PEDS Chapter 36: Pain Management Flashcards
Why is pain management of concern in children
Untreated pain in children can lead to serious physical and emotional consequences. Such as increased oxygen consumption, alterations in blood glucose metabolism
Untreated pain may lead to long term physiologic and psychological consequences
Classifications of Pain: Duration
Acute or chronic
Acute-rapid onset of varying intensity
Chronic pain-continues past the expected point of healing
Classifications of Pain: Etiology
Nociceptive or neuropathic
Neuropathic pain=malfunctioning of the peripheral or central nervous system(burning, squeezing, spasm like pain) post surgical or trauma type injuries (Phantom limb pain)
Nociceptive pain due to noxious stimuli damages normal tissue( chemical burns, sunburns cuts, appendicitis, and bladder distention)(NERVOUS SYSTEM FUNCTIONING INTACT)
Classifications of Pain: Source/location
Somatic or visceral
Somatic- develops in tissues
Visceral develops in organs- such as heart, GI tract, pancreas, liver, gallbladder, pancreas, kidneys, bladder
Phantom Pain
Occurs where receptors and nerves are clearly absent
Has no demonstrated physiologic or pathologic substance
Example- amputated limb
One theory suggests that sensory misrepresentations from the missing limb may still be in the brain therefore causing phantom pain.
Covered more in mobility
Source of pain
Sprained ankle= somatic pain-develops in tissues
Source of pain
Post op abdominal pain, internal organ = visceral pain
Factors Influencing Pain
Age Gender Cognitive level Temperament Previous pain experiences Family and cultural background
Boys and girls differ on pain experience
Cognitive level and ability to communicate
Indicators of Pain in Infants
Behavioral
Facial expressions, body movements, crying
Physiologic
Changes in heart rate, respiratory rate, blood pressure, oxygen saturation levels, vagal tone, palmar sweating, and plasma cortisol or catecholamine levels
Cortisol helps with the stress response elevated in pain
Catecholamine function as neurotransmitters and hormones within the body. Elevated in pain
Is the following statement true or false?
The nurse assessing pain in children is correct in stating that the school-age child is usually able to communicate the type, location, and severity of pain.
True. The school-age child is usually able to communicate the type, location, and severity of pain.
Rationale: Children older than the age of 8 years can use specific words, such as sharp as a knife, burning, or pulling, to describe their pain. However, they may deny pain in an attempt to appear brave or to avoid further pain related to a procedure or intervention.
Factors Affecting Children’s Responses to Pain
Type of pain
Extent of pain
Age/developmental level
Key Principles of Pain Assessment (QUESTT)
Question the child.
Use a reliable and valid pain scale.
Evaluate the child’s behavior and physiologic changes to establish a baseline and determine the effectiveness of the intervention.
Secure the parent’s involvement.
Take the cause of pain into account when intervening.
Take action.
Health History Data Related to Pain Assessment
Location, quality, severity, and onset of the pain, as well as the circumstances in which the child experiences the pain
Conditions, if any, that preceded the onset of pain and conditions that followed the onset of pain
Any associated symptoms, such as weight loss, fever, vomiting, or diarrhea, that may indicate a current illness
Any recent trauma, including any interventions that were used in an attempt to relieve the pain
Pediatric Pain Assessment Tools
FACES pain rating scale Oucher pain rating scale Poker chip tool Word-graphic rating scale Visual analog and numeric scales Adolescent Pediatric Pain Tool
The nurse is assessing the pain of a 3-year-old child. Which of the following pain assessment scales would be most appropriate?
a. Visual analog scale b. Visual numeric scale c. Word-graphic rating scale d. FACES pain rating scale
d. FACES pain rating scale. The FACES pain rating scale would be most appropriate for a 3-year-old.
Rationale: The FACES pain rating scale is a self-report tool that can be used by children as young as 3 or 4 years of age. The word-graphic rating scale is useful for children between 4 and 17 years old. The visual analog scale can be used with children 7 years or older. The numeric scale can be used with children 8 years or older.
