Peds Final Review - PAIN ASSESSMENT AND MANAGEMENT

Question 1

Nursing Assessment:

Verbal report by the child.

Answer 1

Children as young as 3 years of age are able to report the location and degree of pain they are experiencing

Question 2

Nursing Assessment:

Observe for nonverbal signs of pain, such as:

Answer 2

grimacing, irritability, restlessness, and difficulty in sleeping or feeding

Question 3

Nursing Assessment:

Answer 3

Include the child’s parents in the assessment

Question 4

Nursing Assessment:

Observe for physiologic responses to pain, such as:

Answer 4

increased heart rate, increased respiratory rate, diaphoresis, and decreased oxygen levels

Question 5

Nursing Assessment:

Answer 5

Physiologic responses to pain are most often seen in response to acute pain rather than in response to chronic pain.

Question 6

Nursing diagnosis:

Answer 6

Acute pain related to

Anxiety related to

Disturbed sleep pattern related to

Ineffective infant feeding pattern related to

Question 7

Nursing Plan and Interventions:

1. A pain rating scale appropriate for the child’s age and developmental level should be used

Answer 7

A. Faces Pain Scale (Wong & Baker) and the Poker Chip Scale can be used by children of preschool age and older

B. Numeric Pain Scale can be used by children 9 years of age and older

C. Documentation of a child’s self-report of pain is essential to effectively treat the child’s pain

D. A nonverbal child can be assessed using the FLACC pain assessment tool. This tool has the nurse evaluate the child’s facial expression, leg movement, activity, cry, and consolability

Question 8

Nursing Plan and Interventions:

2. Nonpharmacologic interventions

Answer 8

A. They should be used according to the child’s age and developmental level

B. Infants – pacifiers, holding, rocking

C. Toddlers, preschoolers – distraction through books, music, television, bubble blowing

D. School-age, adolescents – Guided imagery

E. Other interventions may include massage, application of heat or cold, and deep-breathing exercises

Question 9

Nursing Plan and Interventions:

3. Pharmacologic interventions

Answer 9

A. Prior to administering a pain medication to a pediatric client, verify that the prescribed dose is safe for the child on the basis of the child’s weight

B. Monitor the child’s vital signs following administration of opioid medications

C. Children as young as 5 years of age may be taught to use a PCA pump

D. Children may deny pain if they fear receiving an IM injection