or asleep)
  > 1: moans or whimpers, occasional complaint
  > 2: crying steadily, screams ot sobs, frequent complaints
• Consolability
  > 0: content, relaxed
  > 1: reassured by occasional touching, hugging or being talked to, distractible
  > 2: difficult to console or comfort

Question 10

NIPS Scale

Answer 10

• Facial expression
  > relaxed = 0
  > grimace = 1
• Cry
  > no cry = 0
  > whimper = 1
  > vigorous crying = 2
• Breathing Patterns
  > relaxed = 0
  > change in breathing = 1
• Arms & Legs (separate points)
  > restrained = 0
  > relaxed = 0
  > flexed = 1
  > extended = 1
• State of Arousal
  > sleeping = 0
  > awake = 0
  > fussy = 1
  max score is 7

Question 11

Pain Management - Pharmacologic

Answer 11

• Non-opioids: tylenol, motrin (at 6mnths), acetaminophen
• Opioids
• Coanalgesic drugs
• Choosing timing of analgesia
• Choosing method of administration
• Patient controlled analgesia
• Epidural analgesia
• Transmucosial & transdermal analgesia

Question 12

Pain Management - Nursing Management

Answer 12

• Monitoring for side effects
• Evaluation & effectiveness of pain regimen
• Reassess
• Cosequences of untreated pain in infants:
  > physiologic indicators
  > behavioral inidcators

Question 13

Pain Management - Nonpharmacologic

Answer 13

• Distraction
  > best for toddlers, do not lie
• Relaxation & Guided Imagery
  > when a little older
• Cutaneous stimulation
• Containment & Swaddling
• Nonnutritive sucking
  > sugar water
• Kangaroo care

Question 14

Common Pain States

pt. 1

Answer 14

• Painful & invasive procedures
  > procedural sedation & analgesia
• Postop pain
  > associated w/ surgery
  > combination of meds
• Burn pain
  > multiple components
  > difficult & challenging to control
• Recurrent headaches
  > tension, dental braces, weakness of eye muscles, sinusitis, epilespy, sleep apnea, injury

Question 15

Common Pain States

pt. 2

Answer 15

• Recurrent abdominal pain
  > common in children
• Pain associated w/ sickle cell disease
  > ED visitis for poioid treatment
• Cancer pain in children
  > most prevalent symptom is pain
• Pain & sedation in end-of-life care
  > comfort can be relief w/ a combination of opioids & adjuvant analgesics